WEDNESDAY, Nov. 2, 2005 (HealthDay News) -- Producing 20 million doses of bird flu vaccine, stockpiling antiviral medications, and creating national and international surveillance networks are some of the keys to U.S. preparations for a potential avian flu pandemic.
Federal health officials on Wednesday spelled out the finer points of a $7.1 billion strategy outlined by President George Bush the day before to cope with a global outbreak of avian flu. Such a pandemic is long overdue, health experts say, and could result in the deaths of millions of people worldwide.
Bush's plan, which requires approval by Congress, would include $1.2 billion for enough vaccine to protect 20 million Americans against H5N1, the current strain of bird flu. The decision about who gets the 20 million shots was not at all clear, according to news reports.
The avian flu strain, which first surfaced among poultry in Asian nations several years ago, has yet to show the ability to infect large numbers of people. But health officials are worried the strain could mutate, and possibly adapt with a more common flu strain, making it far easier for person-to-person transmission.
U.S. Health and Human Services Secretary Mike Leavitt said at a news conference Wednesday that no one knows when or where a deadly strain of flu will strike, but "pandemics happen."
"There is uncertainty about its future, but scientists worry that the H5N1 virus is following a pattern that could achieve human-to-human transmission. If it isn't the H5N1, it will be another virus because pandemics, in fact, do occur," he said.
Leavitt did not reveal whether the government planned on restricting travel in the event of a pandemic, saying only that the plans were still being developed by the departments of Homeland Security and Transportation.
He also denied that such planning was an overreaction.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, added, "It is unlikely that something is going to happen, but we are assuming the worst-case scenario."
A draft of a federal report, obtained by The New York Times, recently predicted such a worst-case avian flu scenario in the United States that could lead to the deaths of 1.9 million Americans and the hospitalization of 8.5 million more people with costs exceeding $450 billion.
Leavitt outlined a six-point public health and medical response to a potential pandemic.
"A virus is a network enemy, and if it is approached with a mainframe response, we will not succeed," he said. "We have to have a network response. That means a network internationally, a network in terms of federal agencies, in the way the federal government interacts with state and local governments, and with the private sector."
The plan includes:
- Manufacturing a 20-million-course vaccine stockpile that would be directed at the current strain of H5N1, and developing the capacity to produce 300 million courses of the vaccine within a six-month period. This latter point would involve expanding existing egg-based production facilities while adding cell-based capabilities and adjuvants, or ways to make the vaccine more efficient. This is not a plan to actually give the vaccine to 300 million Americans, but simply to have the capacity to make the vaccine, Leavitt stressed.
- Stockpiling 20 million courses of several different antivirals, such as Tamiflu, by the end of 2006, and up to 81 million courses by the summer of 2007.
- Establishing international and domestic surveillance networks of labs, epidemic investigators and rapid-response teams.
- Improving communication abilities.
- Ensuring state and local preparation.
According to the current plan, the federal government would pay for 50 million doses of vaccine, with states paying 25 percent of the cost of the remaining 31 million courses.
Enhancements in avian flu vaccine manufacturing capabilities would feed into seasonal vaccine capacities and vice versa, officials said.
"We have been expanding the indications for the influenza vaccines," said U.S. Centers for Disease Control and Prevention Director Dr. Julie Gerberding. "Manufacturers will make more if we use more, and this is a good way to develop a more robust manufacturing capacity over time. The investment we would make in augmenting pandemic flu vaccine capacity would also help us have a much more robust manufacturing capacity for avian flu."
Leavitt added: "The reality is that if the H5N1 virus does not trigger a pandemic flu, there will be another virus at a later time. We will have accomplished five important things with this plan." Those items include expanding and upgrading vaccine production capacity, better state and local preparedness for any medical emergency, and "peace of mind knowing we're ready."
Worldwide, health officials have confirmed 77 human cases of avian flu infection, including an estimated 60 deaths. All cases have been confined to Southeast Asia.
Early outbreaks of avian flu occurred among poultry in eight Asia countries -- Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam -- during late 2003 and early 2004. In response, officials ordered the slaughter of more than 100 million birds in the affected countries in an effort to control the outbreak. By March 2004, the outbreak seemed under control.
But beginning in late June 2004, new outbreaks of avian flu among poultry were reported in such Asian countries as Cambodia, China, Indonesia, Kazakhastan, Malaysia, Mongolia, Thailand and Vietnam, according to the U.S. Centers for Disease Control and Prevention.
Recently, avian flu has continued its westward push, with cases identified among poultry in Turkey and Romania.
The last great pandemic, the Spanish flu outbreak of 1918-19, killed an estimated 20 million to 40 million people worldwide. An estimated 675,000 Americans died of influenza during the pandemic.
Even in a normal year, an average of 36,000 Americans die from seasonal flu. Most of those deaths occur among people with weak immune systems, such as infants, the elderly and people with AIDS.
More information
The U.S. Centers for Disease Control and Prevention has more on avian flu.
