[Mb-civic] Long-Predicted Flu Finally Tops Agenda - Washington Post

[William Swiggard]

Long-Predicted Flu Finally Tops Agenda

By David Brown
Washington Post Staff Writer
Monday, November 7, 2005; Page A01

Tommy G. Thompson's schedule for Sept. 11, 2001, had penciled into the 
9:30 a.m. slot: "flu vaccine briefing."

Experts from several federal agencies were going to tell the new 
secretary of Health and Human Services what to expect in the upcoming 
flu season -- and give him a status report on preparations for a 
possible worldwide outbreak of influenza, a pandemic.

"He wanted to know why the pandemic plan wasn't finished," a person who 
was there recalled recently. "He was very annoyed -- having been 
convinced pandemic flu was a danger -- that it had been allowed to 
languish." Another participant remembers Thompson as "livid."

As the news of that morning's terrorist attacks trickled in, Thompson at 
first insisted the meeting proceed before dismissing the group, saying 
they would meet later.

The aborted briefing that morning symbolizes the tortuous route that the 
issue of pandemic influenza has taken as it has ascended the national 
agenda -- a place it occupies today in a way few health issues ever do.

Last week, President Bush asked Congress for $7.1 billion to confront 
the threat, and the administration released a massive and long-awaited 
flu preparedness plan. Today, U.S. health officials and experts are in 
Geneva for a three-day international meeting on how to stop the spread 
of a potential pandemic virus that has begun spreading around the world.

But it took more than an earnest and angry Cabinet secretary to get the 
country's attention. It took four more years of cajoling, the 
reappearance of "bird flu" in Asia with a chilling trickle of human 
deaths, a vaccine debacle, Bush's summer reading, migrating birds and a 
hurricane. Ironically, the events of Sept. 11 may also have prompted action.

Whatever the reasons, pandemic flu has now arrived -- not the disease, 
but the issue. The latest milestone in its march into the public eye was 
last week's release of the "pandemic influenza plan" -- 396 pages of 
dire prediction and advice. It is the plan Thompson was asking about 
four years ago.

"There is no question that the tipping point has finally arrived," 
Thompson, now a private consultant, said recently. "I'm sorry it wasn't 
two years ago."

But the seemingly overnight appearance of worries about pandemic flu on 
the front pages and in water-cooler conversations is misleading. The 
subject has been evolving out of sight for years -- much like the virus 
itself.

"I think there was always rather intense interest at the level of the 
[HHS] department," said Anthony S. Fauci, director of the National 
Institute of Allergy and Infectious Diseases and a chief adviser of the 
past two secretaries. "Influenza has always been at the very top of my 
short list of things to be concerned about."

"The idea that pandemic flu has just gotten traction is not strictly 
accurate," said Martin G. Myers, former head of the National Vaccine 
Program Office and now a professor of pediatrics at the University of 
Texas Medical Branch in Galveston. He said a draft was presented in 1998 
to Donna E. Shalala, HHS secretary in the Clinton administration.

An influenza pandemic occurs when a strain of flu virus emerges that has 
the capacity to be transmitted easily from person to person but is so 
different from previously circulating strains that just about everyone 
is susceptible to it. It occurred only three times in the 20th century 
-- 1918, 1957 and 1968.

Over a long enough period of time, a flu pandemic is inevitable. But the 
intervals can be long enough that an entire generation reaches maturity 
with no recollection of one.

"Flu people have a saying: 'The clock is ticking. We just don't know 
what time it is,'" Myers said.

A hint that pandemic hour might be nigh occurred in 1997 when an 
unusually virulent form of avian influenza called A/H5N1 appeared in 
Hong Kong. The virus swept through chicken flocks causing close to 100 
percent mortality. More troubling, it occasionally infected people who 
came into contact with the birds. Over several weeks, 18 people got it 
and six died.

It was the first time flu viruses of the broad H5 subtype had been known 
to infect people. Hong Kong authorities ordered every bird in the 
territory killed to stop the outbreak and prevent further adaptation of 
the virus to human hosts.

Myers was one of many scientists already convinced that pandemic flu was 
no idle threat. He convinced Stewart Simonson, HHS deputy general 
counsel, and Simonson in turn helped convince Thompson.

