Avian Flu - What we need to know

The Washington Post on US pandemic plan

President Bush is expected to approve soon a national pandemic influenza response plan that identifies more than 300 specific tasks for federal agencies, including determining which frontline workers should be the first vaccinated and expanding Internet capacity to handle what would probably be a flood of people working from their home computers.

The Treasury Department is poised to sign agreements with other nations to produce currency if U.S. mints cannot operate. The Pentagon, anticipating difficulties acquiring supplies from the Far East, is considering stockpiling millions of latex gloves. And the Department of Veterans Affairs has developed a drive-through medical exam to quickly assess patients who suspect they have been infected.

The document is the first attempt to spell out in some detail how the government would detect and respond to an outbreak, and continue functioning through what could be an 18-month crisis, which in a worst-case scenario could kill 1.9 million Americans. Bush was briefed on a draft of the implementation plan on March 17. He is expected to approve the plan within the week, but it continues to evolve, said several administration officials who have been working on it.

[...] To keep the 1.8 million federal workers healthy and productive through a pandemic, the Bush administration would tap into its secure stash of medications, cancel large gatherings, encourage schools to close and shift air traffic controllers to the busier hubs -- probably where flu had not yet struck. Retired federal employees would be summoned back to work, and National Guard troops could be dispatched to cities facing possible "insurrection," said Jeffrey W. Runge, chief medical officer at the Department of Homeland Security.

The administration hopes to help contain the first cases overseas by rushing in medical teams and supplies. "If there is a small outbreak in a country, it may behoove us to introduce travel restrictions," Runge said, "to help stamp out that spark."

Read the full article here.

US to stockpile Relenza

The U.S. health department said it ordered about 1.75 million courses of Relenza on March 2 and another 2.2 million courses on March 26.

The department has already ordered 22 million courses of Tamiflu, which until the launch of Relenza was the only drug on the market with the capabilities to prevent influenza A and B and also be used as a treatment for people with the infection.

From CNN.

US to start large scale bird screening

Scientists will study live birds, others that are found dead or killed by hunters, and environmental samples that might carry the worrisome form of bird flu. While most concern about birds flying south through the United States focuses on their Pacific route in the western states, other migratory paths will be included, Clifford said.

The goal is to test 75,000 to 100,000 live or dead birds this year, said Angela Harless of the USDA. The testing, which also will include some Pacific Ocean islands, will focus on waterfowl and shorebirds.

At the same time, Clifford said, officials will continue to monitor other activities that may introduce the virus to the United States: importing and smuggling of birds.

From CNN.

Mike Leavitt's testimony to Congress

The lethal avian flu that is spreading rapidly around the world could soon infect wild birds and domesticated flocks in the United States, U.S. Health and Human Services Secretary Michael Leavitt said on Wednesday.

[...] Leavitt told the committee that by the end of this year, the United States will have about 20 million doses of anti-viral drugs, mostly Tamiflu, stockpiled.

But the development of a vaccine is three to five years away, Leavitt said. He downplayed chances that this timetable could be accelerated significantly and added that even with vaccine technology, it would take drug companies six months after the start of a pandemic to produce an effective one.

"In the first six months of a pandemic we are dependent on basic public health, social distancing; every business, every school, every church, every county to have a plan," Leavitt said, adding, "We are overdue (for a pandemic) and under-protected, but we are moving with dispatch."

Leavitt also was skeptical that the federal government could provide all localities with the full arsenal of basic medical equipment, such as ventilators, masks, gauze and gloves, needed during a pandemic. That surprised Senate Budget Committee Chairman Judd Gregg, a New Hampshire Republican, who said he had thought the billions of dollars being spent would cover such stockpiles.

Source. Effect Measure offers a critical take. Tradesports puts the chance of bird flu being detected in the US by the end of June at 40%.

CDC's Julie Gerberding on US preparedness

Read the transcript of her Face The Nation interview (starts on page 7). Via CBS News.

The US expands embargo list

Kazakhstan, Romania, Russia, Turkey, and Ukraine are the latest countries to make the list - read the official announcement on the CDC site.

Liability protection and vaccine development

Whether or not drug companies really need a liability shield is concealed in their proprietary balance sheets. But there aren't many companies that can make pandemic flu vaccines, and history has shown that they just won't make them unless we provide this shield. In 1976, President Ford ordered mass immunization following the detection of the "swine flu" influenza virus in an Army recruit who died from it. That year, production of the vaccine was delayed several months because the drug industry could not get insurance. Congress finally underwrote the campaign, and the insurance industry turned out to have been right—the vaccine was associated with an unusual paralytic disease called Guillain-Barré syndrome. The federal government had to handle 5,000-plus claims from allegedly vaccine-injured patients and paid out nearly $100 million in compensation.

[...] But Congress' treatment of pandemic flu vaccine makers takes risk-protection to an excessive level. The bill would make it impossible to sue a vaccine or antiviral drug-maker without proof of "willful misconduct." This will be almost impossible to prove, because the bill stipulates that any claim of injury would be adjudicated not by judges, with their investigatory powers, but by the secretary of the Department of Health and Human Services. The bill protects companies without establishing a fund to pay potential vaccine victims. This is not a reassuring decision, and since vaccination programs rely on public trust, it is a remarkably shortsighted one. Even drug company officials were worried that the measure could further harm their reputation and diminish confidence in vaccines. Apparently, however, House budget hawks were adamant that the bill contain no compensation provision that costs money and thus adds to the federal deficit.

Flu vaccines today are safer than they were in 1976. But it should be the duty of experts on vaccine safety, and not HHS Secretary Mike Leavitt, to decide whether a bad outcome after vaccination was caused by the vaccine. In the battle against dangerous bugs, our troops—which is to say, ourselves—deserve better.

Read the full Arthur Allen article on Slate.com.

US House passes bird flu bill

Yesterday the US House of Representatives approved a $3.78 billion package for bird flu preparedness. The bill also provides some liability protection for drug companies during an epidemic. The legislation is part of a national defense bill that still needs to be approved by the US Senate. Read the full report from CNN.

FDA warns nine companies to stop selling bird flu "remedies"

Here is the FDA's letter to the companies.

Social Science and Pandemic Flu briefing

Christal Sheppard sends me the link to a Congress briefing titled "Gaps in the National Flu Preparedness Plan: Social Science Planning and Response". It will take place tomorrow and it is open to the public, here is the link.