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White House Plan Defers Leadership In Bird-Flu Fight

SARS, a virus that emerged in China, caused about 8,400 cases of illness in 28 countries and about 800 deaths. The WHO organized the global response in a way unprecedented for the Geneva-based agency. It coordinated disease surveillance, helped disseminate treatment strategies and influenced governments' behavior, advising against travel to Canada and forcing China to make a full accounting of its SARS cases. Many experts believe the SARS experience amounted to a dry run for a much more dangerous flu pandemic.

The Bush plan cedes to the WHO the lead role in managing this global health crisis -- something it has resisted on other health issues, notably AIDS.

"The World Health Organization represents the linchpin of international preparedness and response activities. . . . During a pandemic we will rely upon it to be a highly visible and credible coordinator of the international response," the plan says.

In particular, the authors wrote, "we will rely upon the WHO to confirm sustained human-to-human transmission of a novel influenza virus." That decision will trigger the global response and have repercussions through the United States even if there are no cases here. In practice, U.S. scientists will have a major say in making that crucial call, as the Centers for Disease Control and Prevention in Atlanta is a major source of the WHO's expertise.

The plan specifies that the Department of Homeland Security "is responsible for overall coordination of federal response actions for a pandemic." However, the disastrous response to Katrina seems to echo in a statement that, in effect, advises people not to wait for help from Washington.

Nothing in the plan "alters or impedes the ability of federal, state, local, or tribal departments and agencies to carry out their specific authorities or perform their responsibilities under applicable laws," its authors wrote.

Despite the $7.1 billion Bush has asked for pandemic preparation, Irwin Redlener, a physician at Columbia University's Mailman School of Public Health, said little of the money will go to localities. Most will be spent on vaccine development and building a national stockpile of antiviral drugs.

Local hospitals and health departments "cannot possibly fulfill what amounts to a string of unfunded mandates," he said.

This view was shared by Joshua M. Sharfstein, Baltimore's health commissioner.

"The key challenge from our perspective is to answer the question, How do we keep Baltimore running? How do we ensure the trash is picked up, the police and fire departments work, that businesses can stay open?" he said. "It would be immensely easier if we had additional resources equal to what we are being asked to do."

Leading Democrats in Congress also criticized it, with Sen. Charles E. Schumer (N.Y.) saying that "pawning [responsibility] off on the state and local government is not a solution." Sen. Edward M. Kennedy (Mass.) said the document "still leaves us without a coherent overall national plan."

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