Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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—Franklin Delano Roosevelt2432

The “better late than never” Bush proposal of billions to improve domestic antiviral and vaccine capacity is not without its critics. The head of the UN Food and Agriculture Organization questions why the United States isn’t helping more with efforts to monitor and control the disease in Southeast Asia. “It doesn’t look to us quite rational,” he said, “that we would be ready to spend so much money on the second line of defense and then on the first line of the combat field, we’re not putting even $100 million.”2433 Once it hits, paltry Tamiflu stockpiles in rich countries, as the Canadian Medical Association put it, provide no more than a pandemic “speed bump.”2434 But even if, on a global scale, antivirals do turn out just to be a “Band-Aid,” as the dean of Drexel University’s School of Public Health noted, they would stop some of the bleeding.2435

Putting all our bird flu eggs in one Tamiflu basket may not be the wisest allocation of U.S. funds, though. A better solution may be to revitalize our critical public health infrastructure, which has been crippled, according to the National Academy of Science’s Institute of Medicine, by “grave underfunding and political neglect.”2436 As one senior senator admitted, “The decline in preparedness and effectiveness of the nation’s first-line medical defense systems can be traced to these ill advised budget cuts which forced the termination of essential research and training programs.”2437 Quoting from a 1988 Institute of Medicine report, “We have let down our public health guard as a nation and the health of the public is unnecessarily threatened as a result.”2438 A 2002 updated Institute report concluded that the U.S. public health system “that was in disarray in 1988 remains in disarray today.”2439

The General Director of the conservative Mercatus Center suggests a budget-neutral switch of most of the $10 billion currently going to developing anti-ballistic missile defense to in part help bolster local public health system preparedness.2440 Unfortunately, the opposite trend seems to be happening. Just as President Bush repeatedly underfunded the New Orleans levees,2441 funding for local and state public health departments continues to be cut. For fiscal 2005, the administration proposed a $100 million cut for state and local public health preparedness2442 and $129 million in proposed cuts for 2006.2443 House Democratic Leader Nancy Pelosi criticized these cuts as leaving “our state and local health agencies without the resources they need to protect communities in the event of a pandemic.”2444 The president of the National Association of County and City Health Officials agreed. “Critical funding is shrinking,” he said, “just as public health agencies are being required to expand their work in pandemic influenza preparation and response.”2445

After 9/11, the Department of Homeland Security spent billions preparing for disasters, but most of it understandably concentrated on acts of terrorism.2446 “No one cares about disasters until they happen,” laments one emergency management expert. “That is a political fact of life.”2447 The president of the Institute of Medicine and former dean of the Harvard School of Public Health describes nature as the worst terrorist one can imagine.2448 “It’s too bad that Saddam Hussein’s not behind influenza,” complained a member of the federal government’s advisory panel on vaccination. “We’d be doing a better job.”2449