President Bush unveiled a flu response plan for the United States amid concerns that the H5N1 strain of the bird flu that has infected birds and on rare instances humans in Asia and Europe, will become a worldwide pandemic. A health unit report outlines the plan.
[ Download complete HHS plan as 396 page (32.7MB) PDF or select section at HHS]
SUSAN DENTZER: Speaking today at the National Institutes of Health, President Bush said the nation can waste no time preparing for a potential flu pandemic possibly worse than any since 1918.
PRESIDENT GEORGE W. BUSH: There is no pandemic flu in our country or in the world at this time. But if we wait for a pandemic to appear, it will be too late to prepare, and one day many lives could be needlessly lost because we failed to act today.
SUSAN DENTZER: The president said he was asking Congress for $7.1 billion in emergency funding for a strategic pandemic flu response plan. That's roughly in line with a $7.9 billion package the Senate already adopted last week.
PRESIDENT GEORGE W. BUSH: Our strategy is designed to meet three critical goals: First, we must detect outbreaks that occur anywhere in the world; second, we must protect the American people by stockpiling vaccines and antiviral drugs, and improve our ability to rapidly produce new vaccines against a pandemic strain; and third, we must be ready to respond at the federal, state and local levels in the event that a pandemic reaches our shores.
SUSAN DENTZER: University of Minnesota public health expert Michael Osterholm says in the worst-case scenario, a pandemic flu could sicken millions of Americans and kill at least two million, plus tens of millions more worldwide.
MICHAEL OSTERHOLM: We can predict now twelve to eighteen months of stress, of watching loved ones die, of potentially not going to work, of wondering if you're going to have food on the table the next day. Those are all things that are going to mean that we're going to have to plan unlike any other kind of crisis that we've had in literally the last 80-some years in this country.
SUSAN DENTZER: The current strain of bird flu isn't yet a pandemic strain since it isn't readily transmissible from human to human. But the president noted that it appears to be evolving genetically in that direction.
PRESIDENT GEORGE W. BUSH: So we're taking immediate steps to ensure early warning of an avian or pandemic flu outbreak among animals or humans anywhere in the world.
SUSAN DENTZER: That includes a new so-called national bio- surveillance initiative. It's designed to pick up the earliest signs - such as sick patients in doctors' offices and hospitals -- that a pandemic flu strain has migrated to the U.S.
The plan also includes proposals to build a massive stockpile of vaccines, drugs and other medical supplies. That includes 20 million doses of an existing avian flu vaccine that could partially protect first responders early in a pandemic.
Far more ambitious is a $2.8 billion crash program to develop advanced new vaccine-production technologies, and to build capacity to produce 600 million doses of flu vaccine each year in the United States. Only a handful of producers now make flu vaccine, much of it in plants outside the US
Although they praise much of the government's plan, vaccine manufacturers like global pharmaceutical company GlaxoSmithKline are already questioning the goal of building all that production capacity in the USDAVID STOUT (president of pharmaceutical operations for GlaxoSmithKline): If you said in the long term is that possible, yes. In the next one to two years, I don't think that's possible, nor do I think it's necessary. In a very short time, I don't think you're going to be able to build 600 million doses of capacity in the US
SUSAN DENTZER: Today Senate Democrats said they also objected to a provision of the plan that relies on states to pay much of the cost of purchasing anti-virals, drugs like Tamiflu and Relenza, that could reduce deaths.
SEN. TOM HARKIN (Senator from Iowa): Louisiana's got money for that? Mississippi's got money for that? How about a lot of other states that don't have the money? Well, we're not going to go along with that at all. This is a national emergency; it ought to be paid for as an emergency. It ought to be backed by the federal government, and we ought to be putting the resources out there for our state and local public health departments.
SUSAN DENTZER: Tomorrow, the Department of Health and Human Services will release full details of health-related aspects of the strategic plan.
Osterholm, who consulted with the government on it, says it will call for sweeping preparations by all 50 state governments, and myriad local ones.MICHAEL OSTERHOLM: The plan is absolutely clear about the fact that when this happens in every hamlet, every town, every city, every county, every state, and for that matter every country in the world, locals are going to be on their own. They will have support from the federal government in general terms, but not specific and that means that locals have to get prepared.
SUSAN DENTZER: Osterholm says that means all communities must draft plans to shut down sporting events and other public gatherings to minimize the spread of infection, and prepare to treat thousands of sick patients in improvised hospitals in schools and sports arenas.
And with tens of thousands of Americans certain to die in the event of a pandemic, Osterholm says local communities must also prepare for the grisly task of handling an unprecedented number of bodies.SUSAN DENTZER: Following release of the health plan tomorrow, additional plans from other federal agencies are expected in coming weeks.
The next installments will grapple with other thorny issues, such as transportation shutdowns like those that accompanied the SARS virus outbreak in 2003.
