Thursday, February 22, 2007

Avian Flu: One More Disaster Bush Is In Denial About

Another excuse for Bush to invoke the Warner Act, after failing yet again to anticipate, move to mitigate or avoid, and make concrete arrangements for an appropriate and speedy response to a potential disaster. In the case of a worldwide outbreak of avian flu, we're talking potential catastrophe with tens of millions likely dying and possibly far more. Whether it's global warming or avian flu, Bush/Cheney are equal opportunity deniers.

The following article contains a number of shocking revelations, but this one probably takes the cake:

"The plan also calls for a national stockpile of 133 million courses of antiviral treatment. The administration has bought 4.3 million."

New York Times
October 8, 2005
Bush Plan Shows U.S. Is Not Ready for Deadly Flu

By GARDINER HARRIS
WASHINGTON, Oct. 7 - A plan developed by the Bush administration to deal with any possible outbreak of pandemic flu shows that the United States is woefully unprepared for what could become the worst disaster in the nation's history.

A draft of the final plan, which has been years in the making and is expected to be released later this month, says a large outbreak that began in Asia would be likely, because of modern travel patterns, to reach the United States within "a few months or even weeks."

If such an outbreak occurred, hospitals would become overwhelmed, riots would engulf vaccination clinics, and even power and food would be in short supply, according to the plan, which was obtained by The New York Times.

The 381-page plan calls for quarantine and travel restrictions but concedes that such measures "are unlikely to delay introduction of pandemic disease into the U.S. by more than a month or two."

The plan's 10 supplements suggest specific ways that local and state governments should prepare now for an eventual pandemic by, for instance, drafting legal documents that would justify quarantines. Written by health officials, the plan does not yet address responses by the military or other governmental departments.

The plan outlines a worst-case scenario in which more than 1.9 million Americans would die and 8.5 million would be hospitalized with costs exceeding $450 billion.

It also calls for a domestic vaccine production capacity of 600 million doses within six months, more than 10 times the present capacity.

On Friday, President Bush invited the leaders of the nation's top six vaccine producers to the White House to cajole them into increasing their domestic vaccine capacity, and the flu plan demonstrates just how monumental a task these companies have before them.

In the wake of Hurricane Katrina, the Bush administration's efforts to plan for a possible pandemic flu have become controversial, with many Democrats in Congress charging that the administration has not done enough. Many have pointed to the lengthy writing process of the flu plan as evidence of this.

But while the administration's flu plan, officially called the Pandemic Influenza Strategic Plan, closely outlines how the Health and Human Services Department may react during a pandemic, it skirts many essential decisions, like how the military may be deployed.

"The real shortcoming of the plan is that it doesn't say who's in charge," said a top health official who provided the plan to The Times. "We don't want to have a FEMA-like response, where it's not clear who's running what."

Still, the official, who asked for anonymity because the plan was not supposed to be distributed, called the plan a "major milestone" that was "very comprehensive" and sorely needed.

The draft provided to The Times is dated Sept. 30, and is stamped "for internal H.H.S. use only." The plan asks government officials to clear it by Oct. 6.

Christina Pearson, a spokeswoman for Health and Human Services Secretary Michael O. Leavitt, responded, "We recognize that the H.H.S. plan will be a foundation for a governmentwide plan, and that process has already begun."

Ms. Pearson said that Mr. Leavitt has already had one-on-one meetings with other cabinet secretaries to begin the coordination process across the federal government. But she emphasized that the plan given to The Times was a draft and had not been finalized.

Mr. Leavitt is leaving Saturday for a 10-day trip to at least four Asian nations, where he will meet with health and agriculture officials to discuss planning for a pandemic flu. He said at a briefing on Friday that the administration's flu plan would be officially released soon. He was not aware at the briefing that The Times had a copy of the plan. And he emphasized that the chances that the virus now killing birds in Asia would become a human pandemic were unknown but probably low. A pandemic is global epidemic of disease.

"It may be a while longer, but pandemic will likely occur in the future," he said.

And he said that flu planning would soon become a national exercise.

