Remarks to the Convening of the States on Pandemic Influenza Preparedness

Good morning. Thank you all for coming to this convening of the states on pandemic influenza today.

Joining us today is my colleague Secretary of Homeland Security, Michael Chertoff. Secretary Chertoff, I am delighted you are able to join us briefly. We would appreciate hearing from you now.

I begin with appreciation for the attention and care that you have been giving to this issue.

The Public Health Community has been talking about pandemic influenza for years. You understand its danger � how it can touch each life, how it can change each community and how it can shape the nation.

Pandemics happen. It is a fact of biology, a fact of the unseen world of viruses, which are constantly mutating, adapting, and attacking.

There have been ten pandemics of influenza in the last three hundred years. There have been three in the last century.

There is no rational basis to believe that the early years of the 21st century will be different. When it comes to a pandemic we are overdue and under prepared.

When pandemics strike, they not only cause massive sickness and terrible loss of life they reshape the culture, the politics and the prosperity of nations. The bubonic plague reshaped the face of Europe in the 14th Century. Viruses like smallpox helped to bring down powerful Native American kingdoms in the New World. Whispers of the 1918 Pandemic still echo across Europe and America.

While pandemics are thought of in terms of continents and centuries they are experienced in hometowns. Countless towns and communities in the United States were changed by the great pandemic of 1918; your hometown and mine. My hometown is Cedar City, Utah, a small city in the southwest corner of Utah. It had about 3,000 people at the time.

The town doctor was L. W. MacFarlane, or Dr. Mac, as everyone called him. He was the consummate country doctor. And naturally served as the chairman of the town's public health committee.

Dr. Macfarlane wrote, "Quite a group had gone from Cedar City to attend [the] conference and State Fair in Salt Lake. They returned home bringing unexpected gifts with them. By the time they got back to Cedar City, Mr. and Mrs. Don Coppin and their son Billy, Mrs. James E. Anderson and their daughter Ethel, and Miss Mell Corlett were definitely sick with the flu. Miss Mary Palmer, returning from Salt Lake City, and her sister Evelyn... brought the infection to their family. Before many days had passed, influenza was sweeping like a fire though Cedar City and breaking out in the surrounding communities."

A Mrs. George Foster was the first victim of the influenza. She left a husband and a "little motherless child." As others were stricken, authorities rushed to contain its spread.

For instance, Elias M. Corry, the mayor of Cedar City issued an official proclamation, cosigned by M.J. Macfarlane, City Health Officer, ordering several stringent measures.

Public gatherings were prohibited. Those with symptoms of influenza were to be isolated. So were their caretakers. Those who went out on the streets or in public places had to wear gauze masks, although exceptions were made for individuals who were, "actually engaged in eating or in a barber chair."

The penalty for not following the proclamation was a misdemeanor, punishable by a fine, imprisonment or both. Despite those potential penalties, the proclamation did not always have its intended effect.

As Dr. Macfarlane noted, "The wearing of the masks was annoying to everyone, but it was particularly galling to those members of the community addicted to chewing tobacco. One elderly member of this fraternity is recalled whose mask was tied on, sure enough, but hung around his neck, leaving his nose and mouth well uncovered, and served only to rescue whatever tobacco juice had failed to clear his chin. Since he came though the epidemic unscathed, one can only suppose that the tobacco juice had an effect on influenza something like it has on garden pests. This theory, of course, is entirely tentative, unproven, and original."

Others tried unusual remedies to cure influenza. One newspaper suggested the use of Vicks Vaporub, which it claimed would, "loose the phlegm, open the air passages and stimulate the mucous membrane to throw off the germs."

Despite all efforts to contain it, pandemic influenza continued to spread through Cedar City. Less than a month after it arrived, a local newspaper headline declared, "Influenza Worse Than Bullets," making the point that children who didn't keep the flu rules were six times more likely to die than those that went to war.

Impacts of the pandemic of 1918 re-shaped the history of my hometown as it did hometowns all over America. Today, scientists and public health officials are properly concerned with the H5N1 virus. It looks and acts more like the virus of 1918 than any of its more moderate cousins, the pandemics of l957 and 1968. Should it continue along that malignant path of mutation, it may become one of the most terrible threats to life that the world has faced.

