The health care debate that was waged all summer has made its way into the fall. First the public plan was killed, now politicians may be working it in at the state level, using federal funding. Americans have called the lack of a state system medieval and the threat of one fascist. And in the midst of all this talk about whether a public health plan should or shouldn't be, the federal government has appropriated 7.5 billion dollars of taxpayer dollars for a medical preparation campaign, including billions for a vaccine it hopes to distribute to every citizen of the United States, at no extra cost to them.

Some would call this move more socialist than bailing out the banks. Park Slope pediatrician Dr. Philippa Gordon calls it "a cooperative program between the government and vaccine manufacturers... done as though we were a country that had a public health system." And Center for Disease Control spokesperson Joe Quimby calls the mass vaccination "an unprecedented time in our history." But what kind of crisis could generate the political will to support such swift and sweeping action, especially as rumors of "death panels" simmer to last month's murmurs and the dull pain of Obama's first failure still aches?

That crisis is swine flu. It's surprising that this illness would be the one to inspire a public health project of this scale. According to the CDC, swine flu has caused approximately 822 deaths since it hit in the spring (now they've stopped counting deaths from H1N1 separately from deaths from the seasonal flu). NYC's Department of Health and Mental Hygiene says 54 of those deaths were in New York City. The DOH estimates 1,000 deaths annually from the regular flu. To compare with another public health crisis, the DOH says 2,625 people died from HIV in New York in 1997. Of course, we've been producing flu vaccines for 50 years, so the method of manufacturing this new vaccine is well established and incomparable to HIV and AIDS prevention techniques, but in terms of government response, the numbers are worth noting.

What's alarming about H1N1 is that it seems to target younger people. CDC spokesperson Quimby told the Reader that "this flu is not like any other we've faced before... this flu is attacking 5 to 24-year old young people." But this isn't some alien virus that preys on only the supple and fresh. Dr. Gordon, who has written an informative set of FAQs published on "Only the Blog Knows Brooklyn" and encourages her patients to get the vaccine, explains that "the flu undergoes minor changes, what are called drifts, every season. So for the seasonal flu, the outbreaks tend to be shorter, 6-8 weeks in winter. Occasionally... on average, three times a century, it shifts, and if it's a radically different... strain, then nobody's immune to it."

That's what happened in 1918, and what Gerald Ford's government anticipated happening in 1976 (though that year the outbreak never happened, and the plan to vaccinate most of the US population came to an abrupt halt when several senior citizens died shortly after being vaccinated, and the media blamed the vaccine). But "in this case," says Gordon, "since it's occurring in mostly younger children, it seems that maybe the older generation had contact with something similar to it."

According to CDC, the reasoning behind the urgent mass vaccination is that "there are no known antibodies in anybody's system," so the population must be systematically immunized using the man-made option, which will be available in a nasal spray and injectable form, rather than "risking it" and trusting our bodies to develop immunity the old-fashioned way. (This reasoning does not entirely jibe with Dr. Gordon's analysis, which inferred that the older generation may in fact have developed antibodies, obviously not to the H1N1 sub-set itself, but most likely to a similar strain). Whether developing a "natural" immunity to a virus or "artificially" receiving it through inoculation, makes a person stronger, is a question this writer is prepared to pose, though not answer.

Either way, four corporations-MedImmune LLC, CSL Limited, Novartis Vaccines and Diagnostics Limited, and Sanofi Pasteur, have been approved by the FDA to manufacture the vaccine. CSL Limited and Sanofi Pasteur are concluding clinical trials begun July 22. When the Reader asked FDA spokesperson Patricia El-Hinnawy if these trials were being completed in an unusually short amount of time, she replied that "the H1N1 vaccine is prepared according to the same stringent production protocol and standards as the seasonal flu vaccine... we expect the 2009 H1N1 flu vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record."

Things were different in 1976, when Brooklyn writer Patrick Di Justo wrote his April 2009 piece for Salon. "The drug companies insisted that proper vaccine development required years of experimentation and clinical trials, and they were reluctant to develop and distribute an untested drug." El-Hinnawy explains that each year, the FDA and CDC work with scientists to choose several strains of flu to use in vaccines. This year, swine flu hit the US after they'd decided which strains to make the seasonal flu vaccines with, so they authorized an extra round of production.

To make a flu vaccine, a form of the virus is injected into a live chicken egg, one chicken egg per dose of vaccine. For the CDC to reach its goal of inoculating the entire US population, that's around 300,000,000 live chicken eggs. (We're guessing they're not organic. And if you're allergic to chicken eggs, you shouldn't get the vaccine.) The CDC said at the end of September that they had about 6-7 million doses, so it's safe to bet that by the end of October, New York City will have gotten its allotment.

The DOH is offering the vaccine to all New York City schools, public private, and parochial. Unlike in the case of New York State health care workers, who are currently protesting the recent radical mandate to get the swine and seasonal vaccines, NYC school children are not required to get the vaccine and will not have it administered to them without the consent of a parent or guardian.

This leaves much of the fate of this exceptional public health program in the hands of New York City parents, and in Park Slope, parents are mulling it over.

Stuart Miller, who has a child at PS 107, said he and his son "have an appointment to get a flu shot from his regular doctor" and he anticipates getting the swine flu vaccine from his pediatrician as well, though "if the question is would I trust the school system to administer the vaccine, yeah... I'm inclined to say that I'd rather not have my son get sick."

But Myrta Echeverria, a Park Slope mom with boys at New York City Lab School and New Voices, won't, because she's for one not inclined to get flu shots, and in addition, her family's already seen the swine flu, and come away unscathed. "From what I know this virus is nothing life threatening unless you have another health condition, so I don't think I'm going to use the vaccine on my children. Last May there were children at the school that had the virus in my son's class, and the school didn't get closed, and he didn't get sick."

One expecting mother, who asked to remain anonymous, cites history: "The Bubonic Plague killed a lot of people, but medical historians say that it also did something for the European population it affected, which was to enact a receptor that proved vital in that population's resistance to the AIDS virus. In Africa, where the Bubonic plague did not wreak havoc, AIDs has."

Dr. Gordon says that she sees a lot of pregnant women and "most of them do seem interested. The number of people absolutely opposed to vaccination has gone down. Now most people have stopped being so suspicious. It was like a vogue."

Grace Smith is a writer from Baltimore