The Bush administration's long-awaited plan on how to fight the next superflu probably will include beefed-up attempts to spot human infections early, both here and abroad, and how to isolate the sick.
Governors and mayors will have to decide who will inject stockpiled vaccines into the arms of panicked people.
President Bush is scheduled to visit the National Institutes of Health on Tuesday to announce his administration's strategy on how to prepare for the next flu pandemic, whether it is caused by the bird flu or some other super strain of influenza. Federal health officials have spent the past year updating a national plan on how to do that.
The president will ask Congress for money not just for a vaccine against bird flu but also to fund a buildup of infrastructure ready to deal with any pandemic, said a senior administration official, who spoke yesterday on the condition of anonymity.
Stockpiling drugs and vaccines is just one component.
"Understand that a lot of the things we need to do to prepare are not related to magic bullets," said Michael Osterholm of the University of Minnesota, an infectious-disease specialist who has advised the government on preparations for the next worldwide flu outbreak but has not seen the final version of the plan.
How to provide food supplies, everyday medical care for people who do not have the superflu, basic utilities and even security must be part of the plan, Osterholm and others have counseled the Bush administration.
"In this day and age of a global economy, with just-in-time delivery and no surge capacity and international supply chains -- those things are very difficult to do for a week, let alone for 12 to 18 months of what will be a very tough time," he said.
Although it is impossible to say when the next superflu will strike, there have been three pandemics in the past century, and influenza experts say the world is overdue. Concern is growing that bird flu could trigger one if it mutates to start spreading easily among people -- something that has not yet happened.
Already the government is buying $162.5 million worth of vaccine against a bird flu strain, called H5N1, from two companies -- Sanofi-Aventis and Chiron Corp. -- in case that happens. It is also ordering millions of doses of Tamiflu and Relenza, two antiflu drugs believed to offer some protection against bird flu, and the pandemic plan could order larger stockpiles.
Lawmakers angry at months of delay have already given Bush money to begin preparations: $8 billion in emergency funding that the Senate, pushed by Democrats, passed on Thursday -- and an amount considered close to what federal health officials will need. The money is to be spent at the president's discretion, but senators said it should be used both for medications and vaccine, and for beefing up hospitals and other systems to detect and contain a superflu.