11-2-05 - Faced with how to stretch scarce vaccines and where to put hacking patients when hospitals overflow in the next super-flu crisis, cities and states are awaiting instructions on how to make President Bush's $7.1 billion plan work.
States already got an unpleasant surprise Tuesday when Bush said he wants them to purchase millions of doses of an anti-flu drug with their own money to supplement the federal government's stockpile.
"They expect us to pay 75 cents on a dollar for flu medicine _ that's going to be a tough pill to swallow," Republican Arkansas Gov. Mike Huckabee, chairman of the National Governors Association, said through a spokeswoman.
Bush outlined his strategy to get ready for a possible worldwide flu outbreak, emphasizing better early warning systems to spot super-strains of influenza before they reach the United States and better ways to brew vaccines to protect against them.
On Wednesday, the Department of Health and Human Services was releasing crucial details on how the plan will work, including how cities and states will get vaccine and medications to panicked citizens.
"Every nation, every state in this union and every community in these states must be ready," Bush said.
Pandemics strike when the easy-to-mutate influenza virus shifts to a strain that people have never experienced before, something that happened three times in the last century.
It is impossible to say when the next super-flu will strike, and Bush sought to reassure a jittery public Tuesday that there's no sign one is imminent. Still, 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.
Topping Bush's strategy is a $2.8 billion investment 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.
The idea is that when scientists spot a super-flu emerging abroad, they eventually would be able to produce enough vaccine for every American within six months.
That's a huge change that will take years to implement. Bush's goal is 2010.
So also on the agenda:
_$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 their anticipated bill.
_$251 million for international preparations, including improving early warning systems to spot novel flu strains before they reach the U.S.
_$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 new 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.
Public health specialists called the strategy a good start but anxiously awaited details.
"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 the plan doesn't go far 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.
On the Net:
Government's pandemic flu site: http://www.pandemicflu.gov