TOPICS > Health

U.S. Government Releases New Plans for Pandemic Flu

May 3, 2006 at 6:17 PM EDT

RAY SUAREZ: For years, government and health officials have been warning the U.S. needs a more comprehensive strategy to combat a global flu pandemic.

The rise of a deadly strain of avian flu has heightened those fears. There’s concern the virus might mutate into a form that could spread rapidly from human to human.

The H5N1 strain was first detected in birds in 1996, and appeared in humans a year later, and reappeared in 2003. Since then, it’s infected more than 200 people in nine countries and killed more than half.

Most victims lived in Southeast Asia, and most had direct contact with infected poultry.

Reacting to Moussaoui verdict

In recent months, the H5N1 virus in birds has spread to nearly 50 countries on three continents. The virus' rapid spread has been blamed mainly on migratory birds who pass H5N1 to domesticated flocks. That's prompted European countries to vaccinate free-range birds and cull infected populations.

The virus is widely expected to be present in U.S. birds before the end of the year. And that has helped prompt the administration to draft a plan to combat the worse-case scenario: a modern pandemic flu that would kill between 200,000 and 2 million Americans.

Joining me now is the president's homeland security adviser Frances Townsend.

Welcome to the program.

FRANCES TOWNSEND, Homeland Security Adviser: Thank you, Ray.

RAY SUAREZ: Before we take a look at the administration's strategy, let's speak a bit about the Moussaoui verdict that came in today. You work in homeland security. What's your reaction?

FRANCES TOWNSEND: Well, you know, Ray, I'm a former federal prosecutor. I spent six years in the southern district of New York, the U.S. attorney's office, and then another six years or so in the Justice Department.

I will tell you that I view today's verdict as a victory for the justice system, for the prosecutor, but most importantly for the victims. What I think will resonate in people's minds, the memory is of the courage and perseverance of those families.

What we wanted to see, what every American wants to see is justice done. Today, justice triumphed over evil; this man will spend the rest of his life in jail, and that is a victory for the American people but, again, most importantly for the victims' families.

Preparing for the pandemic

RAY SUAREZ: Now to pandemic influenza. You took pains today to say that we don't know if, in fact, a pandemic influenza outbreak will ever occur, but then you laid out plan for what happens if it does. What's the triggering event? What do you have to see to set these plans into motion?

FRANCES TOWNSEND: Well, let me back up for a minute, because today isn't the beginning of the planning process. As you know, the administration has invested over $6 billion since 2001 in public health preparedness.

In addition to that, going back to September of last year in the U.N. General Assembly, the president put this on the international agenda as a priority for action in nations around the world, because, after all, our best defense is to increase the capability for surveillance, detection and response in nations around the world.

We've already seen the outbreak in the bird population. And the president wanted to make it a priority.

He released his strategy then in November, along with a budget request to Congress for $7.1 billion, largely focused on vaccine production, but including working with state and local authorities, increasing stockpiles of anti-virals, and other pieces of the strategy.

Congress has appropriated by emergency supplemental $3.8 billion of that. We will seek another $2.3 billion to advance the strategy in the '07 budget and then another billion in '08.

RAY SUAREZ: So today's plan is the fruit of that process. What does it call for to happen, once you realize there's been human-to-human transmission?

FRANCES TOWNSEND: Our implementation plan really tracks with the World Health Organization. As you know, the World Health Organization breaks the pandemic into six stages.

What we did was we took the World Health Organization's six stages and subdivided that, so we could show what actions we would take, what policy considerations that we would be confronting.

One of the biggest triggers -- we will look for the -- we're already beyond sort of the first stages in the World Health Organization's preparedness, and planning, and reaction, because we've already seen bird-to-bird transmission.

And then, in terms of human infection, what we've seen is those who had direct contact really with birds who are infected are at greatest risk, but there are additional triggers later in pandemic. For example, if there was human-to-human contact outside our borders, the plan goes through: What are the kinds of actions we would begin to take?

For example, we would look to see whether or not we were willing to make available up to 5 percent of our strategic national stockpile of things like anti-virals to contribute to an international effort so we could contain it overseas, if that's where the first outbreak was.

We would ramp up our measures of preparedness, if there was sustained or pervasive human-to-human contact overseas. We would institute screening measures at our borders. And even before borders, we would begin to institute screening procedures at points of departure, in-flight and upon arrival.

Initial steps during an outbreak

RAY SUAREZ: So what I'm hearing you saying is step one is, first, try to keep it from entering the United States, aid other countries, aid other governments. Then there is a detected case here on American soil. What measures go into effect?

FRANCES TOWNSEND: Well, part of the plan looks at: What are the measures that we can take at all levels of government? Appendix A of the report talks about what you can do at an individual level, a family level, businesses, universities.

