The 2006 flu season has not even peaked, yet doctors and hospitals should already be ordering next year's supply of vaccine.
There are, as usual, no guarantees. They might be promised a quantity of doses that is cut in half or never arrives. Or the vaccine might arrive in dribs and drabs, making it hard to know how many shots to administer and how many to hold back. And there's no way to know when there's a shortage if someone nearby is hoarding a stash.
In Baltimore this season, city clinics got help from the state, but commercial clinics shut down early and doctors in private practice were last on the supply chain.
What's really scary about this wing-and-prayer flu vaccine distribution system, which has malfunctioned in five of the past six years, is that it's the same one on which the nation would have to rely if the much-feared pandemic actually arrives.
So dysfunctional is the use of the private pharmaceutical market to meet a public health need that repairs defy easy solutions. But it seems clear that more federal government involvement is required.
At base is a chicken-and-egg supply problem. Seasonal flu vaccine is hard to make and usable one season at a time, so it's not very profitable. Thus, only a handful of manufacturers are left, and they can't produce even half of the 180 million doses required to vaccinate all Americans at risk of serious complications from the flu or who have contact with those at high risk.
City and county health officials throughout the nation are urging voluntary flu vaccination for all adults, to ensure a steady market and to create the framework for dealing with a pandemic. But that could take years.
Except for very young children and the very old, flu shots are not routine for most Americans - not even for health care workers, two-thirds of whom do not get the annual flu shots, according to a recent study.
For healthy people, the flu probably just means time lost from work. But 36,000 Americans die from seasonal flu annually.
Medical and health officials meeting recently at a summit sponsored by the Centers for Disease Control and Prevention considered urging that flu vaccinations be increased among schoolchildren, a group that can be particularly efficient in spreading the virus. Flu shots generally stop now at age 2.
Even that modest expansion of the program would likely require some federal support, such as an agreement to buy at the end of each flu season any leftover vaccine.
Perhaps even more important is development of a tracking system to help get flu shots to those who need them on a timely basis.
If drugmakers would drop their opposition to such an effort, they could not only avoid more drastic interference but also create an invaluable public health tool that may suddenly be needed for a pandemic.