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‘No Nation Can Afford to Ignore This Threat’

America Prepares for Avian Flu
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The avian flu virus has been spreading through bird populations in Asia and Europe, and has so far killed several dozen infected humans. If the virus mutates so that it can pass easily from human to human, it could spread quickly around the globe, killing untold thousands. The Bush administration has been developing a strategy to prepare for and respond to such an influenza pandemic. President Bush outlined the plan in a speech at the National Institutes of Health on November 1, 2005, excerpted below.

Our strategy is designed to meet three critical goals: First, we must detect outbreaks that occur anywhere in the world; second, we must protect the American people by stockpiling vaccines and antiviral drugs, and improve our ability to rapidly produce new vaccines against a pandemic strain; and, third, we must be ready to respond at the federal, state, and local levels in the event that a pandemic reaches our shores.

To meet these three goals, our strategy will require the combined efforts of government officials in public health, medical, veterinary, and law enforcement communities and the private sector. It will require the active participation of the American people. And it will require the immediate attention of the United States Congress so we can have the resources in place to begin implementing this strategy right away.

The first part of our strategy is to detect outbreaks before they spread across the world. In the fight against avian and pandemic flu, early detection is our first line of defense. A pandemic is a lot like a forest fire: if caught early, it might be extinguished with limited damage; if allowed to smolder undetected, it can grow to an inferno that spreads quickly beyond our ability to control it. So we’re taking immediate steps to ensure early warning of an avian or pandemic flu outbreak among animals or humans anywhere in the world.

In September at the United Nations, I announced a new International Partnership on Avian and Pandemic Influenza — a global network of surveillance and preparedness that will help us to detect and respond quickly to any outbreaks of disease. The partnership requires participating countries that face an outbreak to immediately share information and provide samples to the World Health Organization. By requiring transparency, we can respond more rapidly to dangerous outbreaks.

Since we announced this global initiative, the response from across the world has been very positive. Already, 88 countries and nine international organizations have joined the effort. Senior officials from participating governments recently convened the partnership’s first meeting here in Washington.

Together, we’re working to control and monitor avian flu in Asia, and to ensure that all nations have structures in place to recognize and report outbreaks before they spread beyond human control. I’ve requested $251 million from Congress to help our foreign partners train local medical personnel, expand their surveillance and testing capacity, draw up preparedness plans, and take other vital actions to detect and contain outbreaks.

A flu pandemic would have global consequences, so no nation can afford to ignore this threat, and every nation has responsibilities to detect and stop its spread.

Here in the United States, we’re doing our part. To strengthen domestic surveillance, my administration is launching the National Biosurveillance Initiative. This initiative will help us rapidly detect, quantify and respond to outbreaks of disease in humans and animals, and deliver information quickly to state, and local, and national and international public health officials. By creating systems that provide continuous situational awareness, we’re more likely to be able to stop, slow, or limit the spread of the pandemic and save American lives.

The second part of our strategy is to protect the American people by stockpiling vaccines and antiviral drugs, and accelerating development of new vaccine technologies. One of the challenges presented by a pandemic is that scientists need a sample of the new strain before they can produce a vaccine against it. This means it is difficult to produce a pandemic vaccine before the pandemic actually appears — and so there may not be a vaccine capable of fully immunizing our citizens from the new influenza virus during the first several months of a pandemic.

To help protect our citizens during these early months when a fully effective vaccine would not be available, we’re taking a number of immediate steps. Researchers here at the NIH have developed a vaccine based on the current strain of the avian flu virus; the vaccine is already in clinical trials. And I am asking that the Congress fund $1.2 billion for the Department of Health and Human Services to purchase enough doses of this vaccine from manufacturers to vaccinate 20 million people.

This vaccine would not be a perfect match to pandemic flu because the pandemic strain would probably differ somewhat from the avian flu virus it grew from. But a vaccine against the current avian flu virus would likely offer some protection against a pandemic strain, and possibly save many lives in the first critical months of an outbreak.

We’re also increasing stockpiles of antiviral drugs such as Tamiflu and Relenza. Antiviral drugs cannot prevent people from contracting the flu, but they can reduce the severity of the illness when taken within 48 hours of getting sick. So in addition to vaccines, which are the foundation of our pandemic response, I am asking Congress for a billion dollars to stockpile additional antiviral medications, so that we have enough on hand to help treat first responders and those on the front lines, as well as populations most at risk in the first stages of a pandemic.

