A preventable problem.

Byline: The Register-Guard

At this point, it looks like the only thing that will make a meaningful difference in the nation's efforts to cope with a critical shortage of flu vaccine is a mild flu season.

It has come to this: Several hundred thousand Americans in high-risk groups who could have been protected from a dangerous illness must now simply cross their fingers and keep washing their hands. That speaks volumes about the current state of U.S. vaccine production and public health policy on infectious disease prevention.

Those lucky enough to secure any of the scarce remaining flu shots will likely have to wait in long lines. Others will literally win their immunizations in lotteries being held by apologetic clinics trying to find a fair way to distribute too few doses of vaccine.

Though the specific circumstances of this year's vaccine shortage caught U.S. health officials by surprise, there have been flu vaccine shortages and problems for the last four years. It's past time to heed the lessons of a chronic public health problem.

Lesson No. 1: The Food and Drug Administration must accelerate efforts to broaden the list of producers licensed to sell vaccines in the United States. This year's debacle has created a more critical vaccine shortage in the U.S. than in any other nation. (Canada has a surplus of flu vaccine and is sending extra doses to the U.S.)

The U.S. put all of its flu shot eggs into two baskets: Chiron Corp. in California and the French-owned Aventis Pasteur. Four other companies produce flu vaccine, but they are not licensed to sell their products in the United States.

When bacterial contamination knocked 48 million doses of Chiron's vaccine off the market, the U.S. was left with the 55 million shots available from Aventis Pasteur. Additional vaccine is projected to arrive in January, but health officials say that may be too late in the flu season to help many in the high-risk groups.

Lesson No. 2: The annual flu season represents a more tangible bio-threat to national security and public health than smallpox, anthrax or Severe Acute Respiratory Syndrome combined. There is no room for ideological bickering in the development of a national policy on flu vaccine. Passively letting the free market determine the solution is not a policy, it is a prescription for increasingly more deadly repetitions of the current crisis.

Flu kills some 36,000 Americans every year and sucks an estimated $4.6 billion in direct medical costs from the U.S. economy. Given the annual toll in human lives and health care dollars, providing high-risk groups with immunizations is one of the most cost-effective public health strategies available. Yet there is no coherent national policy addressing flu vaccine production or distribution.

Ultimately, the federal government must intervene in the vaccine production process. The consolidation of drug manufacturers, poor profit margins for vaccines, the inability to accurately forecast demand and the high risk of liability make it unlikely that effective solutions will emerge from the industry.

Lesson No. 3: Adjusting the current vaccine funding priorities is a no-brainer. If government incentives are necessary to assure adequate supplies of flu vaccine, policy discussions should begin immediately. Incentives should be created from a public health perspective that recognizes the enormous overall profits reaped by the drug industry.

There isn't a shortage of government funding available for research. The New York Times reported that the government is spending $283 million a year on flu research and $5.6 billion on research for a vaccine against anthrax. That's 20 times more research money for a theoretical threat.

The federal government could substantially enhance its credibility on homeland security issues if it mobilizes to address these problems before the 2005 flu season begins to wreak its annual havoc on the nation.