Staff writer

A frantic mother brought her 3-year-old boy in to receive a flu shot from pediatrician Taneki Mouri. "He is supposed to take an entrance exam for a nursery school soon," said the mother, concerned that the exam would decide the boy's entire future.

"I just told her to give him enough rest and nutritious food," Mouri said, adding that many frantic mothers like her have visited him this year. "At one point, five or six mothers like her were visiting each day. That is very unusual."

"Parents of examinees have been desperate for flu shots this year," echoed Hiroko Mori, a public health expert and director of the Totsuka Public Health Department in Yokohama.

The flu epidemic that hit the country this month is once again spurring debate about flu vaccination. Although some experts earlier said the outbreak would be small this year due to the warm winter, a type-A Hong Kong virus slightly different from last year's has been raging fiercely throughout the country.

Clinic lobbies have been packed with patients, elementary and junior high schools have been forced to close, and fatalities have been reported. As of Friday, at least 23 children and seven adults nationwide had died of flu complications, according to Kyodo News.

"In Omiya (Saitama Prefecture), three school girls died of brain inflammation early this month after being hospitalized with flulike symptoms," said Kaori Nagasaki, an official at the Saitama Prefectural Government.

The Health and Welfare Ministry said the outbreak is the worst in 10 years, with the number of school-age patients topping 1 million. However, the flu epidemic hits every year, and deaths from flu complications are not new.

Although calls for flu vaccinations seem to be louder now than ever, the vaccine supply is becoming scarce. Last year, five manufacturers of the flu vaccine produced 730,000 doses for this season in accordance with demand from the previous year.

The stock ran out at the end of last year, and the vaccine makers, following a government request, began producing an additional 60,000 doses. The ministry attributes the rise in inoculations to its vaccine campaign.

Since last year, the ministry has been urging the public -- the elderly and the chronically ill, in particular -- to receive flu shots, according to Takeshi Kasai, a ministry official. "I guess our message is now permeating through the public," he said.

Curiously, however, mounting interest has provoked calls for caution from flu shot opponents such as Mouri and Mori. "Many people who mistakenly thought that the vaccine would be effective for Hong Kong 'bird flu' rushed in for the shots," Mouri said.

He said the effectiveness of the vaccine has yet to be established. "The flu vaccine also has side effects. I basically don't give flu shots to my clients," Mouri said. Japan's production of the vaccine has a peculiar history.

Under a government policy seeking to prevent a flu outbreak among schoolchildren, mass vaccination of children began in 1962. Until recently, schoolchildren lined up in gyms each fall for flu shots given by school doctors, and seven flu vaccine makers produced a total of more than 20 million doses a year.

But due to the vaccine's side effects -- in some cases children were disabled or even died as a result of being inoculated -- citizens' groups, with the support of some doctors, launched an opposition campaign. Following lawsuits and studies published by doctors opposing the shots, the government changed its policy in 1994, withdrawing the vaccine from a list of compulsory inoculations.

Production of the vaccine then decreased sharply, from 4.7 million doses in 1993 to 300,000 the following year. Two companies have already stopped producing it, and some experts close to the ministry say the flu vaccine in Japan is on the verge of extinction.

Critics see the ministry's recent advocacy of the shots as an effort to boost consumption of the vaccine. "The ministry and vaccine makers are afraid that they won't be able to supply enough products in the event of the outbreak of a new lethal virus. So, to increase production, they are now trying to shift their target to the elderly," said Masako Koga of the Consumers Union of Japan.

Mori agrees with Koga. "Unless the government and experts advocating the vaccine review the legacy of mass vaccination, we can't trust their word. If they think the vaccine is effective for the elderly, they should convince us by showing the data," Mori said.

Yoshio Hirota, an associate professor of public health at Kyushu University Medical School, said the decline in the vaccination rate was triggered by unsubstantiated studies claiming flu shots were ineffective.