U.S. Flu Outbreak Plan Criticized

"If you look at the plan, the basic message is, 'This is going to be one hell of a problem, and you better get ready.' You better get ready. You the cities, you the states, you the citizens," Greenberger said. "The pandemic flu preparations in the United States are a tragedy."

Since late 2005, Congress and the president have devoted more than $6 billion to pandemic flu preparedness, although little has gone directly to states and communities. The vast majority has been spent on researching vaccines and building the capacity to manufacture and distribute them, and on antiviral drugs and overseas disease surveillance, analysts said.

Near the end of 2005, the government also allocated a separate $600 million, one-time pot of money for pandemic preparedness grants to states and localities, as well as another $170 million to help states buy antiviral drugs, but much of that money has been spent already. Other grants for state and local bioterrorism preparedness and hospital emergency preparedness total hundreds of millions of dollars annually, but they have declined in recent years.

Raub, the HHS official, said the government's strategy and funding are sound. Overseas surveillance could help delay a pandemic's arrival or lessen its severity, he said. And domestically, the goal is not to simply throw money around but to help states and communities develop plans -- even low-tech ones such as encouraging sick people and family members to stay home -- that could minimize the spread of flu while stretching medical resources.

"A lot of leadership will come from the trenches," Raub said. "None of this is a panacea, and I don't mean to represent that we've got this solved. But at least there are substantial public resources flowing with a focus on what we think are the practical things that, unglamorous as they are, can be done."

Health and hospital officials around the country vary in the degree to which they believe they are ready, but even those who say they have made good progress want the federal government to do more.

"So far we don't have supplies and that sort of thing in large quantities," said Ron Anderson, president of Parkland Health & Hospital System, which runs the county hospital in Dallas. "We don't know how we would treat all the people who would be coming in large numbers. I'm afraid this country doesn't understand that there isn't much surge capacity here, not only for pandemics but for any kind of biological terrorism or something like that."

In Northern Virginia, Inova Health System has focused much of its planning on regional collaboration, said Dan Hanfling, director of emergency management and disaster medicine. Inova has spearheaded a regional hospital alliance that has examined how best to deploy durable medical goods, drugs and other supplies, he said, and has purchased a "modest" supply of extra ventilators to help victims whose lungs have been devastated by flu.

Hanfling agrees that federal officials have provided leadership and some important funding streams, but he, too, said more needs to be done.

"The amounts of funding still pale in comparison to the tremendous need that exists," he said. "It's a big, complex, daunting issue. . . . It makes our current state of readiness tenuous, at best."

In Farmington, Maine, the Franklin Community Health Network, a nonprofit system serving 50,000 people, has developed plans to relocate existing patients and, if necessary, house its medical staff for weeks, said Richard Batt, the network's president.

Franklin Memorial Hospital, a 50-bed facility with $60 million in annual revenue, spent $100,000 to stockpile a month's worth of gloves, masks, drugs and other supplies at a warehouse, Batt said. Much of it must be regularly rotated into the hospital's inventory and replaced to keep it from deteriorating.

Batt, whose hospital has received about $10,000 in federal help, said federal funders have favored police and fire departments over hospitals and primary-care systems.

"In a pandemic, the action is going to be in the doctor's office and in the hospital emergency room and the ICUs," he said. "It isn't going to be with the fire department intercept squad. . . . You'll find that there are almost no resources going to this problem proportionate to the real risk it presents."