If President Bush had been awake at the switch earlier this year -- instead of, for example, obsessing about Social Security privatization schemes -- the United States would probably not find itself near the end of an international line for influenza medicine.
As it is, his sudden realization that the potential of a public health disaster looms has set of an unseemly governmental scramble that mostly misses the point.
Even now, the Bush response to repeated wakeup calls betrays a weird fixation on one of the less central questions that would be raised by the outbreak of a significant epidemic of avian flu -- whether the armed forces would have to be used to quarantine an invaded part of the country.
The most important point is that a well-governed modern society requires a sound public health infrastructure that citizens can look to with confidence if communicable disease threatens.
But the public health infrastructure -- four years after the 9/11 attacks and the anthrax murders -- is more in disrepair than prepared, just as government was not ready to respond in a timely fashion to a predictable major storm in the Gulf of Mexico.
The immediate problem flowing from a lack of response to urgent pleas to get ready for an avian flu pandemic is that a widely recognized, useful drug is going to be difficult to stockpile quickly. Between last spring, when much of the industrialized world appears to have mobilized with greater urgency that the United States did, and last week when the Bush administration began going more public with its concerns, a great deal of very valuable time was lost.
The drug in question is called Tamiflu, manufactured by the international drug giant, Roche. According to public health experts, it is a rare medicine with proven effectiveness in greatly reducing the severity of influenza symptoms and shortening the disease's duration. Generally, to work optimally, Tamiflu needs to be taken within a couple of days of infection.
When concerns about a possible pandemic emerged earlier this year, several governments responded vigorously. In Scandinavia and in Britain, France, Canada, Japan, and Switzerland, orders were placed with Roche designed to provide enough medicine to treat 20-40 percent of their populations.
According to US officials, there is enough Tamiflu around in this country to help at most 2 percent of the population. Enough to treat a quarter of the total is prudent, but because of the long delay in responding, that is going to take a long time, possibly until the end of next year, leaving the nation vulnerable. Playing catch-up will be expensive -- multiple billions that, as we have discovered post-Iraq and post-Katrina, the country doesn't have except via more debt.
After dragging its feet for months, the administration has sprung to life with surprising and welcome alacrity. The point person has been Mike Leavitt, Bush's secretary of health and human services, who has a decent political reputation from his time as an effective governor of Utah. Over the last couple of weeks he has supervised detailed, rather scary briefings of reporters, of congressmen and senators, and last week of a group of senior administrations including Bush himself.
The president has learned the technical name for the influenza (H591), but in responding to a question at his Rose Garden news conference last week, an ordinary American might have been forgiven for thinking pandemic was imminent. Bush's long riff about whether the armed forces should be mobilized to enforce quarantines was particularly alarmist.
According to experts, the nature of globalization makes it much more likely that flu would arrive here from multiple points of origin in several places. There are legitimate quarantine scenarios to worry about, but not to the extent Bush's rambling answer suggested. It is much more important to build an effective structure for care and response. Several Democrats have joined behind a mobilization proposal; for those who like bipartisan alternatives, one has been offered by Republican Senator Pat Robert of Kansas and Hillary Clinton.
As a practical matter, these will be the yardsticks against which the administration's tardy response -- due in a matter of days -- is measured. There was an international conference here at the end of last week, though many of the attendees are further along than their hosts.
At the beginning of last year, Senator Edward Kennedy wrote Leavitt's predecessor, Tommy Thompson, asking pointedly for an administration preparedness plan so the job of implementing one could begin. All these months later, something has finally begun to happen.
© 2005 The Boston Globe