Senate hearing raises pandemic readiness, funding issues

Lisa Schnirring and Robert Roos  Staff Writers

Apr 28, 2009 (CIDRAP News) –At an emergency hearing today of the Senate appropriations committee, Sen TomHarkin, D-Iowa, said the Obama administration will ask for $1.5 billion tofight the swine influenza epidemic, as committee members sought to get a handleon the elements and cost estimates of the public health response.

Previous federal investmentsin pandemic planning appear to be paying off, but Harkin said he wasdisappointed that legislators cut an $870 million program to acceleratecell-based influenza vaccine capacity from the economic stimulus bill a fewmonths ago. "I will push to include it in supplemental funding later thismonth," he said.

Steps toward a vaccine
During the hearing, Anthony Fauci, MD, director of the National Institute ofAllergy and Infectious Diseases (NIAID), told legislators that federalofficials are aggressively pursuing a vaccine against swine flu. "The bellhas rung, and it's moving along."

With current vaccineproduction methods, it will take manufacturers about 8 weeks to conduct dosing,safety, and efficacy testing on pilot batches from a swine flu seed strain thatthe Centers for Disease Control and Prevention (CDC) is producing, he said.Then it would take 4 to 6 more months for the first vaccine batches to roll offthe production line, though he said some of the production steps can take placesimultaneously during the pilot-testing phase.

Fauci said discussion isunder way among federal health experts on whether to produce a single vaccinespecifically against the swine flu strain or to include it along with the otherthree strains in the seasonal flu vaccine.

In the meantime, AnneSchuchat, MD, interim deputy director for the CDC's science and public healthprogram, said antiviral medications are already on their way to states thathave been affected by swine flu and that the rest of the states should receivetheir supplies by May 3.

Scarce resources threatenresponse
Harkin asked the health officials if they had enough staffing and financialresources to distribute the antivirals and perform other key flu epidemicresponse functions.

Paul Jarris, MD, MBA,executive director if the Association of State and Territorial Health Officials(ASTHO) said that, as of August 2008, every state has developed and practiced apandemic plan and all have now activated their plans, which include systems fordistributing antivirals.

However, he said funding forthe activities expired in August 2008. "We're at a point of critical need,because there's been no further investment," Jarris said, adding that thecuts have been compounded by declines in preparedness money from the CDC andreduced hospital preparedness funding from the Department of Health and HumanServices (HHS).

State budget problems have led to 12,000 public healthdepartment layoffs in 2008, with the same level of attrition expected thisyear.

If a vaccine against the flustrain is developed, "you still need the [public health] people to put itinto people's arms," Jarris said.

Harkin responded, "Iremain deeply concerned about the ability to rapidly respond to a growingpandemic."

Jarris estimated that thenation's public health systems need $350 million to continue their pandemicplanning work, but will need more if the epidemic becomes a full-blownpandemic. In addition, health departments need $122 million to finish stockingstate stockpiles and $563 million to equip healthcare workers with protectiveequipment and antiviral medication.

Ag sector chafes at virusname
John Clifford, DVM, deputy director of veterinary services for the USDepartment of Agriculture's (USDA's) Animal and Plant Inspection Services toldlegislators that the department is evaluating its resource needs. The USDA isworking with states to intensify livestock surveillance for the virus, but sofar the new strain has not been found in animals.

The biggest problem theagency faces revolves around the "swine flu" label that has beenplaced on the new virus, Clifford said. He said the nomenclature isscientifically incorrect and has prompted other countries to ban US porkproducts, which is already hurting farmers and feed producers.

USDA officials are workingwith international trading partners to make sure they're basing their decisionson clearing or blocking US pork on reasonable scientific standards, Cliffordsaid. However, some countries seem to be basing their decisions on a reactionto the name of the virus.

Yesterday the WorldOrganization for Animal Health (OIE) emphasized in a statement that the newvirus has not been isolated in animals and that calling the virus "swineflu" is not justified. It said names of past human influenza epidemicswith animal origins have used a geographic name, such as Spanish influenza."Thus it would be logical to call this disease “North-Americaninfluenza," the group said.

At a CDC press conferencetoday, Richard Besser, acting director of the CDC, said, "We've beenseeing a fair amount of misconception that by calling it swine flu, there couldbe transmission from pork products." The name refers to one of thecomponents of the new flu strain, but doesn't allude to how the virus spreads.He said officials are discussing if there's a better way to describe the virusthat wouldn't confuse the public.

At a World Health Organization (WHO) briefing this morning,Keiji Fukuda, MD, the agency's assistant director-general for health, security,and environment, said the WHO hasn't made any plans to change the name of thevirus. "We hope the introduction of new names doesn't cause anyconfusion," he said.

Harkin presses CDC on labdelay report
Harkin questioned Schuchat about media reports that Mexico sent its influenzasamples to Canada early on in the outbreak to avoid what it perceived aspaperwork obstacles at the CDC that might have delayed characterization of thenew virus. He said the event may have left US officials in the dark during acrucial time when the virus was becoming a bigger threat.

"We have spent a lot ofmoney building lab capacity. Why did this happen?" he asked.

Schuchat said the CDC is oneof four WHO reference labs and regularly receives samples from Mexico. She saidon Apr 17 CDC scientists identified the unusual virus that was isolated in SanDiego and distributed sequence information to other scientists.

Four days later the CDCpublished a report on two cases involving the new strain in a special issue of Morbidityand Mortality Weekly Report (MMWR),and on Apr 23 the agency conducted a press briefing on the identification ofadditional cases.

Schuchat pointed out that theCDC's identification of and communication about the virus led the Canadian labto link their Mexican samples to the US isolates.

"We don't like it whenpeople find our bureaucracy difficult. I would like to do better, but I'm proudof our staff for getting the report out quickly," Schuchat said.

See also:

Apr 27 OIE statement