Let's strengthen our frontline defenses against flu outbreaks

The Bush administration has belatedly come forward with a plan to prepare the United States for a future outbreak of avian flu. Overall, it is a sound plan, which follows the basic blueprint set forth in my $8 billion avian flu amendment to the Labor, Health and Human Services appropriations bill last month.

But the president’s plan falls dangerously short in preparing state and local health agencies to cope with the cataclysm of a pandemic.  In a future fight against avian flu, it would leave our front line understaffed, under-equipped, and unprepared, with disastrous consequences. 

An outbreak of human-to-human-transmitted avian flu could take place next year, next month, or next week.  Because of the administration’s tardiness in producing a plan — by comparison, Japan produced its national plan in 1997! — we are playing catch-up.

The World Health Organization recommends that nations stockpile enough anti-viral medication to cover at least 25 percent of the population.  Today, the United States has only enough active medication for 2 percent of the population.  We need to move aggressively in four broad areas to prepare for a future pandemic:  First, to create an early-warning tripwire, we need to dramatically step up international surveillance of avian flu outbreaks overseas. The Centers for Disease Control and Prevention is doing an excellent job working with governments in Asia and elsewhere to detect the disease and help to stop its spread.  Surveillance can alert us to an outbreak, and governments can then take measures to isolate the disease.  The sooner we identify and contain an outbreak, the better off we’ll be here in the United States.  To coin a phrase: It’s better to fight this enemy over there than here at home. 

Two, we need to ramp up our vaccine-production infrastructure here in the United States.  Currently, the United States has just one plant capable of manufacturing flu vaccines.  In the event of a worldwide pandemic, we would have to rely on imported vaccines that other countries might not be willing or able to export to us.  Our goal should be to build the research and production capacity to isolate a virus, convert it to a vaccine, and produce enough vaccine for nearly 300 million

Americans — all within a timeframe of three to six months.

Three, we need an aggressive program of purchasing and stockpiling vaccines and also anti-virals — medications that can help mitigate the effects of the disease in those who take the drugs after infection. 

And, four, we need to aggressively build up the capacity of our state and local public health infrastructure.  We need to hire more public-health professionals — epidemiologists, physicians, laboratory technicians and others.  At the same time, we need to dramatically increase the surge capacity of hospitals all across the country.  Right now, hospital emergency rooms across the United States have trouble coping with a busy Saturday night.  They would be utterly overwhelmed by a major pandemic or act of bioterrorism.  Even if we had an adequate stock of vaccine, it would go for naught if we lacked the public health infrastructure to deliver it. 

Clearly, state and local preparedness is the weakest link in the president’s plan.  His budget for fiscal year 2006 actually proposed to cut $120 million from state public health agencies.  Not only does the president’s plan fail to restore that cut, it would require states to pick up the tab for a large share of the cost of stockpiling avian flu vaccine. 

I have been deluged with calls from state health officials who believe the president’s plan piles on new responsibilities while cutting their resources.  It is a mistake to force yet another unfunded mandate on state governments at time when they are already desperately short of resources to prepare for a pandemic. 

In coming weeks, as the Senate goes to conference with the House on the Labor, Health and Human Services appropriations bill, I will fight to secure appropriate funding.  Bear in mind that the $8 billion I have proposed to fight avian flu is less than we spend in two months in Iraq.  I will also insist that we provide adequate resources for state and local health agencies on the front line, where the war on avian flu is going to be won or lost.  We dare not be penny wise and pound foolish in the face of this grave, potentially unprecedented threat to the American people.

Harkin is a member of the Senate HELP Committee and ranking member of the Appropriations Labor, Health and Human Services Subcommittee.