President Bush yesterday asked Congress for $7.1 billion to help prepare the country for a global epidemic of influenza, telling a high-powered gathering of scientists and public officials at the National Institutes of Health that "our country has been given fair warning of this danger to our homeland."
The request -- the latest addition to a burgeoning investment in public health preparedness since the Sept. 11, 2001, attacks -- would go toward vaccine development, drug and vaccine stockpiling, disease surveillance, and local health departments' manpower needs.
The biggest share, $2.8 billion, would subsidize the rapid development of cell-based technology for making influenza vaccine -- an investment that the United States' dwindling vaccine industry has been making only slowly.
Between $1.2 billion and $1.5 billion would be used to build a 20 million-dose stockpile of an experimental vaccine based on the bird flu virus now circulating in Asia, $1 billion for antiviral medicines, $800 million to develop new flu treatments, and $644 million to help local governments make their own preparations for a flu pandemic.
Bush said he will also ask lawmakers "to remove one of the greatest obstacles to domestic vaccine production -- the growing burden of litigation," adding that "Congress must pass liability protection for the makers of life-saving vaccines." He did not provide any details of that proposal.
The president's request is similar to a $7.9 billion supplemental appropriation for flu pandemic planning assembled by Democratic leaders and passed last week by the Senate. Democrats and Republicans are now scrambling to show who can do the most to combat a threat that no longer seems theoretical with the spread of the H5N1 avian influenza out of Asia and into Europe in the past month.
Since late December 2003, there have been 122 human cases of avian flu, 62 of them fatal. Thailand confirmed yesterday that a 50-year-old woman from Bangkok became ill with H5N1 influenza on Oct. 26 and remains hospitalized. She is the third confirmed case in Thailand in a month.
The virus is highly infectious and lethal to chickens; about 140 million have been killed or culled during the current outbreak. But some ducks and several species of wild, migratory birds can be infected without dying or even becoming ill, a fact that is helping spread the microbe.
The H5N1 virus lacks the capacity to be easily transmitted from person to person, which it would need to trigger a pandemic. Experts fear, however, that it could acquire the necessary genetic changes. There have been three flu pandemics in the past century; the worst, in 1918, killed at least 50 million people in a little more than a year.
Underscoring the multinational, multiagency preparations against the threat, Bush spoke before two departmental secretaries, the surgeon general, the directors of the NIH and the Centers for Disease Control and Prevention, and the director general of the World Health Organization, Lee Jong Wook.
"For me personally, this is a historic day in public health," said Julie L. Gerberding, head of the CDC. "We have worked hard for a decade to put influenza on the table."
After the speech, Michael T. Osterholm, a former state health official from Minnesota, said the administration has made it clear that responsibility for pandemic preparedness involves every sector of society.
"State and local governments, academia, health systems, the private sector -- they all have a part to play. If they're waiting for someone to come and rescue them, that's the wrong answer," he said.
Politicians, trade groups, advocacy organizations and professional societies commented on Bush's strategy, praising it, finding deficiencies and exploiting it for partisan gain.
"The president's announcement is a long-awaited first step toward a comprehensive pandemic flu plan," said Sen. Edward M. Kennedy (D-Mass.). "Democrats have sounded the call . . . and today the president answered."
Bush's 26-minute speech at the government's premier campus for medical research was the first of a two-day blitz on the threat.
Today, the Department of Health and Human Services is scheduled to release its preparedness plan, which has been in preparation since the late 1970s. A draft was released in August 2004, but the document has undergone extensive revision since then, including in the past two weeks.
Local officials, public health officers, hospital administrators and clinicians -- as well as drug companies, medical equipment suppliers, airlines, and police and state militias -- hope the plan will give them a clearer idea of what to do during an influenza epidemic.
Bush's speech described a many-pronged strategy that ranges from providing $251 million to help other countries train local physicians, epidemiologists and lab technicians, to the creation of a Web site, www.pandemicflu.gov, that suggests "what every American can do to decrease their risk of contracting and spreading the disease in the event of an outbreak."
Influenza experts believe public support for strategies to limit contagion will be essential to prevent or confine a pandemic. These include frequent hand-washing, travel restrictions during an outbreak, self-imposed home quarantines of the ill, and possibly stockpiling of food and other essential items.
Until a vaccine is widely available -- which will take years -- these low-tech defenses are likely to be the most important.
Currently, flu vaccine is made by growing weakened strains of flu virus in fertile chicken eggs, a process that takes six to eight months. Growing the virus in cells -- which can be frozen and stored in vast quantities -- would give vaccine makers a flexibility and "surge capacity" they now lack, but industrial-scale vaccine production using cell cultures is unlikely to be possible in less than five years.
The $644 million to "ensure that all levels of government are prepared" supplements about $7.2 billion budgeted for state and local public health preparedness since 2001, HHS spokesman Bill Hall said.
The plan to be released today apparently calls for states to buy enough antiviral medicine to treat 31 million people, with the federal government providing a 25 percent subsidy. According to calculations made by the advocacy group Trust for America's Health, this "amounts to an unfunded mandate" of about $510 million.
The administration's decision to release it a day after the president's speech left many issuing statements decrying expected deficiencies in the plan before seeing a final copy.