Flu pandemic: Not if, but when — and will the U.S. be prepared?

If a moderately severe strain of a pandemic flu virus hits the United States, more than 500,000 Americans could die and more than 2.3 million could be hospitalized, according to state-by-state figures from a model developed by the Centers for Disease Control and Prevention and used by Trust for America’s Health (TFAH). (See chart.) The model also projects 66.9 million Americans at risk of contracting the disease.

“This is not a drill,” says Shelley Hearne, TFAH executive director. “This is not a planning exercise. This is for real. Americans are being placed needlessly at risk. The U.S. must take fast and furious action to prepare for a possible pandemic outbreak here at home.”

The urgency comes because the TFAH report — “A Killer Flu? ‘Inevitable’ Epidemic Could Kill Millions”— found that the U.S. has stockpiled only 2.3 million courses and has placed orders for an additional 3 million courses of antiviral pharmaceuticals (produced as Tamiflu by Roche Pharmaceuticals), which would likely be available in 2006. This would be enough to cover 5.3 million Americans, leaving more than 60 million who could be infected and would not be able to receive medication before an effective vaccine to combat the flu strain is identified and produced.

The urgency also comes because people such as House Government Reform Committee chairman Tom Davis are saying that experts say the next flu pandemic “is a matter of when, not if. No one knows exactly when it might strike, or whether the next worldwide pandemic will be a version of the avian flu . . . or a different influenza strain.

“What is not up for debate is that the stakes — in dollars, resources, and human lives — are enormous. According to experts, the next pandemic could be worse than the Spanish flu, which is estimated to have caused the deaths of 40 million to 50 million people worldwide from 1918 to 1919. Given the global integration of today’s economic markets and the capacity for rapid travel from one corner of the globe to another, a pandemic could move around the world in the same amount of time it takes to fly from New York to Tokyo. This occurred in the case of the SARS outbreak two years ago.”

Despite such warnings, many people in the United States either don’t know or don’t care about a potential outbreak.

A Harris Interactive poll for the Wall Street Journal’s Online Health Industry Edition found that 53% of U.S. adults are either not very or not at all familiar with the avian flu and that 41% are not very or not at all concerned that the United States might be part of an avian flu pandemic in the near future. But despite this lack of familiarity and concern, majorities of adults believe that particular steps should be taken to prepare for a potential pandemic, including:

1. Develop plans to quickly provide critical medical supplies to areas of the globe that experience avian flu outbreaks (71%).
2. Develop plans to limit spread of avian flu via quarantines, travel restrictions, etc. (65%).
3. Invest government dollars in development and production of avian flu vaccines (61%).
4. Stockpile antiviral drugs that might slow an outbreak of avian flu (62%).
5. Stockpile critical medical supplies (such as surgical masks and gloves) that can help slow the spread of avian flu (55%).

Additional TFAH findings included:

  • While there are estimates that more than 2 million Americans may need to be hospitalized during a pandemic outbreak, the United States currently only has some 965,250 staffed hospital beds.
  • The United States has not adequately planned for the disruption a flu pandemic could cause to the economy, daily life, food, and supply distributions or homeland security.
  • The United States lags in pandemic leadership compared to Great Britain and Canada based on an examination of leadership, vaccine development, vaccine and antiviral planning, health care system surge capacity planning, coordination between public and private sectors, and emergency communications planning.

As the highest populated state, California could feel the greatest impact, with more than 60,875 deaths, 273,090 hospitalized, and more than 8 million infected people.

With 5.3 million courses of antivirals evenly distributed among states, California could face a shortfall of more than 7.4 million infected people who could not receive medication. As the least populated state, Alaska could have 866 deaths, 4,558 hospitalized, 152,328 cases, and an antiviral shortfall of 140,263.

Take steps now

“We believe that Congress and the administration must take steps now to ensure that the nation’s public health system and the health care delivery system will be able to respond to a major health crisis, even beyond some of our fears of bioterrorism or chemical terrorism,” Ms. Hearne testified before Mr. Davis’ committee.

