Prioritizing Flu Vaccine: Individual Patient vs. Aggregate Rules

This is a fairly big issue and I’ll probably devote more than one post to it.

In recent days newspaper headlines have made misleading statements that relate to how to ‘prioritize’ swine flu vaccine (potentially demand will exceeed supply).

For example, one headline today ran “Flu vaccine to pregnant women first“. What the study in question actually showed (or, rather, suggested) is that pregnant women may, on average and as a group, be at greater risk for swine flu and swine flu complications.

But to keep in mind is that each person’s circumstances are unique. Assessment of flu vaccine candidacy, assuming there’s a vaccine shortage, must consider all relevant factors of a person: medical history, age, risk of exposure, health status, risk of complications, risk of infecting others, etc.

While being pregnant is a factor to consider, so are others. It’s not as simple as putting all pregnant women ahead of all non-pregnant women in the ‘queue’, as the headline seems to suggest.

Another headline this week similarly suggested “Antiviral drugs for swine flu patients may be wasted on the elderly.” Again this is an incorrect and misleading statement. On average, elderly people perhaps respond less well to antiviral flu medicine (they do show somewhat lower immunoresponse to flu vaccination on average than younger people) ; they areprobably less likely, again on average, to have a lot of contact with children .

But there are plenty of people above age 65 who vary from the average. Some respond well to vaccines, some have a lot of contact with children, etc.

Decisions to administer antivirals or to give swine flu vaccinations have to be made on a case-by-case basis, considering all relevant aspects of the person and their circumstances.

It can easily be shown that approaching vaccine allocation by a blanket rule like “only young people and pregnant women should get the vaccine” would be extremely suboptimal. The degree of suboptimality associated with such rules — or what could be technically termed marginal prediction — can be estimated; in this case such faulty prediction would likely produce considerable excess mortality and morbidity,  reduced overall quality of life, and unnecessary loss of many millions of dollars.

One alternative is to construct a simple statistical decision tool that  would compute a score for each person (e.g., 1 = lowest priority to 100 = highest priority) based on the person’s individual data. This could be put online for people or doctors to use, for example.

The data to construct such a tool exists in various places, but would need to be collated and analyzed. At present I’m tentatively planning to develop a prototype tool, hopefully in the next couple of weeks.

Protect Yourself from the Flu – Video

Protect Yourself from the Flu

A leading flu vaccine producer, GlaxoSmithKline (GSK), has generously released this audio-visual presentation, originally developed for their employees, to the public:

GSK flu prevention video

When the new window opens, press the “Next” button on the lower right to continue.

This is the best presentation of its kind available today. Watch it yourself and show it to your family and friends.

If enough people follow the simple, common-sense steps outlined here, it can have a significant effect on reducing the swine flu pandemic. Because pandemic disease transmission follows an exponential pattern, even minor preventive steps like those explained here can have a major impact on total disease incidence.

College Tuition Inflation

As promised, here is a graph showing the disparity between general cost-of-living inflation and inflation associated with college tuition and fees (if the student I promised this to reads this, please let me know if the post is clear):

Source: Bureau of Labor Statistics and the College Board.

The figure compares inflation over the last 30 years associated with (1) the general cost of living, (2) the cost of medical care, and (3) college tuition and fees.

Inflation factors were computed to answer the question: in each year, how many dollars would be needed to have the same buying power as $1.00 had in 1978? The calculations made use of published data on the Consumer Price Index for all urban consumers (CPI-U), the medical costs component of the CPI, and historical data on inflation of college tuition and fees.

As is well known, medical care costs have grown faster than the general cost of living — by 2008, nearly twice as much. This receives a lot of public attention and many complaints.

Yet college tuition and fees inflated at a much faster rate: nearly three times that of general inflation. Thus while it took $3.30 in 2008 to buy the same general commodities purchasable for $1.00 in 1978, for college tuition and fees nearly $10 in 2008 was needed to buy what $1.00 got in 1978.

This excess inflation has, incidentally, occurred across the board: for both private and public 4-year colleges, and for public 2-year colleges.

This is why students are being forced to take out exorbitant loans.

In short:

• After adjusting for inflation, college tuition and fees are roughly three times more expensive now than in 1978. Why? What has intrinsically changed about college education so that this is the case?

• Excess inflation of healthcare costs is a prominent issue and receives much attention; but excess inflation of college costs is even greater. Why is this not a major social issue?

Shouldn’t we be making a college education easier to obtain instead of more difficult? We claim to rely on young people to make a better world in the future. How are they supposed to do that when they step into adulthood already burdened with debt?

Reading and Resources

• The College Board. Trends in College Pricing. Princeton, NJ: 2008.

• The Education Sector. Drowning in Debt: The Emerging Student Loan Crisis. July 2009

• Ronald Ehrenberg. Tuition Rising: Why College Costs So Much. Harvard University Press, 2002.

• The Project on Student Debt

• Paul Streitz. The Great American College Tuition Rip-Off. Oxford Institute Press, 2005.

• Richard K. Vedder. Going Broke by Degree: Why College Costs Too Much. American Enterprise Institute, 2004.

• Penelope Wang. Is college still worth the price? Money Magazine. August 20, 2008.

The Injustice of High College Tuition

I met a college student last weekend and promised her I’d put a post online about the outrageously high cost of college tuition.  I’m working on some figures now and hope to post a chart by tomorrow.

Meanwhile the bottom line remains the same.  It doesn’t matter much which inflation indices or economic indicators one looks at.  The brute fact is that when I went to college in the 70’s, students in California didn’t have to take out loans, but today they to have to.  Big loans, too.

1.  This indicates that we are moving backwards, not forward in terms of higher education in our society.

2. It is unjust, absurd, and socially counterproductive in the extreme to subject youth to this burden.

3. They are being taken advantage of, because they lack the historical perspective to understand that this was not the case 25 or 30 years ago.

4.  Nobody is speaking up for them or representing their interests.

5.  If anything, the costs of a college education should be declining (relative to the cost of living) because computer and internet technology can be used to facilitate distance learning, video lectures, etc.

More on this topic later…

My websites under construction

My websites (listed on the panel to the right) are currently under construction.

My old service provider (Compuserve Ourworld) has closed, and I’m gradually moving pages to a new provider. This may take a week or two.

Please be patient with any broken links, etc.

John Uebersax