Bush Plan Shows U.S. Is Not Ready for Deadly Flu - New York Times
The New York Times

October 8, 2005

Bush Plan Shows U.S. Is Not Ready for Deadly Flu
By
GARDINER HARRIS

WASHINGTON, Oct. 7 - A plan developed by the Bush administration to deal
with any possible outbreak of
pandemic
flu
shows that the
United States
is woefully unprepared for what could become the worst disaster in the
nation's history.

A draft of the final plan, which has been years in the making and is
expected to be released later this month, says a large outbreak that began
in Asia
would be likely, because of modern travel patterns, to reach the United
States within "a few months or even weeks."

If such an outbreak occurred, hospitals would become overwhelmed, riots
would engulf
vaccination
clinics, and even power and food would be in short supply, according to the
plan, which was obtained by The New York Times.

The 381-page plan calls for quarantine and travel restrictions but concedes
that such measures "are unlikely to delay introduction of pandemic disease
into
the U.S. by more than a month or two."

The plan's 10 supplements suggest specific ways that local and state
governments should prepare now for an eventual pandemic by, for instance,
drafting
legal documents that would justify quarantines. Written by health officials,
the plan does yet address responses by the military or other governmental
departments.

The plan outlines a worst-case scenario in which more than 1.9 million
Americans would die and 8.5 million would be hospitalized with costs
exceeding $450
billion.

It also calls for a domestic vaccine production capacity of 600 million
doses within six months, more than 10 times the present capacity.

On Friday, President Bush invited the leaders of the nation's top six
vaccine producers to the White House to cajole them into increasing their
domestic
vaccine capacity, and the flu plan demonstrates just how monumental a task
these companies have before them.

In the wake of Hurricane Katrina, the Bush administration's efforts to plan
for a possible pandemic flu have become controversial, with many Democrats
in
Congress charging that the administration has not done enough. Many have
pointed to the lengthy writing process of the flu plan as evidence of this.

But while the administration's flu plan, officially called the Pandemic
Influenza Strategic Plan, closely outlines how the Health and Human Services
Department
may react during a pandemic, it skirts many essential decisions, like how
the military may be deployed.

"The real shortcoming of the plan is that it doesn't say who's in charge,"
said a top health official who provided the plan to The Times. "We don't
want
to have a FEMA-like response, where it's not clear who's running what."

Still, the official, who asked for anonymity because the plan was not
supposed to be distributed, called the plan a "major milestone" that was
"very comprehensive"
and sorely needed.

The draft provided to The Times is dated Sept. 30, and is stamped "for
internal H.H.S. use only." The plan asks government officials to clear it by
Oct.
6.

Christina Pearson, a spokeswoman for Health and Human Services Secretary
Michael O. Leavitt, responded, "We recognize that the H.H.S. plan will be a
foundation
for a governmentwide plan, and that process has already begun."

Ms. Pearson said that Mr. Leavitt has already had one-on-one meetings with
other cabinet secretaries to begin the coordination process across the
federal
government. But she emphasized that the plan given to The Times was a draft
and had not been finalized.

Mr. Leavitt is leaving Saturday for a 10-day trip to at least four Asian
nations, where he will meet with health and agriculture officials to discuss
planning
for a pandemic flu. He said at a briefing on Friday that the
administration's flu plan would be officially released soon. He was not
aware at the briefing
that The Times had a copy of the plan. And he emphasized that the chances
that the
virus
now killing birds in Asia would become a human pandemic were unknown but
probably low. A pandemic is global epidemic of disease.

"It may be a while longer, but pandemic will likely occur in the future," he
said.

And he said that flu planning would soon become a national exercise.

"It will require school districts to have a plan on how they will deal with
school opening and closing," he said. "It will require the mayor to have a
plan
on whether or not they're going to ask the theaters not to have a movie."

"Over the next couple of months you will see a great deal of activity asking
metropolitan areas, 'Are you ready?' If not, here is what must be done," he
said.

A key point of contention if an epidemic strikes is who will get vaccines
first. The administration's plan suggests a triage distribution for these
essential
medicines. Groups like the military, National Guard and other national
security groups were left out.

Beyond the military, however, the first in line for essential medicines are
workers in plants making the vaccines and drugs as well as medical personnel
working directly with those sickened by the disease. Next are the elderly
and severely ill. Then come pregnant women, transplant and
AIDS
patients, and parents of infants. Finally, the police, firefighters and
government leaders are next.

The plan also calls for a national stockpile of 133 million courses of
antiviral treatment. The administration has bought 4.3 million.

The plan details the responsibilities of top health officials in each phase
of a spreading pandemic, starting with planning and surveillance efforts and
ending with coordination with the Department of Defense.

Much of the plan is a dry recitation of the science and basic bureaucratic
steps that must be followed as a virus races around the globe. But the plan
has
the feel of a television movie-of-the-week when it describes a possible
pandemic situation that begins, "In April of the current year, an outbreak
of severe
respiratory illness is identified in a small village."

"Twenty patients have required hospitalization at the local provincial
hospital, five of whom have died from pneumonia and respiratory failure,"
the plan
states.

The flu spreads and begins to make headlines around the world. Top health
officials swing into action and isolate the new viral strain in
laboratories.
The scientists discover that "the vaccine developed previously for the avian
strain will only provide partial protection," the plan states.

In June, federal health officials find airline passengers infected with the
virus "arriving in four major U.S. cities," the plan states. By July, small
outbreaks are being reported around the nation. It spreads.

As the outbreak peaks, about a quarter of workers stay home because they are
sick or afraid of becoming sick. Hospitals are overwhelmed.

"Social unrest occurs," the plan states. "Public anxiety heightens mistrust
of government, diminishing compliance with public health advisories."
Mortuaries
and funeral homes are overwhelmed.

Presently, an avian virus has decimated chicken and other bird flocks in 11
countries. It has infected more than 100 people, about 60 of whom have died,
but nearly all of these victims got the disease directly from birds. An
epidemic is only possible when a virus begins to pass easily among humans.

Lawrence K. Altman contributed reporting for this article.

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The New York Times Company

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