"It will require school districts to have a plan on how they will deal with school opening and closing," he said. "It will require the mayor to have a plan on whether or not they're going to ask the theaters not to have a movie."

"Over the next couple of months you will see a great deal of activity asking metropolitan areas, 'Are you ready?' If not, here is what must be done," he said.

A key point of contention if an epidemic strikes is who will get vaccines first. The administration's plan suggests a triage distribution for these essential medicines. Groups like the military, National Guard and other national security groups were left out.

Beyond the military, however, the first in line for essential medicines are workers in plants making the vaccines and drugs as well as medical personnel working directly with those sickened by the disease. Next are the elderly and severely ill. Then come pregnant women, transplant and AIDS patients, and parents of infants. Finally, the police, firefighters and government leaders are next.

The plan also calls for a national stockpile of 133 million courses of antiviral treatment. The administration has bought 4.3 million.

The plan details the responsibilities of top health officials in each phase of a spreading pandemic, starting with planning and surveillance efforts and ending with coordination with the Department of Defense.

Much of the plan is a dry recitation of the science and basic bureaucratic steps that must be followed as a virus races around the globe. But the plan has the feel of a television movie-of-the-week when it describes a possible pandemic situation that begins, "In April of the current year, an outbreak of severe respiratory illness is identified in a small village."

"Twenty patients have required hospitalization at the local provincial hospital, five of whom have died from pneumonia and respiratory failure," the plan states.

The flu spreads and begins to make headlines around the world. Top health officials swing into action and isolate the new viral strain in laboratories. The scientists discover that "the vaccine developed previously for the avian strain will only provide partial protection," the plan states.

In June, federal health officials find airline passengers infected with the virus "arriving in four major U.S. cities," the plan states. By July, small outbreaks are being reported around the nation. It spreads.

As the outbreak peaks, about a quarter of workers stay home because they are sick or afraid of becoming sick. Hospitals are overwhelmed.

"Social unrest occurs," the plan states. "Public anxiety heightens mistrust of government, diminishing compliance with public health advisories." Mortuaries and funeral homes are overwhelmed.

Presently, an avian virus has decimated chicken and other bird flocks in 11 countries. It has infected more than 100 people, about 60 of whom have died, but nearly all of these victims got the disease directly from birds. An epidemic is only possible when a virus begins to pass easily among humans.

Lawrence K. Altman contributed reporting for this article.


Has Time Run Out?
The Coming Avian Flu Pandemic
By Mike Davis
TomDispatch.com

Deadly avian flu is on the wing.

The first bar-headed geese have already arrived at their wintering grounds near the Cauvery River in the southern Indian state of Karnataka. Over the next ten weeks, 100,000 more geese, gulls, and cormorants will leave their summer home at Lake Qinghai in western China, headed for India, Bangladesh, Myanmar, and, eventually, Australia.

An unknown number of these beautiful migrating birds will carry H5N1, the avian flu subtype that has killed 61 people in Southeast Asia and which the World Health Organization (WHO) fears is on the verge of mutating into a pandemic form like that which killed 50 to 100 million people in the fall of 1918. As the birds arrive in the wetlands of South Asia, they will excrete the virus into the water where it risks spreading to migrating waterfowl from Europe as well as to domestic poultry. In the worst-case scenario, this will bring avian flu to the doorstep of the dense slums of Dhaka, Kolkata, Karachi, and Mumbai.

The avian flu outbreak at Lake Qinghai was first identified by Chinese wildlife officials at the end of April. Initially it was confined to a small islet in the huge salt lake, where geese suddenly began to act spasmodically, then to collapse and die. By mid-May it had spread through the lake's entire avian population, killing thousands of birds. An ornithologist called it "the biggest and most extensively mortal avian influenza event ever seen in wild birds."

Chinese scientists, meanwhile, were horrified by the virulence of the new strain: when mice were infected they died even quicker than when injected with "genotype Z," the fearsome H5N1 variant currently killing farmers and their children in Vietnam.

Yi Guan, leader of a famed team of avian flu researchers who have been fighting the pandemic menace since 1997, complained to the British Guardian in July about the lackadaisical response of Chinese authorities to the unprecedented biological conflagration at Lake Qinghai.

