$7.1B plan to fight flu outlined

? Four times, President Bush tried to reassure a jittery world. “There is no pandemic flu in our country or in the world at this time,” he said, even as he outlined a $7.1 billion plan to get the country prepared – just in case.

Key to those preparations: better early warning systems to detect and contain novel influenza strains before they reach the nation’s shores, and overhauling the vaccine industry so that eventually every American could be inoculated within six months of a pandemic’s beginning.

The ambitious vaccine change will take years to implement – Bush’s goal is 2010 – and his plan drew immediate fire from critics who said it didn’t provide enough protection in the meantime. States, too, got an unpleasant surprise, ordered to purchase millions of doses of an anti-flu drug with their own money.

But Bush said cities, states and countries will all have to do their fair share to survive a worldwide outbreak of the worrisome Asian bird flu or some other super-strain of influenza.

Chinese Pigeon Assn. workers inoculate birds with a bird flu vaccine at a collective event to vaccinate more than 40,000 pigeons in Shenzhen, in southern China's Guangdong province. Officials in the region warned of more human infections unless the spread of the disease is curbed. The Chinese banner behind them reads: To

“Every nation, every state in this union and every community in these states must be ready,” Bush said in a speech Tuesday at the National Institutes of Health. “If we wait for a pandemic to appear, it will be too late to prepare.”

Pandemics strike when the easy-to-mutate influenza virus shifts to a strain that people have never experienced before, something that has happened three times in the last century. While it is impossible to say when the next super-flu will strike, concern is growing that the bird flu strain known as H5N1 could trigger one if it mutates to start spreading easily among people. Since 2003, at least 62 people in Southeast Asia have died from H5N1; most of the victims regularly handled poultry.

Plan highlights

Topping Bush’s strategy:

¢ $1.2 billion to stockpile enough vaccine against the current H5N1 flu strain to protect 20 million Americans, the estimated number of health workers and other first-responders involved in a pandemic. If a similar bird flu causes a pandemic, the shots should provide some protection while better-matched versions are manufactured.

¢ $1 billion for the drugs Tamiflu and Relenza, which can treat and, in some cases, prevent flu infection. Enough to treat 44 million people and prevent infection in 6 million others is headed for the federal stockpile. States were told to buy 31 million treatment courses, but Bush is funding only a quarter of the states’ anticipated bill.

Flu overview

A pandemic is an epidemic (sudden outbreak) that becomes very widespread and affects a whole region, a continent or the world.

Avian, or bird, flu, is a highly contagious viral disease with up to 100 percent mortality in domestic fowl. Humans are only rarely affected, and only after contact with infected birds, but bird flu could evolve into a form that spreads from human to human.

Source: MedicineNet.com

¢ $2.8 billion to create ways to manufacture flu vaccines in easier-to-handle cell cultures, instead of today’s slow method that relies on millions of chicken eggs. If this overhaul works, it one day would allow faster production of both pandemic vaccines and regular winter flu shots.

¢ $251 million for international preparations, including improving early warning systems to spot human infections with new flu strains.

¢ $100 million for state preparations, including determining how to deliver stockpiled medicines directly to patients.

¢ $56 million to test poultry and wild birds for H5N1 or other novel flu strains entering the U.S. bird population.

¢ A call for Congress to provide liability protection for makers of a pandemic vaccine, which unlike shots against the regular winter flu, would be experimental, largely untested.

Bush’s announcement came after his administration was battered by criticism over its lethargic response to Hurricane Katrina.

Public health specialists, briefed on the strategy but awaiting details, called it a good start.

“Clearly this is the No. 1 public health issue on the radar screen,” said Michael Osterholm of the University of Minnesota, who advises the government on infectious disease threats.

But it’s not strong enough, said Sen. Edward Kennedy, D-Mass., who helped lead Senate passage last month of $8 billion in emergency funding for pandemic preparations.

“Stockpiles alone aren’t enough without the capacity to make use of them,” he said, calling for steps to help states, cities and hospitals prepare for a flood of panicked patients.

“There is a gaping hole” in the plan, added Sen. Charles Schumer, D-N.Y., who said the nation should stockpile enough Tamiflu for half the population, not the quarter that would be covered if the states added their share under Bush’s plan.

States are strapped

The states’ contribution will be difficult, said Republican Arkansas Gov. Mike Huckabee, chairman of the National Governors Assn. “They expect us to pay 75 cents on a dollar for flu medicine – that’s going to be a tough pill to swallow,” he said through a spokeswoman.

The states’ collective tab would reach $510 million, said Kim Elliott, deputy director of the nonpartisan Trust for America’s Health. She worried that some wouldn’t buy any, and that others wouldn’t share their Tamiflu stash if a pandemic struck in a part of the country that ran out.

“It depends on where you live and the state of your state’s budget as to whether or not you might receive a treatment drug,” she said.

If a pandemic strikes, the Department of Health and Human Services will direct the medical response, and today it will unveil long-awaited details. Still to be finalized is a plan from the Homeland Security Department, which will coordinate how the government balances protecting the public with keeping schools, businesses and transportation sectors running.

“People think, ‘Oh, if I get sick, I’ll stay home,”‘ said homeland security spokesman Brian Doyle. “But what happens when schools are closed for four months? Will truck drivers want to deliver food?”