Video: How is the U.S. preparing?

By Ann Curry
NBC News

Last Sunday, April 23, Dateline showed you what might happen if a pandemic were to occur soon. But does it have to be that way?  Could a vaccine be produced sooner? 

Could hospitals be better prepared?

Co-anchor Ann Curry spoke to the Secretary of Health and Human Services, Mike Leavitt, the man charged with preparing the U.S. for the next pandemic. Below, is more of that interview.

ANN CURRY, DATELINE CO-ANCHOR: This is your operations room. What happens here?

SEC. MIKE LEAVITT: This we use this far more than we wish we did.  This is where we’re tracking flu, it’s where we’re tracking storms, it’s where we’re tracking anything that could have an adverse effect on the people of United States, or our humanitarian interests around the world.

CURRY: I see, “H5N1”—

LEAVITT: We’re actually tracking birds, we’re tracking at least the flu from birds.  You can see those that have actually had confirmed cases, and you can see those where we have suspected. And you’ll see that there are parts of the world that we know very little about. When you get into Burma, when you get into parts of China, when you get into parts of Southeast Asia; we just don’t know a lot about what’s going on there.

CURRY: I notice here you have a graph, “Total Human Deaths”.  Do you think that’s accurate, or under reporting the total human deaths?

LEAVITT: Well again, we don’t know. One would suspect, in the vastness of Asia, in the vastness of Africa, that there have been those who have contracted the flu, that we don’t know about.  There are parts of Asia, for example, where Vietnam’s had many deaths, but there are 54 million farms in Vietnam.

We can’t possibly know what’s going on in the villages of Vietnam, or Thailand, or Laos; the same will be true in Africa.  So, there’s a lot we don’t know about.  There’s a lot we don’t know about the virus—but we’re doing everything we can to track it, and to watch it.  We have the best people, literally, in the world, doing it.

CURRY: If it hits us, as a pandemic, it’ll happen very fast. Is this where you’re going to be?

LEAVITT: It’s unlikely, frankly, that we will see it happen  rapidly.  It’s more likely that we’ll see the virus begin to develop, and migrate, or rather, mutate in a fashion that will allow us to begin to see it happen.  Now, that’s what the scientists are telling me.  In 1918, that wasn’t the case. 

CURRY: Okay, but you seem to think we’re gonna get warning if this thing mutates?

LEAVITT: We just don’t know.  It’s possible that we’ll begin to see the virus mutate in a way that will become person to person transmittable.  It’s also possible, that just somewhere we’ll suddenly see a case—where there is person to person transmission.

We’re watching the virus, literally, everyday.  We know its mutating.  All viruses do.  To the extent that it’s possible to have information, but there’s a lot we don’t know as well.

CURRY: You know, you’re the top guy, in terms of trying to protect Americans from getting this disease if it comes. How would you describe it?

LEAVITT: Well pandemics happen.  They have happened since the beginning of time.  We have had 10 pandemics in the last-- 300 years, we’ve had three in the last 100 years.  There’s no reason to believe that the 21st Century will be different than any previous centuries.

CURRY: People think that the level of science, the level of medical care, is such that we can be protected now.

LEAVITT: When it comes to a pandemic, we’re overdue, and we’re under prepared.

CURRY: So, we should not be confident that the system can keep us from having, potentially, massive deaths, if in fact, we do have a pandemic?

LEAVITT: We are better prepared today, than we were yesterday, and we’ll be better prepared tomorrow, than we are today.  But this is not a new risk.  This has been part of humanity, since the beginning of the time.  It’s a biologic fact; these things occur.  When they do occur—they are world changing events.  They change, not just the health of millions, they change the politics, they change the prosperity, they change the society of entire regions of the world.

CURRY: What is it like to have your job at this time in our history?

LEAVITT: Well, this is a sobering job.  But there are remarkable people who surround me; the Center for Disease Control, National Institutes of Health, the World Health Organization—lots of people thinking about this.  And it’s the kind of thing, that frankly—is frightening to people.

