U.S. efforts to counter a possible influenza pandemic, including an outbreak of bird flu, are moving slowly and may be inadequate in an emergency, several witnesses told lawmakers Thursday.
Experts say the Bush administration has lagged in finalizing plans for responding to a widespread flu outbreak, which scientists warn could potentially cause widespread fatalities and economic disruptions. They also call moves to stockpile antiviral drugs capable of muting the severity of bird flu inadequate.
Government officials defended their planning in congressional hearings, saying that they plan on completing a national plan by the end of the summer.
Bird flu has infected millions of poultry livestock and other birds in Southeast Asia and has sickened 97 humans this year as of May 19, according to the World Health Organization. Fifty-three people have died of the disease.
Humans Lack Bird Flu Immunity
The disease is especially alarming to health officials because humans lack immunity to the bird flu virus, known as H5N1, and no effective vaccine is ready for mass use. That raises the prospect of a pandemic of a flu strain to which virtually none of the human population is protected.
Health officials have seen only one case where evidence points to human-to-human spread of bird flu, says CDC director Julie M. Gerberding, MD. But the potential for its spread among humans has sent health authorities in several countries scrambling to secure supplies of drugs able to treat it.
But a WHO report earlier this month suggested that the bird flu virus may be changing in ways to make it increasingly better at person-to-person spread.
Governments in the U.K. and France have ordered enough doses of the flu drug Tamiflu to treat 25 percent of their populations in the event of an outbreak. U.S. authorities have stockpiled 2.3 million doses, enough to treat less than 1 percent of the population.
Flu Vaccine Stockpile Inadequate?
Experts and several lawmakers criticized Bush administration officials over the stockpile, saying it will not go far in the event that a pandemic emergency depletes commercially available supplies.
"The 2.3 million doses we have in the stockpile now clearly are inadequate," says Andrew T. Pavia, MD, chairman of the Infectious Diseases Society of America task force on pandemic influenza. The group recommended Thursday that the government purchase enough Tamiflu to treat half the U.S. population.
Officials said they are moving to purchase more drugs for the stockpile but defended their decision not to engage in a massive buildup. While the drug can lessen disease severity if taken with 48 hours of the start of symptoms, no studies have shown that it improves patients' chances of surviving bird flu, Gerberding says.
"Making enormous purchases in stockpiling may be a premature decision," she says. "The studies simply haven't been done."
"We don't want you to get the impression that this is a knockout drop for the virus. It is not," Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases, told lawmakers.
Others criticized Bush health officials over a flu epidemic response plan that has been in progress for more than five years. A draft of the plan was completed in August 2004 but remains incomplete in key areas, a Government Accountability Office official says.
Marcia Cross, the agency's director for health care, told lawmakers that federal officials have yet to determine what role the federal government will take in purchasing supplies of vaccine against bird flu and other flu strains. The government has also not cemented which population groups would be priorities for emergency vaccination in the event of an outbreak or finalized plans for possible quarantines or travel restrictions.
The delay has left state health departments unable to properly plan for flu emergencies, she says.
"It is important for the federal government and the states to work through these issues before we are in a time of crisis," Cross says.
Bruce G. Gellin, MD, who heads the National Vaccine Program Office in the Department of Health and Human Services, told lawmakers that the plan would be finalized "this summer."
An experimental bird flu vaccine is undergoing safety and effectiveness testing at the National Institutes of Health. Early safety data are expected this summer, Fauci says.
Questions over increasing the U.S. flu vaccine supply extend beyond a bird flu vaccine, however. Last year's vaccine shortage has resparked a debate in Congress over how to offer incentives to vaccine makers to enter the flu market. Only one company, Sanofi-Pasteur, has a flu vaccine manufacturing facility in the U.S.
"With ordinary vaccine production so low, the amounts we can produce in the face of a global pandemic are insufficient," says Rep. Joe Barton, R-Texas, chairman of the House Energy and Commerce Committee.
SOURCES: Julie M. Gerberding, MD, director, CDC. Andrew T. Pavia, MD, Infectious Disease Society of America. Anthony Fauci, MD, director, National Institute of Allergy and Infectious Disease. Marcia Cross, director, health care, Government Accountability Office. Bruce G. Gellin, MD, director, National Vaccine Program Office. Rep. Joe Barton, R-Texas.