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‘A Dramatic Disconnect’
A disaster preparedness expert says the U.S. government's plans—and funding—to fight a potential deadly flu outbreak still fall short.
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Ken George / ABC-AP
A fictional outbreak in a Hong Kong market spreads throughout the world in the upcoming TV movie, 'Fatal Contact; Bird Flu in America'
WEB EXCLUSIVE
By Jennifer Barrett
Newsweek
Updated: 10:46 a.m. ET May 3, 2006
May 3, 2006 - Even as the White House prepares to unveil Wednesday a road map to its $7.1 billion plan to fight a potential flu pandemic, some public health officials worry that the government isn’t ready. Last fall, President George W. Bush announced Washington’s strategy to a deadly flu outbreak, including plans to stockpile millions of doses of antivirals and bird flu vaccine (now under development). The latest report outlines the roles of various branches of government, as well as the private sector, in trying to contain any potential pandemic and minimize its damage. Some of the suggestions—like preventing infections at work by asking employees to avoid shaking hands and staying three feet away from each other—have produced snickers. But the report's projection that an outbreak could kill up to 2 million Americans and affect 40 percent of the nation's workforce is deadly serious. NEWSWEEK’s Jennifer Barrett spoke with Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, about the government’s plans. Excerpts:
NEWSWEEK: According to the latest draft report, the government is preparing for a worst-case scenario of up to 2 million deaths in the United States. Is that realistic?[/B
Dr. Irwin Redlener: Unfortunately, almost anything is realistic because we don’t really know much about how virulent this virus would be when it becomes pandemic in form. So if we look at the 1918 Spanish flu as the benchmark, we had 3 percent or so on average of those infected dying. If 35 percent of the population, or about 100 million Americans, are infected now and somewhere between 2 to 3 percent die, that’s a really large number. It is feasible. But that’s just the beginning of the story. For every person who dies, we can expect somewhere between three and 10 more people who need to go to the hospital, and we don’t have the capacity to treat that many people in the United States. So you’ve got the emotional burden of people who don’t make it added to the extra logistical challenge of a health-care system that’s not too healthy itself now trying to treat an unprecedented number of people.
So the health-care system isn’t prepared to handle such numbers?[/B]
No—not even close. If we had a full-blown pandemic of the type we’re discussing, for example, about 700,000 to 800,000 people would need mechanical ventilators. We can’t afford them and we don’t have enough people who know how to use them. We only have about 105,000 mechanical ventilators in the United States now. We’re about to face the consequences of a health-care system that’s in essence been neglected and allowed to degrade over time. Now it’s too fragile to handle what could be an overwhelming emergency.
This could be a good excuse to improve the health-care system.
The prospect of a pandemic should be putting us into high gear in terms of trying to fix the health-care system even before we get a pandemic. If we wait until it actually hits, it would be a very tragic wake-up call. And we want to avoid that. We want to start fixing the obvious problems in the system, including the fact that we have so many uninsured people. We have more than 40 million uninsured, which would be its own nightmare. At least a third of those people could be infected, so we’d have potentially 15 million uninsured people who will need access.
When we’re talking about an avian-flu pandemic, is it a question of when or if?
Most scientists really believe it is a question of when. There’s a small contingent of my colleagues who think we are making too big a deal about it. It is a judgment call for society. Do we bust the budget on pandemic flu preparedness or to treat AIDS or expand health care for children? It takes a lot of judgment and wisdom to make these kinds of decisions. And both of these seem to be in short supply these days.
I take it you’re not so impressed with the preparedness efforts thus far.
I am very concerned about the preparedness efforts because of a dramatic disconnect between what they put on paper to be done compared to resources actually made available to do them. I haven’t seen the latest report, but the one that came out in November provided a very detailed, comprehensive agenda for the United States and a completely unrealistic budget to go along with it. Out of the $7.1 billion allocated, more than 95 percent has been directed to vaccine development and stockpiling Tamiflu and antivirals.
Is that money misdirected?
It’s not misguided. If we need that money for vaccine development, we need it. We have the technology to rapidly develop vaccines. But one that works on a strain today may not work on the strain of virus that becomes a pandemic. Still we need to do the research and get the technology for rapid manufacturing, and look at generic vaccines … But we also need to find the money for preparedness.
So is it the plan that falls short, or just the budget?