And we want it to be put in perspective.  It’s the kind of thing we want to inform people of, but not enflame them.  We want to inspire their preparation, but not panic.  One of the things we worry about, is that as people hear about various stages of this, that they will become so concerned, that their would behavior that would, ultimately, not be in any of our interests.  SARS was an interesting example of that.

SARS, in pandemic terms, was a very small event.  Eight thousand people contracted SARS, worldwide.  Regrettably, about 800 of them died.  But in pandemic terms, that’s very small.  It paralyzed the Chinese economy—it made a substantial impact on other parts of the world.  The communication of this, in a factual, thoughtful way; so that people are not panicking, or they’re in no way, inflamed by misinformation.

Life goes on.  The vast majority of people who are involved in a pandemic live.  Some of them get sick, but we need to keep it in perspective, and be as well prepared as humanly possible.

ANN CURRY, DATELINE CO-ANCHOR: Mr. Secretary, your predecessor Tommy Thompson, said the prospect of a flu pandemic was a thing that kept him up at night in this job.

SEC. MIKE LEAVITT: We’re at a greater risk of a pandemic than at any time in decades.  We are overdue.  And we’re under prepared.

CURRY: Under prepared.  Is that another way of saying we’re not prepared?

LEAVITT: No one in the world is prepared for a pandemic.  The nature of the event is unlike any natural disaster that humans deal with otherwise.  We’ve been going through Katrina and analyzing what we learn from Katrina.  One of the things I learned is that you have to think about the unthinkable because often it occurs.

I also learned from Katrina how different a pandemic is.  Katrina encompassed Louisiana and encompassed Mississippi and a piece of Alabama.  It was a huge human disaster.  Millions of people displaced.  But at least it was confined to a specific geographic area.  A pandemic would be unfolding at as many as 5,000 different communities within the United States all at one time and around the world.

Katrina was three or four hellish days and then on to recovery.  A pandemic is a year or a year and a half happening in six- to eight-week cycles.  First in one community and then another.  Sometimes simultaneous.  It means that what happened during Katrina, with people coming from all over the country to help those who were afflicted, could not and would not happen.  If it was happening in my home town, I would be there to make certain that my neighbors were cared for and my family.  Or I might be there because I’m concerned if I go somewhere else I might catch it.  People will be much closer to the area of their home to assure that they’re cared for.

CURRY: So in trying to picture this unthinkable thing, you’ve made a comparison to Katrina.  Another difference is it would not be a big wall of water that came through your city.  It’d be very different.  How do you foresee it? 

LEAVITT: Well, I’ve actually done a lot of study on what happened in 1918, which is the most recent serious pandemic.  I’ve studied what happened in home towns all across America.  Went back and looked what happened in my own home town of Cedar City, it was about 3,000 people at the time.  The public health official was one doctor, a guy named Dr. Mack who was the town physician.

He required everyone to wear gauze masks.  They terminated any public meeting.  They canceled schools.  They canceled church.  They put serious restrictions on the kind of movement that could occur and that people would want to undertake during that period.  That wasn’t for the entire year.  But it would be during six- or eight-week periods throughout the year.

I think we could count on the same kind of thing happening.  Life would go on.  It would have to.  People will still need food.  People will still need to educate their children.  So it wouldn’t be a complete standstill.  But it would clearly be disruptive—to many aspects, particularly during those six- to eight-week—stretches or waves.

I think the best way to view the—a future pandemic is looking at past pandemics.  What we know is that through the course of the entire pandemic episode, about 30 percent of a population will become ill.  Roughly half of those will be serious enough that they’ll require either hospitalization or some kind of significant medical attention.

Regrettably, about two percent of that number in the most serious cases will die.  Now, that means that 98 percent of the population who are sick will ultimately recover.  But there’s a lot of disruption.  It means surges into our hospitals and to clinics that could not be accommodated.  It would mean that most communities during those periods would have to find ways of being able to find places to care for them.

