Every year, tens of millions of Americans roll up their sleeves for sometimes painful flu shots. The Food and Drug Administration is expected soon to approve a painless alternative — a flu vaccine squirted into the nose rather than injected.

But some doctors say the immediate potential of the new vaccine, FluMist, will be blunted because it will not be approved for those who need it most.

Some experts say that over time, the needle-free vaccine and the advertising dollars that will be behind it could vastly increase the number of people who get flu vaccines each year. That could cut the annual toll of 114,000 hospitalizations and 36,000 deaths from the disease.

"It's so simple for patients to receive the vaccine," said Dr. Robert B. Belshe, professor of medicine and director of the Center for Vaccine Development at Saint Louis University. "There are a lot of people who don't like needles, and a spray in the nose they welcome."

N.Y. TImes