Public-health experts say President Bush's proposal for dealing with a possible pandemic of avian influenza is a good start and they're glad the issue is being addressed at the federal level.
But some question whether the proposed $7.1 billion is enough and they're anxious to see more details of the plan, which are scheduled to be released Wednesday by Health and Human Services Secretary Michael Leavitt.
"The devil will be in the details," said Dr. Georges C. Benjamin, executive director of the American Public Health Association.
"I didn't hear anything that I didn't agree with broadly," Benjamin said. Specifically, he said he was pleased that the president is "putting dollars on the table" though he called the amount "a downpayment."
Bush said the plan, announced Tuesday, would allot $1.2 billion to make enough vaccine against the current bird flu strain to protect 20 million Americans, $2.8 billion to develop new vaccines, $1 billion to stockpile more anti-viral drugs, such as Tamiflu, that would lessen the severity of bird flu symptoms, and $583 million for state and local governments to prepare emergency response plans.
Need for a 'well worked-out plan'
Dr. Neil Schachter, medical director of the respiratory care department at Mount Sinai Medical Center in New York, said the Bush plan seems like a “reasonable overview,” but questioned whether the billions requested would be sufficient to meet the president’s defined goals.
“All of these things are important and they should all be addressed," he said, "but there should be a well worked-out plan so that it’s not just throwing money at ideas but that these things actually produce what they are intended to produce.”
Experts were particularly happy that the president emphasized the importance of vaccine production and development, and recommended that vaccine manufacturers receive liability protection.
The liability issue has made manufacturers leery of producing vaccines, so protecting the companies will be important, said Schachter. He said the administration’s plan to modernize the vaccine manufacturing process is critical and should also provide incentives for companies to develop the product.
The current vaccine-making system requires millions of chicken eggs to grow a virus strain and takes nine months to produce each year’s flu shots.
“The lifeline to the vaccine is tremendously tenuous," Schachter said. "You have to step back and not just say you’re going to prepare new vaccine and stockpile vaccines, but you’re going to have to redefine the whole vaccine development process.”
Efforts may help combat regular flu, too
Investing in the vaccine production infrastructure will mean that the medical community will be able to better cope with the yearly epidemic of regular influenza, as well as preparing the nation for a pandemic, said Dr. Brian Currie, vice president and senior medical director of New York's Montefiore Medical Center.
“I found it encouraging,” Currie said of the government’s strategy. “Production that works for bird flu will work for regular flu.”
While bird flu is still a theoretical concern in the U.S., the common flu bug kills an average of 20,000 Americans each year.
But the plan to stockpile anti-virals such as Tamiflu came under criticism from Currie for “being behind the eight ball.”
World production of the drug is being outstripped by demand and currently the U.S. has ordered only enough of the anti-virals Tamiflu and Relenza for about 5 million people.
“We may order all we want but until it is produced and available, it’s no help,” he said.
Experts also said that it's critical for the federal government to work with state and local governments.
Dr. William Schaffner, chair of the department of preventive medicine at the University of Nashville and a spokesperson for the Infectious Disease Society of America, said he was pleased the president emphasized the role of state and local governments in responding to a potential outbreak of avian influenza.
"You can't expect the federal calvary to come in and rescue the community," he said, as often happens after a flood or other natural disaster. Instead, everyone must work together to develop an action plan and test it to make sure it works, he added.
Schaffner noted that the president didn't discuss isolation and quarantine as a method of containing an outbreak, but the issue needs to be addressed. Schaffner said the approach is controversial, with most public-health experts agreeing that the strategy is ineffective because an infected person could be contagious 24 hours before developing symptoms.
"You can't catch up with it," he said.