I have been writing articles lately about the reasons for the H1N1 vaccine shortage and what to do about it. You can find these pieces in Forbes.com, Slate, and most recently as an oped in Wednesday’s NY Daily News. I believe that fear has played a major role in governing our public health response to H1N1 swine flu and the pressing need for a plentiful pandemic vaccine. I realize that it is easy to bludgeon our officials with the retrospectoscope, on the other hand, many of these nervous responses are chronic, and require significant adjustment going forward:

• Vaccine fear mongers do significant harm. Fear of thimerosal (a mercury-containing preservative that is used to bundle doses and has been shown not to cause autism) led to too much time spent trying to produce single vaccine doses without it.
• The CDC’s fear of overreacting to a possible pandemic, as they did in 1976 when 40 million people were vaccinated unnecessarily for a pandemic that never came, led to too much caution here, where instead a shift in vaccine production to the H1N1 vaccine could have led to many more million doses available now.
• Fear of seasonal flu, which doesn’t peak until much later, if at all (maybe crowded out by the H1N1 pandemic strain), led to 115 million doses of seasonal flu vaccine produced, when there is no seasonal flu around.
• Fear of new vaccines in the U.S. has led the FDA to fail to approve several new vaccines which use more up to date technologies such as mammalian cell culture instead of hen eggs, or additives known as adjuvants which make vaccines more potent so a smaller supply can be used for more inoculations. One American company, Baxter, makes a mammalian cell vaccine that will be used extensively in Europe, especially for those with egg allergies, but is not approved for use here.
• Fear of vaccines has led to poor compliance, especially for children, the group that currently seems to be most at risk for complications of the disease.
• Fear of admitting error has led our public health officials to delay in acknowledging the shortage or in correcting it, delay in accepting that it is H1N1 that is the predominant flu this year, not the seasonal strains.
• Fear of the spreading flu may be useful to combat fear of the vaccine, but a better approach would be a rational discourse based on statistics and real risk.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

Cases of swine flu, or H1N1, are climbing and spreading to more states.  At least 141 people in the U.S. have been infected, and one Mexican boy visiting Texas has died.  Many more cases will be diagnosed—likely many thousands—before the spread of the illness ebbs.  Public health officials and journalists warn of a pandemic, an epidemic of infectious disease that sweeps across a large geographic area, such as a continent, or around the whole world.
 
The toll of this new flu may turn out to be disastrous, but there’s no current evidence that a calamity is brewing.  Thus far, every American who has contracted the illness has survived.  Even if there turns out to be 250,000 cases this year, the number will still be dwarfed by the toll of diseases like cancer, heart disease, diabetes, asthma, depression and alcoholism on our population.
 
What the 141 cases of H1N1 flu have already proven, however, is how vulnerable we are to panic.  Americans are on edge, uncertain about the economy and uncertain about the direction our President is leading us.  Ultimately, for all but those with the steadiest of nerves and most solid sense of self, we are a nation collectively experiencing a sense of impending doom—one of the hallmarks of panic disorder.  H1N1 may or may not cause serious physical suffering for our population, but its emergence will cause serious psychological suffering for a nation already traumatized by deep doubts about whether the solutions to our collective problems reside in bailouts, embracing dictators and apologizing for our national shortcomings.
 
 Some might say that connecting our reaction to H1N1 flu to the economic crisis and cultural crisis at hand is too great a leap, that we are as steady on our feet emotionally as a population as ever.  I don’t think so.  I’ve been at my work 16 years, seeing adults and adolescents facing every imaginable twist and turn of fate.  Never before I have seen as many individuals who feel disempowered, unable to mount any resistance (words intentionally chosen) to the stressors impacting them.
 
Our psychological resistance to trauma of any kind is down right now.  That’s one reason that Air Force One flying low near Ground Zero was such a grand faux pax:  It re-traumatized thousands of people who don’t have emotional bandwidth to spare.  It’s even possible that our psychological stress could reduce our resistance to physical illnesses, including H1N1.
 
 It’s time for a real public health initiative, rolled out through private health care providers and, perhaps, community health educators, that targets two certain epidemics already sweeping the nation:  anxiety and depression.  They may not be spread by coughing and sneezing, but they have the capacity to paralyze us emotionally and cost our nation dearly.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.