In three of the past four years, the government has urged certain high-risk people to get the shots first in case of a shortage.

But Tuesday's stunning announcement that the United States wouldn't get half its expected supply has caused more anguish than usual. This is the first time the government has asked healthy people to consider delaying or going entirely without the shot during the flu season.

U.S. health officials are urging flu shots first for babies and toddlers 6-23 months, the elderly, people with chronic health problems, pregnant women, and other specific risk groups and health care workers.

"It's not the first year we have had a problem with supply. Why is it we are dealing with this problem over and over again?," asked Dr. Adam Aponte, medical director for North General Diagnostic and Treatment Center in New York. "Now we are stuck in the middle of flu season with a shortage of supply and that's not a good position to be in."

Last year, it seemed the nation's 87 million doses of flu shots would be enough. But demand for flu shots quickly soared when the 2003-04 season started earlier than expected in October and the deaths of several children seemed to signal the start of a flu season many thought would be severe.

By December, nearly all the supplies of the injectable flu vaccine were gone and shortages appeared around the country, prompting the government to once again ask the public to allow high-risk groups and health workers the chance to get immunized first.

Health officials say more companies, particularly U.S. companies, should be making flu shots.

"We need as a country to be very conscious of what it is we need to do to cover our population - that's something that needs to be refocused," Aponte said.

Part of the problem is more flu vaccine is being used than ever before. Four times as many flu shots were used in recent years compared to 15 years ago, said Ray Strikas of the National Immunization Program for the Centers for Disease Control and Prevention. He said from the mid-1960s to the mid-1980s, only 10 million to 20 million doses were used each year.

Since the mid-1980s, the popularity of preventive medicine has prompted an increase in demand for flu shots. The shots being added to Medicare coverage in 1993 also contributed to the rise, Strikas said.

This year the United States expected 100 million vaccine doses, but that plan was ripped apart by the surprise announcement by British health authorities to suspend the license at vaccine maker Chiron Corp.'s Liverpool factory for unexplained reasons.

The company said it would not be providing the 46 million to 48 million vaccines expected for the U.S. market.

The CDC recommended prioritizing flu shots for the first time during the 2000-01 flu season, when two of the nation's then-four flu shot manufacturers had problems meeting federal manufacturing standards.

One producer, Parkdale Pharmaceuticals, ended flu shot production that year. The other, Wyeth, was able to resume production but later than normal, said Dr. Walter Orenstein, associate director of the Emory Vaccine Clinic and formerly the top vaccine expert for the Centers for Disease Control and Prevention.

That caused delays in getting enough shots out to the public. The CDC asked that available shots be given first to those in high-risk groups.

More regulatory problems with Wyeth in 2001 caused delays that left the United States with about 26 million fewer doses than expected by the end of October 2001, Orenstein said. Because of the early season shortage, the CDC recommended in the 2001-02 flu season that high-risk groups get the flu shot as quickly as possible.

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On The Net

CDC flu info: http://www.cdc.gov/flu