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| THE AVIAN FLU PANDEMIC | |
 October 5, 2005  | |
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| SUSAN DENTZER: For years scientists have warned of a devastating outbreak of bird or avian flu, starting in Asia, then spreading to the United States and the rest of the world. President Bush was asked about that prospect yesterday. PRESIDENT GEORGE W. BUSH: The people of the country ought to rest assured that we're doing everything we can. We're watching it, we're careful. We're in communications with the world. I'm not predicting an outbreak. I'm just suggesting to you that we better be thinking about it, and we are. SUSAN DENTZER: In the past two years, there have been reports of 116 known cases of avian flu and 60 deaths -- all of them in southeast Asia. Last week Indonesian officials announced the latest known death, that of a 27-year-old woman at this hospital in Jakarta. So far, the avian flu virus, dubbed H5N1, has apparently spread only from birds usually chickens, to humans but scientists worry the virus will mutate and then spread from one person to another. Since virtually no one has immunity to this new virus that could quickly spark a global pandemic. Experts fear that could result in the worst world flu pandemic since 1918 and 1919 when twenty million to forty million people died. Andrew Jakomas lived through that era. ANDREW JAKOMAS: We had little caskets for the little babies that stretched for four and five blocks, eight high, ten high. SUSAN DENTZER: The core issue for U.S. policymakers is how prepared the nation is to cope. Iowa Senator Tom Harkin raised that concern on the Senate floor last week. SEN. TOM HARKIN: We've had two disasters in the last four years: 9/11 and Katrina followed by Rita. And the federal government was totally unprepared for both despite clear warnings. Similarly we have been warned in no uncertain terms about avian flu, but our preparations so far have been grossly inadequate. SUSAN DENTZER: Recent congressional hearings have probed the fact that there's just one current vaccine that shows promise in fighting the virus. It could take months to make enough of it. Anti-viral drugs like Tamiflu and Relenza could help fight flu infections and cut the numbers of deaths. The US Government has stockpiled more than 4 million courses of therapy of both drugs. It ultimately wants to acquire 20 million but with many other nations also competing for the drugs it's having trouble getting more. DR. ANTHONY FAUCI: We certainly don't have enough right now. We're well aware of that which is the reason why we are in the process of negotiating to get more. SUSAN DENTZER: Another issue echoes one that surfaced after Hurricane Katrina, dividing up responsibility for preparing and responding to emergencies among the federal government, states and localities. Health and Human Services Secretary Michael Leavitt has emphasized that local officials must be ready to act first in the event of a flu pandemic. MICHAEL LEAVITT: It will be absolutely essential that local communities are well prepared, have a plan, and that we have sorted out who will be responsible for what. SUSAN DENTZER: President Bush suggested this week that the military could be called on to respond to a pandemic and to enforce mandatory quarantines. PRESIDENT GEORGE W. BUSH: If we had an outbreak somewhere in the United States, do we not then quarantine that part of the country? And who best to be able to effect a quarantine? One option is the use of a military that's able to plan and move. So that's why I put it on the table. I think it's an important debate for Congress to have. SUSAN DENTZER: Lawmakers have now vowed to devote far more attention in coming weeks to preparing and responding to a flu pandemic. GWEN IFILL: To assess the risks of avian flu and what options should be considered to prepare for it, we turn to: Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention; and Dr. William Schaffner, head of the Department of Preventive Medicine at Vanderbilt University. Dr. Gerberding, how serious is the potential for an avian flu pandemic here in the US? DR. JULIE GERBERDING: Most experts are saying that it's not really a question of if; it's a question of when. We're overdue for a pandemic and that's part of the reason why we're putting so much emphasis on preparedness. That and the situation that we see in Asia right now with this H5N1 strain which is very, very serious from our standpoint in public health. GWEN IFILL: What preparedness are you talking about? We just heard Dr. Fauci said there is not enough vaccine. What else is being done to prepare? DR. JULIE GERBERDING: We're working on a comprehensive strategy in the Department of Health and Human Services. One of the most important components is our ability to detect the emergence of a pandemic strain before it leaves the local community where the outbreak exists. That's going to take international cooperation, laboratories and scientists who are able to investigate and respond quickly. We also need those kinds of capabilities here in the United States as well as vaccine supplies, anti-viral drugs, a communications strategy for sure, and then the ability to take the public health measures to isolate and quarantine people if those steps become necessary. GWEN IFILL: Dr. Schaffner, what is your sense on how prepared we might be for any potential pandemic? DR. WILLIAM SCHAFFNER: Well, preparation is a process. It's a process that's ongoing. We're better prepared than we were, but we still have quite a ways to go. GWEN IFILL: What does that mean quite a ways? How much of a ways? Will we get to that way before the actual pandemic hits? DR. WILLIAM SCHAFFNER: Well, Dr. Gerberding mentioned that the federal government has an influenza pandemic preparedness plan in the works, and we have seen early drafts of that. In my conversations with colleagues over the last several days, they're really waiting for the last draft to come down so that they can dovetail their plans into what it is that the federal government intends to do. In the meantime, we have to think globally but we must act locally. And so at the state level in communities and in my own hospital, for