Senate hearing raises pandemic readiness, funding issues

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

Previous federal investments in pandemic planning appear to be paying off, but Harkin said he was disappointed that legislators cut an $870 million program to accelerate cell-based influenza vaccine capacity from the economic stimulus bill a few months ago. "I will push to include it in supplemental funding later this month," he said.

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

With current vaccine production methods, it will take manufacturers about 8 weeks to conduct dosing, safety, and efficacy testing on pilot batches from a swine flu seed strain that the 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 off the production line, though he said some of the production steps can take place simultaneously during the pilot-testing phase.

Fauci said discussion is under way among federal health experts on whether to produce a single vaccine specifically against the swine flu strain or to include it along with the other three strains in the seasonal flu vaccine.

In the meantime, Anne Schuchat, MD, interim deputy director for the CDC's science and public health program, said antiviral medications are already on their way to states that have been affected by swine flu and that the rest of the states should receive their supplies by May 3.

Scarce resources threaten response
Harkin asked the health officials if they had enough staffing and financial resources to distribute the antivirals and perform other key flu epidemic response 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 a pandemic plan and all have now activated their plans, which include systems for distributing antivirals.

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

State budget problems have led to 12,000 public health department layoffs in 2008, with the same level of attrition expected this year.

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

Harkin responded, "I remain deeply concerned about the ability to rapidly respond to a growing pandemic."

Jarris estimated that the nation's public health systems need $350 million to continue their pandemic planning work, but will need more if the epidemic becomes a full-blown pandemic. In addition, health departments need $122 million to finish stocking state stockpiles and $563 million to equip healthcare workers with protective equipment and antiviral medication.

Ag sector chafes at virus name
John Clifford, DVM, deputy director of veterinary services for the US Department of Agriculture's (USDA's) Animal and Plant Inspection Services told legislators that the department is evaluating its resource needs. The USDA is working with states to intensify livestock surveillance for the virus, but so far the new strain has not been found in animals.

The biggest problem the agency faces revolves around the "swine flu" label that has been placed on the new virus, Clifford said. He said the nomenclature is scientifically incorrect and has prompted other countries to ban US pork products, which is already hurting farmers and feed producers.

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

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

At a CDC press conference today, Richard Besser, acting director of the CDC, said, "We've been seeing a fair amount of misconception that by calling it swine flu, there could be transmission from pork products." The name refers to one of the components 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 virus that 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 the virus. "We hope the introduction of new names doesn't cause any confusion," he said.

Harkin presses CDC on lab delay report
Harkin questioned Schuchat about media reports that Mexico sent its influenza samples to Canada early on in the outbreak to avoid what it perceived as paperwork obstacles at the CDC that might have delayed characterization of the new virus. He said the event may have left US officials in the dark during a crucial time when the virus was becoming a bigger threat.

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

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

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

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

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

See also:

Apr 27 OIE statement

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