Federal Government Releases Pandemic Flu Plan
The U.S. health care system will not be able to meet the country's needs in the event of a flu pandemic, according to the government's official pandemic flu plan released Wednesday, the Los Angeles Times reports (Gerstenzang, Los Angeles Times, 5/4). The 227-page document, divided into nine chapters, provides a list of actions federal departments must complete as a pandemic spreads; makes predictions about the effect of a pandemic; and makes recommendations for state and local governments, as well as businesses (Harris, New York Times, 5/4).
The report cites avian flu, specifically the H5N1 strain, as a potential source for the next pandemic, although it has not at this time mutated into a form that is easily transmissible between people. The report says even if the H5N1 strain never becomes a global threat, "another novel influenza virus will emerge ... and threaten an unsuspecting human population" (Allday, San Francisco Chronicle, 5/4).
The plan estimates that a flu pandemic, likely to start abroad, would probably spread in two or three global waves, each lasting about three months. It predicts an outbreak would last six to eight weeks in any given community (Brown, Washington Post, 5/4).
The report estimates that one-third of the U.S. population could become infected, two million people could die, 40% of employees could be absent from work during the height of an outbreak, and $600 billion in income could be lost across the country (New York Times, 5/4). The report says, "In the event of multiple simultaneous outbreaks, there may be insufficient medical resources or personnel to augment local capabilities."
The report adds that state, local and tribal governments should "anticipate that all sources of external aid may be compromised during a pandemic." It also says that local communities "will have to address the medical and nonmedical effects of the pandemic with available resources."
The report says the federal government's strategy in the event of a pandemic is based upon three elements: preparation, surveillance and detection, and containment. It lists more than 300 steps the federal government would take, has already begun to take or would recommend that states and local governments take (Los Angeles Times, 5/4).
It also lists a timetable for completing those tasks. The plan says the federal government cannot and should not try to fully manage the response to a pandemic.
The report states, "The impact of a severe pandemic may be more comparable to that of war or a widespread economic crisis than a hurricane, earthquake, or act of terrorism." It adds, "The center of gravity of the pandemic response will be in communities, (and) the support the federal government can guarantee to any state, tribe or community will be limited."
The plan gives responsibility to the World Health Organization to be in charge of managing global issues. It says WHO "represents the linchpin of international preparedness and response activities. ... During a pandemic we will rely upon it to be a highly visible and credible coordinator of the international response."
The plan adds, "[W]e will rely upon the WHO to confirm sustained human-to-human transmission of a novel influenza virus," and that decision will trigger the global and domestic response (Washington Post, 5/4).
The report says HHS will conduct the federal health and medical response, while the Department of Homeland Security would be responsible for coordinating the federal operations and resources (New York Times, 5/4). Federal responsibilities listed by the plan include:
- Supporting containment efforts abroad to limit arrival of a pandemic in the U.S.;
- Guidance to state and local governments and other entities on measures to protect against a pandemic;
- Changes in "monetary policy" to lesson economic damage;
- Obtaining and distributing vaccines and antiviral drugs; and
- Hastening research to develop drugs and vaccines (Reichard, CQ HealthBeat, 5/3).
The government has a goal of stockpiling 75 million antiviral medications for humans and 110 million doses of vaccine for poultry (Rockoff, Baltimore Sun, 5/4). The plan expresses hope that there will be enough vaccine to treat 20 million people, in addition to other medical supplies and medications to give some protection while manufacturers create a strain-specific inoculation.
The report says the goal is to slow the progress of transmission of the flu, beginning with screening international travelers for signs of infection and quarantining potentially sick passengers. As the pandemic spreads throughout the U.S., people will be asked to stay away from crowds and to cancel nonessential travel.
In addition, patients' families would be temporarily isolated, while schools in affected communities would close. Employers would be requested to let people telecommute and regularly clean buildings (Neergaard, AP/Atlanta Journal-Constitution, 5/4).
The government will not close the nation's borders but likely will limit the number of airports that accept international flights and carefully screen travelers (New York Times, 5/4). In addition, the government plans to help local governments develop plans for canceling school and triaging patients at hospital emergency departments (Washington Post, 5/4).
The report says, "Plan for the possible reduction or loss of income if you are unable to work or your place of employment is closed. Stock a supply of water and food" (CQ HealthBeat, 5/3).
