Bush plan offered to fight a flu epidemic

President Bush unveiled a $7.1 billion battle plan yesterday to arm the nation against a long-feared influenza epidemic, proposing to expand flu medication stockpiles, hasten vaccine research, and hone state and local preparation for such a sweeping health emergency.

The three most expensive components of the plan would buy vaccine for 20 million people, expand stockpiles of flu pills, and engineer a radically different method for making shots. The White House timetable for fully implementing the plan is 2010.

But public health specialists said the plan may prove to be too little, too late, providing vaccine and drugs for only a small fraction of Americans.

The president's call to action, which needs congressional approval, arrives amid increasing concerns that avian flu could be the spark that ignites a global wave of respiratory illness, killing millions and overwhelming hospitals. While the president in a speech at the National Institutes of Health attempted to tamp down fears that a global epidemic is imminent, he acknowledged that ''at some point we are likely to face another pandemic."

''Our country has been given fair warning of this danger to our homeland and time to prepare," Bush said.

Bird flu was first identified in 1997 in Hong Kong, and the latest wave of illness blamed on the virus has resulted in 122 human infections since 2003, resulting in 62 deaths.

''The best you can say about this plan is, 'Better late than never,' " said Dr. David Ozonoff, an environmental health specialist at Boston University School of Public Health. ''Why aren't we already prepared? It sounds like this is a surprise, and that is absurd."

A global epidemic could exact a devastating toll: The notorious outbreak of 1918, one of three in the 20th century, killed more than 20 million people worldwide, sweeping the globe in a matter of months. The president's plan is directed at controlling an epidemic caused by bird flu or other particularly lethal flu strains.

Virtually all of the human cases of bird flu have been caused by direct contact with infected birds, not through person-to-person transmission. Some infectious disease doctors said they believe the virus is close to gaining the ability to spread between humans.

Specialists said the potential speed and ferocity of a flu epidemic demand that measures such as stockpiling vaccine be adopted swiftly.

''We don't have time to wait for it to come and start making vaccine then," said Barry Bloom, dean of the Harvard School of Public Health. ''That's a grisly prospect."

The Senate last week, as part of a broader spending bill, approved $8 billion for flu epidemic preparations, and a spokesman for the House Committee on Appropriations said a hearing is scheduled today to consider Bush's plan.

While the president's plan appears to cover similar ground as the Senate proposal, details of the president's initiative are expected to be released today. Senator Edward M. Kennedy, who championed the Senate's flu plan, said the full Congress should act expeditiously.

''The president today should be calling the House of Representatives to say, accept the Senate spending we passed," Kennedy, a Massachusetts Democrat, said in a telephone interview last night.

Dr. Georges C. Benjamin, the executive director of the American Public Health Association, said that when he heard Bush was proposing spending $7.1 billion on flu preparations, '' 'down payment' is what I thought. It's hard to say whether it's truly enough. I'm very likely to come back and say we're going to need more."

The cornerstones of the president's proposal involve increasing caches of flu medication as well as accelerating development of better and faster methods for making flu vaccine.

Bush asked Congress to approve $1 billion to buy additional reserves of flu pills such as Tamiflu and Relenza -- enough for 44 million people. Those government stockpiles, the president said, would be dedicated to treating healthcare and emergency workers as well as patients whose underlying medical conditions place them in greatest peril of dying from the flu.

The network for delivering that medication to private and public health personnel has not been developed. The drugs have been shown to shorten the time patients are ill with flu, although they do not cure the disease.

The maker of Tamiflu, Roche Holding AG of Switzerland, issued a statement after the president's speech indicating that it was prepared to make more of the medication for the US reserve. The company last year supplied enough pills for 2.3 million patients and said it should be able to deliver 2 million additional courses of treatment this year.

Still, specialists said, flu pills offer only limited help in combating a flu epidemic.

''They're to be used literally after the flu bomb has gone off to shorten the period of infection," said Dr. Michael Callahan, director of Biodefense and Mass Casualty Care at the Center for Integration of Medicine and Innovative Technology, a Cambridge research consortium.

In addition, scientists are still trying to ascertain how well the drugs work against avian flu, said Dr. Paul Biddinger, a Harvard specialist in public health preparedness who has designed elaborate drills to test the readiness of Boston doctors and healthcare agencies to cope with an epidemic. Still, he said, building reserves of the pills makes sense -- at least for now.

Developing a vaccine against avian flu and other epidemic strains is the ultimate goal of flu preparations. Government and private scientists are engaged in the hunt for a shot that will work, and with negligible side effects, against bird flu.

Bush called for $1.2 billion to be invested in purchasing avian flu vaccine, assuming researchers are successful in developing a reliable shot. That would be enough, the president said, to vaccinate 20 million people.

But the way drug companies now make vaccine against the flu is an infamously messy, chancy proposition requiring months and massive numbers of chicken eggs. That's true whether it's vaccine against the seasonal strain or vaccine that's being studied to thwart bird flu.

To make vaccine, scientists need lots of virus. To do that, samples of flu virus are injected into eggs, where they multiply and are later extracted, purified, and engineered so that they can't cause illness when made into a vaccine.

The process of making vaccine can take 10 months, assuming there are enough eggs available.

Bush's proposal calls for spending $2.8 billion to speed research into an alternative manufacturing process for flu vaccine. That procedure is known as cell-based technology and involves using thawed cells that are infected with flu strains. After the flu strain multiples, virus is extracted from those cells, purified, and made into vaccine.

Successfully adopting such a process is years away, specialists said.

''We don't know whether the next pandemic strain is coming this year, next year, or in five years," Biddinger said. ''Certainly, the real progress that [Bush's] plan promises is several years off."

The president's proposal also attempts to address an issue that drug companies maintain prevents them from getting into the vaccine business: lawsuits. The president in his speech asked Congress to limit the financial liability of the makers of vaccine and medicine in the event that patients sue over side effects.

The Pharmaceutical Research and Manufacturers of America, a leading industry organization, applauded the president's call for limiting liability, saying it would increase the willingness of companies to make flu vaccine. But the Association of Trial Lawyers of America condemned the liability proposal, saying in a statement that ''some big drug companies put their bottom line before the health and safety of the public."

Stephen Smith can be reached at stsmith@globe.com.