A $3.9-Billion First Strike
Published on Friday, October 7, 2005 by the Los Angeles Times
A $3.9-Billion First Strike
by Laurie Garrett
 

Pandemic Influenza anxieties have reached fever pitch in Washington amid growing concern that the H5N1 avian flu virus now circulating in Jakarta, Indonesia, may mutate into a human-to-human transmitter that could claim hundreds of millions of lives. After years of relegating flu preparedness to one small office inside the Department of Health and Human Services, the government, from the president on down, seems suddenly in a mad flurry to do something — anything — to prepare for disaster. Perhaps the hurricanes have taught them a lesson.

"The people of the country ought to rest assured that we're doing everything we can…. And we are," President Bush said in a news conference Tuesday. But racing around like a chicken with its head cut off (pun intended) won't put the United States any closer to safety than we were before flu anxiety hit.

For example, on Tuesday, the president suggested we might need to quarantine sections of the nation, adding, "and who best to be able to effect a quarantine? One option is the use of a military that's able to plan and move."

But hold on, Mr. President: Even your own top flu experts at the Department of Health and Human Services and the Centers for Disease Control will tell you that human influenzas are so contagious there is little, if any, evidence that quarantine helps. Further, your top military leaders have told me that there is no Defense Department plan in place for the protection of active-duty personnel, much less one aimed at putting the armed forces in charge of domestic epidemic management.

Last week, the also agitated Senate, by unanimous consent, tagged a $3.9-billion "pandemic influenza preparedness" rider onto the 2006 Defense Department appropriation bill. If the House agrees to it, this would, among other things, guarantee a supply of the potentially lifesaving drug Tamiflu for about half of all Americans.

That's a start, but the White House has threatened to veto the entire bill, saying it considers the flu problem a domestic issue that shouldn't be addressed in defense appropriation legislation. The Bush administration should back down from its veto threat — especially if the president envisions a military epidemic response.

SCIENTISTS have been nervously following developments in Asia with the H5N1 avian influenza virus since it first emerged in 1996, and anxiety is rising. About three weeks ago, H5N1 broke out in Jakarta, population 9 million. About 60 suspected human cases of H5N1 have been placed under treatment there, and seven people have died. Statistics gathered since 2003 indicate that 55% of those who contract H5N1 will die of it. (In chickens, felines, ferrets and mice, H5N1 kills 100% of the time.)

For the moment, the pattern of H5N1 infection does not show that avian flu is easily transmitted from human to human. But viruses evolve quickly. The number of suspected cases in Jakarta increases the concern that H5N1 is spreading and mutating. It doesn't help that scientists studying the virus that caused the 1918 flu pandemic see key similarities between it and H5N1.

Last Friday, the Assn. of Southeast Asian Nations approved a three-year plan that requires its 10 member nations to wage an "all-out coordinated regional effort" to quash the virus in bird populations. Similarly, the Asian-Pacific Economic Cooperation forum is drawing up guidelines for controlling the virus in animals and, should it become a human epidemic, for limiting its effect on populations and economies. Last month, China's president, Hu Jintao, promised an open, scientific exchange with the United States in hopes of stemming a flu tsunami.

But the United States must do more. Sen. Ted Stevens (R-Alaska) suggested last week that "we ought to wait" because avian flu "has not yet become a threat to human beings." But waiting until confirmed human-to-human transmission is underway means dooming millions to die. A human-to-human avian flu eruption would spread around our globalized world in a matter of weeks, perhaps days. The lessons of the hurricane season are clear: It costs less in lives and dollars to invest in adequate defenses than to react once disaster strikes.

Does the Senate rider do enough? The overall appropriation, $3.9 billion, may be about right, but the devil is in the details. The Senate plan sets aside 80% of that money primarily for buying Tamiflu. The other 20% would be used for global flu surveillance, bolstering local preparedness and improving flu vaccine production. The ratio isn't correct.

Tamiflu can suppress H5N1 at the beginning of infection, but it isn't a cure. It must be taken at the right time or it's ineffective. It also has not been approved for use in children. And in some adults, it may only partly suppress the virus, leaving them ambulatory carriers of infection. On top of that, the latest scientific studies indicate that some H5N1 viruses may already be resistant to the drug.

That means that instead of spending most of the appropriation on Tamiflu, we should demand that the pharmaceutical industry rev up flu vaccine production and then use some of the $3.9 billion to pull genuine innovations out of the lab and into quick mass production. Further, a hefty percentage of that money should be spent on helping Los Angeles and other cities and states prepare: Where will they put all the patients? The bodies? How will they feed house-bound millions? How can they keep the economies and machineries of their jurisdictions running while a deadly pandemic holds them in its grip for more than a year?

Still, the Senate plan is a step in responding to an urgent need. The House should fine-tune it, and the president should sign it into law. As Sen. Tom Harkin (D-Iowa) said Thursday: "It's the midnight hour. We have to get moving … now, not next year, not after some study group in the White House bangs this thing around for another three months." He's absolutely right.

Laurie Garrett is a Pulitzer Prize-winning writer and senior fellow for global health at the Council on Foreign Relations.

© 2005 Los Angeles Times

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