Public health threat plans under review

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By Ann Geracimos

On a day when the government announced it had made available less than half the hoped-for number of H1N1 vaccine doses, Health and Human Services Secretary Kathleen Sebelius said her department would undertake a thorough review of policies affecting all of the country's public health emergencies.

The plan goes beyond longstanding problems associated with the swine flu vaccine program to include what she called "countermeasures" against disasters, both natural and manmade.

"Today, we face a wider range of public health threats than ever before in our history," she told the American Medical Association's Congress on Health System Readiness. "It could be anthrax delivered in an envelope. It could be a dirty bomb set off in a subway car. It could be a new strain of flu that our bodies have no immunity to."

Speaking to the AMA group in Washington, Mrs. Sebelius admitted the "challenges" involved in the government's billion-dollar campaign to protect the population against the current pandemic, but she concentrated on obstacles beyond development of better vaccines. An old-fashioned egg-based method of vaccine production, among other matters, has slowed the ambitious program.

"We don't just need 21st-century technology. We also need 21st-century financial, legal, and regulatory frameworks that create incentives for companies to build these advanced countermeasures."

A new system is needed, she said, "that is so dependable and comprehensive that it deters potential bioterrorism attacks and makes our enemies say: 'It's not worth the effort.' "

The review, to be completed in the first quarter of the new year by the HHS Office of Preparedness and Response, will center on improving medical response to a wide range of threats and include long-term investments in research and the production of improved vaccines.

Being able to handle such threats, Mrs. Sebelius noted, "depends on the strength and numbers of our health care work force. It depends on whether we have enough hospital beds and working emergency rooms. It depends on our ability to coordinate across government agencies and how well we can execute a national response strategy on the local level."

This isn't first time that HHS has undertaken such a review, according to a department spokesman, but it is the first one to be undertaken by the Obama administration.

The department's investment in an advanced flu-vaccine technology that uses a dead virus, incubated in insect cells rather than chicken eggs, was expected to grow faster and easier. But the project suffered a recent setback when a Food and Drug Administration advisory panel ruled that the company had not yet shown the vaccine was safe enough for full approval.

Novartis opened the first American plant for another advanced method in North Carolina last week but that factory is not expected to be fully operational for two years, unless the president declares a national emergency, according to Robin Robinson, a virologist who heads HHS' Biomedical Advanced Research Development Authority.

He said in an interview that Congress had appropriated $5.6 billion in pandemic preparedness funds for a five-year program now in its third year.

The "money that goes into more than vaccines and includes antivirals and state planning and establishing stockpiles ahead," Mr. Robinson said, adding that he expects the number of advanced vaccine-manufacturing facilities on U.S. soil to double.

Nearly 70 million out of an original goal of some 160 million doses of vaccine have either been distributed or are on order, Dr. Thomas Frieden, head of the Centers of Disease Control and Prevention, said in a media conference Tuesday.

Emphasizing that the novel H1N1 flu was "unpredictable" and still widespread in 32 states,down from a high of 48, he said it was slowing down.

In a poll of "about a dozen" of world influenza experts, CDC found half thought another wave, or surge, could be expected before the Northern Hemisphere flu season ends in May, and half thought not.

"And one said, flip a coin," Dr. Frieden said.

He called this period "a window of opportunity," during which people will continue to become infected but that more and more should take advantage of increasing vaccine supplies to get protected. "And as that happens, it's harder for the virus to spread."