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Why does the U.S. have a shortage of influenza vaccine?On Oct. 5, British regulators suspended the licence of vaccine maker Chiron, which operates a plant in Liverpool, after it was discovered that some of the flu vaccine it produced was contaminated with bacteria.

The United States was depending on Chiron for 48 million doses of flu vaccine -- half the country's supply -- but production was scrapped.

However, the contaminated flu vaccine has simply highlighted grave structural problems that have led to chronic shortages of vaccines in the United States, chief among them the lack of domestic manufacturing capacity.

Large pharmaceutical companies are abandoning vaccine manufacturing because it is not very profitable and because vaccines generate a lot of lawsuits in the United States.

Is Canada at risk of a shortage?

No, not this year. The entire supply of flu vaccine, about 11 million doses, has been manufactured and delivered to public-health units and clinics across Canada.

Canada has two suppliers of flu vaccine: ID Biomedical Corp. produces Fluviral at its plant in Sainte-Foy, Que., and Aventis Pasteur Ltd. produces Vaxigrip, which it imports from its plant in Marcy-l'Étoile, France.

Unlike the United States, Canada does bulk buying; this year, Health Canada purchased 9,967,170 doses, at a cost of $4 per dose, and just over one million more doses were sold privately.

Can't we just sell our flu vaccine to the United States?

Because the makeup of the vaccine changes annually -- this year's version protects against three strains: A/New Caledonia, A/Wyoming and B/Jiangsu -- manufacturers only produce what they have sold in advance, so there are no large stockpiles. ID Biomedical has about 1.2 million doses of Fluviral available and is willing to sell it to the U.S. but the product has not yet been licensed there.

Why don't manufacturers just make more vaccine?

The manufacturing process for flux vaccine is complex and time-consuming. Production of the vaccine that is currently being used began last February and ended in September. Different strains are cultivated in fertilized eggs, then concentrated and purified. The final vaccine, however, contains only dead viral fragments. Because of the risk of contamination, vaccines are produced in ultraclean environments, and inspections are frequent and thorough.

Who should get the flu shot?

Canada's National Advisory Committee on Immunization recommends that everyone over the age of six months be immunized against the flu annually. The vaccine is 70- to 90-per-cent effective, meaning you can still get the flu if you are immunized. However, the vaccine itself cannot give you influenza as it contains no live virus.

How much does it cost?

In the United States, the vaccine sells for about $60 (U.S.) a dose, though the shortage has driven the price as high as $800. In Canada, most people can get the vaccine free or at little cost.

Ontario provides the vaccine free to all residents. All other provinces provide it free only to people considered at high risk -- those over the age of 65 and those with chronic lung and heart disorders. The majority of provinces also provide the flu vaccine free to children. Many employers stage free flu-shot clinics in the workplace. Many physicians will sell and administer the flu vaccine for less than $20. You can also buy it in pharmacies, if you have a prescription. Because of demand, however, many jurisdictions are now demanding proof of residency.

How serious is the flu?

Influenza is not a mundane illness; it sickens four million Canadians each year, most of them children and seniors, and kills between 4,500 and 9,000 people annually, most of them frail and elderly. Influenza also has a major economic impact: It is one of the leading causes of absenteeism over the winter months.

Health Canada estimates that a pandemic strain of influenza -- a mutation for which a vaccine would offer little protection -- would kill as many as 58,000 people in a matter of weeks.

When does flu season begin?

There have already been cases of influenza reported in Alberta, B.C., the Yukon, and at one school in Ontario, but infections will build in the coming weeks and likely peak in late December. When influenza is severe, as it was last year, demand for the vaccine grows.