A pandemic virus is a relentless aggressor. It is constantly adapting and spreading. It comes not from one direction, but from many. It builds a powerful network � stop it in one place � and it re-emerges in another. Exercises we conduct to test our nation's pandemic readiness make me increasingly concerned about the cascading consequences that such a disaster could produce.

School closures have consequences. Movement restrictions present economic dilemmas. Allocations of scarce supplies of medicine and fuel force difficult choices.

Workforce issues among healthcare workers, utility operators, transportation providers, or law enforcement not only create economic disruptions, they are threats to the safety and security of our nation.

No nation on earth can ignore the pandemic threat.

President Bush, joined by other world leaders, sounded the alarm mobilizing more aggressive preparations. His $7.1 billion emergency appropriation request to Congress boosts our international and domestic disease monitoring, rebuilds our vaccine industry, builds stockpiles of medicines and other needed supplies, and enables the drafting of communications plans.

The President's action also fuels the integration of pandemic plans at every level of government and society. He has called upon the Department of Heath and Human Services to lead our nation's public heath pandemic readiness and directed that as Secretary, I convene state and local authorities to coordinate our efforts.

Shortly after the President's November 1st speech on pandemic readiness, I initiated a call to the nation's governors proposing a national summit. They are to be conducted under joint state/federal sponsorship and are to be held not in Washington, but in at least one city in every state in America.

The Governors responded enthusiastically to that proposal. So today, we are very pleased to announce the fact that we will, over the next 120 days, hold a summit in each state.

It is primary in my thinking that this summit is not simply about public health or about emergency preparedness as a community. We've talked a lot about this in planning for the summits in Minnesota and Arizona.

We've talked about the fact that public health people get this. And if we come to Arizona or Arkansas or Vermont or Delaware or New York or New Mexico, and simply talk to the public health community, then we are simply talking to ourselves.

We need to lift this to the broader community, to those who have not yet begun to understand the potential risks and consequences that a pandemic could have on every aspect of our society.

We need to have our schools, we need to have leaders of the economic community, we need to have the entire medical community, we need to have faith-based organizations. These summits are designed to be a means by which the public health community, the public preparedness community, can lift an understanding of what must be done to political leaders � to state legislators, to city council members to mayors � so that they can be supportive of decisions that you, the public health and public preparedness people, must make to be adequately prepared.

The State Summit will not be a one-time event. We see this involving follow-up meetings. We have to maintain the level of urgency that's apparent right now.

There needs to be a method of public accountability and a method of progress measurement. We need to come back and we need to constantly be asking how well we are doing and constantly making progress.

Each of you represents your governor today, or an association that is critical to the success of this Fifty State Summit. Later in the day we will have a chance to talk about these summits and how to optimize their benefit. I would like you to be thinking about that.

We'll have an hour-and-a-half discussion. We anticipate that you will be the initial contact and that within a week or two or three of this meeting, you expect that we will be contacting you to formalize the beginning process of planning this version of the pandemic summit that will occur in your state.

Joining with the Department of Health and Human Services from the federal government will be other federal agencies such as the Departments of Homeland Security, Agriculture, Commerce, Transportation, Interior and Defense. All play critical and central roles pandemic planning.

Last month we released the HHS pandemic plan. We are now working with each of the other federal departments to integrate their roles and plans. The HHS plan combined with the other federal agency plans will be referred to as the Federal Pandemic Plan.

The graphic you now see on the screen depicts how we see that interacting with other pandemic planning efforts. They must form a network of preparedness we will call our Nationwide Pandemic Plan. Dr. Rajeev Venkayya, Special Assistant to the President for Biological Defense Policy, will give more details about this process.

An integrated plan requires a unified target. Today, we announce a set of pandemic planning assumptions that will be used throughout the federal government to define a severe case scenario.

Dr. Bruce Gellin, will discuss them later today and we will also publish them on our website. We believe it would be an advantage if these assumptions were considered uniformly for our national planning efforts.

