WASHINGTON — The federal government’s voluminous plans for dealing with pandemic flu do not adequately account for the overwhelming strain an outbreak would place on hospitals and public-health systems trying to cope with millions of seriously ill people, some public-health experts and local health officials say.
The Bush administration’s plans, which run more than 1,000 pages, contemplate the nightmare medical scenarios that many experts fear. But critics say federal officials have left too much of the responsibility and the cost of preparing to a health care system that even in normal times is stretched to the breaking point and leaves millions of people without adequate access to care.
“The amount going into actually being prepared at a community level is not enough,” said Patrick Libbey, executive director of the National Association of County and City Health Officials. “We are still talking about rearranging, with little additional resources, the assets of a system that are built on such a thin margin now that you have significant amounts of people without access to care and hospitals that are periodically shutting down their ERs and the like.”
The Bush administration argues that it is doing a lot to help communities as part of its strategy for dealing with the flu threat. It has doled out hundreds of millions of dollars in preparedness grants for hospitals and public-health systems every year, subsidized the stockpiling of antiviral drugs, conferred with governors and encouraged resource-sharing plans among hospitals.
Its larger strategy involves partnering with countries to quickly identify and contain potential outbreaks overseas, developing vaccines and other medical measures to limit the virus’ spread if it reaches U.S. shores, and working with state and local officials to keep the economy and society functioning as normally as possible. But administration officials acknowledge that gaps remain.
“We’re seeing substantial progress across the board in terms of various aspects of preparedness for flu,” said William Raub, science adviser to Health and Human Services Secretary Mike Leavitt. “But I won’t sugarcoat this. In virtually every area, we have a good way to go.”
A serious outbreak and its fallout would probably overwhelm medical centers, cause lengthy delays in emergency and routine care, and trigger shortages of beds, ventilators, drugs, masks, gloves and other supplies, experts said. Unlike a hurricane or a bombing, the crisis would drag on for months and affect communities nationwide at the same time.
A vaccine, if one becomes available, could be difficult to transport and distribute, and imperfect vaccines and antiviral drugs used in the early stages of an outbreak probably could not forestall a pandemic.
“If we have even a moderate-sized pandemic, these supply chains are going down overnight,” said Michael Osterholm, director of the Center for Infectious Disease Research & Policy at the University of Minnesota.
Osterholm and others said that a serious flu outbreak would be nearly impossible to contain and that building the medical capacity to treat the surge of victims would require billions more in sustained federal aid. Moreover, health experts say there should be greater attention paid to who will control scarce resources and to how people will get care at home and in other nonhospital settings.
Michael Greenberger, director of the Center for Health and Homeland Security at the University of Maryland, said the federal effort amounts to a “classic” unfunded mandate.
“If you look at the plan, the basic message is, ‘. . . You better get ready.’ You better get ready. You the cities, you the states, you the citizens,” Greenberger said.
Since late 2005, Congress and the president have devoted more than $6 billion to pandemic-flu preparedness, although little has gone directly to states and communities. The vast majority has been spent on researching vaccines and building the capacity to manufacture and distribute them, and on overseas disease surveillance, analysts said.