“While experts predict a pandemic flu may be inevitable, subsequent death rates predicted to be in the millions are not. What will make the difference? We need strong, directed, and rapid federal leadership; we must convert national and state pandemic influenza plans into operational blueprints; and we should increase vaccine production and capacity, procure adequate vaccines and antivirals for treatment, and stockpile additional medical supplies and equipment. Simply put, U.S. pandemic influenza preparedness is inadequate. Both the federal pandemic plan and various state pandemic plans are insufficient blueprints for an effective national response to a pandemic influenza,” she continued.

TFAH breaks down its detailed recommendations into:

1. crucial immediate steps that must be taken to minimize loss if a pandemic occurs in the near term, including outbreak tracking, stockpiling medical supplies, and communications plans;
2. intermediate steps that must be considered if a pandemic occurs with several years to prepare, including stockpiling antivirals and developing additional surge capacity plans for hospitals and other medical providers;
3. longer-range steps that should be undertaken if there are a number of years to prepare, including increasing vaccine production and development of new vaccine technologies.

Ms. Hearne tells State Health Watch that because TFAH has been positioned for several years as an honest broker about issues of public health defenses, the report is seen as a concrete statement of the problem and what needs to be done and has received considerable support. “I’ve never seen public health experts as spooked as they are by the H5N1 avian influenza A virus,” she says. “People are being challenged to find ways to get all the public and private sectors to take this issue seriously.”

According to Ms. Hearne, the report has been heard at many levels in the federal government but needs to become a greater priority, starting with the White House.

She says it will be important to have a White House-chartered federal commission so the issues are clearly understood by everyone.

She praises the Department of Homeland Security for recognizing a flu pandemic as a major threat to the country and for creating a chief medical officer position within that agency.

The need for wide-ranging coordination is imperative, according to Ms. Hearne, because a flu pandemic is not just a public health problem, but will have major societal and economic consequences.

“Schools and workplaces may have to close,” she explains. “People may not be able to show up for critical infrastructure jobs. Law enforcement will have a primary need for treatment. We could see a grinding halt to the economy. There will be a need for a clearly defined organizational structure and chain of command. The president needs to create a cabinet-level center with someone in charge.”

In the near future

Pressed on how much time we may have, Ms. Hearne hedges a bit but finally offers the notion that “in the near future, we will see something of significant consequence.” But she hastens to remind policy-makers that any planning that is done will pay off with whatever flu strain finally hits us and whenever that may be.

Testifying before the Government Reform Committee, Mary Selecky, Washington state secretary of health who was representing the Association of State and Territorial Health Officials, said state health officials are concerned that public health agencies are being asked to take on pandemic flu activities on top of existing priorities already established for the federal preparedness cooperative agreement funding.

“If the federal government is truly committed to enhancing our pandemic flu response,” she said, “we need significant increases in resources for state and local efforts. Vaccines and antivirals are an important part of the answer but not nearly enough by themselves. All the preventive and therapeutic measures in the world are useless without the ability to get them to those who desperately need them.”

She said development of national guidelines is critically important to ensure a consistent response across the country, but the guidelines need to be flexible enough to allow each state to address its specific needs and essential services.

While states were required to have pandemic flu plans completed by July 2005, Ms. Selecky said that work had been made more difficult because the federal plan wasn’t completed and available for use as a guide for state planners.

She left the committee with four key messages:

1. Pandemic flu preparedness is a critical issue for public health to address as part of its overall prevention, detection, and response efforts for any natural or terrorist event.
2. Collaboration among all levels of governmental public health is essential for influenza pandemic preparedness.
3. Reducing federal funding for preparedness is exactly the wrong thing to do at this time because a sustained federal commitment to preparedness is vital.
4. Progress has been made, but there is much more to be done.

[Download the TFAH report from www.tfah.org. Contact Ms. Hearne at (202) 223-9874. Download testimony before the House Government Reform Committee from http://reform.house.gov/GovReform/Hearings/EventSingle.aspx?EventID=29304. Download the Harris Poll from www.harrisinteractive.com/news/newsletters_wsj.asp.]