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Six years of worrying about bird flu did much to prepare the United States for the current swine flu outbreak, federal officials and an independent monitoring group said Thursday, but they cautioned that there were still gaps in planning.
After the H5N1 avian flu emerged widely in Asia in 2003, killing about 60 percent of those infected by it, many countries took steps to head off the crisis that would emerge if that virus were to acquire the ability to jump easily from human to human. It has not, but a number of the measures were helpful. These are some of them:
¶The federal government stockpiled 50 million courses of Tamiflu.
¶New vaccine factories were opened.
¶Pandemic plans were written, and emergency drills were held.
“Everyone was concerned about the avian flu, and biology played a trick on us,” said Jeffrey Levi, executive director of the monitoring group, the Trust for America’s Health, a nonprofit organization that has tracked the country’s preparations for flu pandemics for several years.
The first case of the H1N1 virus in the United States — a San Diego resident who is believed to have fallen ill on March 28 — was uncovered only because of pandemic planning, said Dr. Anne Schuchat, director of immunization and respiratory disease for the Centers for Disease Control and Prevention.
A Navy medical laboratory in San Diego was trying out a new rapid flu test and realized it had found something different from any previous virus. The sample then had to be sent to the C.D.C. for sequencing, which produced its results the same week as the Canadian national laboratory sequenced some flu samples taken in Mexico.
The H5N1 virus “was really a wake-up call for the world that serious threats are out there,” Dr. Schuchat said.
But a report from Dr. Levi’s organization pointed out weaknesses. These are some of them:
¶Closing schools to slow the spread of the epidemic caused confusion and frustrated parents and their employers.
¶Conversely, many adults went to work sick, endangering their co-workers. According to the report by the Trust for America’s Health, 48 percent of Americans have no paid sick days.
¶Some hospitals were overwhelmed, even by mild cases, because the “worried well,” especially those people with no insurance or family doctor, filled emergency rooms.
¶Underfinanced state laboratories fell chronically behind on testing.
¶The World Health Organization’s pandemic alert levels caused confusion.
It also became clearer Thursday that little vaccine would be available by the fall, even if nothing went awry in production.
The goal of pandemic plans is to make 600 million doses in six months, enough for two doses for each American; that could cost $8 billion. Manufacturers now have seed virus. But clinical trials of their first runs will last into the summer, and federal regulators must wait until those are finished, Dr. Schuchat said.
Domestic production capacity is still “completely inadequate,” according to a 2008 Congressional Budget Office report, and it seems unlikely that foreign governments will let vaccine factories on their soil export doses before their own needs are met.