CURRY: People in their houses not wanting to leave.  Having to rely on their own devices to survive?

LEAVITT: For the most part.  Now, we live in a world where that’s much more possible than it might have been in 1918.  We have the Internet.  People could stay at home and work if that was necessary.  A lot more commerce could be conducted in that fashion.

Children could stay at home and be schooled.  That’s the kind of thing that every local community needs to be thinking through.  It’s the kind of thing that every business needs to be thinking through.  If you’re a business, you ought to be asking yourself the question.

CURRY:  What would we do if 40 percent of our employees couldn’t show up for work?  If you’re a county sheriff and you have to take care of people in jail, you need to be asking:  What do I do if I haven’t got deputies who show up?  How do I deal with these prisoners who, in fact, could become infected themselves?

LEAVITT: If you run a hospital, you need to be asking:  How do I deal with the fact that I’m not gonna have enough ventilators in certain situations?  Now, there are things we can do.  And we can have an impact.  We can’t stop it.  This is a fact of biologic history.  It happens periodically.  Pandemics happen.  But we can impact the way they impact us.

We can essentially slow them down in a way that they don’t affect as many people in as rapid a fashion.  We also have vaccines.  Now, vaccines, as we have a chance to develop capacity to produce them, can protect us.  We have anti-virals that, in fact, can help us once we get sick.

We’re in a far better position to deal with a pandemic than they were in 1918 or, for that matter, at any point in human history.  Now, that doesn’t mean that people wouldn’t get sick.  It doesn’t mean that people wouldn’t die.  But it does mean that we would get through this.  The more we do to prepare for a pandemic, the less impact it will have on our lives and on society in general.

CURRY: Let’s take a look at some of your numbers.  Because you were talking about percentages.  And it’s one thing to think about it in percentages.  It’s another thing to think about it in the real numbers.  Your agency says the “direct and indirect health costs alone have been estimated to approach $181 billion.”  Billion dollars?  For a moderate pandemic.

LEAVITT: Pandemics not only affect the health of people, they rearrange entire societies.  They affect the politics.  They affect the culture.  They affect the prosperity.  And, again, this is not new.  You can go back through the history of time and see Athens in 400 BC.  You can see Black Beth in the 14th century.

You can see any of the ten pandemics that have occurred in the last 300 years.  Now, we don’t know anything about what happened in the years leading up to 1918.  We do know what happened in 1918.  And then it changed every town across this country.  Just as a pandemic would in the 21st century.

Go into a Internet search engine and put your home town name and put “pandemic 1918” and it will bring up some article, some way in which your home town was affected—by a pandemic.  It affected virtually every community in America in 1918.  It’s been long enough now that this generation forgets or doesn’t know.

But I routinely now run into people who say, “Yes, my grandmother died in 1918 of the flu.”  They think of it as the flu like the annual flu.  Well, it wasn’t the annual flu.  It was a pandemic flu.  I keep finding people in are of prominence whose parents or grandparents died.  I was in West Virginia not long ago and learned a story about a little boy, a baby, whose parents, living in South Carolina at the time died.  The grandparents adopted the baby, moved to West Virginia.  It was Senator Byrd from West Virginia.

CURRY:   Really?

LEAVITT: The governor of West Virginia, when I told him that story, said, “My grandfather died of the avian flu.”  It’s everywhere you look.  In my hometown there’s a hospital that was converted into an office building that my family had purchased.  And I found out it was built in 1920.  Why?  They didn’t have a hospital.

And in 1918 when the pandemic struck, they had to close a little college and literally fill it with hospital beds.  And at the conclusion, they resolved that they would never find themselves in that situation again.  You can read the weekly newspaper of almost any town in America during the period between September of 1918 and December and find how it affected the lives of individual people.

CURRY: We’ll all be affected if we are hit with a flu pandemic.  True or false?

