Pandemic Influenza: The Importance of Local Preparedness

Good morning. Thank you, Mayor (Beverly O'Neill, Mayor of Long Beach, CA). I'm delighted to have this opportunity to speak to you.

Before I turn to the topic of my speech-avian influenza, what we're doing at HHS about it, and what you can do around the country-I would like to talk a bit about homelessness in America.

Each year, 2 to 3 million Americans are affected by homelessness. For most people, homelessness is a short, one-time event. But a relatively small and visible number of people live without a home to go to repeatedly or for long periods of time. This group of people is most often made of single, poor adults with disabilities.

Secretary Leavitt and I are committed to helping end homelessness in America. Today, I am pleased to announce that local governments and community groups will soon be able to use federal surplus property for permanent, supportive housing to meet the needs of disabled individuals and families who are experiencing homelessness.

This proposed policy change, once completed, will go a long way in continuing the Administration's efforts to provide permanent supportive housing for one of our most vulnerable populations.

This type of housing is aimed at individuals with mental or physical disabilities or substance abuse problems requiring health, case management, or other supportive services. Until now, the use of federal surplus property was restricted to homeless shelters or transitional housing for up to, and not exceeding, 24 months.

Permanent, supportive housing has been found to be an effective and efficient way of ending the cycle of homelessness by providing long-term housing resources packaged with integrated supportive services, such as mental and primary health care, job training, and case management. We have a moral duty to lend a helping hand to our neighbors in need, and I would like to encourage you to reach out to HHS so that we can find more ways to help end homelessness in your communities.

Now I'd like to talk about avian influenza, another problem where we can work together. The threat of an influenza pandemic is one of the most important health threats that we face today-and we will need to work together as a nation to prepare to meet this challenge.

There are three main points I'd like to communicate to you today:

1. Pandemics happen-and we are overdue and under prepared.
2. We must be prepared on the local level.
3. The more and better we prepare, the more lives will be saved.

Pandemics are a biological fact, as history has shown us time and time again. Viruses and bacteria are constantly mutating, adapting-and attacking. And when pandemics strike, they not only cause a great deal of sickness and terrible loss of life; they reshape nations.

Over the last three hundred years there have been ten pandemics, including three in the last century. Two of them, 1957 and 1968, were relatively minor events. But the pandemic of 1918 was catastrophic.

If a similar one were to occur today, we could find ourselves with 90 million people sick with the flu, 45 million in need of medical attention, and 2 million people dead.

John Barry, author of The Great Influenza, a history of the 1918 pandemic, described what happened in Philadelphia when the pandemic hit.

Barry wrote, “It now seemed as if there had never been life in Philadelphia before the epidemic. The disease informed every action of every person in the city.

“By then many of those who had earlier rushed forward to volunteer had withdrawn. The work was too gruesome or they were too frightened.

“On the single day of October 10, the epidemic alone killed 759 people in Philadelphia. During the week of October 16th alone, 4,597 Philadelphians died from influenza or pneumonia.

“Prior to the outbreak, deaths from all causes-all illnesses, all accidents, all suicides, and all murders-averaged 485 a week.

“The hundreds of thousands sick in the city became a great weight dragging upon it. And the city began to implode in chaos and fear.”

Will another influenza pandemic strike us soon? We don't know. But we do know that we are overdue for the next pandemic.

And why are we so concerned right now? That's a good question, since the H5N1 virus, the one that scientists are most worried about, is currently a bird disease.

The H5N1 virus is being spread by wild birds all over the world. But the H5N1 virus looks and acts more like the virus of 1918 than any of its more moderate cousins. Scientists are worried that the virus will develop the ability to transmit effectively from person to person. The virus has already crossed the species barrier into 148 people, and 79 people have died.

We are seeing some of the symptoms from the 1918 flu in victims of H5N1 today. If the H5N1 strain, or any other strain of animal influenza, were to develop into a pandemic strain, no one would have immunity.

Philadelphia didn't go through a unique experience with the flu. Towns and communities all across the United States, and the whole world, were changed by the pandemic.

I'm from Salisbury, Maryland. It's a small city on Maryland's eastern shore. In 1918, Salisbury had a population of about 11,000 people. The pandemic killed about 800.

When it comes to pandemics, there is no basis to believe that the first part of the 21st century will be much different than the past. And when a pandemic strikes, it will likely come back to Philadelphia, Salisbury, and all of your cities, too. That's why we must be prepared on the local level.

Local preparedness is the foundation of pandemic readiness. Leadership must come from governors, mayors, country commissioners, pastors, school principals, corporate planners, the entire medical community, individuals, and families. Any community that fails to prepare-with the expectation that the federal government can or will offer a lifeline-will be tragically wrong.

Epidemiologists have been studying the patterns of pandemic influenza. Because we have the most information on them, they've focused primarily on the 1918, 1957, and 1968 pandemics. They've noticed some patterns.

The different viruses substantially differ in how virulent they are, but in each case, 25 to 30% of the population became ill. Since prudent planning dictates that we look at the most serious case, if we estimate that a future pandemic resembles the 1918 one, of the 30% who become ill, half will require significant medical attention, and about 2% will die.

Base your planning off of those assumptions. Schools, businesses, and communities can interpolate how much of an impact a pandemic would have on them. For example, if you run a small business where you employ 100 people, or are principal of a school with 100 faculty members, you need to start planning for what you would do when 30 to 40 people are absent from your workforce during the 6 to 8 week duration of each wave.

If a pandemic were to strike any one of your communities, we could assume that it would arrive at a transportation hub such as an airport or train station, and then spread throughout the state, reaching nearly every community.

