WASHINGTON, Oct. 7 - A plan developed
by the Bush administration to deal with any possible
outbreak of pandemic flu shows that the United States is
woefully unprepared for what could become the worst
disaster in the nation's history.
A draft of the final plan, which has
been years in the making and is expected to be released
later this month, says a large outbreak that began in
Asia would be likely, because of modern travel patterns,
to reach the United States within "a few months or even
If such an outbreak occurred,
hospitals would become overwhelmed, riots would engulf
vaccination clinics, and even power and food would be in
short supply, according to the plan, which was obtained
by The New York Times.
The 381-page plan calls for quarantine
and travel restrictions but concedes that such measures
"are unlikely to delay introduction of pandemic disease
into the U.S. by more than a month or two."
The plan's 10 supplements
suggest specific ways that local and state governments
should prepare now for an eventual pandemic by, for
instance, drafting legal documents that would justify
quarantines. Written by health officials, the plan does
yet address responses by the military or other
The plan outlines a worst-case
scenario in which more than 1.9 million Americans would
die and 8.5 million would be hospitalized with costs
exceeding $450 billion.
It also calls for a domestic vaccine
production capacity of 600 million doses within six
months, more than 10 times the present capacity.
On Friday, President Bush invited the
leaders of the nation's top six vaccine producers to the
White House to cajole them into increasing their domestic
vaccine capacity, and the flu plan demonstrates just how
monumental a task these companies have before them.
In the wake of Hurricane Katrina, the
Bush administration's efforts to plan for a possible
pandemic flu have become controversial, with many
Democrats in Congress charging that the administration
has not done enough. Many have pointed to the lengthy
writing process of the flu plan as evidence of this.
But while the administration's flu
plan, officially called the Pandemic Influenza Strategic
Plan, closely outlines how the Health and Human Services
Department may react during a pandemic, it skirts many
essential decisions, like how the military may be
"The real shortcoming of the plan is
that it doesn't say who's in charge," said a top health
official who provided the plan to The Times. "We don't
want to have a FEMA-like response, where it's not clear
who's running what."
Still, the official, who asked for
anonymity because the plan was not supposed to be
distributed, called the plan a "major milestone" that was
"very comprehensive" and sorely needed.
The draft provided to The Times is
dated Sept. 30, and is stamped "for internal H.H.S. use
only." The plan asks government officials to clear it by
Christina Pearson, a spokeswoman for
Health and Human Services Secretary Michael O. Leavitt,
responded, "We recognize that the H.H.S. plan will be a
foundation for a governmentwide plan, and that process
has already begun."
Ms. Pearson said that Mr. Leavitt has
already had one-on-one meetings with other cabinet
secretaries to begin the coordination process across the
federal government. But she emphasized that the plan
given to The Times was a draft and had not been
Mr. Leavitt is leaving Saturday for a
10-day trip to at least four Asian nations, where he will
meet with health and agriculture officials to discuss
planning for a pandemic flu. He said at a briefing on
Friday that the administration's flu plan would be
officially released soon. He was not aware at the
briefing that The Times had a copy of the plan. And he
emphasized that the chances that the virus now killing
birds in Asia would become a human pandemic were unknown
but probably low. A pandemic is global epidemic of
"It may be a while longer, but
pandemic will likely occur in the future," he said.
And he said that flu planning would
soon become a national exercise.
"It will require school districts to
have a plan on how they will deal with school opening and
closing," he said. "It will require the mayor to have a
plan on whether or not they're going to ask the theaters
not to have a movie."
"Over the next couple of months you
will see a great deal of activity asking metropolitan
areas, 'Are you ready?' If not, here is what must be
done," he said.
A key point of contention if an
epidemic strikes is who will get vaccines first. The
administration's plan suggests a triage distribution for
these essential medicines. Groups like the military,
National Guard and other national security groups were
Beyond the military, however, the
first in line for essential medicines are workers in
plants making the vaccines and drugs as well as medical
personnel working directly with those sickened by the
disease. Next are the elderly and severely ill. Then come
pregnant women, transplant and AIDS patients, and parents
of infants. Finally, the police, firefighters and
government leaders are next.
The plan also calls for a national
stockpile of 133 million courses of antiviral treatment.
The administration has bought 4.3 million.
The plan details the responsibilities
of top health officials in each phase of a spreading
pandemic, starting with planning and surveillance efforts
and ending with coordination with the Department of
Much of the plan is a dry recitation
of the science and basic bureaucratic steps that must be
followed as a virus races around the globe. But the plan
has the feel of a television movie-of-the-week when it
describes a possible pandemic situation that begins, "In
April of the current year, an outbreak of severe
respiratory illness is identified in a small
"Twenty patients have required
hospitalization at the local provincial hospital, five of
whom have died from pneumonia and respiratory failure,"
the plan states.
The flu spreads and begins to make
headlines around the world. Top health officials swing
into action and isolate the new viral strain in
laboratories. The scientists discover that "the vaccine
developed previously for the avian strain will only
provide partial protection," the plan states.
In June, federal health officials find
airline passengers infected with the virus "arriving in
four major U.S. cities," the plan states. By July, small
outbreaks are being reported around the nation. It
As the outbreak peaks, about a quarter
of workers stay home because they are sick or afraid of
becoming sick. Hospitals are overwhelmed.
"Social unrest occurs," the plan
states. "Public anxiety heightens mistrust of government,
diminishing compliance with public health advisories."
Mortuaries and funeral homes are overwhelmed.
Presently, an avian virus has
decimated chicken and other bird flocks in 11 countries.
It has infected more than 100 people, about 60 of whom
have died, but nearly all of these victims got the
disease directly from birds. An epidemic is only possible
when a virus begins to pass easily among humans.