Alison is a 19-year-old university student with moderately severe asthma. She was hospitalized once when she was twelve

[answerhappygod]

Alison is a 19-year-old university student with moderately
severe asthma. She was hospitalized once when she was twelve and
caught a bad cold, and she has had some serious attacks in the past
few years. If Alison were to catch the flu, it would likely cause
an even more severe inflammation of the lungs than a cold, leading
to even more severe asthma attacks 1. Alison would be unable to
breathe and her fast-acting inhaler might not be enough to clear
her airways. Getting a flu vaccine is Alison's best defense against
getting the flu in the first place; it can cut her risk of getting
the flu by up to 90 percent. When she was a child, her mother
always took her to get her flu vaccine, and since she has been away
at school she has been careful to get her own yearly vaccination.
Unfortunately, this year there is a shortage, making it difficult
to obtain the seasonal flu vaccine. Influenza vaccines are not
considered very profitable to make, because they are expensive and
any extra has to be thrown away at the end of the flu season, since
a new vaccine must be produced every year. Consequently, not many
companies produce the flu vaccine. Given that no single person or
agency is in charge of ensuring that the United States has an
adequate supply of influenza vaccines, it is not surprising that
shortages do occur. This year, one of the companies, in charge of
producing nearly half of the United States' supply, had a bacterial
contamination that forced them to shut down all vaccine production.
Alison is very afraid of catching the flu. Her worst asthma attacks
have been when she had a cold, and she is terrified of not being
able to breathe. Alison wants to be sure to still get her yearly
flu vaccine, but there is currently no system in place to ensure
that at-risk populations receive the limited supply of vaccines
available. It is entirely dependent on each clinic to try to ration
their limited supply. To do this, some clinics attempt to use
medical necessity criteria, which are challenging to define;
Medicare defines medical necessity as "services or supplies that
are needed for the diagnosis or treatment of your medical condition
and meet accepted standards of medical practice." This is a
subjective standard, and is frequently assessed by an insurance
company that never sees the patient, to determine if payment will
be issued. Alternatively, many clinics avoid the issue by using a
lottery. The most common method of distribution, however, is a
"first-come first-served" basis, with some consideration of medical
necessity requirements. In Santa Clara county in the 2009 H1N1
vaccine distribution, the initial shipment to arrive was a nasal
form of the vaccine, so it was limited to healthy children 2 years
and older, especially those younger than 10 years who are
recommended to receive two doses; and healthy household contacts (2
- 49 years) of infants younger than 6 months 2. The next shipments
of the injection vaccine were then directed towards high risk
groups such as pregnant women, household contacts and caregivers
for children younger than 6 months of age, health care
professionals, all people from 6 months of age to 24 years old (due
to their particular vulnerability to H1N1), and people aged 25 to
64 who have medical conditions such as asthma that put them at a
higher risk of complications from the flu. To ensure that is she is
among the lucky few who receive a vaccination this year, Alison
gets up at 4:00 in the morning on a Friday and drives to the
nearest clinic, which opens at 6:00 a.m. This clinic is the only
clinic within 50 miles of Alison's home to have received any
vaccine supply, so everyone from the surrounding area is also
coming here for their supply. Arriving shortly after 4:30 a.m., she
is number 62 in line for the vaccine. If she does not make it to
the front of the line before all the shots are gone, she will not
receive a vaccine. If she makes it to the front, but is determined
not to be "enough" at-risk because she is not a senior, she will
not receive a vaccine. Seniors are especially at risk for
contracting pneumonia or bronchitis given their generally lowered
levels of activity and weaker immune systems. Alison finds herself
in line behind a sixty-three year old man who doesn't have any
money to pay for the vaccine, but is not yet eligible for Medicare.
Seniors are generally considered one of the high-priority groups
for getting the flu vaccine, because they tend to have weaker
immune systems and therefore develop more complications that are
frequently fatal. He tells Alison that he is nervous that he will
be turned away because he cannot pay, even though he is very close
in age to the at-risk population. He also mentions his daughter who
wanted to bring her two young children to try and get the vaccine,
but she works at a nearby canning factory and couldn't get the time
off to bring them to the clinic. Up at the front of the line there
is some commotion over a young man being turned away because he is
not considered at-risk. He can be heard shouting, "I'll pay
anything, just give me the vaccine!"
1.) Is this a fair method of distributing vaccines?
2.) Should people with money be able to buy the vaccine, even if
they aren't at risk? Should the elderly man receive the vaccine
even if he can't pay?
3.) Is the government morally responsible for assuring there is
an adequate vaccine supply or appropriate distribution plan?