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Bush’s Flu Plan Stresses Vaccine

Times Staff Writer

Preparing for the possibility of a devastating flu pandemic, President Bush outlined a $7.1-billion plan Tuesday to provide enough vaccine for the nation and to create stockpiles of drugs to treat those who become infected.

“There is no pandemic flu in our country, or in the world, at this time,” Bush said in a speech at the National Institutes of Health. “But if we wait for a pandemic to appear, it will be too late to prepare and ... many lives could be needlessly lost.”

For the record:

12:00 AM, Nov. 03, 2005 For The Record
Los Angeles Times Thursday November 03, 2005 Home Edition Main News Part A Page 2 National Desk 1 inches; 48 words Type of Material: Correction
Flu plan -- An article in Wednesday’s Section A about President Bush’s flu pandemic preparations said the plan would not begin until 2010. In fact, the capability to vaccinate the entire U.S. population would not be available until 2010, but other elements of the plan take effect immediately.

Public health experts said it was only a matter of time before a super-flu developed with the potential to spread around the globe and kill millions of people.

Pandemics occur when a viral strain to which humans have no immunity mutates and becomes easily transmissible from person to person. Such viruses commonly appear first among birds, and scientists are closely tracking an especially virulent strain -- called H5N1 -- first identified in China in 1996. That strain has killed 62 people.

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Some elements of Bush’s plan, which would not begin until 2010, are expected to be controversial.

For example, it would protect vaccine manufacturers from liability lawsuits but offer no compensation for individuals who suffered serious reactions to a vaccine.

And states would be responsible for purchasing about 40% of the antiviral stockpile needed to safeguard their residents, which could lead to uneven levels of coverage. Several critics said Tuesday that the $100 million the president would allocate for state preparedness and planning was not enough.

“You can pump billions into vaccine development, but if you don’t have the local infrastructure to administer the vaccines, that’s a problem,” said Dr. Christian Sandrock, a pulmonary and infectious disease specialist at UC Davis Medical Center who is advising California officials on flu preparedness.

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Public health experts also expressed concern that the plan would place the Department of Homeland Security -- not the Department of Health and Human Services -- in overall command of the government’s response should a pandemic erupt. Homeland Security oversaw the much-criticized federal response to Hurricane Katrina.

“When the emergency occurs,” said Kim Elliott, deputy director of the nonprofit, nonpartisan Trust for America’s Health, “it would be handed to folks most of whom have not been trained on the public health aspects.”

In the case of H5N1, there have been 122 known cases of human infection, virtually all among people who were in close contact with affected birds.

The virus has not developed the ability to pass easily among humans. But if it does, it could kill 2 million to 7.4 million people worldwide, according to World Health Organization estimates.

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“A pandemic is a lot like a fire -- a forest fire,” Bush said. “If caught early, it might be extinguished with limited damage. If allowed to smolder undetected, it can grow to an inferno that spreads quickly beyond our ability to control it.”

Underscoring the seriousness of the threat, two top United Nations officials and six U.S. Cabinet secretaries attended Bush’s speech, as did Sen. Edward M. Kennedy of Massachusetts, the ranking Democrat on the Senate health committee.

The Senate has passed an $8-billion flu preparedness plan.

Kennedy called the president’s announcement “a long-awaited first step” but said that it needed “to be stronger to ensure that the American people have the protections they deserve.” He called for more aid to local hospitals and a vaccine victims compensation fund.

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Health and Human Services Secretary Mike Leavitt today will release the details of the flu plan, which took the administration months to prepare.

Leavitt recently returned from a tour of Asian nations hit by the H5N1 virus. In addition to meeting with foreign officials, he visited a family that had caught the virus from chickens but survived thanks to prompt treatment.

Bush said Tuesday that working with other countries was the first step in his three-part pandemic plan. The administration has set up an international partnership, whose 88 member nations have pledged to share information and provide virus samples to the World Health Organization. Bush’s plan seeks $251 million -- or 3.5% of the total program -- to help foreign governments track flu viruses and respond to new outbreaks.

Said University of Michigan epidemiologist Dr. Arnold S. Monto: “I would be a supporter of a stronger emphasis on the international problem.”

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For example, Monto said, paying for widespread vaccinations in Vietnam -- which has the highest number of human H5N1 cases -- could “help extinguish influenza at its source.”

The second part of Bush’s plan -- and its core -- is a $6-billion effort to purchase vaccines and antiviral drugs and to revolutionize the way vaccines are manufactured. The president set a goal of having enough vaccine for every American.

Vaccines currently are made using a 1950s technique that involves inoculating a virus into fertilized hens’ eggs. That requires the government to help maintain huge flocks of chickens. Promising new approaches would use cell cultures to produce vaccine more efficiently.

However, it may be impossible to develop a fully effective vaccine until after a pandemic flu has struck. That’s because scientists ideally should first isolate the specific strain of flu responsible for the outbreak.

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To address what could be a time lag of six months or more, Bush called for stockpiling the antiviral medicines Tamiflu and Relenza. Taken early, they can help reduce the severity of the illness. They also can prevent some people from becoming infected in the first place.

Bush’s plan calls for a national stockpile of 81 million courses of antiviral treatments, about four times what previously had been deemed sufficient. States would be responsible for purchasing 31 million of those treatment courses -- a provision that critics say represents a weakness in the plan, because some states may not have the money.

“If the feds do it, they’d have more purchasing power,” Sandrock of UC Davis said.

A White House official said the federal government would subsidize 25% of the states’ cost to buy the drugs and would also try to help them obtain the discounts Washington received.

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The federal antiviral stockpile would be reserved for medical personnel, first responders, air crews and others likely to be directly in harm’s way. With the added state supplies, the U.S. would be able to cover about 25% of its population of more than 297 million, a level recommended by international health experts.

If a human flu outbreak does threaten the U.S., the government could impose travel restrictions, as well as screening and quarantine procedures for arriving passengers.

The final part of Bush’s plan calls for engaging state and local governments, as well as individual Americans, in making their own preparations.

States and communities would have to consider such issues as whether to keep schools open in the event of an outbreak. Churches might suspend the practice of shaking hands in greeting during services.

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Bush launched a government website, at www.pandemicflu.gov, to help educate the public.

“Every American must take personal responsibility for stopping the spread of the virus,” Bush said.

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Times staff writer Charles Piller contributed to this report.

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