WASHINGTON, June 24, 2005 – Trust for America’s Health (TFAH) today released state-by-state projections that found over half a million Americans could die and over 2.3 million could be hospitalized if a moderately severe strain of a pandemic flu virus hits the U.S. Additionally, based on the model estimates, 66.9 million Americans are at risk of contracting the disease. The study also found that the U.S. currently only has stockpiled 2.3 million courses and has placed orders for an additional three million courses of antiviral pharmaceuticals (produced as Tamiflu by Roche Pharmaceuticals), which would likely be available in 2006. This would be enough to cover 5.3 million Americans, leaving over 60 million who could be infected and would not be able to receive medication before an effective vaccine to combat the flu strain is identified and produced.
TFAH’s numerical projections are included in a new report, “A Killer Flu? ‘Inevitable’ Epidemic Could Kill Millions.”
“This is not a drill. This is not a planning exercise. This is for real,” said Shelley A. Hearne, DrPH, Executive Director of TFAH. “Americans are being placed needlessly at risk. The U.S. must take fast and furious action to prepare for a possible pandemic outbreak here at home.”
“The Government Reform Committee has held several hearings over the last few years to let people know that the flu is not something to take lightly,” said U.S. Congressman Tom Davis (R-VA), Chairman of the House Government Reform Committee. “TFAH's report clearly demonstrates that the emergence of a pandemic flu could exact a tremendous toll on U.S. health and economic stability. In order to identify problem areas and prioritize planning and response efforts, the Committee will hold a hearing next week on the threats posed by a potential flu pandemic.”
Dr. Hearne will be testifying Thursday, June 30th, before the House Government Reform Committee on U.S. preparedness for pandemic and annual flu. Some of the TFAH report’s other findings include:
- While estimates find that over two million Americans may need to be hospitalized during a pandemic outbreak, the U.S. currently only has approximately 965,256 staffed hospital beds.
- The U.S. has not adequately planned for the disruption a flu pandemic could cause to the economy, daily life, food and supply distributions, or homeland security.
- The U.S. lags in pandemic preparations compared to Great Britain and Canada based on an examination of leadership, vaccine development, vaccine and antiviral planning, health care system surge capacity planning, coordination between public and private sectors, and emergency communications planning.
TFAH provides a series of detailed recommendations to help ensure the U.S. is better prepared regardless of whether a pandemic occurs as soon as this year or in several years. With a crisis looming, the U.S. plan for the pandemic should be finalized and the President should designate an official with authority to coordinate the U.S. response across federal agencies. Other top level recommendations include taking:
- Immediate steps of outbreak tracking, stockpiling medical supplies, and developing emergency communications plans;
- Intermediate steps of stockpiling additional antivirals and developing surge capacity plans for hospitals and health care providers; and
- Longer range steps to increase vaccine production and the development of new technologies for vaccines.
I figure, humans being humans, we'll have a big pandemic and millions will die and only afterwards all the recommendations about building more rapid vaccine production technologies, stockpiling of medical supplies, and better methods of reducing human-to-human transmission will be implemented. The warnings coming from infectious disease experts and others are being discounted as the standard exaggerated doom and gloom fare of coming disasters.
The full report projects a high economic cost from a pandemic. (PDF format)
The estimated economic impact of a pandemic flu outbreak in the U.S. today, based on projections from the relatively mild 1968 flu epidemic, would be $71.3 to $166.5 billion due to death and lost productivity, excluding other “disruptions to commerce and society.”6
Note the real possibility that the avian flu could have a higher lethality rate than the 1918 flu. So the economic costs, number of hospitalizations, and total deaths could be much greater than the estimates provided above.
Some countries could be politically destabilized by the effects of a flu pandemic. Though I'm going to go out on a limb here and guess that in Africa with so much disease already a flu pandemic might seem like nothing out of the ordinary.
The U.S. would be impacted by the global implications as soon as a pandemic outbreak occurred in any part of the world due to the interdependence of economies. Sectors, such as hospitals and the health care system, which rely on supplies manufactured in other parts of the world, including Asia, would feel immediate repercussions and supply shortages. Travel restrictions, possible limitations on public gatherings and events, and other measures taken to limit the spread of disease would also have rapid and far reaching repercussions. Since a pandemic could likely result in political and economic destabilization, particularly in developing countries, it poses serious national security concerns for the U.S.
Those who think the threat of the avian flu is overblown need to learn about the larger historical context: Influenza pandemics have occurred regularly in human history and statistically speaking we are overdue for the next one.
Based on historical trends and projections, virologists and epidemiologists predict a new flu pandemic will emerge three to four times each century.8 Health officials around the world are troubled by the severity of the “avian flu” circulating in Asia, which scientists refer to as the H5N1 flu strain. They fear this avian flu could become the next pandemic for humans. The regional director of the WHO for the Western Pacific region stated in February 2005 that the “world is now in the gravest possible danger of a pandemic.”9
We currently run the risk that the avian flu will not only be the next pandemic but that it will be much more lethal than the average pandemic.
The economic disruptions of a pandemic would reach the United States rapidly due to the interdependent nature of economies.
The U.S. has not assessed or planned for the disruption a flu pandemic could cause both to the economy and society as a whole. This includes daily life considerations, such as potential school and workplace closures, potential travel and mass transit restrictions, and the potential need to close stores resulting in complications in the delivery of food and basic supplies to people. Daily life and economic problems would likely emerge in the U.S. even before the pandemic flu hit the country due to the global interdependence of the world economy.
