NEW YORK – Editor's note: This is the last in a series on avian influenza that has been featured all this week on FOXNews.com.
State and local officials say they need more help from the federal government to make sure they have enough money and personnel to care for their residents in case bird flu or some other sort of pandemic influenza crosses the Atlantic or Pacific oceans.
President Bush on Nov. 1 released his $7.1 billion pandemic and avian influenza strategy, $583 million of which is designated for state use in preparing for an epidemic. About $100 million is supposed to be used to help states complete and test their pandemic plans before a deadly outbreak strikes. Congress has yet to approve the funding.
"We are woefully underfunded," said Dr. Rex Archer, president of the National Association of County and City Health Officials and health director of Kansas City, Mo. "The president's plan for pandemic influenza has some great points in it, frankly, many parts we should have started five years ago and we really need to get moving on.
"It recognizes that everything happens on the local level and that's where we save lives. Unfortunately, it doesn't put its money where its mouth is and doesn't actually fund the local levels to become better prepared," Archer said.
States are being asked to pay 75 cents of every $1 that's spent on medicines and vaccines stockpiled ahead of a pandemic flu; their tab would be about $510 million.
That's a real problem for many states already struggling with tight budgets, which is why the federal government needs to make sure states actually take the necessary steps to prepare, former New York City Health Commissioner Margaret Hamburg told FOX News.
"You cannot rely on states and localities to make individual decisions whether they need the medication and to pay for it," Hamburg said. "Right now there's an unfunded mandate on states and localities to purchase these critical drugs and vaccines and I think we can't afford to do that."
The H5N1 avian influenza virus, or "bird flu," — found predominantly in poultry but known to have jumped to animals like cats and pigs — has infected at least 130 people in five Asian countries and killed 69 of them. That's a better than 50 percent mortality rate. From China to Ukraine, birds are being killed by the millions to decrease the chances of human transmission.
According to the Health and Human Services Department, in theory the United States could see up to 722,000 pandemic influenza cases at the end of a six-week outbreak that could begin in a small Thai village before spreading to Europe and the United States. Within 16 weeks, 92 million Americans could be infected.
Health officials also fear that H5N1 could mutate, and if that happens, it could quickly be transmitted among humans, a scenario that would greatly increase the current percentage of mortalities. Many medical experts agree that even if bird flu proves not to be the next pandemic, the world is due for one or another strain of virus.
H5N1 has demonstrated unprecedented scope, magnitude and speed at which it is spread, Rajeev Venkayya, senior director for biodefense at the White House Homeland Security Council, said during an HHS conference on avian flu in Washington last week.
"When you combine that with the fact this is a virus that has demonstrated the biological ability to infect humans … you realize we might be rewinding the tape — we might be watching history repeat itself," he said, referring to the 1918 Spanish flu pandemic that killed about 40 million people. "This is a remarkable opportunity."
'We're Going to Be Ready for Anything'
State and local officials have used the opportunity provided by the increased focus on public health to boost infrastructures that have been somewhat neglected in the absence of an impending storm.
"It's going to take everybody, and if we're prepared for avian flu, we're going to be ready for anything," said North Carolina State Health Director Leah Devlin, who also serves as president of the Association of State and Territorial Health Officials. "The daily preparations for whatever we need to deal with in public health, whether it be natural disaster or communicable disease outbreak, or truly something enormous like pandemic flu, if we're ready for pandemic flu, we're ready on a daily basis for the rest."
On Wednesday in Minneapolis HHS will hold the first in a series of local meetings designed to ensure state, local and federal health officials are prepared and know what to do in the case of a pandemic. Federal officials like HHS Secretary Michael Leavitt, Centers for Disease Control and Prevention chief Julie Gerberding and many other health officials will be on hand.
"One of the reasons Minnesota has been selected for this first meeting is that we have a particularly strong surveillance system and partnership between our state and public health officials, hospitals, health clinics and labs so that we can quickly identify any potential pandemic," said Brian McClung, spokesman for Minnesota Gov. Tim Pawlenty who, along with Arizona Gov. Janet Napolitano, are heading up the National Governors Association's committee on avian and pandemic flu.