Thompson soon had pandemic flu and food safety at the top of his list of 
20 high-priority issues. The events of Sept. 11, however, and the 
anthrax attacks that followed, forced pandemic flu down the agenda.

Nevertheless, when Bruce G. Gellin, a physician and epidemiologist from 
Vanderbilt University, arrived in late summer 2002 to replace Myers, 
Thompson told him "his first, second and third jobs were to get the 
pandemic plan out," according to an HHS insider.

The issue took on new urgency in February 2003, when two members of a 
Hong Kong family that had recently visited mainland China became ill 
with H5N1 flu, and one died. But what really concerned public health 
officials was the appearance that same month of a new disease initially 
mistaken for flu -- SARS, or severe acute respiratory syndrome.

Also arising in China, SARS eventually spread to more than 30 countries 
over six months. It infected 8,000 people, killed about 800, and cost 
the world $80 billion. Yet the control of SARS was an unprecedented 
success. A report by the National Academy of Sciences' Institute of 
Medicine in 2004 said that "the quality, speed, and effectiveness of the 
public health response to SARS brilliantly outshone past responses to 
international outbreaks of infectious disease."

Experts knew a fully human-adapted influenza virus would be far more 
contagious than the SARS microbe. If a pandemic strain of flu emerged 
and spread even half as far as SARS, it would be unstoppable. They also 
knew the only really good tool to stop influenza would be a vaccine.

In 2003, HHS requested $100 million for "pandemic vaccine development" 
in the 2004 budget. It asked the Office of Management and Budget for 
more than that, although how much more Thompson will not say. Congress 
appropriated $49.7 million. The most resistance came from House Republicans.

"I think it was the lack of knowledge and information that people had," 
Thompson recalled. "This was a new idea and they figured, 'Give them 
half.' I don't think they understood the science and the probabilities 
and the possibilities."

The next year HHS again asked for $100 million. Congress again prepared 
to give it less, with the House appropriations bill calling for $60 
million, the Senate's for $75 million. But before the two houses could 
decide on a final number, the nation's flu vaccine supply was cut in 
half overnight because of contamination at a Chiron Corp. plant. That 
led to a panicky search for vaccine by high-risk patients and 
government-directed rationing of the diminished supply.

The Chiron debacle had nothing to do with pandemic flu. But suddenly 
congressional committees wanted no part of cutting money for flu 
vaccine. The full $100 million request was appropriated.

When Thompson resigned last December, the HHS pandemic plan still was 
not out. In his exit speech, he warned that bird flu was "a really huge 
bomb that could adversely impact the health care of the world."

The man who replaced him, former Utah governor Mike Leavitt, quickly 
became a believer, too. Days after his arrival, Simonson handed his new 
boss a copy of what has become the cause's proselytizing text -- John M. 
Barry's 2004 bestseller "The Great Influenza," a 546-page history of the 
1918 pandemic.

Leavitt read the book in February. He then read it again, tagging and 
underlining a half-dozen key passages -- all great eye-openers, he said 
recently. He gave nearly 100 marked copies of Barry's book to Cabinet 
members, administration staffers and Capitol Hill leaders.

The president himself read "The Great Influenza" during his summer 
vacation in Crawford, Tex. At a news conference in September, Bush 
referred to the book when asked a question about pandemic flu.

But something other than persuasion began to make people pay attention 
to the subject.

In December 2003, the H5N1 virus appeared in Southeast Asia for a third 
time. Since then, it has led to the death of 140 million birds and 
infected about 125 people, killing half of them.

In August, the virus showed up in Mongolia, Kazakhstan and Siberia, 
apparently carried by migrating birds. Last month, it reached Europe, 
infecting flocks in Romania, Croatia and Greece.

"People realized it was no longer an Asian problem," Charles H. 
Riemenschneider, an official of the U.N. Food and Agriculture 
Organization, said in an interview.

Last month, scientists completed a 10-year project in which they 
reconstructed the 1918 virus from the frozen and chemically preserved 
tissue of three victims. It showed that Spanish flu was a bird virus 
that adapted to man, and that the H5N1 strain that has been killing 
people in Asia bears genetic similarities to it.

http://www.washingtonpost.com/wp-dyn/content/article/2005/11/06/AR2005110601282.html?nav=hcmodule
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