If there were only 500,000 swine flu shots available this fall, who should get them?

The CDC recommends “pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk” (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm) receive the swine flu vaccine but, in a country of over 300,000,000 getting down to 500,000 would take far more specific parameters. In the New England Journal of Medicine (September 2009) Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H, Liu F, Dong L, Devos JR, Gargiullo PM, Brammer TL, Cox NJ, Tumpey TM, Katz JM reported that 34% of people born before 1950 “had a titer of 80 or more” of antibodies cross reactive to 1976 and todays H1N1 so perhaps we could limit the amount of vaccine given to the elderly. One could try and limit vaccinations to health care workers but the fact that alone the number of registered nurses in America stands a 2.9 million means 500,000 would be nowhere near enough to cover them and the myriad other medical professionals. Although people who are 25 to 64 are “at higher risk” this group encompasses tens of millions of people. Pregnant woman would certainly be a go choice but it must be kept in mind that the CDC states that the FluMist not recommended for them as well as people over 50, or who have asthma or heart disease so only the injected vaccine could be used.