HHS has advised states to come up with plans that will map out the roles and responsibilities of state and local agencies and officers; build on existing response plans for bioterorism events, SARS and other infectious disease emergencies; address any legal issues surrounding hospital staffing, patient care and quarantine; and be regularly reviewed and updated.
During this series of meetings, local officials likely will debate the effectiveness of isolation and quarantines. They also are expected to ask for more guidance on "priority populations" — who will get the vaccine and antivirals first and methods of distribution, whether it be through doctors' offices, clinics or mass vaccinations.
"That's going to be particularly important because there won't be enough vaccine and they're going to have to make some tough decisions," said Jeff Levi, senior policy advisor at Trust for America's Health.
Federal officials maintain that if demand increases for the annual flu vaccine, drug companies will be more willing to invest in pandemic vaccine production.
But local health officials say they worry that if they can't assure their residents they have the seasonal vaccine process under control, people won't have faith in their government's ability to ensure everyone has vaccines and antivirals when and if a pandemic flu hits.
Already, the ability to produce flu vaccine for ordinary annual influenza has proven difficult. Earlier this year, flu shots were only supposed to be given to the elderly, infants, people with chronic illnesses and health workers during the 2005-2006 flu season but those restrictions were recently lifted. Now, the CDC says this year's supply of flu vaccine will reach 80 million doses before the year's end. The U.S. population is 297 million.
Doctors are ordering more doses than they can get, seemingly to compensate for the shortage experienced last year. But Oxford, England-based, Chiron Corp., a major producer of the annual U.S. influenza vaccine, is producing less doses than it originally planned even as some states have reported shortages. Chiron attributed production delays to problems at the company’s vaccine facility in Liverpool, England, and changes in production methods required to correct those problems.
As for other drugs, antiviral companies have told some states it will be at least six months until states are even considered as future recipients of large doses of medicines to help combat the effects of bird flu or pandemic influenza.
While Leavitt talks about "putting the pill in the palm of the people," the United States needs the surge capacity that "effectively puts the shot in the arm," North Carolina's Devlin said. "It's very hard to be credible that we're going to be able to manage pandemic flu if we can't manage the regular flu season. So we really need that fix."
Lessons From Katrina
Many officials point to Hurricane Katrina as classic case of how states can never be over-prepared for a catastrophic event. In Louisiana, for example, no distribution system was effective in in getting medicine and other items to thousands of hurricane evacuees.
"We certainly learned a very painful lesson through Katrina. I think what's different is, Katrina happened so that you lost the traditional health care system because the hospitals were flooding," Levi said. "What it did raise was when there's an interruption in the supply chain, we get into trouble very quickly."
"Hurricane Katrina was a wakeup call. … We learned that many of our health services were not connected through a phone system or Internet," former Assistant Surgeon General Susan Blumenthal said during a recent Council on Foreign Relations conference on avian flu.
During Katrina, responsibility for many response areas simply "fell apart," William, Winkenwerder, assistant secretary of health affairs for the Defense Department, said during that event.
Officials as high up as the president need to be able to rely on officials on the ground to make sure effective response plans are put into place, Winkenwerder added, so it's up to state and local officials to make sure they're as ready as they can be.
But where the nation came together by sending in volunteers and rescuers to New Orleans and other areas hard-hit by Katrina, that response may not be possible if pandemic flu batters the United States.
"When you look at a natural disaster like Hurricane Katrina, those states relied on other states to share assets and if we end up with the bird flu, it's going to be affecting everybody at the same time so you won't necessarily have the ability to share assets or rely on another state to send public health officials or first responders," McClung, Pawlenty's spokesman, said.
Blumenthal suggesting setting up grassroots-level public health systems modeled after AmeriCorps, which is a network of local, state, and national service programs of 70,000 Americans who train how to meet the country's critical needs in education, public safety, health, and the environment. AmeriCorps members serve with more than 3,000 nonprofits, public agencies, and faith-based and community organizations.
"You can't put a show on without a dress rehearsal, so everyone needs to feel empowered because there will be mass panic" if pandemic flu hits, Blumenthal said.