"They have taken almost no action to control this outbreak. They should have asked for international support. These birds will go to India and Bangladesh and there they will meet birds that come from Europe." Yi Guan called for the creation of an international task force to monitor the wild bird pandemic, as well as the relaxation of rules that prevent the free movement of foreign scientists to outbreak zones in China.

In a paper published in the British science magazine Nature, Yi Guan and his associates also revealed that the Lake Qinghai strain was related to officially unreported recent outbreaks of H5N1 among birds in southern China. This would not be the first time that Chinese authorities have been charged with covering up an outbreak. They also lied about the nature and extent of the 2003 SARS epidemic, which originated in Guangdong but quickly spread to 25 other countries. As in the case of SARS' whistleblowers, the Chinese bureaucracy is now trying to gag avian-flu scientists, shutting down one of Yi Guan's laboratories at Shantou University and arming the conservative Agriculture Ministry with new powers over research.

Meanwhile, as anxious Indian scientists monitor bird sanctuaries throughout the subcontinent, H5N1 has spread to the outskirts of Lhasa, the capital of Tibet; to western Mongolia; and, most disturbingly, to chickens and wildfowl near the Siberian capital of Novosibirsk.

Despite frantic efforts to cull local poultry, Russian Health Ministry experts have expressed pessimism that the outbreak can be contained on the Asian side of the Urals. Siberian wildfowl migrate every fall to the Black Sea and southern Europe; another flyway leads from Siberia to Alaska and Canada.

In anticipation of this next, and perhaps inevitable, stage in the world journey of avian flu, poultry populations are being tracked in Moscow; Alaskan scientists are studying birds migrating across the Bering Straits, and even the Swiss are looking over their shoulders at the tufted ducks and pochards arriving from Eurasia.

H5N1's human epicenter is also expanding: in mid-July Indonesian authorities confirmed that a father and his two young daughters had died of avian flu in a wealthy suburb of Jakarta. Disturbingly, the family had no known contact with poultry and near panic ensued in the neighborhood as the press speculated about possible human-to-human transmission.

At the same time, five new outbreaks among poultry were reported in Thailand, dealing a terrible blow to the nation's extensive and highly-publicized campaign to eradicate the disease. Meanwhile, as Vietnamese officials renewed their appeal for more international aid, H5N1 was claiming new victims in the country that remains of chief concern to the WHO.

The bottom line is that avian influenza is endemic and probably ineradicable among poultry in Southeast Asia, and now seems to be spreading at pandemic velocity amongst migratory birds, with the potential to reach most of the earth in the next year.

Each new outpost of H5N1 - whether among ducks in Siberia, pigs in Indonesia, or humans in Vietnam - is a further opportunity for the rapidly evolving virus to acquire the gene or even simply the protein mutation that it needs to become a mass-killer of humans.

This exponential multiplication of hot spots and silent reservoirs (as among infected but asymptomatic ducks) is why the chorus of warnings from scientists, public-health officials, and finally, governments has become so plangently insistent in recent months.

The new US Health and Human Services Secretary Mike Leavitt told the Associated Press in early August that an influenza pandemic was now an "absolute certainty," echoing repeated warnings from the World Health Organization that it was "inevitable." Likewise Science magazine observed that expert opinion held the odds of a global outbreak as "100 percent."

In the same grim spirit, the British press revealed that officials were scouring the country for suitable sites for mass mortuaries, based on official fears that avian flu could kill as many as 700,000 Britons. The Blair government is already conducting emergency simulations of a pandemic outbreak ("Operation Arctic Sea") and is reported to have readied "Cobra" - a cabinet-level working group that coordinates government responses to national emergencies like the recent London bombings from a secret war room in Whitehall - to deal with an avian flu crisis.

Little of this Churchillian resolve is apparent in Washington. Although a sense of extreme urgency is evident in the National Institutes of Health where the czar for pandemic planning, Dr. Anthony Fauci, warns of "the mother of all emerging infections," the White House has seemed even less perturbed by migrating plagues than by wanton carnage in Iraq.