Last year President Bush said maybe we’ll use the military to do the quarantine. Two months ago, Secretary of Health and Human Services Michael Leavitt recommended that Americans start storing canned tuna under the bed. There are a lot of off-the-wall ideas that are not necessarily based in science. I’ve heard a few tidbits from the new report—like telling airlines to stockpile air masks. You’re going to tell this to bankrupt airlines that are already taking away our meals
Maybe they’ll just charge us for the masks like they do with meals.
[Laughs.] Right. For $4, you can choose between a meal or an air mask.
I think I’ll take the air mask. Seriously, how is the government going to fund—or even enforce—these recommendations for the private sector?
Can the government force the airlines to buy masks?
I don’t know. If the airline says it can’t afford it, is that the end of the argument? This is a public-health issue. Will the public get caught in middle between the private sector and the government in terms of fulfilling the pandemic flu agenda? We don’t want this to be a ping-pong match on who pays for it.
How worried should Americans be?
The question of whether we are panicking people unnecessarily is a legitimate question. But if this is a real possibility—and most scientists think it is—then we have to do something prudent without breaking the bank. We need to come up with a plan that is affordable, workable and effective. Right now we don’t have any of that. These plans on paper are neither feasible nor affordable and there’s no money behind it. What the government is doing now is exacerbating the potential for people to be very frightened by creating a to-do list without providing the money to pay for the things on the list.
What do you recommend?
We need a $5 billion immediate infusion into the health-care systems to boost staffs, equipment and supplies, and general resiliency. There are about 5,000 hospitals in the United States and virtually all of them would need to be upgraded to respond to this or other major emergencies. Then we need to at least put into play a program to make sure that we don’t have uninsured people in the United States. It’s been on the agenda for 20 years. But now it could be a matter of life or death.
What else could the government be doing now?
It should be doing a lot more guiding in terms of what we are going to do with limited resources ... Also, one of the big deficits in the original plan and all the state plans I’ve seen is this dramatic failure to consider the special needs of certain populations like children. Children would be one of the groups that would be more vulnerable but who also need very specialized responses in terms of training, equipment and doses.
How optimistic are you that we’ll be prepared if, or when, an outbreak happens in the United States?
Well, I’m always hopeful. But I am very, very concerned that we aren’t going to get the job done in time.
‘A Dramatic Disconnect’
A disaster preparedness expert says the U.S. government's plans—and funding—to fight a potential deadly flu outbreak still fall short.
<table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td style="padding: 25px 0px 0px 15px;">
Ken George / ABC-APA fictional outbreak in a Hong Kong market spreads throughout the world in the upcoming TV movie, 'Fatal Contact; Bird Flu in America'
WEB EXCLUSIVE
By Jennifer Barrett
Newsweek
Updated: 10:46 a.m. ET May 3, 2006
May 3, 2006 - Even as the White House prepares to unveil Wednesday a road map to its $7.1 billion plan to fight a potential flu pandemic, some public health officials worry that the government isn’t ready. Last fall, President George W. Bush announced Washington’s strategy to a deadly flu outbreak, including plans to stockpile millions of doses of antivirals and bird flu vaccine (now under development). The latest report outlines the roles of various branches of government, as well as the private sector, in trying to contain any potential pandemic and minimize its damage. Some of the suggestions—like preventing infections at work by asking employees to avoid shaking hands and staying three feet away from each other—have produced snickers. But the report's projection that an outbreak could kill up to 2 million Americans and affect 40 percent of the nation's workforce is deadly serious. NEWSWEEK’s Jennifer Barrett spoke with Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, about the government’s plans. Excerpts:
NEWSWEEK: According to the latest draft report, the government is preparing for a worst-case scenario of up to 2 million deaths in the United States. Is that realistic?[/B
Dr. Irwin Redlener: Unfortunately, almost anything is realistic because we don’t really know much about how virulent this virus would be when it becomes pandemic in form. So if we look at the 1918 Spanish flu as the benchmark, we had 3 percent or so on average of those infected dying. If 35 percent of the population, or about 100 million Americans, are infected now and somewhere between 2 to 3 percent die, that’s a really large number. It is feasible. But that’s just the beginning of the story. For every person who dies, we can expect somewhere between three and 10 more people who need to go to the hospital, and we don’t have the capacity to treat that many people in the United States. So you’ve got the emotional burden of people who don’t make it added to the extra logistical challenge of a health-care system that’s not too healthy itself now trying to treat an unprecedented number of people.
