The Threat of the Avian Flu Pandemic

Background and Analysis

The Bush administration plans to ask Congress for an estimated $6 billion to $10 billion to stockpile vaccines and antiviral medications as part of its plans to prepare the U.S. for a possible flu pandemic, the Wall Street Journal reports (Rogers/Wysocki, Wall Street Journal, 10/1). According to the Los Angeles Times, HHS 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.” The funding request is expected to cover some of the plan. The current draft plan, which is several hundred pages long, describes the role the federal government would take in coordinating a response to a flu pandemic. In addition, it describes the steps to be taken at all levels of government before and during an outbreak. The plan calls for the production and stockpiling of antiviral medicines and vaccines — which already has begun — as well as research, public education campaigns and the development of ways for hospitals to treat large numbers of patients. Some experts say the production of vaccines will be the biggest challenge, in part because scientists cannot create the most effective vaccine until they know which strain of influenza is causing a pandemic. To stem the spread of a pandemic during the delay in vaccine availability, the plan calls for stockpiling antiviral medicines, which reduce the severity of symptoms and the duration of illness if administered during the first 48 hours of infection. Other steps authorities could take include quarantines, travel restrictions, cancellation of public events and closures of public facilities (Vieth, Los Angeles Times, 10/3).


“Avian flu could be the Katrina of medicine,” John Bartlett, chief of the infectious disease unit of Johns Hopkins University School of Medicine, said. Senate Budget Committee Chair Judd Gregg (R-N.H.) said, “There’s a sense of urgency that we have to get in front of this. It’s safe to say that it’s going to take a lot of money” (Rogers/Wysocki, Wall Street Journal, 10/3). HHS Secretary Mike Leavitt, who is directing development of the plan, said, “It’s a world-changing event when it occurs. It reaches beyond health. It affects economies, cultures, politics and prosperity — not to mention human life, counted by the millions.” However, some health experts and preparedness advocates said the efforts do not compensate 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,” the Times reports (Los Angeles Times, 10/3).


According to the Journal, the Bush administration’s efforts come after the Senate on Thursday approved an amendment to the defense-spending bill that would earmark $3.9 billion to prepare the U.S. for a flu pandemic (Rogers/Wysocki, Wall Street Journal, 10/1). The amendment — which still faces a vote when the Senate considers the full defense bill — earmarks $3 billion for stockpiling of the antiviral medication Tamiflu; $125 million to improve vaccine “infrastructure,” including manufacturing and research capacity; $600 million for grants to local and state health officials to help them improve monitoring and vaccination programs; and $75 million for improving communications to providers, hospitals, business and the public in the event of a pandemic. The office of Sen. Tom Harkin (D-Iowa), who sponsored the amendment, said the funding also would be used to improve hospitals’ surge capacity. The National Association of City and County Health Officials is urging the House to consider similar legislation (CQ HealthBeat, 9/30).


In related news, CDC has come under fire from some members of the scientific community for not releasing data “crucial” for development of flu vaccines, the Atlanta Journal-Constitution reports. The journal Nature on Sept. 22 reported “widespread concern among influenza researchers that too little flu data collected” by CDC are being made available to researchers, hampering their efforts to develop flu vaccines, according to the Journal-Constitution. Nancy Cox, director of CDC’s influenza branch, said the increasing concern about a flu outbreak has resulted in a large number of requests that CDC cannot accommodate. “Given the sheer volume of such requests, we have had to make hard choices about how to respond because we do not have the capacity to comply with all requests while also meeting our other public health responsibilities,” she said. Cox added that CDC works with international health officials on policies for controlling and preventing influenza and the need to share information must be “balanced against the needs for maintaining high standards for data quality and for protecting sensitive information when the situation warrants.” However, she added that CDC hopes to improve its data-sharing efforts and recently revised its policy to share information in a more timely manner (Carr, Atlanta Journal-Constitution, 10/3).


Meanwhile, the World Health Organization on Friday sought to “revise alarming predictions” that an influenza pandemic could result in as many as 150 million deaths worldwide, a statistic cited by David Nabarro, the recently named United Nations coordinator for avian and human influenza. WHO influenza spokesperson Dick Thompson did not call the 150 million statistic incorrect but said that an estimate of 7.4 million deaths is more realistic. “We’re not going to know how lethal the next pandemic is going to be until the pandemic begins,” he said, adding, “You could pick almost any number.” WHO said the most likely scenario is a death toll of two million to 7.4 million people (Ross, AP/Las Vegas Sun, 9/30).


The Wall Street Journal on Monday examined efforts by governments in Asia to prepare for a possible avian flu outbreak among humans. Experts have said a flu pandemic most likely would begin in Asia, where many nations have only recently begun addressing the threat. Australia recently announced it was donating funding for at least 400,000 tablets of Tamiflu to Indonesia, which would be enough antiviral medication to treat 40,000 people. William Aldis, WHO’s chief representative in Thailand, said that country’s government is working on a “radical” plan to stockpile a number of avian flu drugs that could be offered to other nations. The Chinese Ministry of Health released its avian-flu preparedness plan last week, and Singapore has stockpiled enough Tamiflu for its health care workers. In addition, Malaysia has established an avian flu committee to help stockpile antiviral medications, vaccines and protective gear, while Japan’s Ministry of Health, Labor and Welfare is planning to stockpile enough Tamiflu for as many as five million people over the next five years (Zamiska, Wall Street Journal, 10/3). Meanwhile, the Pan American Health Organization announced Thursday that it will help member countries with “planning, strengthening surveillance to boost the odds of early detection of a pandemic, and ensuring the availability of vaccine and antiviral drugs,” CQ HealthBeat reports. Otavio Oliva, PAHO’s regional adviser on viral diseases, said, “Unfortunately, few of our countries have preparedness plans in place” (CQ HealthBeat, 9/30).

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