First came the jibes about the U.S. government rushing out an untested swine flu vaccine. Now, critics say it is not fast enough.
The premise that 'you can't win' is part of the equation, said Dr. D.A. Henderson, who advised the administration of former president George W. Bush on pandemic preparedness.
It is a lesson playing out in real time by U.S. government health officials as theH1N1 pandemic turns from a scientific and logistical battle to a political one.
Plans have been in the works for handling a flu pandemic since 2003, when H5N1 avian influenza re-emerged in Asia. Health officials held roundtables and ran tabletop exercises, with journalists, bloggers and activists.
They knew it would take time to make a vaccine against a new flu strain and handle the delicate balance between communicating the need for the vaccine without sparking anxiety if manufacturers were unable to deliver it on time.
Now that the H1N1 flu pandemic has arrived, health officials are facing the inevitable, Henderson, who helped lead the vaccination effort that eliminated smallpox in 1979, said in an e-mail.
If one anticipates a potential disaster and is successful in having enough done to head it off, there is criticism of the energy and money expended for something that didn't happen. The converse is obvious.
QUESTIONING NEED AND SAFETY
For the most part, public health experts have praised the administration of President Barack Obama for how it has dealt with H1N1. Companies formulated a vaccine in a record five months. Antivirals and other supplies from the Strategic National Stockpile were pushed out.
The National Institutes of Health is conducting research on new antivirals and how best to slow the spread of flu.
The Centers for Disease Control and Prevention has briefed the media frequently, and the agency is using new media such as pages on Facebook, updates on Twitter and videos on YouTube.
But now Health and Human Services is under fire for having miscalculated how much vaccine would become available and when. Officials said 40 million doses of vaccine would be available by the end of October, with 20 million a week rolling out after that. As of Tuesday, 22.4 million were ready.
HHS Secretary Kathleen Sebelius began making appearances in which she promised that every American who wanted a vaccine would get one and said 250 million doses were on order.
The one thing they have to stop saying is there is a dose for everybody, said Mike Osterholm, a former Minnesota public health official and expert on pandemic preparedness at the University of Minnesota.
The virus has been in a race with the vaccine and the virus is winning. It doesn't matter if there is a dose for everybody if it doesn't get to them before they become ill.
CDC has stopped trying to count how many people have caught swine flu, saying only that it is millions. Officially, 1,000 U.S. deaths have been attributed to H1N1since April.
Members of Congress have begun to question the vaccine numbers. Republican Senator Susan Collins took Sebelius to task on Monday for having released estimates too soon, then herself demanded a new timetable of estimates.
Dr. Bruce Gellin, head of HHS's National Vaccine Program Office, defended the decision to give numbers as they became available and change them as necessary.
I think that all along was the pledge to be as transparent as we could at the time, Gellin said in a telephone interview.
States would have been overwhelmed if they had been told they would only get a few vaccines and then millions were dumped on them, he said.
The United States has ordered up to 250 million doses of H1N1 swine flu vaccine from five companies -- MedImmune, a unit of AstraZeneca, Sanofi-Aventis, Australia's CSL, GlaxoSmithKline and Novartis.
Except for MedImmune, all had problems making vaccine at first and are still struggling to make the virus grow in eggs, the first step to manufacturing influenza vaccine.
MedImmune has prolific production -- officials say the company can make 200 million doses of its nasal spray vaccine -- but only had 40 million sprayers to deliver it. The company is working with the federal government to perfect a device to drip the vaccine into the nose.
How did we do with this one? From my vantage point, we could have done far better had due attention been paid to history, said Henderson, a veteran of the last two flu pandemics in 1957 and 1968.