As the President was packing for his long holiday in Texas, the Trust for America's Health was warning that domestic preparations for a pandemic lagged far behind the energetic measures being undertaken in Britain and Canada, and that the administration had failed "to establish a cohesive, rapid and transparent US pandemic strategy."

That increasingly independent operator, Senate majority leader Bill Frist (R-Tenn.), had already criticized the administration in an extraordinary (and under-reported) speech at Harvard at the beginning of June. Referring to Washington's failure to stockpile an adequate supply of the crucial anti-viral oseltamivir (or Tamiflu), Frist sarcastically noted that "to acquire more anti-viral agent, we would need to get in line behind Britain and France and Canada and others who have tens of millions of doses on order."

The New York Times on its July 17 editorial page, a May 26 special issue of Nature and the July/August issue of Foreign Affairs have also hammered away at Washington's failure to stockpile enough scarce anti-virals - current inventories cover less than 1% of the US population - and to modernize vaccine production. Even a few prominent Senate Democrats have stirred into action, although none as boldly as Frist at Harvard.

The Department of Health and Human Services, in response, has sought to calm critics with recent hikes in spending on vaccine research and antiviral stockpiles. There has also been much official and media ballyhoo about the announcement of a series of successful tests in early August of an experimental avian flu vaccine.

But there is no guarantee that the vaccine prototype, based on a "reverse-genetically-engineered" strain of H5N1, will actually be effective against a pandemic strain with different genes and proteins. Moreover, trial success was based upon the administration of two doses plus a booster. Since the government has only ordered 2 million doses of the vaccine from pharmaceutical giant Sanofi Pasteur, this may provide protection for only 450,000 people. As one researcher told Science magazine, "it's a vaccine for the happy few."

At the least, gearing up for larger-scale production will take many months and production itself is limited by the antiquated technology of vaccine manufacture which depends upon a vulnerable and limited supply of fertile chicken eggs. It would also likely mean the curtailment of the production of the annual winter flu vaccine that is so often a lifesaver for many senior citizens.

Likewise, Washington's new orders for anti-virals, as Senator Frist predicted, will have to wait in line behind the other customers of Roche's single Tamiflu plant in Switzerland.

In short, it is good news that the vaccine tests were successful, but that does little to change the judgment of the New York Times that "there is not enough vaccine or antiviral medicine available to protect more than a handful of people, and no industrial capacity to produce a lot more of these medicines quickly."

Moreover, the majority of the world, including all the poor countries of South Asia and Africa where, history tells us, pandemics are likely to hit especially hard, will have no access to expensive anti-virals or scarce vaccines. It is even doubtful whether the WHO will have the minimal pharmaceuticals to respond to an initial outbreak.

Recent theoretical studies by mathematical epidemiologists in Atlanta and London have raised hopes that a pandemic might be stopped in its tracks if 1 to 3 million doses of oseltamivir (Tamiflu) were available to douse an outbreak in a failsafe radius around the early cases.

After years of effort, however, the WHO has only managed to inventory about 123,000 courses of Tamiflu. Although Roche has promised to donate more, the desperate rush of rich countries to accumulate Tamiflu will be certain to undercut the World Health Organization's stockpile.

As for a universally available "world vaccine," it remains a pipe-dream without new, billion-dollar commitments from the rich countries, above all the United States, and even then, we are probably too late.

"People just don't get it," Dr. Michael Osterholm, the outspoken director of the Center for Infectious Disease Research and Policy at the University of Minnesota recently complained. "If we were to begin a Manhattan Project-type response tonight to expand vaccine and drug production, we wouldn't have a measurable impact on the availability of these critical products to sufficiently address a worldwide pandemic for at least several years."

"Several years" is a luxury that Washington has already squandered. The best guess, as the geese head west and south, is that we have almost run out of time. As Shigeru Omi, the Western Pacific director of WHO, told a UN meeting in Kuala Lumpur in early July: "We're at the tipping point."


