evidence: Of course, with or without recycling, a pattern like those seen in 1957 or 1968 would result in the elderly having a higher absolute risk of death. If the metric used to measure effectiveness of vaccination were "numbers of deaths prevented," then perhaps the elderly should be given priority—assuming they can produce an adequate antibody response to the pandemic vaccine. But if the concern is to minimize the years-of-life-lost, then the vaccine may be better used in young and middle-aged adults. This point was illustrated in a paper that sought to determine vaccination priorities by age and risk status; when basing priority on "returns due to vaccination," an endpoint that is heavily influenced by years of life lost, the young and middle aged rose to the top of the priority list (Meltzer et al., 1999). Other authors have proposed that children be given priority to receive pandemic vaccine (Stuart-Harris, 1970; Longini et al., 1978; Reichert et al., 2001) and antivirals (Longini et al., 2004) in order to reduce transmission in the community and thereby indirectly reduce influenza impact among the elderly.