The assumptions were developed by HHS after wide consultation and extensive study of the pandemics of 1918, 1957 and 1968. Because we want our assumptions to exercise the severe case, the model and assumptions resemble 1918 most closely. It is also worth a reminder that the H5N1 virus is genetically closest to the 1918 virus. We are beginning to use these assumptions to develop models that will be extremely helpful to all of us in making difficult decisions. These tools illustrate graphically how profound our task is.

Unified planning assumptions are an example of the way we integrate plans. Another tool is the use of checklists.

Today we will release the first of a serious of checklists that we believe can serve as a means to organize our national thinking and bring consistency to our efforts. The State and Local Government checklist will be made public today. Later this week, preparation checklists for businesses and for schools and colleges will be released. In ensuing weeks there will be checklists for faith-based and community organizations and one for individuals and families.

Now there are a couple of other subjects I want to talk to you about because I know they are very much on your minds. They are subjects that are ripe for discussion but not yet for results.

The first is money. I want you to know that as a person who has served as the governor of a state for 11 years, I am intensely aware of the pressures that face state governors. They are many and complex. Having yet another potential catastrophe to prepare for in an unexpected way is difficult.

As you know, President Bush has made a proposal to Congress of $7.1 billion. It is the most robust proposal ever made for public health at one time. However, there are some people who believe it is too much and others who believe it is not enough. I believe that over the next few weeks, it will be resolved.

I want to give you our commitment that we will be working aggressively to ensure that that happens. It needs to happen and it needs to happen soon because every day that we are acting without Congress acting is a day that creates a lag in our ability to deliver a vaccine.

There is a profound opportunity for us here as a community. We need to make sure that we work hard to make the best of it. We'll have an opportunity to talk about the financial aspect of this later on.

It is uncertain as of this moment, but I feel confident that Congress will respond to the President's strong advocacy of this.

The second issue is the allocation of anti-virals and vaccines. In a few minutes, we are going to talk about the current status of vaccines and anti-virals. But again, this is a subject that is not resolvable today. We will be consulting with you extensively in the course of it.

We know that you need to know the information that we can provide once it is available that will allow you to begin planning your own response.

There is, I believe, one other question that we ought to be talking about. What if this doesn't happen in the near term? What if the H5N1 virus does not trigger a pandemic?

Should that happen, should the pandemic be delayed, perhaps indefinitely, would all our preparations be in vain?

Not at all.

Will it be said that we overreacted?

Yes.

Will it be said that we cried wolf?

Yes.

But let me remind you that at the end of the fable of the boy who cried wolf, the wolf came. The flock was scattered.

If we are fortunate enough to go five years without a pandemic, we can become the first generation in history to be ready.

We will have established a cell-based technology for producing flu vaccine. That provides the capability to quickly expand available quantities of vaccine when necessary, and so will save the lives of millions of people for generations to come.

The annual flu as we know it, and dread it, will have been taken off the table, saving thousands of lives each year.

We will have a better capacity to develop vaccines, not only against pandemic flu, but against other viruses as well. We will also have created better anti-virals. That technology is likely to be invaluable during other public health emergencies.

In addition, state and local governments will be better prepared for any medical disaster, whether at the hand of man or the hand of nature. Few of us have forgotten the anthrax attacks of 2001. Each of us could imagine even a worse national emergency. Preparing against the pandemic will strengthen our preparedness against the countless terrible threats to the public health.

That preparation will bring peace of mind. It will bring the sure knowledge that when it is time to panic, there is no reason to panic, for preparations have shown the way to containment and safety. We are able to fight pandemic flu. Through preparation, we can be ready.

Pandemic flu is a terrible threat. The annals of history are filled with countless tear-stained chapters of its effects. But today is the beginning of a new chapter. Today, we are writing the words of hope, not dread, of faith, not fear.

Today, we can tell the story of something that the world has never known and never seen: of prepared individuals, ready to leap into action; of prepared states and cities, ready to act in concert to control and contain, of a prepared world, ready to meet a pandemic with all its power and might. Our job now is to inform not inflame; to inspire preparation not panic.

It can happen.

All it takes is faith and hope and action � a faith that we can be ready, a hope that we will be, and the actions to make it happen.

Let's get started.

Thank you.

Last revised: December 28, 2005

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