US Mulls Federal Troops for Bird Flu Quarantine
Reuters

Wednesday 12 October 2005

Washington - The Pentagon is looking at the possibility of using federal troops to enforce a quarantine in the event of an outbreak of pandemic bird flu in the United States, a senior official said on Wednesday.

President George W. Bush said last week he would consider using the military to "effect a quarantine" in response to any outbreak of avian influenza, but provided few details.

Bush at the time also suggested he might place National Guard troops, normally commanded by state governors, under federal control as part of the government's response to the "catastrophe" of such a flu pandemic.

Paul McHale, assistant defense secretary for homeland defense, said quarantine law historically has been under the primary jurisdiction of states, not the federal government.

"And my expectation is that any quarantine measures that would be put in place would likely involve a substantial employment of the National Guard, probably under command and control of the governor of an affected state," McHale told a group of reporters.

"However, we are looking at a wide range of contingencies, potentially involving Title 10 forces (federal troops) if a pandemic outbreak of a biological threat were to occur," McHale added.

The H5N1 avian influenza virus has killed or forced the destruction of tens of millions of birds and infected more than 100 people, killing at least 60 in four Asian nations since late 2003.

Experts fear that the virus, known to pass to humans from birds, could mutate and start to spread easily from person to person, potentially killing millions worldwide. Experts have questioned America's preparedness.

McHale said he believed there would be a clearer understanding within a few weeks of the military role in response to pandemic bird flu as part of a broader federal response. Pentagon officials were meeting on Wednesday to discuss the department's role in a flu pandemic.

Legal Barriers

One issue that could face the U.S. government in the event of an outbreak is whether or how to cordon off parts of the country to prevent the disease from spreading.

The Posse Comitatus Act of 1878, enacted during the post-Civil War reconstruction period, prohibits federal military personnel from taking part in law-enforcement within the United States. But a president can waive the law in an emergency.

National Guard troops under the command of state governors are permitted to perform law enforcement duties, but would not be permitted to do so if they were put under federal control.

McHale noted that the military has been used only under extraordinary circumstances for domestic law enforcement and restoring civil order.

While not specifically referring to enforcing a quarantine, McHale said the Pentagon has active-duty federal military units on alert and deployable at the direction of the president "to deal with occurrences of massive civil disturbance." He did not identify the units.

On the topic of possible domestic attack involving biological, chemical or nuclear weapons, McHale said the government needs "a more robust civilian capability" to respond so the country is not exclusively dependent on the military.

McHale said the Pentagon is working to help make the Department of Homeland Security better able to make strategic plans for natural disasters or domestic attacks involving weapons of mass destruction. The department's Federal Emergency Management Agency was strongly criticized for its slow response to the Hurricane Katrina disaster on the U.S. Gulf Coast in August.

1 comment:

Mark said...

While the medical response to pandemic flu will be important to controlling its spread and limiting its toll, there are considerable non-medical issues related to flu preparedness that are essential for ensuring the continued well-being of the nation's economy. Planning for Continuity of Operations (COOP) and Continuity of Government (COG) is critical to maintaining the overall viability of society. Thus, while we rightly prepare for the flu, we must be equally prepared to function during the flu.

The Center for Technology and National Security Policy of the DOD's National Defense University has prepared a number of freely-available items which can help civilians be prepared both before and during the flu. "Bird Flu and You" is a poster available in 9 languages with basic information about influenza preparedness. "Weathering the Storm" is a report with information about planning for COOP, including instructions for carrying out "tabletop excercises" with a COOP plan.

Electronic copies of the poster are available at http://www.ndu.edu/ctnsp/Bird_flu.htm. Electronic copies of the report are available at http://www.ndu.edu/ctnsp/Def_Tech/DTP%2038%20Weathering%20The%20Storm.pdf, and to request hard copies of the
report, contact the Life Sciences group at lifesciences@ndu.edu.

Robert E. Armstrong, Ph.D.
&
Mark D. Drapeau, Ph.D.

Center for Technology and National Security Policy
National Defense University
Washington, DC

This is the view of the authors and does not represent the official view of National Defense University, the U.S. Dept. of Defense, or the U.S government.