Last year in the United States, just about anybody who had the money and wanted a flu shot could get the influenza vaccine. But after the entire batch of vaccine from the largest supplier in Britain was tainted and had to be destroyed, only one-half as many doses will be available this flu season. VOA's Ted Landphair says these shortages have forced physicians and public-health officials to wrestle with who should, and who won't, get the vaccine.

At first it seemed simple enough to health-care providers like family physician Ellen Brull in the Chicago suburb of Niles, Illinois. Give your scarce supply of flu vaccine to those at high risk: the very old, the very young, and the very sick. But Dr. Brull and her medical partner received only fifty of the five hundred doses they ordered. There are many more than fifty elderly, young, and sick people in their practice.

In some ways, I felt like I was playing God, that, well, 'You're going to get this flu vaccine, and you're not. It's not fun. It's not how I view myself as a doctor.

Dr. Brull says other physicians in the Chicago area simply did what many supermarkets and pharmacies did. They dispensed the vaccine on a first-come, first-served basis. To her, that seemed too mechanical, almost uncaring.

My partner and I kind of put our heads to together and said, 'Let's figure out, of all the people who meet the criteria, who are our actual sickest patients who need the flu vaccine the most desperately, and that's who we've been giving it to.

people like asthma and emphysema patients with poor lung function and weakened immune systems. For them, influenza -- which produces fever and a dry, wracking cough -- can be deadly.

There simply wasn't enough vaccine for healthy kids and old folks -- who normally are among the first to get the vaccine as a preventive measure.

Most of them are very gracious. If they're a healthy, elderly person, they're like, 'Fine, I understand. I'm not sick. You give it to somebody who needs it more than me.'

The question of who should get this year's scarce flu vaccine has been such a dilemma that the U-S Centers for Disease Control appointed a five-member panel of ethicists to advise it on how best to allocate the vaccine. One member is Daniel Callahan, a philosopher at the Hastings Center, an independent bioethics research facility in New York State. He says modern medicine has faced a few -- but just a few -- similar situations in which priorities had to be set for who would get treatment. In the early 1970s when kidney dialysis was first introduced, there were not enough machines to meet the demand. And more recently, strict rules determine who goes to the head of the line for heart and other organ transplants.

Mr. Callahan admits getting a flu shot is less dramatic. But many more people are affected. Last year, influenza killed thirty-six thousand Americans, a fact that adds urgency to the question of how to fairly distribute the flu vaccine:

A lottery is one way you could do it [decide who gets the vaccine]. Everybody over sixty-five who wants the vaccine, put them in the lottery and say that 'you get the luck of the draw.' That's one way. I remember a discussion some years ago at C-D-C [the Centers for Disease Control] where they were really speculating about the possibility of a serious flu pandemic -- a worldwide, catastrophic attack of some new strain of flu. And again the question came up about how priorities might be set. It didn't go very far because it was still a kind of speculative issue.

But the issue is not speculative this year. In part because of media attention to the shortage, the public is clamoring for the vaccine.

I think there's enormous discomfort with making such decisions in our society. We're used to having everything, and it's very hard to determine what's actually fair. But as time goes on, given the fact that our health-care costs are rising and we're getting more and more new, expensive technologies, I think we're going to have to have these discussions much more frequently.

One suggested remedy for flu vaccine shortages won't work this year. In 2000, researchers at several universities got promising results when they diluted the vaccine to stretch a limited supply. But critics noted that those trials were conducted on healthy people, not on the weak or sick for whom inoculation against influenza is most critical. Besides, health experts say this year, the scarce vaccine is being used so fast at full strength, there would not be any doses available to dilute.