The swine flu vaccine is available now -- you just need to cut in front of a pregnant woman to get it.
Large numbers of people clamoring to get the H1N1 vaccine as it became available -- potentially spurred by President Obama's declaration that the H1N1 pandemic was a national emergency -- led many health care professionals to wonder whether publicizing guidelines on who should get the vaccine first was enough.
It might be necessary, some said, to screen interlopers actively -- and turn them away until more vaccine is available.
"It is ludicrous to leave the allocation of scarce vaccine to individual judgment and self-interest," said Arthur Caplan, professor of bioethics at the University of Pennsylvania.
The U.S. Centers for Disease Control and Prevention has not made recommendations for screening high- or low-priority cases at public clinics because it would be logistically difficult.
"We have made it clear to providers who we want vaccinated first. At the end of the day, it is up to that provider to decide who to vaccinate," said Tom Skinner, a CDC spokesman.
The CDC suggests that people at high risk for H1N1 infection be first in line. They include pregnant women, young people between 6 months and 24 years of age, caretakers for infants, health care workers, and people with chronic medical conditions.
ABC News correspondents Lisa Stark, who dropped in at a vaccination clinic in Montgomery County, Md., and Lisa Fletcher, who observed several clinics around Los Angeles, Calif., reported that indeed, it appeared that most of those lining up for shots were in these priority groups.
Still, some said steps should be taken to ensure this remains the case.
"It should be clear and shouldn't be fudged: People who do not fall within the high risk groups will be turned away," said Rosamond Rhodes, a professor of bioethics at Mt. Sinai School of Medicine in New York. "This is a statement health departments and vaccine centers should make very pronounced... Unless everyone can be confident that the rules are being enforced, people will not want to comply."
However, some fear rigorous screening could reduce efficiency in busy clinics.
"Clearly those who are not at increased risk from H1N1 should not commit fraud to jump to the front of the line," said Dr. Robert Schooley, head of the Division of Infectious Diseases at the University of California, San Diego. "[But] if in the effort to prevent a few people who shouldn't be vaccinated from jumping to the front of the line, vaccine lines grind to a virtual halt, those who do need to be vaccinated might well just decide to stay home and take their chances. Not a winning approach."
According to CDC data, a total of 43,677 laboratory-confirmed cases of H1N1 were reported in the U.S. through July 2009 and researchers estimate that there may have been up to 5.7 million infections.
But some states have opted not to screen people based on risk, to avoid gumming the workflow.
David Paulson, director of the Maryland Department of Health and Mental Hygiene, said they encourage people to allow high risk groups be the first to receive the vaccine, but won't turn anyone away.