THE PRESIDENT has called it a "crash program." Mike Leavitt, the secretary of health and human services, used the word "blueprint." Unfortunately, the administration flu pandemic plan released this week is neither of those things.
On a general level, the plan and the funding request accompanying it show that the administration is taking preparedness seriously. Particularly important is the president's recognition that the United States needs to learn how to speed up production of vaccines, because they offer the best hope for protection against any pandemic. By far the largest chunk of the president's $7.1 billion funding request is devoted to vaccine and antiviral drug research and building up vaccine stockpiles, and rightly so. Nevertheless, the earliest date by which the government could meet its goal of having the capability to produce a vaccine for every American within six months of the begin- ning of a pandemic is 2010 -- hardly a "crash program."
In the meantime, the flu plan mainly consists of a long list of things that local governments and public health officers should be doing, such as building surge capacity in laboratories and hospitals, carrying out "preparedness planning" and identifying potential isolation and quarantine facilities. But there is only a small slice of funding for such measures, and no real explanation of how they will be implemented. At times, the plan seems divorced from reality, such as when it points out that people could, in case of a pandemic, be asked to remain at home for a certain period. But does that include utility workers? Grocery store workers? Is any locality really in a position to feed and care for a quarantined population -- and if not, should that even be an option under consideration?
The same implementation issues plague the discussion of vaccine distribution. At the onset of a pandemic, HHS says it will "work with the pharmaceutical industry" and vaccine distribution will occur "via private-sector vaccine distributors or directly via manufacturer." Yet at the moment, manufacturers cannot distribute ordinary flu vaccine in a timely manner. How will they do so during a mass panic?
Finally, both the plan and the funding proposal ignore the benefits to Americans of working with countries in Asia and possibly Africa, where the virus could break out first and be halted or slowed before it gets here. The president has called for about $250 million to be spent internationally, but that won't suffice either to acquire vaccines and antiviral drugs in sufficient numbers or to enable rickety health care systems abroad to help prevent a pandemic. If a flu epidemic begins abroad, one of the first moral and practical issues this country will face is whether to share American stockpiles with others: Aside from proposing a small program to manufacture and hold clinical trials of flu vaccine in Vietnam, it doesn't seem as if the administration has confronted that issue at all. While not a bad start, the administration's flu plan is still too vague to be reassuring.