So the health-care system isn’t prepared to handle such numbers?[/B]
No—not even close. If we had a full-blown pandemic of the type we’re discussing, for example, about 700,000 to 800,000 people would need mechanical ventilators. We can’t afford them and we don’t have enough people who know how to use them. We only have about 105,000 mechanical ventilators in the United States now. We’re about to face the consequences of a health-care system that’s in essence been neglected and allowed to degrade over time. Now it’s too fragile to handle what could be an overwhelming emergency.
This could be a good excuse to improve the health-care system.
The prospect of a pandemic should be putting us into high gear in terms of trying to fix the health-care system even before we get a pandemic. If we wait until it actually hits, it would be a very tragic wake-up call. And we want to avoid that. We want to start fixing the obvious problems in the system, including the fact that we have so many uninsured people. We have more than 40 million uninsured, which would be its own nightmare. At least a third of those people could be infected, so we’d have potentially 15 million uninsured people who will need access.
When we’re talking about an avian-flu pandemic, is it a question of when or if?
Most scientists really believe it is a question of when. There’s a small contingent of my colleagues who think we are making too big a deal about it. It is a judgment call for society. Do we bust the budget on pandemic flu preparedness or to treat AIDS or expand health care for children? It takes a lot of judgment and wisdom to make these kinds of decisions. And both of these seem to be in short supply these days.
I take it you’re not so impressed with the preparedness efforts thus far.
I am very concerned about the preparedness efforts because of a dramatic disconnect between what they put on paper to be done compared to resources actually made available to do them. I haven’t seen the latest report, but the one that came out in November provided a very detailed, comprehensive agenda for the United States and a completely unrealistic budget to go along with it. Out of the $7.1 billion allocated, more than 95 percent has been directed to vaccine development and stockpiling Tamiflu and antivirals.
Is that money misdirected?
It’s not misguided. If we need that money for vaccine development, we need it. We have the technology to rapidly develop vaccines. But one that works on a strain today may not work on the strain of virus that becomes a pandemic. Still we need to do the research and get the technology for rapid manufacturing, and look at generic vaccines … But we also need to find the money for preparedness.
So is it the plan that falls short, or just the budget?
Last year President Bush said maybe we’ll use the military to do the quarantine. Two months ago, Secretary of Health and Human Services Michael Leavitt recommended that Americans start storing canned tuna under the bed. There are a lot of off-the-wall ideas that are not necessarily based in science. I’ve heard a few tidbits from the new report—like telling airlines to stockpile air masks. You’re going to tell this to bankrupt airlines that are already taking away our meals
Maybe they’ll just charge us for the masks like they do with meals.
[Laughs.] Right. For $4, you can choose between a meal or an air mask.
I think I’ll take the air mask. Seriously, how is the government going to fund—or even enforce—these recommendations for the private sector?
Can the government force the airlines to buy masks?
I don’t know. If the airline says it can’t afford it, is that the end of the argument? This is a public-health issue. Will the public get caught in middle between the private sector and the government in terms of fulfilling the pandemic flu agenda? We don’t want this to be a ping-pong match on who pays for it.
How worried should Americans be?
The question of whether we are panicking people unnecessarily is a legitimate question. But if this is a real possibility—and most scientists think it is—then we have to do something prudent without breaking the bank. We need to come up with a plan that is affordable, workable and effective. Right now we don’t have any of that. These plans on paper are neither feasible nor affordable and there’s no money behind it. What the government is doing now is exacerbating the potential for people to be very frightened by creating a to-do list without providing the money to pay for the things on the list.
What do you recommend?
We need a $5 billion immediate infusion into the health-care systems to boost staffs, equipment and supplies, and general resiliency. There are about 5,000 hospitals in the United States and virtually all of them would need to be upgraded to respond to this or other major emergencies. Then we need to at least put into play a program to make sure that we don’t have uninsured people in the United States. It’s been on the agenda for 20 years. But now it could be a matter of life or death.
What else could the government be doing now?
It should be doing a lot more guiding in terms of what we are going to do with limited resources ... Also, one of the big deficits in the original plan and all the state plans I’ve seen is this dramatic failure to consider the special needs of certain populations like children. Children would be one of the groups that would be more vulnerable but who also need very specialized responses in terms of training, equipment and doses.
How optimistic are you that we’ll be prepared if, or when, an outbreak happens in the United States?
Well, I’m always hopeful. But I am very, very concerned that we aren’t going to get the job done in time.
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