LEAVITT: We will all be affected.  Perhaps we won’t get sick.  Only about 1/3 of the people—really only about 30 percent of the people will get sick.  And about half of those will be so serious that they’ll require medical attention.  Many people who get this flu will not be affected in a life-threatening way.  But too many will.

CURRY: Your numbers predict 90 million Americans will get sick in a moderate or severe pandemic.

LEAVITT: If we had a severe pandemic like the one they had in 1918, we project that 90 million Americans will become ill.  About 45 million of them would require medical attention.  And regrettably, as many as 2 million would die.  Now, that sounds like a Stephen King novel.  It’s not.

It’s simply a reflection of what happened in 1918.  These pandemics happen.  They have for centuries, and they will in the future.  And we may be among the first generations to have warning or to be able to do anything to have an impact on what the pandemic does to our society.  So this is a very important time for which we are preparing.

Now, some people say this is a the little boy who cried wolf?  Is this a Y2K all over again? Is this something we’re being warned about that we really don’t have to worry about?  Well, there’s a lot of things to worry about.  But a pandemic ultimately will happen.  It may not be the H5N1 virus that sparks it.  But there will be a pandemic event at some point in the future.  And now’s the time for us to prepare.  And there are things we can do that will have a substantial impact on the impact that it would have on us.

CURRY: So let’s talk about that.  Let’s talk about how we’re preparing. If a flu pandemic hits the United States within the next 12 months, we’re in trouble.  True or false?

LEAVITT: If a pandemic, a serious pandemic comes at any time, the next 12 months or the next 12 years, it’s trouble.  And people will be sick, and they will die.  Society will, for the most part however, continue as it is and we’ll get through it.

CURRY: But you said that this is a first. This may be a first.  We’re in the state now where we can actually prepare, think about getting ready.  Okay.  You are not the United States and the world is not ready for a flu pandemic.  Everybody I’ve talked to says we are getting ready.  Okay?

And you’ve said we’re more ready than we were yesterday.  We’re not as ready as we should be.  But there’s a way to kind of characterize where you want to be and how long it’s gonna take to get there.  We are not ready today.  How long is it gonna take before we in the United States feel ready to at least deal with what you say is coming?

LEAVITT: It will take roughly three to five years for us to develop the manufacturing capability to produce the 300 million courses of a vaccine necessary to treat the entire American public.  The good news is we have a vaccine.  That’s something that they didn’t have in 1918.

The bad news is we don’t have the capacity to manufacture it.  And it will take three to five years to do that.  We’re in the process of inventing, in essence, new technology and creating new capacity.  We’re also creating stockpiles of anti-virals.  And we’re spending an enormous amount of time and effort working at the state and local level, because that is the foundation of pandemic preparedness.

It isn’t just what happens at the national government.  It’s what happens at schools and what happens in businesses.  It’s what happens at the county seat and in the city council.  It’s what happens at the state legislature as they prepare for what is inevitably going to occur.  It may not be this year.  It may not be ten years from now, but it will occur.  The other thing that’s important I think is to recognize that everything we’re doing makes us safer and healthier as a nation. Everything we’re doing applies not just to pandemics.  The preparation for a bioterrorism event is essentially the same as that of a pandemic.  The preparation we would make for a nuclear event, essentially the same as a pandemic.  The preparation we make for a pandemic will assist us in a large hurricane or a major snowstorm.  Having water at home is a good idea no matter what.

Having some food stored, no matter what, is of assistance in a time of crisis.  Having a flashlight, having a first aid kit, having extra prescription medication if you are a person who needs it.  Those are basic rudiments of preparedness.  If you’re a business, asking yourself:  How would we continue our business?  It’s not just important for the health of the business, it’s important for the health of society that we’re able to get food and essential services during that period.

If you’re a school, the principal needs to know the basics of pandemic management.  When does the school open?  When does it close?  If you’re a pastor or a priest, when do we hold church?  If you’re a city council member or a mayor, what do we need to invest in?  Are we better off having some new ventilators or having a new swimming pool?  Those are the kinds of discussions that ought to be going on in local governments all across the country.