To protect the greatest possible number of Americans during a pandemic, the cornerstone of our strategy is to develop new technologies that will allow us to produce new vaccines rapidly. If a pandemic strikes, our country must have a surge capacity in place that will allow us to bring a new vaccine online quickly and manufacture enough to immunize every American against the pandemic strain.

I recently met with leaders of the vaccine industry. They assured me that they will work with the federal government to expand the vaccine industry, so that our country is better prepared for any pandemic.

Today, the NIH is working with vaccine makers to develop new cell-culture techniques that will help us bring a pandemic flu vaccine to the American people faster in the event of an outbreak. Right now, most vaccines are still produced with 1950s technology using chicken eggs that are infected with the influenza virus and then used to develop and produce vaccines. In the event of a pandemic, this antiquated process would take many, many months to produce a vaccine, and it would not allow us to produce enough vaccine for every American in time.

Since American lives depend on rapid advances in vaccine production technology, we must fund a crash program to help our best scientists bring the next generation of technology online rapidly. I’m asking Congress for $2.8 billion to accelerate development of cell-culture technology. By bringing cell-culture technology from the research laboratory into the production line, we should be able to produce enough vaccine for every American within six months of the start of a pandemic.

I’m also asking Congress to remove one of the greatest obstacles to domestic vaccine production: the growing burden of litigation. In the past three decades, the number of vaccine manufacturers in America has plummeted, as the industry has been flooded with lawsuits. Today, there is only one manufacturer in the United States that can produce influenza vaccine. That leaves our nation vulnerable in the event of a pandemic. We must increase the number of vaccine manufacturers in our country, and improve our domestic production capacity. So Congress must pass liability protection for the makers of life-saving vaccines.

By making wise investments in technology and breaking down barriers to vaccine production, we’re working toward a clear goal: In the event of a pandemic, we must have enough vaccine for every American.

The third part of our strategy is to ensure that we are ready to respond to a pandemic outbreak. A pandemic is unlike other natural disasters; outbreaks can happen simultaneously in hundreds, or even thousands, of locations at the same time. And unlike storms or floods, which strike in an instant and then recede, a pandemic can continue spreading destruction in repeated waves that can last for a year or more.

To respond to a pandemic, we must have emergency plans in place in all 50 states and every local community. We must ensure that all levels of government are ready to act to contain an outbreak. We must be able to deliver vaccines and other treatments to frontline responders and at-risk populations.

So my administration is working with public health officials in the medical community to develop effective pandemic emergency plans. We’re working at the federal level. We’re looking at ways and options to coordinate our response with state and local leaders. I’ve asked Mike Leavitt — Secretary Leavitt — to bring together state and local public health officials from across the nation to discuss their plans for a pandemic, and to help them improve pandemic planning at the community level. I’m asking Congress to provide $583 million for pandemic preparedness, including $100 million to help states complete and exercise their pandemic plans now, before a pandemic strikes.

If an influenza pandemic strikes, every nation, every state in this Union, and every community in these states, must be ready.

To respond to a pandemic, we need medical personnel and adequate supplies of equipment. In a pandemic, everything from syringes to hospital beds, respirators, masks and protective equipment would be in short supply. So the federal government is stockpiling critical supplies in locations across America as part of the Strategic National Stockpile. The Department of Health and Human Services is helping states create rosters of medical personnel who are willing to help alleviate local shortfalls during a pandemic. And every federal department involved in health care is expanding plans to ensure that all federal medical facilities, personnel, and response capabilities are available to support local communities in the event of a pandemic crisis.

To respond to a pandemic, the American people need to have information to protect themselves and others. In a pandemic, an infection carried by one person can be transmitted to many other people, and so every American must take personal responsibility for stopping the spread of the virus. To provide Americans with more information about pandemics, we’re launching a new website,…. The website will keep our citizens informed about the preparations underway, steps they can take now to prepare for a pandemic, and what every American can do to decrease their risk of contracting and spreading the disease in the event of an outbreak.

To respond to a pandemic, members of the international community will continue to work together. An influenza pandemic would be an event with global consequences, and therefore we’re continuing to meet to develop a global response. We’ve called nations together in the past, and will continue to call nations together to work with public health experts to better coordinate our efforts to deal with a disaster.

The Editors of The New Atlantis, "No Nation Can Afford to Ignore This Threat," The New Atlantis, Number 11, Winter 2006, pp. 125-129.

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