If there is a limited supply of vaccine, it should go first to those who have longer to live, they argue in an essay in today's issue of the journal Science. That's a conclusion that contradicts government recommendations, which say the elderly should be treated before younger, healthier people.

The article was co-authored by Dr. Ezekiel J. Emanuel, the NIH's department of clinical bioethics chairman and a Harvard University-educated doctor. He's also a former Harvard Medical School associate professor and Dana-Farber faculty member.

"We need to have a national discussion about this," Emanuel said. "We need to have a plan."

Younger People Hit Harder?

Health experts fear that a deadly strain of bird flu called H5N1 could mutate into a virus capable of moving rapidly through humans around the world, killing millions.

If a vaccine can be developed, it will likely need to be rationed. If so, recommendations say it should go first to caregivers and workers in the vaccine factories, a policy with which Emanuel and his co-author Dr. Alan Wertheimer agree.

Who comes next?

Older people and those with multiple underlying medical conditions followed by pregant women, say federal advisers.

The plan is based on the expectation that the elderly are most at risk of dying from the flu. But a 1918 pandemic hit younger people harder, Emanuel said.

Leaving Older People Out in the Cold

"Is it better from an ethical and a moral standpoint to give it to the elderly who have two different illnesses and are at risk of dying?" said Emanual, who at age 48, would go to the end of the line under his plan.

But the idea of leaving older people out in the cold is sure to create a stir.

"It's so preposterous I don't know what to say," said Sue Kirby, executive director of the Massachusetts Senior Action Council. "It's morally indefensible to think you would totally disregard such an important part of the population."

The most important thing is to talk about the issue and develop a strategy to be prepared, Emanuel said.