PRESIDENT GEORGE W. BUSH: By one estimate, the Sars outbreak cost the Asian-Pacific region about $40 billion. The airline industry was hit particularly hard, with air travel to Asia dropping 45 percent in the year after the outbreak. A global influenza pandemic that infects millions and lasts from one to three years could be far worse.
SUSAN DENTZER: Tomorrow, top federal health officials are set to testify in the Senate on further details of the pandemic flu plan.
source: http://www.pbs.org/newshour/bb/health/july-dec05/flu_11-1.html 2nov2005
As the deadly H5N1 strain of the bird flu spreads from Asia to other continents, U.S. health officials are planning for the possibility of the virus becoming more easily transmitted between humans and the possibility of a pandemic killing millions worldwide.
President Bush outlined a national preparedness plan during an appearance before the National Institutes of Health on Nov. 1, 2005, emphasizing vaccines, antiviral drugs, and local and military preparedness.
He asked Congress to approve $7.1 billion in funding for government agencies and vaccine manufacturers.
While the National Strategy for Pandemic Influenza explains that all essential federal agencies will collaborate to prepare for the avian flu, the plan also relies on local government involvement, strong efforts from the private sector and foreign partnerships.
Following the plan's release, Democratic leaders criticized the Bush administration for failing to act sooner to protect the nation against the deadly virus. Senate Majority Leader Harry Reid of Vermont said in a statement, "The recent spread of avian flu to Europe proves we cannot afford to drag our feet any longer. The looming threat of a pandemic demands action now."
Other critics noted that the plan fails to adequately help those countries already battling the virus. "It looks to me like we're spending an awful lot of money per vaccinated American and an awful low amount on your essential surveillance," Laurie Garrett, a senior analyst from the Council on Foreign Relations, told the New York Times.
Much of the plan, and a significant portion of the requested $7.1 billion, deals with the availability and distribution of an avian flu vaccine and antiviral drugs such as Tamiflu. In order for the virus to become a pandemic, it must mutate into a form that will travel easily from human to human, which poses difficulties from a public health perspective because scientists cannot create a vaccine until the virus transforms.
"When and if a flu pandemic virus emerges, we will need to make a vaccine to that virus so it's really not possible to stockpile a vaccine in large quantities in advance," said Julie Gerberding, director of the Centers for Disease Control and Prevention in Atlanta.
President Bush asked Congress to earmark $2.8 billion to expedite the development of a vaccine as new strains emerge and an additional $1.2 billion to purchase enough vaccine for 20 million Americans, including first responders and at-risk populations.
In the meantime, he also requested $1 billion to create a stockpile of antiviral drugs. The Swiss drugmaker Roche, the only manufacturer of the antiviral medication Tamiflu, announced Nov. 1, 2005 that it was prepared to supply the United States with over 2 million doses of the sought-after drug this year.
Some manufacturers are wary of mass drug production because of liability concerns. Federal liability protections currently only apply to childhood vaccines, but both the Senate and President Bush have said they are committed to protecting the drug companies.
"We cannot handle the threats we face today with a broken flu vaccine system," said Sen. Hillary Clinton, D-N.Y., as she introduced legislation with Sen. Pat Roberts, R-Kan., that would guarantee financial returns for vaccine production and increase incentives to manufacture needed vaccines.
The Food and Drug Administration issued recent warnings about counterfeit drugs labeled as Tamiflu or another popular antiviral medication, Relenza. In case the avian flu becomes a pandemic, the FDA indicated that it would be ready with a "rapid response team" to prevent the sale of fraudulent drugs.
The Department of Health and Human Services has said it will cooperate with international groups such as the World Health Organization and the Food and Agricultural Organization in combating the flu.
In early October 2005, HHS Secretary Michael Leavitt toured Southeast Asia with WHO Director General Dr. Lee Jong-wook to encourage other world leaders to put up a united front against the flu. Leavitt also examined the pandemic preparation strategies of other countries, including plans for a multinational stockpile of antiviral drugs.
The U.S. response plan also requires communication between the government and local poultry farmers to ensure that they are familiar with the necessary precautions. Chicken farmers on the Eastern shore of Maryland, Delaware and Virginia have already received instructions from the CDC on safety procedures.
Jenny Rhodes, a poultry farmer in Maryland, told the Washington Post that farmers understand the threats of an outbreak. "For us, biosecurity is something we deal with every day."
The plan also allows for military intervention to enforce quarantines and other operations should outbreaks occur in the United Sates. In the wake of the delayed government response to Hurricane Katrina, President Bush said that one of the government's failures was not militarizing the relief effort.
The Department of Defense would have the national infrastructure to aid both local and federal agencies in the event of a pandemic, the president said. "The military has enormous operational capacity," Gerberding said.
In his speech, President Bush also announced the launch of the Web site www.pandemicflu.gov, a localized site to answer the public's questions about the flu and government response.
-- Compiled for the Online NewsHour by Brian Wolly
source: http://www.pbs.org/newshour/bb/health/birdflu/uspreparedness.html 2nov2005
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