The actual impact would, of course, depend on the virulence of the virus. But we're reasonably certain that many outbreaks would happen in many communities all at the same time. That's why it's so important that every community have its own plan and be able to rely on its own resources as it fights the outbreak or anticipates an imminent one.

If none of us prepare, then as the pandemic spreads and as outbreaks in communities reach their peak, the consequences would cascade. Medical centers would be overwhelmed. Schools would close. Transportation would be disrupted. Food and fuel would be in short supply. There would be power and telecommunications outages.

So then, what does it mean to be prepared? We have five objectives:

• Disease monitoring,
• Stockpiling countermeasures,
• Developing vaccines,
• Setting up local plans, and
• Establishing communications plans

First, disease monitoring. Think of the world as a vast forest, thick with underbrush and dead trees. It's very vulnerable to fire. A single spark can burst into a great inferno that's extremely difficult to put out. But if you're there right after the spark ignites so you can stomp it out, you can limit the damage.

We believe that is true with a pandemic. If we're able to discover the spark quickly, there's a chance we can stomp it out and stop a pandemic. So we're building a network of nations to cooperate in disease monitoring. Likewise, we need communities in the United States with sophisticated systems to watch for the emergence of disease.

Second, we must have stockpiles of anti-viral medications and other supplies. There has been much talk about Tamiflu. Tamiflu is an anti-viral medication that, in some situations, has a positive effect on some people after they come down with the flu. We're accumulating stockpiles, but the amount of Tamiflu you have is not a measure of a country's preparedness. And our readiness exercises have shown us that stockpiles aren't the problem. Distribution is the problem. Unless we can get pills in the palms of those who are sick within 24 to 36 hours of them coming down with the flu, it won't make much difference however large stockpiles might be. The federal government can help build stockpiles. But it's the state and local distribution plans that would define victory.

Third, we need vaccines. Fortunately, we have developed a vaccine that produces an immune response sufficient to protect people. Unfortunately, we don't have sufficient manufacturing capacity to make 300 million courses with the speed to inoculate everyone. And even if we did, no one's developed local distribution plans.

We're currently embarking on a campaign to develop new technology and greater manufacturing capacity, but that's going to take at least 3 to 5 years.

The fourth-and most important objective-is that every state, every tribe, every city, every school, every business, every church, and every family needs a plan that addresses the unique challenges they would face.

This is about much more than the local health community. Doctors, hospitals, clinics, and leaders in health care are all extremely important to preparedness efforts, but preparedness also means community leaders, employers, school officials, and the media need to be informed, engaged, and activated.

Fifth, preparedness needs to include communications plans as well. We all need the capacity to inform people without inflaming them, to inspire proper response, not panic. SARS was a warning to us. Across the world, only 8,000 people got sick, with 800 of them dying, but it paralyzed the Chinese and Canadian economies for several weeks and caused several billion dollars worth of economic disruption.

Avian influenza has already begun to spread fear. Recently, the Turkish health minister visited the town where his country's first reported bird flu deaths occurred and was mobbed by residents. According to some accounts, people shouted to him to “Go see our villages with the dead chickens, where no one dares enter.”

So I want to stress to you that proper preparation would save lives. We have an opportunity to learn from the past and become the first generation in history to have been properly prepared for a pandemic. Because of the impact pandemics have on people's lives, we have a moral obligation to prepare against this threat.

We probably can't prevent a pandemic. But preparation could delay its onset. Preparation's likely to reduce the peak of a pandemic to a level that's much less overwhelming than it could have been, bringing it down to a number of cases that could be cared for.

We all have work to do. On the federal level, we plan to assist states and communities in the planning efforts in three ways:

• Funds,
• Guides, and
• A comprehensive website.

President Bush and Secretary Leavitt are currently mobilizing the nation to prepare for a pandemic, and Congress has acted by passed a $3.8 billion package that includes $350 million in emergency funding for state preparedness. To begin straightaway, we have released $100 million in funding to assist with state and local preparation.

Another $250 million across the country will be awarded later this year in accordance with guidance that will emphasize achievement of certain benchmarks and performance measures.

How should these funds be spent? We're preparing guides to help states decide. We're putting together a series of planning checklists to aid preparation efforts, to organize our national thinking, and to bring consistency to our efforts. We've released four so far-one for state and local governments, one for businesses, one to help individuals and families prepare, and one for faith and community based organizations, and we will continue to release guides as we develop them. As part of the HHS strategic plan, we issued hundreds of pages of technical guidance to state and local health officials and providers. These checklists and plans can be found on the website www.pandemicflu.gov.

There is the possibility that a pandemic might not happen for years or even decades. Some might accuse us of crying wolf. That's a risk we're taking. As Tony Abbott, the health minister of Australia, said, “In the absence of a pandemic, almost any preparation will smack of alarmism. If a pandemic does break out, nothing that's been done will be enough.”

But even if it's a long time before a pandemic strikes, we will accrue real benefits by preparing now:

• We would have established new vaccine technology,
• We would have the capacity to manufacture vaccines much more quickly than we currently do,
• Annual flu would be much less of an issue, and
• We would be better prepared against any medical disaster or health crisis.

Preparation runs along a continuum. We won't ever become completely prepared or finished and done with our preparation efforts. Preparation is like money or friends. Some is good, but more is better.

Each day that we prepare, we make ourselves more ready and more capable of an effective response. We're not prepared yet. But we're more prepared today than we were yesterday. And, with your support and efforts, we'll be more prepared tomorrow than we were today.

Let's continue that work. Thank you.