By Michelle Mittelstadt,The Dallas Morning News

WASHINGTON – Front-line health care providers, vaccine plant workers, pregnant women, government leaders and people with high-risk medical conditions would be among those given first priority for vaccination if a deadly influenza pandemic breaks out.

Issuing its long-awaited pandemic response plan Wednesday, the Bush administration made clear that a flu pandemic could make it necessary to impose travel restrictions, shut down schools and businesses, quarantine cities and ban public gatherings.

The 396-page document sketches the federal public health response and urges state and local authorities to confront the issues that would arise during a super-flu outbreak. They include rationing precious vaccine and drug supplies; issuing quarantines and closing schools; where to house the sick and dying when hospitals become overtaxed; and how to ensure the delivery of food, water and essential services in the midst of a major societal breakdown.

“An influenza pandemic has the potential to cause more death and illness than any other public health threat,” the Health and Human Services Department plan grimly notes, estimating a worst-case scenario could hospitalize 9.9 million people and kill 1.9 million.

The government predicts a third of the population would be sickened, with school-age children having a 40 percent rate of infection. Outbreaks, lasting six to eight weeks and recurring in waves, could cause an economic toll exceeding $181 billion.

“An influenza pandemic will place extraordinary and sustained demands not only on public health and health care providers, but also on providers of essential services across the United States and around the globe,” the plan says.

While public health officials can’t predict when the next pandemic will hit, they are eyeing with concern an avian flu that has raced through Asia’s fowl populations, leading to the slaughter of tens of millions of birds. The strain, known as H5N1, has sickened 122 humans, with 62 confirmed deaths so far.

The H5N1 virus has yet to make the leap to easy person-to-person transmission, and may never do so. But epidemiologists note that with an average three pandemics a century, the last in 1968, the world may be overdue.

The release of the pandemic plan came a day after President Bush outlined a $7.1 billion preparedness proposal that focuses in large measure on stockpiling anti-viral medications and speeding vaccine production technologies and capacity.

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At the Texas Department of State Health Services, officials were poring over the federal document, issued just days after the state released a preliminary version of its pandemic plan. A final version will be issued next year after a public comment period that ends Nov. 23.

“Everything that we’ve observed is that we’re probably going to dovetail pretty closely and be in sync,” state health department spokeswoman Emily Palmer said. “But if we need to make adjustments … we’ll be able to do that.”

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The federal plan seeks to tame what would be a massively complex response, which in some cases would be led by the federal government, in others by local or state officials. Federal authorities stressed Wednesday, however, that much of the response would need to be shouldered by local and state authorities.

Public health officials around the country welcomed the federal plan’s release but complained that only $100 million of the $7.1 billion in proposed spending is earmarked for state and local public health departments.

They also questioned the plan’s reliance on the states to buy enough anti-virals to treat 31 million Americans – a $510 million cost.

“We look forward to working with the administration and the Congress to assure the availability of appropriate resources at the state and local levels necessary to protect all Americans,” said Dr. George Hardy Jr., executive director of the Association of State and Territorial Health Officials.

Testifying Wednesday on Capitol Hill, Health and Human Services Secretary Michael Leavitt stressed that preparedness and response are shared roles for federal, state and local authorities. He defended the administration’s decision to have states pay for 31 million of the 81 million doses of anti-viral treatments the United States intends to stockpile.

“Public health is, and should, remain a state and local function,” he told reporters on a conference call after his Senate testimony. “The role of the national government is to assist them in meeting that obligation. And we will continue to do that.”

But some lawmakers complained that cash-strapped states are not in position to come up with the funding. Sen. Patty Murray, D-Wash., noted that the president’s 2006 budget calls for cuts of $130 million for state and local health departments.

“They are already struggling,” she said. “So if we add this on top of them … we are going to have a public health crisis. And that concerns me greatly.”

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Beyond funding issues, some contend the national plan is far from a complete blueprint.

Jeffrey Levi, a pandemic expert at the nonprofit Trust for America’s Health, expressed concern that the national plan doesn’t outline how the government would cope with a pandemic’s effect on the transportation sector, the economy and business operations.

“We hope the administration and Congress will work together quickly to fix the flaws and create a complete preparedness initiative,” he said.

Echoed Sen. Edward Kennedy, D-Mass.: “After all the buildup and the long wait, the American people had a right to expect a comprehensive plan. But all the administration released was a glossy brochure and a plan for a single agency, the Department of Health and Human Services.”

Leavitt acknowledged that specifics involving travel restrictions, for example, aren’t complete. “Those details will be developed as we go forward with the Department of Homeland Security and the Department of Transportation,” he said.

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(c) 2005, The Dallas Morning News.

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GRAPHIC (from KRT Graphics, 202-383-6064): 20051102 AVIANFLU plan

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