example, we have our own contingency plans and, certainly at Vanderbilt, we have drilled those plans several times. We hope that we are reasonably well prepared. GWEN IFILL: Now, let me ask you this, Dr. Schaffner and I want to ask Dr. Gerberding as well, the president yesterday suggested at least opened the door to the possibility of the use of the military in the case of a widespread problem and also to quarantines. What did you think about that as part of a plan? DR. WILLIAM SCHAFFNER: I'm a little skeptical about that because I think this is the sort of infection -- should it be introduced into the United States -- it wouldn't just go to one or two small places and stay there and have us be able to detect that infection and then kind of put a circle around it and keep folks in and keep folks out. I think it will spread more widely than that, and I think most public health folks are dubious about the use of military to enclose Asian influenza. GWEN IFILL: Dr. Gerberding, how do you respond to that kind of skepticism? DR. JULIE GERBERDING: Well, we've made a strategic decision in the department that our initial strategy will be containment if that's feasible. And obviously containment will work best if we find the virus early and we can act in one or a small number of locations. If we are dealing with the situation where there are multiple locations of infection, then we'll have to look at the local situations as Dr. Schaffner has suggested to determine at the local level -- is containment possible? Do we need to quarantine the people who are exposed to prevent spread to vulnerable people? Or are we going to have to fall back on the anti-viral treatments and the vaccine that is not going to be able for some period of time? There are certainly scenarios where the use of military personnel or the National Guard to maintain civil order, particularly in the context of scarce resources or an overwhelming epidemic, where we would need to have that kind of capability to enforce public health laws and to take the steps necessary to protect people's health. I hope we never have that situation, but it would be foolish not to at least consider it and plan for that as a possibility. GWEN IFILL: Dr. Gerberding, in Susan Dentzer's piece she quoted Senator Tom Harkin, who suggested that maybe some of this talk of bringing the military in for disaster relief is a little post-Katrina talk. Is this something that's been discussed all along? DR. JULIE GERBERDING: Well, we have looked at the Department of Defense for help in a variety of public health operations. For example, just last year with the tsunami, it was the Department of Defense that provided the heavy lifting and helped coordinate among all of the countries with military presence in the region to help out the tsunami victims. The military has enormous operational capacity. At CDC we often turn to them for advice or help on how to improve our own operations. So I think we have an amazing resource. We don't have to conjure up the image of armed people policing our streets to recognize that the DOD has some wonderful attributes to offer us and some experience and some real capabilities that we might benefit from. GWEN IFILL: Dr. Schaffner, what would you like to see in a federal final plan as you described it, were it to come down, say, tomorrow from Mike Leavitt at the Department of Health and Human Services? What would you like to see them focus on: Prevention, on virus treatment; on quarantining and military relief? DR. WILLIAM SCHAFFNER: Well, yes. All of those things. It will have to be a multifaceted plan, seriously, because we'll have to take care of the sick. We'll want to immunize those who are not yet ill. We'll want to distribute the anti-virals appropriately. We need a good communications strategy so that the people in the United States know what we're about and what the plan is. There will have to be some security locally provided by local law enforcement. I like the emphasis on the military providing strong logistic support. They do that wonderfully well. It will have to be a multifaceted plan. And then there are some hard questions. Who will buy the vaccine? Under what conditions will the anti-virals be released and distributed? And once we get the federal plan, a lot of those key elements will be in place and the state plans and those of us in hospitals and smaller communities can also begin to key in on those features and once again visit our plans. As Dr. Gerberding and I both agree, planning -- preparedness planning is never a final event. You keep working on it. You develop relationships that you will rely upon when things really happen. And you can call up your colleague with whom you have drilled and worked on problems in the past. It's preparing for flexibility and being able to respond appropriately. GWEN IFILL: And, Dr. Gerberding, finally, you know, last year after the flu season, there was a lot of reports of running out of flu vaccine. We heard that there are 4 million courses of vaccine for this bird flu that exist and they need 20 million. How do you go about reassuring people that the federal government, that the private sector have enough vaccine if something like this should happen? DR. JULIE GERBERDING: When and if a flu pandemic virus emerges, we will need to make vaccine to that virus so it's really not possible to stock pile a vaccine in large quantities in advance. What we're doing as a nation is stockpiling an H5 vaccine that we believe would have some potential for cross protection, but we can't count on that to be a protective vaccine. And that's why our ability to recognize this emergence when it occurs to develop the seed vaccine products quickly and then scale up our entire nation's vaccine capacity to develop a pandemic vaccine is so essential. Those are the kinds of things that Secretary Leavitt and the whole department, the FDA, the NIH, the CDC, we're all working to make sure that our nation can improve its ability to reliably make large quantities of vaccine for just this kind of an emergency. GWEN IFILL: All right. Dr. Julie Gerberding and Dr. William Schaffner, thank you both very much. DR. JULIE GERBERDING: Thank you. DR. WILLIAM SCHAFFNER: Thank you. |