Any community that fails to prepare with the expectation that the federal government will be able to come in, rescue them at the last moment, will be sadly disappointed.  Not because the federal government isn’t prepared.  Not because we are not able or have the wallet for it.  It’s because when it’s occurring in 5,000 communities at the same time, it’s local preparedness that will ultimately spell the difference.

CURRY: What is the single biggest reason why it’s going to take that long to be ready in your view?

LEAVITT: Vaccines.  We aspire to have the capacity to produce within a six-month period of time 300 million courses of an appropriate vaccine to provide protection from a pandemic influenza.

CURRY: You said earlier that we have a vaccine.  What you mean is a general flu vaccine.

LEAVITT: We have a vaccine that has shown effectiveness against the H5 pandemic-like viruses.  Now, it’s still a trial vaccine.  But it does produce a sufficient immune response that it will—it gives us optimism that it will provide protection.

CURRY: Still under development?

LEAVITT: Still under development.  But we’re advanced enough now to be quite optimistic.  What we lack is the capacity to manufacture it in large enough doses fast enough.  And that’s precisely the reason that the president has proposed a $7 billion campaign to bring out capacity—into being so that we can meet our aspiration on preparedness.

CURRY: Here’s the rub.  The United States used to have many more facilities than it does today to manufacture vaccines.  The drug companies found that they were not profitable and closed a lot of them down.  So—

LEAVITT: That’s true.

CURRY: So by relying on the drug companies to be the source of these vaccines and allowing them to decide that they’re going to close them down because they’re not making enough money, what kind of a position does this put us in as a country facing what you say is a certainty?

LEAVITT: Well, they’re very good at what they do.  That’s where the technical capacity to make these life-preserving vaccines reside.  And that’s true in every country essentially in the world.  We have the leaders of the industry here.  And they are working hard now with us to assure that we do have the capacity to develop these vaccines.  There’s no one in the world, no one, who has the capacity to develop vaccines and to manufacture it fast enough to meet what the need will be.  We will be leading the world in this way.  And in three to five years, we do intend to have the capacity to produce sufficient vaccines to protect the entire country from a pandemic flu.

CURRY: You’ve told the drug companies to increase the number of facilities. You’re creating the facilities.  Where are these facilities coming from?

LEAVITT: We’re actually working together, first of all, in the research to develop a new way of creating vaccines.  Vaccines are currently made out of eggs.  And it limits the amount of vaccine that can be developed because of the number of eggs.  We’re developing a new technology called cell-based where we actually use cells to develop the vaccine.

It can be done much more rapidly in a much more reliable way.  And it will save millions of lives when it occurs.  Because not only will we be able to develop vaccines for us, but we’ll be able to help others around the world do the same.

CURRY: So you’re saying the United States government, your office, has said to the drug companies, “We got to change this.  We got to switch this up.  We need to start opening these facilities, and we need to be able to manufacture this material as quickly as possible.”  True?

LEAVITT: I met individually with each of the manufacturers of vaccines in the country.  The president then met with them as well.  And we said to them we have to solve this problem.  It’s unthinkable for us as a nation not to be able to produce vaccines—for the purpose of protecting our population from a pandemic flu.

They committed to us, and we’re now working with them to produce the technology and the manufacturing capacity that’s necessary.  Congress acted.  $3.3 billion this year.  They’ll put more in next year.  We’re optimistic.  And we’ll be able to solve that problem not just—for now but literally forever.  And not only will it do good with respect to pandemic influenza, but 36,000 people every year die from the annual flu.

We’ll be able to take the problem of the annual flu off the table once and for all because we’ll have enough annual flu vaccine that literally every man, woman, and child in the United States could have a course of the annual flu vaccine if they chose to have it.  That will send tens of thousands of lives.

