House, Senate differ on flu plan

The initial response by House and Senate Republicans to President Bush’s new request for billions of dollars to pay for pandemic-flu preparedness demonstrates the divide between the two chambers on rising government spending.

The initial response by House and Senate Republicans to President Bush’s new request for billions of dollars to pay for pandemic-flu preparedness demonstrates the divide between the two chambers on rising government spending.

While the Senate GOP leadership moved quickly in an attempt to accommodate at least part of the $7.1 billion request, the House leadership indicated that rank-and-file members would demand that the new spending be offset.

Underlying these differences may be the recognition that the administration’s unprecedented federal investment in public health since 2001 has stood as only a first installment.

The bulk of the president’s call for $7.1 billion would go toward developing, purchasing and stockpiling vaccines and drugs and to promoting the expansion of the domestic vaccine manufacturing system.

Nearly $1 billion, however, is targeted to the public-health system, including money for state and local governments, and would build on money distributed in the past four years for similar efforts to ready the country for a bioterrorist attack.

“We must ensure that all levels of government are ready to act to contain an outbreak,” Bush said during his speech at the National Institutes of Health (NIH) in Bethesda, Md., yesterday.

“At this moment, there is no pandemic influenza in the United States or the world. But if history is our guide, there is reason to be concerned,” Bush said, citing the nearly 50 million people killed by pandemic flu strains during the 20th century.

Bush looked to allay public fear of avian flu while emphasizing his view that the need for preparations is urgent. The president undertook a similar balancing act when selling his bioterrorism plans to Congress several years ago. The administration would not say whether it had knowledge of an imminent bioterrorist attack but urged that preparations be made quickly nonetheless.

With its primary focus on developing and procuring vaccines and drugs, the president’s flu proposal has many differences from the bioterrorism strategy. Parts of it, however, represent a continuation of steps taken in recent years to prepare the country for a terrorist attack using a biological agent, such as the October 2001 anthrax incidents on Capitol Hill and in New York and Florida.

In the aftermath of the Sept. 11 terrorist attacks, Bush introduced plans to shore up the nation’s defenses against a bioterrorist attack using killer diseases such as smallpox and anthrax. By extension, the new initiative would establish stronger safeguards against naturally occurring diseases such as the flu, administration officials repeatedly said at the time.

Near the end of his remarks, the president urged Congress to fund his plan. “All the steps I’ve outlined today require immediate resources,” he said.

Congress has provided billions of dollars in funding for local and state agencies, hospitals and other components of the public-health infrastructure since 2001.

However, a Congress wearied by massive emergency spending requests for the war in Iraq, Gulf Coast hurricane relief and other administration priorities may turn a skeptical eye toward ramping up funding for improvements to the public-health system.

“I think there will be a strong desire in our conference, and hopefully in the Senate as well, to pay for those things as they come up,” House Majority Leader Roy Blunt (R-Mo.) told reporters yesterday.

“House Republicans take this matter seriously and will be working with the administration on it,” said a spokesman for House Speaker Dennis Hastert (R-Ill.). The Labor, Health and Human Services Subcommittee of the House Appropriations Committee will hold a hearing on flu preparedness today.

The Senate has already acted by approving a Democratic plan to provide $8 billion for flu preparedness by voice vote last week. One of the lead sponsors of the legislation, Sen. Edward Kennedy (D-Mass.), was a guest of the president at the NIH yesterday.

In a statement, Senate Minority Leader Harry Reid (D-Nev.) remarked, “I’m glad to see that the president has finally followed our lead and released his avian-flu plan today.”

Shortly before the president’s speech, Senate Majority Leader Bill Frist (R-Tenn.) and Senate Budget Committee Chairman Judd Gregg (R-N.H.) proposed dedicating almost $4 billion to flu preparedness by redirecting savings from cuts in the Senate’s budget-reconciliation bill.

Bush’s call for the same actions for pandemic flu as for bioterrorism suggests the previous investments may not have been as broadly targeted as the administration intended.

Public-health officials warned that policymakers should not view the president’s request for more money as a sign that the previous billions were spent in vain.

Leah Devlin, the top public-health official in North Carolina, cautioned that public-health preparedness is an ongoing process. “It’s not a destination; it’s a journey,” she said. “We’ll never be done.”

The public-health system is much better prepared to react to infectious-disease outbreaks, be they natural or terrorist in nature, than it was four years ago, agreed Patrick Libbey, executive director of the National Association of County and City Health Officials. Libbey emphasized that financial resources at the local level continue to be stretched.

American Public Health Association Executive Director Georges Benjamin said that results should be measured using a realistic assessment of where the process started in 2001. “The hole was huge” in the public-health system, so four years of new federal funding has gone only so far, he said.

Benjamin also said that the narrow targeting of the bioterrorism grants issued to states and localities encouraged officials to make sure that all of the dollars were directed to bioterrorism-specific expenses. As a result, money was not spent on activities that could have had broader use.

Moreover, Benjamin noted that the fact that a biological attack had actually taken place using anthrax provided an obvious motivation to focus attention on that area.

Administration officials and members of Congress in both parties have acknowledged that the United States is unprepared to respond adequately to a pandemic flu.

The spread of avian influenza, known as the H5N1 strain of flu, across Asia and into Europe has seized the attention of the administration and lawmakers and created anxiety among the public.

No evidence has emerged that the disease can be transmitted from one person to another, and only people in very close contact with infected birds have so far become infected. Nevertheless, migratory birds to date have carried the disease as far as Eastern Europe. Federal officials and public-health experts agree that birds will continue to become infected and worry that the disease will mutate and become more contagious to humans.

The administration wants to make sure that, in the event of an outbreak of avian flu, the government can prevent the spread of the disease, treat the sick and vaccinate as many people as possible. An outbreak would have to be detected early, local authorities would have to respond quickly, and local, state and federal agencies would have to coordinate with each other and with private-sector entities such as hospitals. In the meantime, the United States will closely watch for signs of an outbreak anywhere in the world and fund research into better vaccines and drugs.

The plan’s focus on domestic vaccine development reflects the concern many policymakers have had for years that the shortcomings of this sector pose a serious threat.

Bush laid much of the blame for the vanishing U.S. vaccine market on the companies’ exposure to liability. “In the past three decades, the number of vaccine manufacturers in America has plummeted, as the industry has been flooded with lawsuits,” he said.

Last year’s shortage of vaccine made abroad for the ordinary flu provided a possible preview of what could happen during a pandemic if vaccine is not available on U.S. soil, proponents of liability protections have argued.

Senate Republicans attempted to include a liability shield for vaccine makers in bioterrorism bills that passed in recent years but relented to assuage Democratic objections.

The Bush plan also would give $2.8 billion to the NIH for research into new, more efficient and speedier vaccine manufacturing techniques. Currently, scientists must obtain an actual sample of a new flu virus before they can begin the months-long process of creating a vaccine.

Legislation penned by Sen. Richard Burr (R-N.C.) includes provisions similar to the president’s plan.

Burr wants to expand the two-year-old Project BioShield, which been criticized for failing to generate adequate interest among the drug and biotechnology companies it needs to succeed. Project BioShield was intended to encourage companies to research and develop treatments for diseases that could be used for terrorism by guaranteeing that the government would stockpile the products.

House Energy and Commerce Committee Chairman Joe Barton (R-Texas) has been drafting a flu bill for several months and tentatively plans a hearing for next week, a spokesperson said.