Healthcare officials braced for a long winter of fighting swine flu can breathe more easily now that the U.S. Food and Drug Administration has an approved vaccine to protect against the H1N1 flu virus. The rest of the world, though, could remain a little congested—especially since some feel the United States is needlessly hoarding vaccine.

Four manufacturers were cleared last week to begin producing 195 million doses for use in the United States, meaning “we will have enough vaccine available for everyone,” Health and Human Services Secretary Kathleen Sebelius stated in a Los Angeles Times article last week.

The problem is that “everyone” won’t want the vaccine. Factors that vary from apathy to public distrust in vaccines keep up to half of the population targeted for vaccinations from getting one, according to the Los Angeles Times. The New York Times cites an even lower national average—33 percent—and points out that only 42 percent of healthcare workers choose to be vaccinated.

Stockpiling more vaccine than might be needed isn’t itself a cause for sideways glances. But adding to that is the United States’ insistence on eschewing adjuvants—additives that reduce the amount of antigen needed in each dose.

While adjuvants can help stretch vaccine dosages and sometimes boost effectiveness, they also might spur autoimmune diseases, according to a related article in the New York Times.

“Our insistence on the safest vaccine possible means halving the supply, even as our own domestic drug factories are devoted to more-profitable drugs,” writes science and medicine writer David Dobbs in an article for Slate. “Effectively, we're taking two doses from others to give us one. We come off looking rather like the proverbial first-class passengers who, having scoffed at the need for lifeboats because they take up deck, now scramble into the few rafts while steerage looks on.”

U.S. health officials have said they don’t want concern about adjuvants to further hamper use of a vaccine already seen as hastily created and approved.

“If you add what the public would perceive as another unknown there, there’s a concern that people would be reluctant to get vaccinated,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, told the New York Times.

Although U.S. actions on both the supply and the anti-adjuvant front can be seen as effective preparation for weathering a pandemic, the lack of vaccine worldwide—and especially in poor countries—casts a greedy shadow. The United States isn’t the only wealthy country that’s been called to the carpet for looking out for its own.

“Rich countries have a responsibility to stand in line and receive their vaccine allotments alongside poor countries, even if they have paid for their vaccine before others could do so,” writes Tadataka Yamada, president of the Bill and Melinda Gates Foundation Global Health Program, in an article for the New England Journal of Medicine. “It would be inexcusable to force poor countries to wait until the rich have been served under their existing contracts with vaccine manufacturers.”

The United States has since announced it will donate 10 percent of its vaccine supply to the World Health Organization for distribution in poorer countries, according to the Washington Post. Eight other countries also pledge vaccine donations.

Still, according to Yamada’s article, even if manufacturers’ full production capacity was directed toward making H1N1 vaccine, it wouldn’t come close to meeting the world’s needs—a fact that WHO Assistant Director General Keiji Fukuda recognized.

“The least developed countries are not really going to have a chance of getting the vaccine,” he is quoted as saying in the Washington Post, acknowledging that “nobody expects the numbers to work out in this pandemic.”

That might be even more of a reason for wealthy countries to do the morally right thing, according to Yamada’s philosophy. “The prospect of a worsening global influenza pandemic is real and will not go away anytime soon,” he wrote. “I cannot imagine standing by and watching if, at the time of crisis, the rich live and the poor die. It will take collective commitment and action by all of us to prevent this from happening.”