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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.

A fictional outbreak in a Hong Kong market spreads throughout the world in the upcoming TV movie, 'Fatal Contact; Bird Flu in America'
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'

By Jennifer Barrett
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:

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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?
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.

Dr. Irwin Redlener
Dr. Irwin Redlener

So the health-care system isn’t prepared to handle such numbers?

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.

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