With such a high level of competition and so much presidential encouragement, it was not surprising that Health and Human Services Secretary Tommy Thompson, one of the more garrulous members of the Cabinet, entered the contest this week by claiming that the shortage of flu vaccine "is not a health crisis."

Tell that to the 36,000 people who die annually in the United States, or the 200,000 who are hospitalized, from causes associated with influenza. Those are yearly averages from the Centers for Disease Control and Prevention as reported by the Government Accountability Office, the agency formerly known as the General Accounting Office.

Formal name changes aside, it's the same GAO that has warned repeatedly over the last four years about the perilous state of vaccine production and distribution. Academics and health professionals outside the government have been as pointed in their periodic alerts. The government response has been anemic.

In May 2001, four months into the Bush administration, Janet Heinrich, director of GAO's health care division, testified before the Senate Special Committee on Aging. The title of her statement could not have been clearer: "Steps Are Needed to Better Prepare for Possible Future Shortages."

Heinrich's testimony was an eerily exacting guide to what is now afoot.

"Manufacturing difficulties could occur in the future and again illustrate the fragility of current methods to produce a new vaccine every year," she said. "Compounding the problem is that when the supply is short, there is no system to ensure that high-risk people have priority for receiving flu shots."