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Three weeks ago, our Monday Medical column encouraged local residents -- particularly those at high risk -- to get vaccinated against influenza. The next day, everything changed with the announcement that Chiron Corp. was forbidden to ship its approximately 47 million doses of flu vaccine to the United States.

The contamination of a manufacturing plant in England has challenged the way Americans think about health care. It has also proven the law of supply and demand.

We are finding out what happens when health care is "rationed." Burglars stole 780 flu vaccine doses from a pediatric clinic in Aurora. Bloomfield, N.J., is holding a lottery to determine who gets its remaining 300 vaccinations. Chicago Bears players, members of the U.S. Congress and university students are being criticized for getting flu shots that could have gone to high-risk individuals.

Residents of border states are driving to Canada to get flu shots, and the government is checking to see whether we can get more flu vaccines from our northern neighbor.

This is a shocking turnaround. In the past, health care providers had to almost beg the public to get flu shots. Now, many physicians are in the difficult position of turning away longtime patients because what remains of the precious vaccine is being reserved for those at highest risk of developing complications from influenza.

It is important to repeat just who is at high risk, as determined by the Centers for Disease Control and Prevention:

n Children ages 6 months to 23 months;

n Adults age 65 years and older;

n People ages 2 to 64 years with underlying chronic medical conditions;

n Women who will be pregnant during the influenza season;

n Residents of nursing homes and long-term care facilities;

n Children ages 6 months to 18 years on chronic aspirin therapy;

n Health care workers involved in direct patient care;

n Out-of-home caregivers and household contacts of children less than 6 months.

That's it. Those of us who are not in one of these categories shouldn't even think about approaching a doctor or health clinic for a flu shot.

This year, our Northwest Colorado Visiting Nurse Association ordered 4,000 doses from Chiron, which were canceled. The VNA has received a smaller amount of vaccine from other sources and is prioritizing who receives it.

"We have had many phone calls," VNA Administrative Assistant Laura LaMetterey said last week. "We thank people for checking with us, but tell them that we just don't have flu shots for the general public." VNA has been serving seniors and is advertising that it can provide flu shots for children ages 6 months to 23 months and others in select high-risk groups.

Laura recommends that people call 211, the new statewide health and human services hotline. "We're trying the best we can to get people used to calling 211 for up-to-date information," she said.

There is another option for healthy children and adults ages 5 to 49. FluMist is a nasal spray that contains weakened live virus. In 2003, Maryland manufacturer MedImmune discarded 80 percent of its 5 million doses because they went unused. This year, the company created only 2 million doses but is preparing to produce more.

Those of us who don't qualify for flu shots or FluMist still can take precautions. Hand washing is the best way to prevent spread of the flu virus. Effective washing requires at least 15 seconds of scrubbing with thick lather. Make sure you reach between your fingers and under the nails. Keep your hands away from the faucet so running water doesn't dilute the lather.

It is important to use a disposable towel. A multiple-use hand towel can easily transfer germs. After you have dried your hands, hang onto the disposable towel and use it to turn off the faucet and open the bathroom door.

The 2004 influenza situation is presenting an ethical challenge to Americans. Can we do the right thing and get through this potential health care crisis together?

Christine McKelvie is public relations

director of Yampa Valley Medical Center.