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WASHINGTON, D.C. -- The Infectious Diseases Society of America (IDSA), in congressional testimony today, outlined several urgent steps that the nation should take to prepare for pandemic influenza.
"Although many levels of government are paying increased attention to the problem, the United States remains woefully unprepared for an influenza pandemic that could kill millions of Americans," says Andrew T. Pavia, MD, chair of IDSA's Pandemic Influenza Task Force. "If policymakers take steps now to provide resources and develop a rational, comprehensive plan, the country could ensure an effective response." Pavia was IDSA's spokesperson at a hearing of the U.S. House Energy and Commerce Subcommittee on Health that focused on the threat of pandemic flu and the U.S. level of preparedness.
Experts believe that the next influenza pandemic is imminent. Particularly ominous is the so-called "bird flu," the H5N1 avian virus that is circulating in Asia and has infected at least 97 people, according to the World Health Organization, and caused 53 fatalities. Should the virus become readily transmissible from person to person, the disease could easily spread beyond Asia's borders and ignite a global pandemic.
"The U.S. population has no immunity and therefore no protection against this deadly virus," Pavia adds. The current mortality rate among patients with H5N1 influenza is more than 50 percent. This may decrease as the virus evolves, but it suggests that it will remain very dangerous. By comparison, the deadly flu virus of 1918, which killed between 50 million and 100 million people worldwide, had a mortality rate of only 2.5 to 5 percent.
To prepare for this deadly threat, IDSA recommends that the United States stockpile a larger supply of antivirals and greatly increase the capacity to rapidly produce flu vaccine. Specifically, IDSA has called for a stockpile of antiviral drugs that is adequate to treat at least 50 percent of the U.S. population. The current stockpile would treat less than 2 percent. Some experts estimate that vaccinating the U.S. population against a pandemic flu strain might require 600 million doses of vaccine. Currently, only about 50 million to 60 million vaccine doses are produced in the United States each year, with another 30 million to 40 million imported.
"Clearly, we need a much larger supply of drugs and vaccine to control a flu pandemic," Pavia says. "We need to build up U.S. manufacturing capacity so that we are not dependent on other countries to meet our needs." Also important, he said, is the need for a specific plan to distribute drugs and vaccines in case of an emergency.
Efforts to develop new technologies for producing flu vaccine and for immunizing people with smaller doses of vaccine also should be accelerated, according to IDSA. Current manufacturing depends on 60-year-old, egg-based technology that requires several months to bring a vaccine to market. The process has to be repeated every year because the flu virus changes from season to season. "Truly innovative vaccines could be developed that do not need to be redesigned each year," Pavia says. "Investment in this research could be extremely important but it will take years."
IDSA is also calling for mandatory flu vaccinations for all health care workers who have contact with patients, with waivers allowed. "The sad truth is that healthcare workers who care for sick patients can spread infections. This doesn't have to happen with influenza," Pavia says. "Only about one-third of U.S. healthcare workers received influenza vaccine in 2002. That's a dismal record and we should not accept it."
The IDSA also recommends:
-- Creating tax incentives for U.S. vaccine and antiviral manufacturers
-- Guaranteeing a market for influenza vaccines
-- Strengthening liability protections during emergency outbreak response
-- Improving coordination, communication, and planning across federal agencies
-- Strengthening efforts to educate healthcare workers and the public about the potential impact of pandemic influenza, as well as how to prevent and treat it
-- Committing to international preparedness, particularly by working with vulnerable countries to ensure that they have sufficient vaccine and antiviral supplies
-- Strengthening the response of federal agencies
Source: Infectious Diseases Society of America (IDSA)