Plan For Flu Pandemic Revealed
Multi-Agency Proposal Awaits Bush's
By Ceci Connolly Washington Post Staff Writer Sunday,
April 16, 2006; A01
President Bush is expected to approve soon a national
pandemic influenza response plan that identifies more
than 300 specific tasks for federal agencies, including
determining which frontline workers should be the first
vaccinated and expanding Internet capacity to handle what
would probably be a flood of people working from their
The Treasury Department is poised to sign agreements with
other nations to
produce currency if U. S. mints cannot operate.
The Pentagon, anticipating difficulties acquiring
supplies from the Far East, is considering stockpiling millions of latex
gloves. And the Department of Veterans Affairs has
developed a drive-through medical
exam to quickly assess patients who suspect they
have been infected.
The document is the first attempt to spell out in some
detail how the government would detect and respond to an
outbreak, and continue functioning through what could be
an 18-month crisis, which in a worst-case scenario could
kill 1.9 million Americans. Bush was briefed on a draft
of the implementation plan on March 17. He is expected to
approve the plan within the week, but it continues to
evolve, said several administration officials who have
been working on it.
Still reeling from the ineffectual response to Hurricane
Katrina, the White House is eager to show it could manage
the medical, security and economic fallout of a major
outbreak. In response to questions posed to several
federal agencies, White House officials offered a
briefing on the near-final version of its 240-page plan.
When it is issued, officials intend to announce several
vaccine manufacturing contracts to jump-start an industry
that has declined in the past few decades.
The background briefing and on-the-record interviews with
experts in and out of government reveal that some
agencies are far along in preparing for a deadly
outbreak. Others have yet to resolve basic questions,
such as who is designated an essential employee and how
the agency would cope if that person were out of
"Most of the
federal government right now is as ill-prepared as any
part of society," said Michael Osterholm, director
of the Center for Infectious Disease Research and Policy
at the University of Minnesota. Osterholm said the
administration has made progress but is nowhere near
prepared for what he compared to a worldwide "12- to
Many critical decisions remain to be made. Administration
scientists are debating how much vaccine would be needed
to immunize against a new strain of avian influenza, and
they are weighing data that may alter their strategy on
who should have priority for antiviral drugs such as
Tamiflu and Relenza.
The new analysis, published in Proceedings of the
National Academy of Sciences, suggests that instead of
giving medicine to first responders and health-care
workers, as currently planned, it might be wiser to give
the drugs to every person with symptoms and others in the
same household, one senior administration official
The approach offers "some real hope for communities to
put a dent in the amount of illness and death, if we go
with that strategy," a White House official said.
Each year, about 36,000 Americans die from seasonal
influenza. A worldwide outbreak, or pandemic, occurs when
a potent new, highly contagious strain of the virus
emerges. It is a far greater threat than annual flu
because everyone is susceptible, and it would take as
much as six months to develop a vaccine. The 1918
pandemic flu, the worst of the 20th century, is estimated
to have killed more than 50 million people worldwide.
Alarm has risen because of the emergence of the most
dangerous strain to appear in decades -- the H5N1 avian
flu. It has primarily struck birds, but about 200 people
worldwide have contracted the disease, and half have
project that the next pandemic -- depending on severity
and countermeasures -- could kill 210,000 to 1.9 million
To keep the 1.8 million federal workers healthy and
productive When will this happen? through a pandemic,
administration would tap into its secure stash of
medications, cancel large gatherings, encourage schools
to close and shift air traffic controllers to the busier
hubs -- probably where flu had not yet struck.
Gotta keep those disease vectors in the air. Retired federal employees
would be summoned back to work, and National Guard troops
could be dispatched to cities facing possible
"insurrection," said Jeffrey W. Runge, chief
medical officer at the Department of Homeland
The administration hopes to help contain the first cases
overseas by rushing in medical teams and supplies. "If
there is a small outbreak in a country, it may behoove us
to introduce travel restrictions," Runge said, "to help
stamp out that spark."
However, even an effective containment effort would
merely postpone the inevitable, said Ellen P. Embrey,
deputy assistant secretary for force health preparedness
and readiness at the Pentagon. "Unfortunately, we believe
the forest fire will burn before we are able to contain
it overseas, and it will arrive on our shores in multiple
locations," she said.
