U.S. Not Ready to Handle Massive Flu Outbreak: Report

As many as 1.9 million Americans could die in a pandemic, document says

SUNDAY, Oct. 9, 2005 (HealthDay News) -- The United States is unprepared for a global flu pandemic, according to a draft of a federal report, which predicts a worst-case scenario 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.

The report, obtained by The New York Times, says a large flu outbreak that began in Asia would probably hit the United States within "a few months or even weeks" due to the ease of modern travel, the newspaper reported Saturday.

If a pandemic, which is a global outbreak of a deadly flu strain, were to occur, U.S. hospitals would be overwhelmed, riots would strike vaccination clinics, and even power and food supplies might be disrupted, according to the plan, the Times reported.

The report, which is 381 pages long, recommends quarantines and travel restrictions but admits such steps "are unlikely to delay introduction of pandemic disease into the U.S. by more than a month or two," the newspaper said.

The report also calls for domestic production of flu vaccine of 600 million doses within six months -- more than 10 times the current capacity, the newspaper said.

The plan also suggests certain steps that state and local governments should take now to prepare for a pandemic, which health experts warn is long overdue. Those steps include creating legal documents that would allow for quarantines, the Times said.

A spokeswoman for U.S. Health and Human Services Secretary Michael O. Leavitt told the newspaper that the plan given to the Times was a draft and not a final document. "We recognize that the H.H.S. plan will be a foundation for a government-wide plan, and that process has already begun," Christina Pearson said.

Pearson added that Leavitt has already met with other cabinet secretaries to begin coordinating a federal response to a pandemic, the newspaper said.

World and U.S. health officials have been warning for months that the bird flu strain sweeping through Asia could trigger the next pandemic.

However, some scientists are saying that, while the current strain of bird flu poses potential health risks, it's not likely to unleash a pandemic in the immediate future.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, told the Sunday Times that a bird flu pandemic was not likely for the coming flu season.

"How unlikely, I can't quantitate it," Fauci said. But, "you must prepare for the worst-case scenario. To do anything less would be irresponsible," he added.

Dr. Jeffery Taubenberger, chief of the molecular pathology department at the Armed Forces Institute of Pathology, in Washington, D.C., told the paper: "I would not say it's [a bird flu epidemic] imminent or inevitable. I think in the future there will be a pandemic." But, he continued, whether that pandemic will be bird flu or another type of flu is impossible to predict at this point.

With concern mounting over the bird flu threat, President George Bush met Friday with executives of major vaccine manufacturers to discuss an expansion of the country's ability to make enough vaccine to counter a possible pandemic.

Liability was one issue addressed, said White House spokesman Scott McClellan. He noted that if a vaccine causes side effects in healthy people, vaccine manufacturers could face massive lawsuits, the Associated Press reported.

That's one reason why many drug companies have stopped making vaccines over the past two decades. A second reason is that vaccines aren't all that profitable. That's especially true for flu vaccines, which have to be reformulated every year to cope with new circulating flu strains.

Sen. Hillary Rodham Clinton (D-N.Y.) and Sen. Pat Roberts (R.-Kan.) on Thursday introduced legislation that would encourage vaccine production in the United States by financially guaranteeing a market for vaccine producers.

Also Friday, representatives of nearly 70 countries expressed their willingness to cooperate to limit the threat of a bird flu pandemic, HHS Secretary Leavitt said.

Leavitt briefed reporters on the State Department conference, which was closed to the press, before he traveled to Southeast Asia, where he will gauge for himself various countries' capacity to monitor the bird flu virus and prevent its spread, the AP reported.

Meanwhile, the Bush administration and Congress are considering spending billions of dollars to buy a stockpile of the antiviral drug Tamiflu, which has shown some success in treating bird flu, the Times reported.

However, because the federal government has spent months delaying a decision, the United States will have to wait in line behind other countries that already ordered Tamiflu. If the Bush administration had placed the order a few months ago, Tamiflu maker Roche could have delivered much of the United States' supply by next year, government and industry sources told the Times.

Complicating the federal government's efforts to avert a possible massive outbreak of bird flu is the fact that vaccine development takes time. And whether Tamiflu will be effective in humans remains unknown, experts said.

The potential threat posed by bird, or avian, flu has been compared to that of the Spanish flu of 1918-19, which killed 50 million people worldwide, including more than 500,000 in the United States.

In fact, U.S. researchers announced last week that the bird flu strain that's emerging in the Far East shares some of the same genetic characteristics as the flu virus that caused the 1918 pandemic.

The current bird flu, called H5N1, is spreading throughout Asia and has reached Russia. So far infection has been mostly confined to millions of birds, but has caused the deaths of an estimated 65 people in Asia. Up till now, transmission of the disease from person to person has been limited, although most experts agree it's only a matter of time before that process becomes easier.

"We are concerned about avian flu," said Stephen S. Morse, an associate professor of epidemiology at Columbia University and director of the school's Center for Public Health Preparedness. "But the next pandemic could come from some other [virus] as yet not on our radar screen -- an unanticipated influenza," he added.

Some trial batches of bird flu vaccine have been made by U.S. researchers, Morse said. "This was done to demonstrate the capability and make sure that all the pieces were in place in case we actually needed such a vaccine for human use."

However, Morse noted that should bird flu become easily transmittable from person to person, a vaccine for that specific strain would have to be developed. "Currently our vaccine capacity is limited. So [developing a vaccine] depends on a number of things, including political will and timing," he said.

Factors needed to produce a vaccine quickly include swift recognition by health experts of a new flu strain and increased manufacturing ability, Morse said. "It can be done if the political will is there," he said. "We are headed in the right direction. I hope we have time to put the pieces in place."

More information

The CDC can tell you more about avian flu.

SOURCES: Stephen S. Morse, Ph.D., director, Center for Public Health Preparedness, and associate professor of epidemiology, Columbia University, New York City; Julie L. Gerberding, M.D., director, U.S. Centers for Disease Control and Prevention, Atlanta; Clarencia Stephen, spokeswoman, MedImmune, Inc., Gaithersburg, Md., Oct. 8, 9, 2005, The New York Times
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