The H1N1 vaccine shortage isn’t just frustrating. It’s unleashing an ethical and emotionally-charged debate about people’s shot-worthiness. Back in August, the CDC announced recommendations on who should be first in line for vaccination. The list: pregnant women, caregivers for babies under 6 months, health-care workers, anybody 6 months to 25 years old, and people with health conditions like asthma and diabetes. But we all know that vaccine distribution hasn’t gone perfectly—lines have been long, supplies have run out, and, yes, some Americans have gotten the shot when they shouldn’t have.

All of this blew up into a vitriolic exchange on a local moms bulletin board in Washington, D.C., after a mother said she’d gotten vaccinated at a Virginia clinic even though she didn’t qualify. And she urged other moms to do the same to protect their kids. Hello swine-flu mommy wars. One woman called her selfish. (And there were choicer words, too.) Another warned there would be a “day of reckoning” for people like her. And this: “To the people who have gotten the H1N1 vaccine and are not in the CDC priority groups—WHAT YOU DID IS DISGUSTING. YOU ARE DISGUSTING.”

The calmer posts said she wasn’t at fault: at least some health-care workers at the clinic, they reported, were encouraging people to get the vaccine while they could—even if they weren’t in one of the priority groups. But that’s not supposed to happen, at least not until more ample supplies of vaccine are available. Moms aren’t the only ones at war. A report that Goldman Sachs and other big New York companies have received vaccine has some people up in arms, even though Goldman says it’ll provide it only to high-risk groups. And then there’s the news that Gitmo detainees will get vaccines, too. House Republican John Boehner isn’t too happy about that—and neither are a lot of other people.

Now, CDC Director Dr. Thomas Frieden is pulling out his megaphone and trying to bring some order. In a letter sent to state and local health officers and released by the CDC today, Frieden said, “It is more important than ever to focus on ensuring equitable access to the vaccine for the priority groups.” He went on to ask local health officials to review their plans immediately and “work to ensure that the maximum number of doses is delivered to those at greatest risk as rapidly as possible.”

Frieden does a good job walking the line between thanking public health officials for their hard work—they are, after all, on the receiving end of vaccine frustration—and making it clear that they need to abide by the recommendations. Now it’s up to the vaccinators to listen.

Read the entire letter after the jump.

Should health-care reform require insurers to cover chiropractors? Acupuncturists? Yoga? Spiritual healers? These are the questions raised by a recently noticed health-care amendment requiring insurers to consider covering "religious and spiritual health care."

The amendment, covered in this Los Angeles Times article, comes with backing from Senate heavyweights like Orrin Hatch, John Kerry, and the late Ted Kennedy. And while it does not mention Christian Science by name, it's been widely interpreted as a protection of the church's prayer treatments, which it encourages as an alternative to medical help. Others have understood the provision as even more far-reaching as to include any health provider acting within the scope of their license.The Freedom From Religion Foundation has criticized the amendment as an unconstitutional violation of church and state.

Even with its powerful supporters, the amendment seems unlikely to make the final bill; Pelosi already dropped it from the House version. But just the suggestion of covering religious health care highlights a difficult question for reformers: how, exactly, does prayer fit into the president's support for evidence-based medicine? Or, more broadly, is there a place for any sort of unproven, alternative medicine, religious or otherwise, in health-care reform?