Flu Pandemic Could Prompt Travel Ban, Drug Rationing

Wall Street Journal 2nov2005

[ Download complete HHS plan as 396 page (32.7MB) PDF or select section at HHS]

WASHINGTON — Sustained person-to-person spread of the bird flu or any other super-influenza strain anywhere in the world could prompt the U.S. to implement travel restrictions or other steps to block a brewing pandemic, according to federal plans released Wednesday.

If a super-flu begins spreading here, states and cities will have to ration scarce medications and triage panicked patients to prevent them from overwhelming hospitals and spreading infection inside emergency rooms, the plan says.

The plan, which the Department of Health and Human Services said is intended to serve as a "blueprint" for how to implement the $7.1 billion plan that President Bush outlined Tuesday, provides long-awaited guidance to the front-line local officials. The plan urges local officials to figure out now how they would take steps to prevent such a crisis scenario, and exhorts them to practice their own plans to ensure that they will work.

HHS officials offered further details in a conference call following the release of the pandemic plan:

• Vaccines: The government aims to develop 20 million courses of flu vaccine by the fourth quarter of 2006 and up to 81 million courses by the summer of 2007. HHS Secretary Mike Leavitt noted that a key tenet of the plan is that all of these are produced domestically.
  
  
• Liability protection: Mr. Leavitt clarified that the president's request that Congress provide liability protection for drug makers would be limited to pandemic-related vaccines and medications.
  
  
• Division of payment: The federal government plans to pay for 44 million doses, as well as another six million to be available on a "spot basis," Mr. Leavitt said. An additional 31 million doses would be split with 75% paid by states and 25% paid by the federal government.
  
  
• Travel restrictions: The government may impose travel restrictions if a human-to-human pandemic breaks out in any country, but plans for travel curbs haven't been fully developed, Mr. Leavitt said.

Pandemics, or world-wide outbreaks, strike when the easy-to-mutate influenza virus shifts to a strain that people have never experienced before, something that has happened three times in the last century.

It is impossible to predict the toll of the next pandemic, but a bad one could infect up to a third of the population and, depending on its virulence, kill anywhere from 209,000 to 1.9 million Americans, the Bush administration's new Pandemic Influenza Plan says.

The illness would spread fastest among school-aged children, infecting about 40% of them, and decline with age, the plan estimates. It puts the health costs alone, not counting disruption to the economy, at $181 billion for even a moderately bad pandemic.

It is also impossible to predict when the next pandemic will strike. But concern is rising that the Asian bird flu, called the H5N1 strain, might trigger the next one if it eventually becomes easily spread from person-to-person.

With a public increasingly jittery about the H5N1 spread among birds and a drumbeat of criticism that the nation is woefully unprepared, President Bush on Tuesday outlined a $7.1 billion strategy to get ready for the next pandemic. Topping his list is improving systems to detect and contain the next super-flu before it reaches the U.S., and overhauling the vaccine industry so that eventually, scientists could quickly make enough for everyone within months of a pandemic's appearance. That vaccine improvement will take years to implement — and the details released Wednesday by HHS stress that early on, the public will be depending on scarce supplies of antiflu drugs and stockpiled vaccines.

Stockpiled drugs "are not the equivalent of preparedness," Mr. Leavitt told a Senate subcommittee Wednesday as he unveiled the details.

Indeed, the plan stresses that if a pandemic begins, Americans should limit visits to doctors and hospitals unless absolutely necessary, and hospitals should triage those seeking care so that suspected super-flu cases have limited contact with other patients, the plan says.

But critics battered Mr. Bush's plan for the federal government to stockpile enough of the antiflu drugs Tamiflu and Relenza to treat 44 million people and make states buy another 31 million treatment courses, mostly with their own money, to cover the rest of the anticipated need.

"States are extremely nervous about what's going to be required of them," Sen. Patty Murray, a Democrat from Washington, told Mr. Leavitt.

In other developments Wednesday:

• China ordered tighter monitoring for bird flu and more aggressive vaccine research. A statement by Chinese Premier Wen Jiabao, read on the national TV evening news, threatened punishment for anyone who fails to report an outbreak. "The government at all levels must make efforts to achieve victory over bird flu,'' Mr. Wen was quoted as saying.
  
  
• Vietnam banned raw blood pudding and poultry-raising in big cities as Asian governments stepped up measures to prevent a possible human outbreak that health experts worry could kill millions.
  
  
• U.S. deputy undersecretary of agriculture Charles Lambert, visiting China to talk about pandemic preparedness, urged caution in banning poultry imports, saying excessive steps could discourage nations from reporting outbreaks. He said China and the U.S. plan to increase technical cooperation and information exchanges.