Inadequate vaccination against influenza and pneumonia is a public health emergency costing tens of thousands of lives each year, several medical experts said yesterday at the start of a campaign to urge broader immunization against the diseases.

"If I told you that over the next six months, 60,000 people would die from Ebola virus or would contract polio, what do you think our public health response would be?" Gregory Poland, chairman of the National Coalition for Adult Immunization, asked at a news conference here.

"But we accept this [equally high mortality from influenza and pneumonia] blithely, as a fact of life," Poland said.

About 20,000 Americans die each year from influenza, and about 40,000 die from infections caused by Streptococcus pneumoniae, the most common cause of bacterial pneumonia in adults.

Taken together, they constitute the fifth-leading cause of death in the United States, according to mortality statistics released this week. After a worse-than-usual flu season last winter, the 1998 death rate from the diseases rose 5 percent over 1997. Pneumonia and influenza rose one place in the ranking of causes of death, and now stand behind only heart disease, cancer, stroke and emphysema.

Influenza vaccine, which must be given each year, is 70 to 90 percent effective in preventing symptoms of flu in people under age 65. It is less effective in preventing illness in older people but still is 80 percent effective in preventing severe complications and death.

Pneumonia vaccine is generally given only once. In older adults, it protects against pneumonia from S. pneumoniae about 65 percent of the time, and against life-threatening blood infections from the organism about 85 percent of the time.

The target population for both shots is people age 65 and older, as well as younger people with chronic conditions such as diabetes, asthma, emphysema or immunosuppression. Vaccination is covered by the federal Medicare program; older people don't have to pay for it.

A survey published yesterday by the Centers for Disease Control and Prevention (CDC) found that 65 percent of people covered by Medicare got a flu shot in the winter of 1995-96. About 45 percent had received pneumonia vaccination at some point.

For whites, the immunization rates were 68 percent for flu and 48 percent for S. pneumoniae (commonly called "pneumococcus"). For blacks, it was 46 percent and 25 percent, respectively; for Hispanics, 53 percent and 36 percent.

The surveyors asked nearly 9,000 Medicare beneficiaries why they didn't get the pneumonia vaccine, and 57 percent said they didn't know it was needed. Among people who didn't get a flu shot, 19 percent said they were unaware of its usefulness.

At the news conference, Surgeon General David Satcher said an especially high priority is increasing vaccination rates in minority communities. He attributed the low rates to many people being "underserved, uninformed and uninspired."

Drug manufacturers have made about 90 million doses of influenza vaccine for the current flu season--up from 70 million in 1995, and 20 million in the mid-1980s.

There are about 47 million people over age 45 who should get the vaccine because of age or risk, and smaller numbers of younger people. Studies have shown that in people younger than 45, less than 30 percent of those who need the shot get it. In some children and teenagers, only 10 percent of those at greatest risk get vaccinated.

Keiji Fukuda, an influenza epidemiologist at the CDC, said experts are unable to predict at this point whether this winter's flu season will be worse than usual.