CURRY: You have made getting prepared a priority from what I gather here in the fall of 2005. But the H5N1 virus first emerged in 1997.  What took so long?

LEAVITT: Well, in 1997 this virus did manifest itself in Hong Kong.  And through some very good public health work, they were able to squelch it.  It then began, in very minor ways, to begin to manifest itself in 2002.  And we began as a government to buy anti-virals and to begin to focus on our preparation.

But as it picked up and accelerated, it became more and more evident that this was the potential of a pandemic.  And that’s the point at which we began to work feverishly to not just prepare ourselves but to sound the alarm around the world to meet with our friends and our allies in other countries.  Because we’re now part of a global society where movement and travel is virtually unlimited.

If it happens in a remote village in Thailand—it won’t be 30 days until it has reached the shores of the United States.  So we are not alone in this.  This is an enterprise that must incorporate the action on the part of people all over the world.

CURRY: Do you wish the United States government had made this a priority sooner?

LEAVITT: We would always be better served—to be better prepared.  There are many things that our country has been preparing for.  We don’t have the luxury of preparing for one danger at a time.  But it’s become evident that our most pressing public health need right now is a pandemic.  It’s just a matter of time.

It may not be this H5N1 virus.  But there’ll be another pandemic.  They have pandemics have happened throughout time.  And they’ll happen again.  And we need to be better prepared.

CURRY: Were you surprised when you assumed this office that more had not been done to prioritize and focus on preparing this nation for this inevitability?

LEAVITT: Public health experts have been talking and worrying about pandemics for decades.  But it is now time for that discussion to go well beyond the public health community, to policy makers, to local elected officials, to mayors, to city councilmen, to—county commissioners and school masters and college presidents and corporate planners.  This is not something that government can do on its own.  This requires society to mobilize.

CURRY: Were we distracted by 9/11?  Did 9/11 prevent us from making this a priority sooner?

LEAVITT: We don’t have the luxury of preparing for one danger at a time.  Bioterrorism is still a danger.  Hurricanes are still a danger.  If we have a pandemic for a year, it doesn’t mean we won’t have a hurricane.  If we have a pandemic, it doesn’t mean that terrorists wouldn’t try to take advantage of that period of vulnerability and strike during that moment.

We have to prepare for all hazards, all risks.  We know that a pandemic is not something that we can in any way accept as lacking danger.  It does.  It’s our highest public health priority at this moment.  But there are others, and we have to deal with those, too.  And we have to think about the potential of seeing them in combination.

CURRY: I’m just looking at the timing of this.  You’re saying three to five years before you feel that this nation is going to be ready for this great tragedy that may occur.

LEAVITT: The dilemma of a pandemic is that anything we say—before a pandemic happens feels alarmist.  Anything that we have done once a pandemic starts seems inadequate.  As we began preparing early on for a pandemic, it had not yet caught the attention of the world.

It began to mobilize when President Bush said we’ve got to become better prepared for a pandemic.  Would it have been better if we had started two years ago? Of course it would.  But the reality is we are on track to become better prepared with a comprehensive plan.  It’s going to require everyone’s work.  Looking back is of no consequence at this moment.  Looking forward is what we have to do.

CURRY:  Sometimes looking back can help light a fire.  I know you’re trying to light a fire now.  You’re going from state to state.  You’re really fighting to let people understand this.  You’re absolutely right.  People are gonna look back on this, and they’re gonna say, “Did you sound the call enough?  Did you do enough?”

LEAVITT: There are local health officers all over America who have known that a pandemic was a possibility for many years.  It did not catch the attention of political policy makers until this particular virus began to manifest itself.  But having said that, we may be the generation that’s best prepared, has had the most warning of any generation in human history right now.

In 1918 when the virus began to move from place to place, they had no idea that it was even happening.  We’re in a position now where we can do some things.  We won’t be able to stop it.  But we can do some things that will clearly mitigate the impact that it would otherwise have on society.

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