Texas recently ordered a shipment of 22,600 doses of the H1N1 flu vaccine to be sent to a doctor in Dallas County. Another doctor got 14,036. Another got 6,780.

LARA SOLT/DMN

Alicia Briseño held daughter Yaneth, 2, Friday before getting her shot at the H1N1 flu-shot clinic at Dallas County Health and Human Services. The clinic ended Friday.

Who are these doctors? The state won't say. It's not clear whether these doctors work in small practices, large clinics or massive hospitals. Not even the Dallas County health department knows who is getting the big batches.

The state says it's helping doctors and patients by withholding any information about where vaccine is going. But Dallas County health director Zachary Thompson said Friday that the silence is creating at least as many troubles as it is avoiding.

"This process needs to be as transparent as possible," said Thompson, who said he had been fielding calls and e-mails from people who can't find a doctor with the vaccine.

People are anxious not only because they know the vaccine is in short supply, but because they don't know where to find it once the supply increases, he said.

"Everyone should have known that the interest [in H1N1 vaccine] would be very high based on the amount of seasonal flu vaccine that went out this year," Thompson said.

Marc Flake, spokesman for the Tarrant County health department, agreed that the state should be releasing at least some information about where the doses are – or where they will be.

"It would be helpful for the public to know," he said. "We're getting the calls from people who say they've been calling around to several pediatricians and can't find any."

But giving out a list of doctors who have the vaccine is not a good answer, said state health department spokeswoman Carrie Williams.

"Given the limited number of doses and the fact that providers are overburdened with requests from people outside the high-risk groups, we are not publicizing that information at this time," she said. "Providers registered for amounts to serve their own patients, and we don't want to create more confusion by giving a false expectation of availability for the general public."

At this point, Dallas County doctors are complaining more about the short supply than worrying about the potential effects of publicity, said Michael Darrouzet, CEO of the Dallas County Medical Society. But unexpected demand could create a problem.

"I'm not sure than any private physician has enough at this point for the general public," he said.

Even patients of doctors with the vaccine may not know the doctors have it. Some practices have been much more aggressive than others about getting the word out when any vaccine arrives, health care officials say.

Everyone involved with the allocation and distribution of the swine flu vaccine agrees about the basic problem: There isn't enough of it.

Federal officials say the manufacturing process turned out to be slower than expected. Nobody has enough yet to meet demand – even to cover those considered at highest risk of getting a bad case of this flu. And it won't be generally available in Texas pharmacies any sooner than the end of November.

Nationally, only about a third of adults who have tried to get a swine flu vaccine have been able to get it, according to a new poll released Friday.

That's true even for people who are at extra risk for severe complications and should be at the front of the line. The numbers are about the same for parents who tried to get the vaccine for their children, the Harvard School of Public Health poll found.

Most people who catch the swine flu recover after a few crummy days. But a few people get very ill and some of them die.

Dallas County confirmed its 16th H1N1-related death Thursday. A 23-year-old Dallas County man who died in early October was infected with the flu. The man had underlying medical conditions, the heath department said. No other details were released.

While the vaccine supply remains tight, apparently Texas has had enough to send several large shipments recently. This week, the health department released a list of the number of shipment orders for every county in the state as of Oct. 30. The document included a list of every shipment to every private provider, but only the amounts, not the names. The list did not include doses sent to public health departments.

Based on that list, Dallas County comes out pretty well. The county's 199,419 doses shipped represented about 8.3 doses for every 100 residents, which placed it among the highest of large counties. Neighboring Tarrant County had received about 6.5 doses for every 100 residents.

Three of the six largest overall shipments were sent to Dallas County. A dozen shipments to Dallas County were at least 2,000 doses, though the state won't say if they went to different doctors or to some of the same providers.

But a lot of shipments to doctors in Dallas County – and elsewhere in the state – were much smaller. About 7,500 of more than 11,000 doses shipped statewide were fewer than 100 doses.

That's important because the company shipping the vaccine for the federal Centers for Disease Control and Prevention will only ship in lots of 100. The smaller shipments are handled in Texas by a separate company that repacks the doses and sends them along, adding to the delay in arrivals to the doctors' offices.

The state said this week that it will increase the supply going to local health departments, setting aside one-fifth of the vaccine that arrives in Texas. That will be welcomed in Dallas County, which used up more than 10,000 doses – all it had – in a three-day walk-in clinic that ended Friday.

Thompson said the state should have planned better about how to get vaccine distribution information to the public. Maybe there could have been an agreement reached up front with those doctors who ordered the largest amounts that their names would be released, he said.

"There has to be a disclosure up front that's part of this process," he said. "These would all be lessons learned."