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The pressure on doctors to give flu shots only to those who need them most just got a little stronger.

Erie County's top health official issued a commissioner's order Wednesday that directs flu shot providers to stick strictly to vaccination distribution guidelines. Otherwise, they could face a misdemeanor charge punishable by a fine.

"These are more than guidelines. This is the way it has to be," said Dr. Anthony J. Billittier IV, health commissioner.

The county Health Department has not received complaints of physicians or others providing flu shots to individuals who are not at high risk of complications.

Instead, Billittier said, the order's primary aim is a bit of preventive medicine -- to educate healthy consumers not to demand vaccine from doctors if they are not high risk.

"The public needs to take the heat off the providers," said Billittier.

A handful of states, including Massachusetts, Oregon and New Mexico, as well as several other counties in New York State, have issued similar orders with varying penalties.

Such orders are issued in cases of imminent public danger.

The U.S. supply of influenza vaccine was cut in half when British regulators halted production of the vaccine by Chiron Corp. because of contamination.

Many scheduled offerings of flu shots have been canceled while the country awaits additional vaccine, which takes about four months to produce.

New York is expected to release a distribution plan next week for the state's share -- 750,000 doses -- of the 22.4 million doses of vaccine that have not yet been shipped to the U.S. from manufacturer Aventis Pasteur, said William Van Slyke, a State Health Department spokesman.

This week, nine Western New York mayors called on the state to explore importing vaccine from Canada to alleviate the shortages in their communities.

"We're hurting. We need it," said Gary Ostrower, mayor of Alfred.

He and the other municipal officials also asked public health officials to give them more guidance on how to prioritize individuals in high-risk groups.

Guidelines by the federal Centers for Disease Control and Prevention recommend that vaccine be reserved for people in eight priority groups: children ages 6 to 23 months; adults 65 years and older; anyone with underlying chronic medical conditions; pregnant women; residents of long-term care facilities; children 6 months to 18 years on chronic aspirin therapy; health care workers in direct patient care; and out-of-home caregivers and household contacts of children younger than 6 months.

Much is made of restricting shots to individuals in the high-risk groups, Ostrower said, but there is not enough vaccine even for them.

"With such limited supplies, we need to know who is the highest risk among the high risk. Do we give the vaccine to everyone over 65? It bewilders me to think there is not a more systematic approach," he said.

The U.S. does not ration medicine. But public health officials in New York and elsewhere are considering guidelines that would designate who among the high-risk groups should get vaccine first.

Billittier said he has adopted the guidelines for Erie County and expected other counties to approve them soon as a standard set of rules for use in medical and bioterrorism emergencies.

In the case of the flu, priority would go to anyone in a position to cause significant spread of the disease to others, including health care workers involved in direct patient care, residents of long-term care facilities and day care center workers.

"Our goal is to immunize people at points of amplification," said Billittier.

Any vaccine the county receives will be targeted toward those three groups. However, Billittier said the county will not impose the stricter guidelines on community physicians.

"Doctors have an obligation to individual patients," he said. "We (Health Department) have the obligation to the whole community."


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