According to the Washington Post, "many crucial questions about the government's response remain unanswered," including how health officials would determine who should receive the limited supplies of vaccine and antiviral drugs; whether the government would use those domestic supplies to help contain a foreign outbreak; the point at which officials should begin mass treatment of U.S. citizens in order to contain the virus here; and how travel and border-crossing might be limited.
Frances Fragos Townsend, President Bush's assistant for homeland security and counterterrorism, said, "We recognize that we cannot make these decisions in a vacuum and must consult with our international partners to ensure that we adopt a consistent approach" (Washington Post, 5/4).
In addition, the plan does not account for how flu pandemic efforts would be paid for.
According to Jeffrey Levi, director of Trust for America's Health, the plan acknowledges that the response to a pandemic could go beyond the financial resources of government agencies. The report cites President Bush's $7.1 billion funding request for preparedness but does not address how to pay for services that would be needed after a pandemic strikes, according to Levi (Manning/Jackson, USA Today, 5/4).
The report is "a very important step forward," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said. He added, "This was a brutally honest but very fair ... assessment of where we're at" (Los Angeles Times, 5/4).
Sen. Edward Kennedy (D-Mass.) said the administration's efforts for the report were inadequate, adding that the U.S. preparations are running behind those in other countries." He said, "A flu plan that doesn't say how to distribute vaccine is about as useful as a hurricane plan that doesn't say how to rescue people" (Baltimore Sun, 5/4).
Josh Sharfstein, commissioner of the Baltimore Health Department, said the plan was welcome but offers "new expectations without new resources." He said the plan asks local governments to deal with a big increase of hospital patients, care for more patients at home and spend millions of dollars on antivirals.
Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, said, "There's a disconnect between the rhetoric about what's needed and the resources on the table. This is the mother of all unfunded mandates."
William Schaffner, chair of preventive medicine at Vanderbilt University, said that the plan was "realistic" in advising against shutting the borders and that cities and states need to be prepared. He said, "Localities cannot rely on the feds to be the cavalry that rides over the hill to rescue every U.S. town and city from pandemic influenza" (New York Times, 5/4).
In related news, the Senate voted on Wednesday to add $289 million to establish a compensation fund for victims of experimental vaccines and other products designed to combat possible pandemics such as avian flu, CongressDaily reports. The measure passed 53-46, with 11 Republicans breaking party lines to vote for the addition to the $109 billion fiscal year 2006 emergency supplemental spending bill (HR 4939), which includes funds for the Iraq and Afghanistan wars.
President Bush has threatened to veto the measure if it comes out of a House-Senate conference greater than $94.5 billion (Cohn/Heil, CongressDaily, 5/3).
A copy of the report is available online. Note: You must have Adobe Acrobat Reader to view the file.
Several broadcast programs reported on the avian flu plan:
- ABCNews' "World News Tonight": The segment includes comments from Frank Cilluffo, director of George Washington University's Homeland Security Policy Institute, and Townsend (Raddatz, "World News Tonight," ABCNews, 5/3). Video of the segment is available online.
- NPR's "All Things Considered": The segment includes comments from Townsend (Knox, "All Things Considered," NPR, 5/3). The complete segment is available online in RealPlayer.
- NPR's "Day to Day": The segment includes comments from Laurie Garrett, senior fellow for global health at the Council on Foreign Relations (Brand, "Day to Day," NPR, 5/3). The complete segment is available online in RealPlayer.
- NPR's "Day to Day": The segment includes comments from Eddie Hedrick, an epidemiologist and the emerging-infections coordinator for the Missouri Department of Health (Brand, "Day to Day," NPR, 5/3). The complete segment is available online in RealPlayer.
- NPR's "Talk of the Nation": Guests on the program included D.A. Henderson, scholar at the Center for Biosecurity at the University of Pittsburgh; Joe Neel, science correspondent for NPR; and Dorothy Teeter, director and health officer for public health in King County, Wash. (Conan, "Talk of the Nation," NPR, 5/3). The complete segment is available online in RealPlayer.
- PBS' "NewsHour with Jim Lehrer": The segment includes comments from Townsend (Suarez, "NewsHour with Jim Lehrer," PBS, 5/3). The complete segment is available online in RealPlayer.