Scientists react to US flu plan

Critics say there are many holes left to fill; U.S. government defends proposal

By | November 23, 2005

Scientists from across the country are weighing in on the US avian flu plan, including the Center for Biosecurity at the University of Pittsburgh Medical Center (UPMC), which released a detailed critique outlining potential problems in case of a pandemic less than a week after the Department of Health and Human Services (HHS) released its 400-page, $7.1 billion plan.

While "the government's efforts so far are an important and serious beginning" to addressing the potential pandemic, the HHS plan "does not convey yet with nearly enough clarity how we're going to resolve the most critical issues," according to Thomas Inglesby, COO and director of the Center for Biosecurity at UPMC.

Other scientists agreed that some details of the plan need a closer look. The plan deserves support, but "it needs fine-tuning," Arnold Monto, professor of epidemiology at the University of Michigan School of Public Health in Ann Arbor, told The Scientist.

In addition to allotting insufficient funds for areas like surveillance in Asia, the UPMC document argues, the plan places too heavy a burden on U.S. state and local authorities with minimal funds, personnel, and political influence. The plan calls for states to handle the bulk of the response, from identifying influenza strains to monitoring hospital admissions, and makes them responsible for individually stockpiling anti-viral medication, bearing 75% of the cost at an estimated $500 million. "There are some parallels [with Hurricane Katrina]," Inglesby said. "Assuming that the states can mount the kind of effort that's required I think is not very realistic," said Monto.

In response, Bill Hall, acting director of the News Division at HHS, told The Scientist that states have been receiving more than $6 billion in "public health preparedness funding" for many years, "in the form of public health grants from CDC and hospital preparedness grants." He added in an Email that antivirals are not the "sole answer to a pandemic," and the plans seeks to provide medication to 25% of the population, including first responders and health care providers.

However, UPMC also raised concerns that the plan allocates over a third of total pandemic funding to the "crash program" to more efficiently develop H5N1 vaccine, yet the program receives short shrift in other ways. For instance, there is still only one U.S. vaccine manufacturer, and the plan does not evaluate alternate means of collaborating globally to maximize vaccine quantities in the short term through techniques like adding adjuvants, which could stretch the current vaccine capacity to protect billions, flu vaccine expert David Fedson has argued.

Hall responded that there are clinical studies "soon to be underway" looking at dose-sparing techniques, including adjuvants. The government is also investigating how to boost domestic vaccine production, he said.

It's also impossible to know if creating vast amounts of vaccine against the H5N1 strain is the right thing to do, said Robert Daum, chief of pediatric infectious diseases at the University of Chicago, since we don't know if that particular strain will ever erupt into a pandemic. However, "the idea of taking a chunk of money to really aggressively fund new vaccine technology is wonderful," Daum said.

Indeed, developing new vaccine technologies will have an added benefit, if the plan helps increase the effectiveness of annual flu vaccines, Monto noted.

Daum said he would also like to see plans to prevent deaths from the secondary infections, such as Staphylococcus or Streptococcus, which can strike patients as they recover from influenza. "That's something that was really ignored in the president's package," he said.

Allocating too little money to developing countries is the biggest weakness of the plan, according to Doris Bucher, associate professor of microbiology and immunology at New York Medical College in Valhalla, whose lab makes the starting strain for flu vaccine production each year. Should an outbreak of avian influenza occur, any vaccine available should be sent "to the people who need it at the time, so that we can prevent it from spreading," Bucher added.

An additional critique of the HHS plan was presented on November 10 as a letter to congressional members in labor HHS committees by the Working Group on Pandemic Influenza Preparedness, which includes the Center for Biosecurity as well as the Federation of American Scientists and the Trust for America's Health. The Center's comments will be published in its quarterly publication, Biosecurity and Bioterrorism, in two weeks.

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