We know, for example, from prior pandemics, school-age children are at greatest risk. And so we talk about elementary schools, but also universities and colleges.

Businesses, nonprofits, what are the source of plans and policies that you can do now to have them in place before a crisis? And those are the sorts of things that you begin to talk about. What are the sort of measures communities can take?

For example, social distancing. Should you be canceling and considering canceling large public gatherings? Should schools be canceled and children stay home because they're safer in an infected environment? Those are the sorts of measures that, based on the expertise of the science, frankly, in the federal and international community, are measures that we would then begin to make.

RAY SUAREZ: More social distancing, for instance, not shaking hands in social situations, keeping three-plus feet distance. Who would make sure that those messages get out to individual workers, to commuters, to the places where you want these practices followed?

FRANCES TOWNSEND: You know, Ray, Secretary Leavitt at Health and Human Services, Secretary Johanns, we've begun that communications effort already.

At the end of last year, Secretary Leavitt invited into Washington representatives of public health services from around the country, from all 50 states. He then went on a 50-state tour visiting with public health officials around the country, talking to them about risk communications.

What do you tell people so that they feel like they have adequate information to make the best decisions for themselves and their families?

I was asked: How would you enforce these sort of unnecessary -- if you're suggesting to people don't take unnecessary travel, how do you enforce that? Well, the answer is, by communicating directly with the American people, it's the commonsense factor.

If you've got children and you know that they're at greater risk if you take them to the mall or to school, people are going to stay home. And so it's less a question of: How does the government enforce it? As you point out, how do we communicate with people so that they have enough information to make good decisions?

Communicating during a crisis

RAY SUAREZ: Well, in planning these measures, the public education, getting the word out, trying to stop people at the border, how do you strike a balance between shutting the country down or having everything going on and just keeping your fingers crossed that nobody is going to get sick? There has to be some middle point where you figure out: This is where it is.

FRANCES TOWNSEND: No, that's right. You know, in some sense, shutting the country down is counterproductive, because we do need to be able to move anti-virals and presumably vaccines. We do need to be able to move emergency responder personnel.

The question has been asked: Well, what about just shutting the border entirely? Well, what you balance that against is: What is the effectiveness of that sort of technique? Well, the answer is, what we found is we may delay it a week or two, but ultimately it won't stop a pandemic from coming here.

I should be clear there's no indication now that this bird virus will actually become a human-to-human pandemic, but we believe it's the responsibility of the government to plan for the worst-case scenario so that, no matter what happens, we are prepared to respond effectively for the American people.

RAY SUAREZ: Both in the September 11th terrorist attacks and in Hurricane Katrina, one of the things in the postmortems that came up was how difficult it was for agencies to talk to each other, to get necessary information out, to get word to individuals about what to do. How do you deal with that in this very education-needy environment?

FRANCES TOWNSEND: Well, part of what we thought was really very important was, one, total transparency. It is unprecedented the detail that we lay out in the report.

We talk very clearly about: What are the policy decisions we will be confronted with at various stages and decisions that we will need to make?

We also, when we talk about -- there are 300 specific actions that we call on departments and agencies to take. They are very specific; they set out very specific goals, and objectives, and very aggressive time lines.

Prior plans haven't done that. We will be able to measure what our effectiveness is and how far, what progress we're making, in terms of the implementation before the crisis.

RAY SUAREZ: And who's in charge? There are a lot of agencies that would seem to have a piece of this, but is there one lead agency that's going to oversee all of this as it's phased out?

FRANCES TOWNSEND: Well, and that's addressed directly. Particularly in the wake of Katrina, we thought we should be very clear, and that's addressed directly in the implementation plan.

As you know, Ray, in a national crisis, it's the president of the United States who's in charge. But, as we made the point in the lessons learned to Katrina, we ought to be looking to the people with the greatest expertise in a particular specialty area, like public health, for advice in that area.

And so, obviously, the president will look to Secretary Leavitt to provide public health advice, but there will be many other issues: transportation, border security, law enforcement-type issues.

And so, by statute, Secretary Chertoff and the Department of Homeland Security are the president's incident managers. And so Secretary Chertoff will be responsible for coordinating across the government the many different kinds of assistance and involvement of the federal government and support the public health response provided -- and the advice provided by Secretary Leavitt.

RAY SUAREZ: But very briefly, a lot of the personal contact, people seeing what's happening, is going to be much, many layers down from that. Isn't it county, city authorities, state people?

FRANCES TOWNSEND: Absolutely. You're absolutely correct, and that's exactly why Secretary Leavitt has made such a priority of reaching out to state and local public health officials to encourage them and give them advice about pre-pandemic planning.

RAY SUAREZ: Frances Townsend, thanks for joining us.

FRANCES TOWNSEND: Ray, thank you.