Last Tuesday, President Bush announced the National Strategy for Pandemic Influenza as well as a proposal to allocate $7.1 billion to prepare for the predicted avian flu outbreak. Aside from the irony of explaining the avian flu menace and the need for more research at a speech to NIH researchers, the Bush "plan" is missing the point in several obvious ways.
Of the $7.1 billion suggested, the majority will be tagged for research and drug stockpiling, with only $583 million devoted to "pandemic preparedness" for state and local institutions.
Faster vaccine development and production is essential to fight a rapidly spreading disease. Nonetheless, the Bush administration is woefully naive if it believes that developing technology is the panacea to a deadly pandemic.
The efficacy requirements dictated by market-style healthcare in the U.S. means that there is little surge capacity for the onrush of patients in an epidemic.
A tabletop exercise performed by the Maryland Department of Health and Mental Hygiene illustrated such dangers by simulating predicted outbreaks (which, incidentally, had one case involving the return of Hopkins' study abroad students from Nanjing leading to 16 hospitalizations and two student deaths).
The exercise predicted existing hospital resources in Maryland would be overwhelmed within five weeks of local outbreaks.
Numbers for surge capacity across the U.S. paint a similarly grim picture. In a statistic cited in the New England Journal of Medicine, 100,000 mechanical ventilators will be needed in an influenza pandemic, while the U.S. has only 105,000 (of which 80,000 are already in use).
This gap between current capacity and pandemic needs means that many, perhaps even most, influenza victims will not receive necessary treatment in case of an outbreak.
Equally alarming is the slighting of community preparedness in Bush's research-heavy initiative.
Recent surveys of local health authorities and care delivery systems have found that little or no planning has been done for the upcoming flu pandemic. And in the case of existing plans, many of those were found to be inadequate for the situation. Without a plan, limited resources such as antiviral agents cannot be distributed efficiently and equitably.
The United States' complex system of multiple payers and providers further complicates any national or state actions put forward in an outbreak.
Without improving communications and coordination among the discrete players in American healthcare, mismanagement and even chaos is likely if the treatment shortage is not fixed.
Furthermore, no formalized plans exist to cover those normally not serviced by America's healthcare system -- 43 million uninsured citizens cared for on an "emergency room" basis.
Without a sensible strategy to cover both the typical and marginal members of society, public health measures such as vaccination schemes or flooding antivirals to stem an outbreak cannot properly be administered.
The laissez-faire policies favored by the current administration are extremely dangerous when applied to epidemic-situation healthcare, as the market incentive to prevent an infrequent occurrence is little. Low financial gains have already crippled our vaccine production capacity. And the market nature of our current healthcare system means faced with scarcity of resources, ability to pay will determine whether care is received.
While belated government sponsorship in critical research should be applauded, the plan's funding of little else represents an ostrich mentality on the part of the federal government.
By shining the spotlight on biotechnology, the Bush administration is sidestepping problems that would imply conservative taboos such as government intervention and managed care for a solution. Unless the Republican administration distances itself from party ideology and reconsiders "liberal" reforms to America's healthcare, the American people will learn the flaws of the broken system in the upcoming pandemic that promises to exceed our current capacity for care. However, unlike lessons in other policies, the price for this one will be paid for dearly in lives, a price that is beyond measured cost, a toll that cannot ever be repaid.
--James Lee is a freshman public health and economics major from Hacienda Heights, Calif.