Put aside for the moment the medical issues (e.g. virus manufacture, acute patient care, drug production, medical supplies shortages, and so on). Think about the problem at the level of human organization to reduce pathogen transmission in ways that minimize economic disruption. We have the potential to develop and find ways to carry out economic functions with less human-to-human exposure. The development of procedures and products, the training of work forces, and the purchase of key pieces of capital equipment could reduce the amount of human contact involved in most types of economic activity. This would simultaneously reduce the rate and extent of spread of the pandemic virus and reduce the size of the economic disruption caused by the virus.
The rate of infection of the population might be between 25% and 50%. But with better economic organization and practices human-to-human contacts and transmission could be greatly decreased.
For Americans who become infected their odds of getting anti-viral medication will be less than 1 in 12. For people on most other countries their odds will be much lower. For anyone who has stockpiled your own personal Tamiflu supply your odds of getting anti-viral treatment are excellent - unless you tell too many people about your stockpile and someone steals it.
As of May 2005, the U.S. has stockpiled 2.3 million courses of the antiviral medication Tamiflu, which could be used as a treatment in the event of an outbreak, and intends to order approximately three million more with funds recently appropriated by Congress to total 5.3 million. The WHO is currently estimating that an avian flu epidemic could impact 25 percent of countries’ populations.
In the U.S., this means it could affect nearly 67 million individuals, based on FluAid projections and population numbers. With the current level of the U.S. Tamiflu order, over 61.5 million Americans who could be infected would not receive antiviral medication. If the U.S. orders additional courses of Tamiflu, they would not be available until 2007, unless production capacity significantly changes.
The Brits have ordered enough Tamiflu anti-viral drug to cover a quarter of their population. If the US government decided to do so it would have to wait till 2007 to have the needed number of doses.
Several other countries have already ordered enough Tamiflu to protect between 20-25 percent of their populations in case of an outbreak. The U.S. is already behind in the queue to place an order for the medication, for which there is a single manufacturer worldwide -- Roche Pharmaceutical, which is located in Switzerland. In testimony before the U.S. House of Representatives Health Subcommittee of the Energy and Commerce Committee, the medical director for Tamiflu of the Roche company explained that historically they have not produced the levels of Tamiflu required for global stockpiling. To help accommodate the growing concerns and orders, they have increased production of the antiviral nearly eight-fold since 2003.42
On March 1, 2005, the British government announced that it was taking steps to procure 14.6 million courses of Tamiflu.43 This procurement would cover 25 percent of the British population, the rate WHO has recommended.
Given the current and projected production capacity, if the U.S. did place a large order for Tamiflu, Roche has testified before Congress that it could be the end of 2007 before they could deliver enough to the national stockpile for 25 percent of the population. Thus, antiviral treatment will only be an effective part of the U.S. response if a pandemic does not occur for several years and, of course, if the pandemic strain is responsive to antiviral medications.
This wll create a real problem for the British: People from other countries will try to sneak into Britain in order to be better protected in case they get sick.
The $58 million the US Congress has appropriated for avian flu preparedness is chump change.
The recently enacted emergency supplemental appropriations legislation made available $58 million for the purchase of influenza countermeasures for the Strategic National Stockpile, including, but not limited to, antiviral medications and vaccines. These funds are most welcome, but TFAH believes that Congress should provide additional funds during the FY 2006 appropriations cycle to continue to build the nation’s antiviral stockpiles from the current level of two percent of the U.S. population to cover a higher percentage of the population.
Does the United States have enough medical supplies to handle a large surge in patients?
Does the National Strategic Stockpile Include ALL Necessary Medical Supplies That Will Be Necessary to Respond to a Pandemic? In addition to stockpiling antivirals and vaccines, when they are available, the U.S. must also stockpile critical medical supplies such as masks, gloves, gowns, bed linens, and all other equipment needed to assure that hospitals and other health care providers are properly protected when the usual supply chain is disrupted either abroad or in the U.S.
Let me answer that question: Of course not! This is all the more reason to avoid getting sick in the first place. If you could go live in a cabin in the mountains for a couple of years and see no one other than those who initially travel there with you then you could avoid getting sick and therefore avoid dying.
We also need an enormous amount of face masks and other paraphernalia that the general population will use to avoid transmission of the pandemic influenza strain in public places.
You might need to wait as long 18 months from the time the pandemic begins before you can be vaccinated against the virus.
Is There a Rapid Response Plan to Develop, Test, and Produce a Vaccine? It will take an estimated six to nine months after a pandemic emerges to develop a vaccine. Questions of how to rapidly review and test the vaccine once it is created remain, including concerns about speeding the approval process by the Food and Drug Administration (FDA), liability protection for vaccine manufacturers, and what type of preservative will be used in the vaccine. In addition, industry representatives have suggested that current production capacity is insufficient to meet the demand for a pandemic influenza vaccine, and that it could take 12-18 months to meet appropriate production levels.26
We need to get beyond the old fashioned fertilized chicken egg technology for growing influenza viruses for vaccines. Newer and faster technologies for making vaccines would go far to reduce the size of the disruption and the number of deaths from a flu pandemic.
We also need better ways to reorganize just about every job and economic function in society so that fewer people have to come in contact with each other while they are working, going to school, going shopping, or receiving services.
If a half million or more Americans were at risk from some type of terrorist attack billions of dollars would be thrown at the problem. We should do the same with the avian flu threat. Avian flu is far more likely to kill you in the next 5 years than anything terrorists might accomplish. Our preparations for it should be commensurate with the scale of the threat it poses.
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