Bird Flu Alarm

2006-05-03-Bird flu plan lacks a key detail

Understanding Avian Influenza

2006-05-03-Bird flu plan lacks a key detail

The Bush administration's pandemic flu action plan, issued Wednesday, is a good step toward getting the nation ready for a 1918-style flu disaster, health experts say, but it's missing a key element: how to pay for it.

The plan acknowledges that the response to a pandemic could exceed the financial resources of government agencies, says Jeffrey Levi, director of Trust for America's Health, a public-health advocacy group. The plan cites President Bush's $7.1 billion funding request for preparedness, but Levi says it doesn't address how to pay for services that would be needed after a pandemic hits.

No one knows when or where a flu pandemic could begin, or how severe it might be. The federal government is not making predictions but is planning for the worst-case scenario: a pandemic like the one in 1918, which killed more than 500,000 people in the USA.

"That's our responsibility, to assume the worst, knowing that anything short of that, we will then be well-prepared for," White House homeland security adviser Fran Townsend says.

Concern about a flu pandemic has grown because a bird flu virus has crossed into humans. The virus has sickened 205 people and killed 113 of them since late 2003, according to the World Health Organization. The flu strain can't spread easily from person to person, but if it develops the ability to do so, it could be difficult to contain.

The new plan outlines the roles of each federal department in a pandemic. It assigns responsibility for medical issues to the secretary of Health and Human Services, non-medical emergency efforts and coordination to the secretary of Homeland Security, and international response issues to the secretary of State.

"The comprehensiveness (of the plan) is an important message about how broadly felt across society a pandemic would be," Levi says. He praises the plan's "level of detail with relatively specific accountability measures and timelines." But he says, "The critical piece that is missing is how we will pay for implementation of these plans when a pandemic hits." For example, he says, there is no mechanism by which the HHS secretary could grant emergency medical coverage to the uninsured.

Among issues that still need to be evaluated, Townsend says, are how to set priorities for distributing vaccine and anti-viral drugs and what kinds of "interventions" to take at borders.

The plan "is a start, but it's certainly not a finish," says Patrick Libbey, director of the National Association of County and City Health Officials. Congress' authorization in December of $350 million to states for pandemic preparedness was more than offset by a 12% funding cut during the current fiscal year, Libbey says.

Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University in New York City, says that by placing so much of the preparedness effort on state and local agencies, the federal government has imposed "the mother of all unfunded mandates."

Townsend says that in addition to Bush's request for preparedness, the administration has spent $6 billion on public-health infrastructure, improvements that would help during a pandemic.

Redlener says most of the money allocated so far for pandemic planning will be spent on vaccine development and drug stockpiling, leaving only about 5% for state and local readiness.

"This is where the plan doesn't jibe with the reality that hospitals in small towns and big cities are going to have to try to accommodate an unprecedented number of very ill patients for which the capacity is not there," he says.

He estimates that $5 billion more is needed for hospitals and local health care.

Understanding Avian Influenza