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U.S. Rushes to Finish Influenza Pandemic Plan

Times Staff Writer

Even before it can tally the full cost of post-hurricane reconstruction, the Bush administration is seeking congressional support for an expanded government effort to prepare for a worldwide influenza pandemic.

The Department of Health and Human Services is rushing to complete its first comprehensive plan for coping with a possible flu pandemic, and could release the final version as early as this week. It is expected to be accompanied by a request for several billion dollars in new funding, and Congress appears to be willing to cover at least a portion.

Health authorities are particularly concerned about a virulent strain of avian flu in Asia that has killed several dozen people who handled infected birds. There are signs the virus may now be developing the ability, through mutation, to spread from human to human. It is the mutated form that could cause a pandemic.

The administration’s pandemic plan is part of a broader effort to accelerate preparations for a potential health disaster. Conservative estimates of fatalities in a flu pandemic number in the millions worldwide, and in the tens of thousands in the United States.

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The government has begun contracting with pharmaceutical makers to develop vaccines targeted at new strains of influenza virus. It has started stockpiling millions of doses of antiviral medicines that could limit symptoms and reduce the chances of spreading the virus. President Bush is pressuring other countries to conduct better surveillance for flu outbreaks, share information more readily and commit to aggressive containment measures.

Still, administration officials cautioned that even perfect planning would only lessen the devastation caused by a pandemic, not prevent it.

Bush’s preparedness initiative is being directed by Health and Human Services Secretary Mike Leavitt, who said that of all the issues within his purview, including hurricane recovery and bioterrorism, the one that keeps him awake at night is influenza.

“It’s a world-changing event when it occurs,” Leavitt said in an interview. “It reaches beyond health. It affects economies, cultures, politics and prosperity -- not to mention human life, counted by the millions.”

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Bush has taken up the cause personally, prodding the United Nations to make a priority of preparing for a pandemic and raising the issue in one-on-one discussions with the presidents of Russia and China and the prime minister of Indonesia, where in many parts of the country avian flu is endemic in poultry.

“We need to take it seriously,” Bush said after a recent meeting with President Vladimir V. Putin of Russia. “I talked to Vladimir about avian flu; I talked to other world leaders about the potential outbreak of avian flu. If avian flu were to hit this country, do we have the proper response mechanisms? Does the federal government have the authority necessary to make certain decisions?”

The need to improve preparedness planning in the U.S. was underscored last October when the American company that provided half of the country’s flu vaccines announced that it could not provide shots because of contamination in its British factory.

Last week, Leavitt held private briefings with key lawmakers on Capitol Hill to present the administration’s case for an expanded preparedness program. The response was almost immediate. Several members issued public statements endorsing a broader campaign, and the Senate on Thursday approved a measure calling for $3.9 billion in new funding.

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That’s about what it would take to finance some of the bigger-ticket items in the pandemic plan, such as the development, acquisition and stockpiling of enough vaccine to inoculate 20 million Americans and enough antiviral drugs to help protect another 20 million, according to estimates by the Trust for America’s Health, an independent policy research and advocacy group based in Washington.

“We need more than just a plan; we need the resources to actually activate it,” said Jeffrey Levi, a pandemic specialist at the Trust. “The real test of the plan will be whether it comes with dollars attached.”

The current draft of the administration’s plan fills several hundred pages. It describes the role of the federal government in coordinating the response to a flu pandemic and outlines steps to be taken at all levels of government before and during an outbreak.

In addition to production and stockpiling of vaccines and antivirals, the plan seeks to conduct research, prepare public education campaigns and develop ways for hospitals to handle large numbers of patients.

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Health authorities say one of the biggest challenges would be vaccine development.

Scientists cannot create the best possible vaccine until they know which form of the virus they’re fighting. That means public health officials must remain vigilant and ready to isolate the virus once one emerges in a form that can spread among humans rapidly.

By then, the first wave of the pandemic probably would have already begun. But officials would still face the work of producing, distributing and administering the vaccine on a widespread basis. The process would take six to eight months, according to the department of Health and Human Services.

Hospital workers and other health professionals would be the first to receive vaccinations, so they could tend to pandemic victims without falling ill themselves. But a rapidly spreading contagion could quickly deplete the initial stores of vaccine, creating national or regional shortages, contributing to public alarm and requiring some kind of rationing program.

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To slow the pandemic’s spread while vaccine production is being cranked up, the plan calls for stockpiling antiviral medicines, which reduce the severity of symptoms and shorten the duration of illness, but only if administered during the first 48 hours of infection.

The plan outlines other steps that federal, state and local authorities might be required to take to contain a pandemic. They include quarantines, travel restrictions, cancellation of public events and other group gatherings, and closures of schools, colleges, office buildings and public facilities.

Levi said the administration deserved credit for stepping up its planning.

“Leavitt has become the point person on this,” he said. “We finally have a political appointee out front talking about these issues. That’s the signal that there’s a much higher level of engagement.”

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But some health authorities and preparedness advocates expressed concern that the flurry of activity had not compensated for what they called an inadequate response to evidence that the risk of a pandemic had increased substantially since new strains of avian flu began infecting humans in 1997.

“They’re struggling to get ahead of the curve,” said John Barry, author of “The Great Influenza,” a book about the 1918 flu pandemic that killed an estimated 50 million people worldwide, including 675,000 in the United States. “They’re not there yet.”

Barry’s book is at the top of Leavitt’s recommended reading list. He said he had handed out at least 30 copies, tabbed and underlined to emphasize key sections, and planned to distribute an additional 50 or so to lawmakers and administration officials in coming days. He said the book had been read by Bush, who took it with him to the Texas ranch where the president spent his August vacation.

The 1918 pandemic was the deadliest flu outbreak in recorded history. Most of the fatalities occurred during the first 24 weeks of the contagion. AIDS, by comparison, has killed half that many people worldwide over the last 24 years.

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During the last year of World War I, the devastation caused by the flu outbreak in the United States was exacerbated by government inaction. Instead of moving aggressively to quarantine the first victims and alert the public to the seriousness of the threat, authorities initially downplayed its significance.

The administration of President Wilson did not want to undermine its efforts to mobilize troops, manufacture materiel and maintain public support for America’s deepening participation in the war.

Blunders by local officials made matters worse. In Philadelphia, where scores of war-bound soldiers had fallen ill, authorities refused to cancel a pro-war parade despite warnings it would spread the virus through the civilian population. Within weeks, the city had so many casualties it ran out of coffins and had to bury victims in mass graves dug with steam shovels.

Leavitt said pandemic preparations were underway before Hurricane Katrina struck in late August. But he acknowledged that for him, at least, the sense of urgency was heightened by what he saw first-hand at the 17 evacuee medical shelters he visited.

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“You cannot walk into one of those places and see bed after bed after bed of hospital cots,” he said, “and not think ... what if we were dealing with this in 50 states?”


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