States and counties will be struggling to vaccinate people against the swine flu pandemic well into December and January -- long after the first peak of the virus in the United States, officials said on Wednesday.

Federal health officials also said it will be years before things get any better, despite years of planning.

It is likely that the current wave of infections will peak, crest and then decline before full vaccine supplies are delivered, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told a House of Representatives Appropriations subcommittee.

The briefing painted a picture of the problems dogging health departments at the height of the pandemic, which has killed at least 1,000 Americans and more than 5,700 people globally.

Our school-based vaccination efforts have now been delayed until late November or early December, Dr. Donald Williamson of the Alabama Department of Public Health told the briefing -- not a formal Congressional hearing.

Current projections show that 62 percent of Alabama's vaccine will not be available until after December 1. That means providers could wait until January to get vaccines.

Frieden said the CDC has now delivered or has available 32.2 million doses of swine flu vaccine and wants to ensure it is not wasted.

We don't want people turned away and told to come back, because they may not come back in the future, he said.

Rob Fulton of St. Paul Ramsey County in Minnesota said the delays will hit other programs.

We are very concerned should we have another emergency event such as a large-scale food-borne outbreak or a tuberculosis outbreak that requires diverting staff, he told the subcommittee, which helps decide on public health funding.

STAFF CUTS

Local and state funding for public health has been impacted by the poor economy and we have just eliminated 5 percent of our staff to meet our 2010 budget goals.

Only 7,800 doses of vaccine will be available for children of 9 and under, but the county has 20,000 such children.

We know that the credibility of the entire public health system is in question due to the slow arrival of H1N1 vaccine, Fulton said.

Both committee chairman David Obey of Wisconsin and Representative Rosa DeLauro of Connecticut noted that they have been holding hearings for years about the lack of public health infrastructure in the United States and the need for better vaccine manufacturing capacity for a pandemic.

I have been hearing this stuff for five years, Obey said, even reading aloud from old testimony.

How do we adequately prepare and have the infrastructure in place to manufacture and distribute vaccine wherever something comes up? asked DeLauro.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said preparations have not been at a standstill.

We have gone from 2003, when our budget for influenza was $50 million. It is now $260 million at a time when the NIH (National Institutes of Health) budget was flat, he said.

NIAID is funding research to make and test new antiviral drugs and to improve vaccines.

The aim is to get what's called a universal vaccine. Then you could make as much as you want, Fauci said, noting that is years away because research and testing takes time.

Medicine