Flu Plan Leaves Many Decisions at Local Level

U.S. Preparedness Draft Also Calls for Unprecedented Cooperation, Expert Says

A public health expert familiar with the latest draft of the federal government's pandemic influenza preparedness plan said it predicts that a full-scale disease outbreak might kill as many as 1.9 million Americans and sicken more than half the country's population.

The military probably would be used to help move critical supplies and provide security at places such as vaccination centers, the expert said, but quarantines will play only a small role in a pandemic response. Many crucial decisions on how to manage disruptions and shortages will be made at the local, not national, level.

Michael T. Osterholm, who advised the Department of Health and Human Services from 2000 to 2003 and now heads a medical think tank in Minnesota, made the comments after an article on the government's proposal appeared in the New York Times yesterday. The article described a 381-page version of the plan dated Sept. 30.

"There have been tremendous improvements in the plan even over the last week to 10 days," Osterholm said. In particular, he said, the most recent version emphasizes the likely prolonged effects of a flu pandemic and the need for unprecedented cooperation between the government and the business sector for more than a year.

"It is very much in flux now," he said. "Up until recently, it has been a plan that was handling this [event] much more like an earthquake or a hurricane. But it is not something that occurs over a very short period of time and then we go into the recovery phase. A pandemic will literally unfold, like a slow-moving tsunami, over 12 to 18 months."

Federal officials refused to provide the latest version or to describe it in any detail. Several of the people most involved in the multi-year writing of the plan were traveling to Southeast Asia yesterday with Health and Human Services Secretary Mike Leavitt and were unavailable.

Leavitt will visit at least four countries where influenza A/H5N1 -- also known as "bird flu" -- has killed or led to the culling of 140 million birds, as well as to 116 human cases and 60 deaths. Accompanying him on the 10-day trip are Jong Wook Lee, director general of the World Health Organization, and Margaret F.C. Chan, WHO's chief of pandemic influenza planning.

The trip's purpose, Leavitt said before departing, was to "emphasize the importance of this issue for the United States" and to stress the "need for the world community to be transparent and cooperative" in disease surveillance and reporting.

The final version of the pandemic preparedness plan is unlikely to be released until Leavitt returns. An HHS spokeswoman, Christina Pearson, said, "it's totally premature" to release the document now.

"We're still getting comments on the plan," she said. Speaking generally, she said that "it outlines the public health and health care responses. It describes things communities should be doing now. It has to be a foundation for further efforts."

Osterholm confirmed this view, although he would not give specific details about the plan.

"Basically, cities and states are going to have to shoulder a lot of this burden of response on their own. There is no other choice. When you have all 50 states, every major city, every county and every hospital in crisis -- the federal government can't address all of that," Osterholm said. "Every place is going to need resources and expertise at the same time, and in fact every country in the world is going to need those things."