There's been a lot of talk in the American media lately about the influenza vaccine shortage. It was touched off when British health officials suspended Chiron Corporation's license to manufacture the vaccine, cutting America's expected supply in half. The shortage is a serious problem, particularly for the elderly and for people with chronic respiratory problems. But the fact is, the flu vaccine isn't mandatory in the United States, which sets it apart from the 12 different vaccines American children are required by law to receive by the age of five. It's been more than 60 years since U.S. health officials started mandating childhood vaccines. But the issue is far from settled.

It's a fairly common sound at doctor's offices across the country, where every day, children receive dozens of shots that they're required to have before they can attend school in the United States. Back in 1940, health officials started mandating that children receive 3 doses of a Diphtheria and Whooping Cough vaccine before the age of five. Today, American children receive about 40 doses of vaccines designed to prevent 12 different diseases, among them, Measles, Tetanus, and Hepatitis B.

At this New York City doctor's office, Sean Reilly's 15-month-old daughter, Emma, just received her inoculations against Polio and Pneumonia. "It went really well. She's very good at getting her shots. Actually, she got three today. The first one she didn't make a peep, and then the other two they said stung, so those bothered her a little bit. But she's brave," he says.

Thanks to mandatory vaccination, diseases that used to be common killers in the United States have become mere blips on the epidemiological radar. Diphtheria, for instance, killed nearly 176,000 Americans from 1920 to 1922. That's the year the vaccine against the disease was first licensed. In 2001, though roughly 60 years after the Diphtheria vaccine became mandatory, just two people in the United States died from the disease. On the surface, it seems like a no-brainer: Mandatory Vaccination is a good thing.

Except that while child mortality has decreased dramatically over the course of the last few decades, the number of children suffering from diagnosed learning disabilities, diabetes, asthma, and autism has gone up.

"We have almost 20 percent of our children now in this country chronically ill or disabled. That's a very different situation from what it was 20 or 30 years ago, and there's no explanation given by the public health authorities as to why that is true," says Barbara Loe Fisher, president of the National Vaccine Information Center. The group was founded in 1982 by parents whose children were injured or even killed by the vaccine against Whooping Cough. Several studies have noted that a small minority of children suffer severe brain damage after receiving the vaccine, though the exact connection is unclear.

In 1986, the U.S. Congress passed the National Childhood Vaccine Injury Act, which established a compensation fund? and requires doctors to inform parents about the benefits and risks of vaccination. But even after they've been informed, parents don't really have the option of refusing to have their children inoculated. Medical exemptions are available for children with compromised immune systems - though they're difficult to get.  Most states do permit religious or ideological exemptions, but Barbara Loe Fisher says those are also hard to get, and there's a movement to eliminate them all together.

"I think that ideologically, certainly, the public health authorities are committed to the mass-use of vaccines to prevent all infectious diseases. And I think one of the most important areas of scientific research that needs to be done is to investigate why some children don't seem to be able to handle the process of vaccination, and instead of becoming healthier, they become sicker," she says.

But the number of children injured each year by mandatory vaccinations is very small in some cases, less than one tenth of one percent. And doctors with the Centers for Disease Control and Prevention and the American Academy of Pediatrics all insist that mandatory vaccination is the best way to prevent the kind of child mortality rates that used to devastate this country and continue to devastate countries where vaccination isn't pervasive.

Daniel Neuspiel is a pediatrician who's written articles for parents concerned about vaccination. "The one disease that in my professional lifetime has been almost eradicated has been Haemophilus Influenze B. The H-Influenza-B vaccine was licensed in 1985, and prior to that, I commonly saw children with meningitis and other serious infections from that disease hospitalized or even dying from it. And I haven't seen a case of it in years," he says.

That's wonderful, says Barbara Loe Fisher, of the National Vaccine Information Center. But she says the fact remains that public health officials are still mandating a policy they know can hurt people. And she says there's very little interest in understanding why children like her son, who has suffered multiple learning disabilities as a result of a vaccine he received in 1980, just can't handle being vaccinated. I think you look at the history of medicine, and whenever you take a 'one size fits all' approach, it usually fails," she says. "Why would it not be failing in terms of vaccination?"

Right now, there are only four companies that manufacture the 12 vaccines required in the United States. Last year, the National Vaccine Advisory Committee, which is part of the CDC, reported shortages in the supply of eight out of the 12 mandatory vaccines. But this year, supply does not seem to be a problem.