AUGUSTA – State health officials have asked doctors to delay regular tetanus vaccine booster shots because of a nationwide shortage of the vaccine caused by fewer companies making it and by increased demand from flood-ravaged areas across the country. In addition, Dr. Dora Mills, director of the Bureau of Health, said there could be shortages of other vaccines.

“We have enough [tetanus] vaccine on hand in the state to handle emergency needs, like at [emergency rooms] or if you go to your doctor after stepping on a rusty nail,” she said. “But there is not enough for the routine preventative use of booster shots, and that is of concern.”

Tetanus, also called lockjaw, is a disease that affects the central nervous system. According to federal statistics, Mill’s analogy of stepping on a rusty nail is pretty much on point. Nearly two-thirds of reported tetanus cases are from puncture wounds, cuts and abrasions. Tetanus can be fatal, with developing countries estimating nearly 300,000 deaths a year.

“But the use of the vaccine has virtually eliminated that threat in the United States,” Mills said. “That is why this vaccine shortage is so troubling. We had a shortage of flu vaccine last fall, and now we have this shortage and I fear we will be having more.”

The reason, Mills said, is that fewer pharmaceutical companies are making many of the vaccines that are basic to health prevention efforts. She said it points to what she sees as a basic flaw in the nation’s health care system.

“I don’t think we can have a system that is entirely driven by the profit motive,” she said. “Vaccines like tetanus no longer have patent protection and companies can’t make the profits on them like they used too. So some are not making them anymore.”

Dr. Stephen Sears, an infectious-disease specialist at MaineGeneral Medical Center in Augusta agrees with Mills. He said he has seen shortages in other medicines, not just vaccines.

“We had a shortage of penicillin, a still important antibiotic that has been around for a long time,” he said. “This is a serious concern.”

Sears said he is more concerned with what may be a trend than with the specific shortage of tetanus vaccine. He said delaying a booster several months or even more than a year may not lessen some individuals’ protection from infection.

“Every individual is different,” he said. “A vaccine may last months, or even years, longer in one person than another. I am more concerned about a possible flu vaccine shortage next fall.”

Andy MacLean, a spokesman for the Maine Medical Association, said there is broad concern among doctors that there could be further vaccine shortages. Although, he said, there is no crisis at present.

“I don’t know what can be done to instill some competition in the industry,” he said. “I think it is clear we need more vaccine manufacturers.”

But the number of companies making the flu vaccine has dropped from 10 to just two in the last decade. And the number of companies doing research and development of new vaccines has also dropped, from 12 to four.

“And that is because of a number of reasons,” said Jeff Truitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a national trade group based in Washington. “Part of it is because of the artificially low prices mandated by government on some of these vaccines.”

Truitt acknowledged there are concerns that with so few companies making vaccines, shortages can occur. But he said price controls are not the answer.

“It costs $500 million to develop a new drug and bring it to market,” he said. “And only one in five makes it to market. These are tremendous costs.”

Truitt said some vaccines are now so cheap, they cost less than the container they are kept in. But he said companies that make those vaccines should be allowed to charge higher prices so they can make the money needed to improve current vaccines and develop new ones.

“There is a tremendous amount of money being spent to try and develop a vaccine for AIDS,” he said. “That money has to come from somewhere.”

Truitt acknowledged there is a concern that fewer companies making vaccines could lead to more shortages. But, he said, government control is a not the answer.

“Officials at the federal Food and Drug Administration are talking with industry representatives about how to resolve this potential problem,” he said. “That’s the way to deal with the issue.”