Protection

At the rate H1NI flu vaccine is showing up at clinics in North Carolina, a swine flu shot could be high on people's Christmas lists. It wasn't supposed to be this way, but a national shortage of the anti-influenza vaccine has made the flu's return this fall an exercise in patience.

That's true for people who want to increase their chances of avoiding influenza (almost everyone) and for the medical and public health officials who have had to tell telephone callers and e-mailers, over and over, that there aren't yet sufficient supplies of vaccine on hand.

Under the circumstances, officials were right to focus on getting the highest priority groups - pregnant women most of all - vaccinated first.

And surely, after overly optimistic predictions by national health officials late this summer that sufficient H1N1 vaccine would be available by mid-October, officials here don't want to mislead people now by forecasting unrealistic delivery dates.

Still, elements of the vaccine distribution process appear to be mysterious and inefficient, and despite all the flu-related facts available on the Web and elsewhere, there's a lack of information about how much vaccine is actually available. Instead, on what seems to be a near-random basis, pharmacies or public health departments announce limited vaccine availability, and people flock to get their flu shots before the doors close.

This is where government agencies need to do better. Someone - and it might as well be the state health director, Dr. Jeffrey Engel - needs to spell out the vaccine distribution criteria (Engel recently suggested that more of the available vaccine is being channeled to private primary care providers, the better to focus on the high-risk groups). It would be helpful to have an accounting of the doses that have been allocated to North Carolina - more than 1 million as of last week, according to federal authorities.

It wouldn't hurt, either, to update the public on what percentage of pregnant women and at-risk children have been vaccinated, and to spell out the order, if any, in which various age groups should get in line behind them.

Nationally and in North Carolina the anti-swine flu campaign has done many things right. The federal government acted swiftly earlier this year in authorizing, and funding, intensive vaccine production by the private companies that make it. However, those companies ran into difficulties. It turned out that although the H1N1 vaccine is a good, effective medicine, it's harder to produce in quantity than had been anticipated. That accounts for the slow, although accelerating, pace of delivery.

Also, public information efforts, especially on Web sites such as flu.gov and flu.nc.gov, are very well done - as far as they go. Too often, however, they've simply provided a convenient way to find out that the local health department has no H1N1 vaccine and doesn't know when to expect some.

Medical authorities say that for most people who get it, the H1N1 flu is no worse than regular, seasonal flu (people seeking protection from both varieties need separate vaccines). And there are some signs that the current wave of swine flu has peaked in the state. Yet because of its effects on vulnerable people, the illness merits the utmost care - and more information on how the vaccination effort is going.

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