As Katrina illustrated, a central issue would be "who is
ultimately in charge and how the agencies will be
coordinated," said former assistant surgeon general Susan
Blumenthal. The Department of Health and Human Services
would take the lead on medical aspects, but Homeland
Security would have overall authority, she noted. "How
are those authorities going to come together?"
Essentially, the president would be in charge, the White
House official replied. Bush is expected to adopt
post-Katrina recommendations that a new interagency task
force coordinate the federal response and a high-level
Disaster Response Group resolve disputes among agencies
or states. Neither entity has been created.
Analysts at the Government Accountability Office found
that earlier efforts by the administration to plan for
disasters were overly broad or simply sat on a shelf.
"Our biggest concern is whether an agency has a clear
idea of what it absolutely has to do, no matter what,"
said Linda Koontz, director of information management
issues at the GAO. "Some had three and some had 400
essential functions. We raised questions about whether
400 were really essential."
In several cases, agencies never trained for or rehearsed
emergency plans, she said, causing concern that when
disaster strikes, "people will be sitting there with a
500-page book in front of them."
government -- as well as private businesses -- should
expect as much as 40 percent of its workforce to be out
during a pandemic, said Bruce Gellin, director of the
National Vaccine Program Office at HHS. Some will be sick
or dead; others could be depressed, or caring for a loved
one or staying at home to prevent spread of the virus.
"The problem is, you never know which 40 percent will be
out," he said.
The Agriculture Department, with 4 million square feet of
office space in metropolitan Washington alone, would
likely stagger shifts, close cafeterias and cancel
face-to-face meetings, said Peter Thomas, the acting
assistant secretary for administration.
The department has bought masks, gloves and hand
sanitizers, and has hired extra nurses and compiled a
list of retired employees who could be temporarily
rehired, he said. A 24-hour employee hotline would
provide medical advice and work updates. And as it did
during Katrina, Agriculture has contingency plans for
meeting the payrolls of several federal departments
totaling 600,000 people.
Similarly, the Commerce Department has identified its
eight priority functions, including the ability to assign
emergency communication frequencies, and how those could
be run with 60 percent of its normal staff.
Operating the largest health-care organization in the
nation, the VA
has directed its 153 hospitals to stock up on other
medications, equipment, food and water, said chief
public health officer Lawrence Deyton. "But it's a few
days' worth, not enough to last months," he added.
Anticipating that some nurses may be home caring for
family members -- and to reduce the number of patients
descending on its hospitals -- the VA intends to put
nurses on its toll-free hotline to help veterans decide
whether they need professional medical care. At many VA hospitals, nurses
and doctors would stand in the parking lots armed with
thermometers and laptop computers to do drive-through
exams. Modeled after its successful drive-through
vaccination program last fall, the parking-lot triage is
intended to keep the flow of patients moving rapidly,
Much of the federal government's plan relies on quick
distribution of medications and vaccine. The Strategic
National Stockpile has 5.1 million courses of Tamiflu on
hand. The goal is to secure 21 million doses of Tamiflu
and 4 million doses of Relenza by the end of this year,
and a total of 51 million by late 2008.
In addition, the administration will pay one-quarter of
the cost of antivirals bought by states. The Pentagon,
VA, USDA and Transportation Department have their own
stockpiles -- and most intend to buy more as it becomes
Blumenthal, the former assistant surgeon general,
questioned why two years after Congress approved a $5.6
billion BioShield program to develop new drugs and
vaccines, so little progress has been made.
Homeland Security's Runge has a different concern: "One
of the scariest thoughts is, if this country has
successfully developed a vaccine within six months of an
outbreak or our supply of antivirals is greater, there
may be a rush into the United States for those
And even if those fears do not materialize, officials
have warned that the federal preparations go only so far.
Much is left to the states, communities and even
that fails to prepare -- with the expectation that the
federal government can come to the rescue -- will be
tragically wrong," HHS Secretary Mike Leavitt said
in a speech April 10. The administration is posting
information on the Internet at http://www.pandemicflu.gov/