Public health advocates in the U.S. are predicting that within five years, annual flu shots will be recommended by the government for every American and not just young children, the elderly and other at-risk people.
Dr. Scott Harper of the federal Centres for Disease Control and Prevention (CDC), says the government panel that sets U.S. vaccine policy is already in discussions about "universal immunization" as a way to boost vaccination rates and reduce flu-linked sickness and deaths.
The idea of vaccinating even more people at the close of what has been a chaotic winter season, where many people were unable to obtain flu shots because of a shortage, seems an inopportune time to broach the idea of vaccinating even more people.
That recent crisis momentarily upstaged universal immunization discussions, says Harper, but it remains a viable proposal.
Harper told vaccine providers, distributors and manufacturers at the national flu vaccine summit, that part of the CDC's job was to just keep the issue on ' the radar screen'.
The vaccine meeting, held every year, seeks to set an agenda for the upcoming flu season. Participants, many of whom have a financial stake in getting more people vaccinated, say the universal vaccination push is likely to come within the next five years.
But some observers are daunted by the likely problems such as, for example, the instability of supply. Factory contamination problems at Chiron Corp's British plant unexpectedly cut the U.S. flu shot supply in half last fall. This year the best case scenario of having about 90 million shots available, is not even enough for the 180 million high-risk people advised to get shots, let alone the total population of 280 million.
Also, because there are always different flu strains circulating, flu vaccine is altered every year, and any unused vaccine is discarded at the end of the season making flu shots financially lacking in appeal for manufacturers.
To date, only one company, Sanofi Pasteur, is licensed to make U.S. flu vaccine for the upcoming season, though public health officials hope two others, including Chiron, will soon gain approval.
Sanofi Pasteur's Philip Hosbach says his company has two idle U.S. factories "because there's not the return on the investment", and universal vaccination could in the long term help stabilize supply if it increased demand.
But Ira Longini, an Emory University biostatistician, who specializes in vaccine analysis, says universal vaccination would be unworkable unless supply problems are resolved.
Dr. Ann O'Malley, a researcher at the Centre for Studying Health System Change, says that demand has always been a problem, as millions of at-risk patients routinely skip annual shots, people worry about the vaccine's safety or simply dislike shots, but many also underestimate the seriousness of flu.
Estimates suggest that in an average year, flu infects about 82 million people nationwide, hospitalizes 200,000 and kills 36,000.
The government has in recent years repeatedly expanded the list of people who should get flu shots, first to healthy adults over age 50, then to babies and toddlers and that is in addition to traditional groups deemed at risk for flu complications, which includes adults aged 65 and older, pregnant women, the chronically ill and health care workers.
O'Malley says the lack of one consistent message causes confusion.
One medical study earlier this year, has in fact suggested the vaccine did not save lives among elderly people, and some researchers say it would probably be more effective to vaccinate children who are the biggest spreaders of the virus.
Dr. Herb Young of the American Academy of Family Physicians said recommending shots for everyone could ease the confusion and his group supports the idea.
Young says that as family physicians take care of the whole family, it makes sense, and he is convinced that nation eventually end up with it.