Health, Education and Welfare Secretary Joseph A. Califano Jr. yesterday recommended that the flu shot program be resumed for 20 million older and chronically ill Americans.

He said state and local health officers and private doctors should give them a combined vaccine that protects against A/Victoria flu and swine flu. The secretary explained that the combined vaccine is the only existing one that can offer protection against the A/Victoria flu that has afflicted 59 residents of a Miami nursing home. No single-purpose A/Victoria vaccine has been manufactured this year.

The combined vaccine may be given, at doctor's discretion, to anyone else with special needs, such as hospital and nursing home workers, Califano said.

He also lifted a moratorium on shots for B/Hong Kong flu, which strikes children and has been causing outbreaks in schools in many parts of the country.

But he declined to end a moratorium on the single-purpose swine flu vaccine that was given to some 30 million people last fall and early winter.

Califano acted after hearing from a panel of scientific and other specialists who met all day Monday at his request.

They recommended that he lift the moratorium on all vaccines, though the members said they did not expect anyone to offer the single-purpose swine flu shots unless swine flu breaks out someplace.

The moratorium on all shots was set Dec. 16 after it became apparent that both the single-purpose swine flu and combined swine and A/Victoria vaccines were causing a rare type of paralysis called the Guillain-Barre syndrome.

Like his scientific advisers, Califano said he had to weigh the excess risk of death from Guillain-Barre - one death in each million people vaccinated - against a possibly increased risk of death from influenza, which he said can kill "approximately 1,260 persons out of million" in high-risk groups.

Califano thus released for use some 27 million doses of the combination vaccine, which are mainly in the hands os state health officers who are expected to distribute them to local health departments as soon as HEW sends revised consent forms that explain the newly assessed risks and benefits.

Some 20 million chronically ill and older persons got the combined vaccine before the moratorium. How many of the 20 million more who are targeted for shots now ill turn up for them is impossible to say, Califano acknowledged.

"This is a free country," he said. "I can't force anyone to do anything. We will make all the information that we have available to doctors. That's the best we can do."

Califano repeatedly refused to say anything stronger to urge people to be vaccinated. Last fall President Ford and his deputies urged "everyone" to get shots to avoid the swine flu that has not so far appeared.

Flu experts now fear the possible spreading of the A/Victoria flu that starting Jan. 20, affected 59 of the 176 patients at the Maimi nursing home and another 15 of 100 staff members, probably causing three deaths among the patients.

As of yesterday, however, there were still no A/Victoria cases reported elsewhere in the United States, with no new cases in Miami since the weekend. Three cases were reported in Canada.

Califano denied yesterday that politics or displeasure with the swine flu program caused his decision to replace Dr. David Sencer as director of the Center for Disease Control in Atlanta.

Sencer told reporters, "I don't think politics involved. I think it's natural for an administration to have people they think they will be comfortable with."