Flu vaccines for all?

An advisory group to the federal government is considering recommending that all Americans receive annual flu vaccinations, a step that would result in the largest vaccination effort in United States history.

Although millions of Americans are vaccinated for a number of other diseases, such as tetanus, diphtheria, and measles, those inoculations require at most a new vaccination every 10 years. But a flu- vaccine program would require yearly inoculations because of constantly changing strains of the disease.

Advocates say the program would reduce incidence of the disease and, quite possibly, reduce fatalities. It would also give drug manufacturers a larger and predictable market for their vaccines, so that shortages would not occur during major epidemics. But some observers are balking. Many Americans have ethical, medical, or religious objections to being vaccinated, they point out. Others suffer from side effects of the vaccine.

"There are a couple of big implications here," says Keiji Fukuda, an epidemiologist at the Centers for Disease Control and Prevention (CDC) in Atlanta. Right now, "there is no vaccine program which targets everybody in the country to get annually vaccinated. The logistics of something like this would be really immense. It would simply be much larger than any other vaccination program in the country."

The discussion also represents an ongoing change in philosophy at the Advisory Committee on Immunization Practices, the group that is advising the CDC on vaccination policy. "It's a direction toward which the ACIP has been moving in the past few years in terms of broadening its recommendations for who should get vaccinated," Dr. Fukuda says in a phone interview. He presented the issue of nationwide vaccination to the ACIP last month.

Not everyone is comfortable with the idea. Although the new standards would remain recommendations, they would set in motion a number of steps that would pressure all Americans to comply, says Barbara Loe Fisher, president of the National Vaccination Information Center. The Vienna, Va., group advocates a cautious approach toward vaccinations. "I think the move is to universal use by all citizens," she says by phone. "And I think that's a very questionable step."

When the CDC puts a universal-use label on a vaccine, "we know that mandates will follow," Ms. Fisher says. For example, it would be a signal to states "to add it to the mandatory vaccination requirements for children who want to go to school." Employers might require it. And the vaccines would probably be covered under the National Childhood Vaccine Injury Act, which protects vaccine manufacturers from liability suits from those who feel they've been harmed.

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