Remarks to the National Press Club on Pandemic Preparedness
I welcome this opportunity to talk to you today about one of the most important public health issues our Nation and the world faces � the threat of a global disease outbreak called a pandemic.
A little less than two weeks ago, I drove with the United States Ambassador to Vietnam about three hours outside Hanoi to a small village/commune called Hung Dao.
There, in a small open air meeting room dominated by a bust of Ho Chi Min and a communist party flag, I met Nguyen Van Voi, the Chairman of the People�s Committee for the village.
Through an interpreter, he described March 9th, the day he got a call any government leader would dread; the H5N1 virus was in his village and chickens were dying.
Within three days, villagers were killing their tiny flocks; chickens they depend for food and income.
About a quarter mile from there lives Vu Van Son. He and his wife were among those ordered to kill their chickens.
They are in their mid 30�s, have been married for 12 years.
They live with three daughters in a home they built on a tiny plot of land they share with their animals.
There is no furniture so we sat on a square of wood flooring that seems to be the talking place.
He offered us tea from a small pot that sat in the middle of the floor.
Mr. Son�s four year old daughter came into the room.
She is a stunningly beautiful but shy little girl.
I picked up a rubber band from the floor and twisted it in a funny shape to attract her attention.
Soon she sat down on my lap and listened to us talk.
I instantly liked both Mr. and Mrs. Son. She was attractive, and quick witted; interrupting our conversation several times to direct child traffic.
He was quieter, but confident.
lternating back and forth with details, the Son�s explained that only five of the three hundred birds had died.
The birds were stacked seven deep in cages behind their house.
The others seemed healthy enough so they decided to eat some of the others; that way it wouldn�t be a complete loss.
Between the two of them the chickens were killed and several were cleaned and prepared for cooking. It was not eating cooked chicken that caused trouble, but the processing and handling of sick and virus carrying birds.
Mr. Son then described what happened in the morning, seven days later.
First, it was nausea, then fever and a cough.
�It seems routine,� he said. �I have experienced it all before.�
Two hours passed; suddenly, everything worsened.
Excruciating pain coursed along his rib cage.
�Every cough,� he said, �was like coughing up my lungs.�
He describes his condition as �completely losing control.�
He was losing the capacity to breathe.
Two hours after that, the four year old girl became ill with the same symptoms her father had.
Mr. and Mrs. Son told me how fortunate they feel to be alive.
They were taken to a near by city and treated with antiviral medicine and ultimately recovered.
Dozens of others in Vietnam have not been that fortunate.
So far, throughout Asia, 121 have contracted H5N1, and 62 have died.
The Son family is a reminder that despite nature�s beauty, part of our world is a biologically dangerous place.
The H5N1 virus that attacked them is part of an unseen microbial world that is constantly mutating, adapting and attacking birds, animals and people.
Usually, human bodies muster a natural response but during at least ten periods in the past 300 years, viruses have mounted massive pandemic assaults that made masses ill and caused millions to die.
In the century past, we have experienced flu pandemics three times: as recently as 1968 and 1957 and what author John M. Barry called the Great Influenza, in 1918.
His book describes in vivid detail the winter of 1918 when recorded history�s most lethal influenza virus started in an army camp in Kansas, extended east with the movement of troops, then skyrocketed, killing as many as 40 million people worldwide.
If the past is prologue, we are overdue for the next pandemic.
A wary world watches the H5N1 virus being carried by wild birds to the nations of the earth.
Scientists warn there is a reasoned concern that given the way viruses change over time, these viruses could evolve and develop the capacity to spread from person to person � and that could set off the conditions for a pandemic.
There is something different now than when other pandemics started.
Migratory birds are not alone in their global travel; people today move about the world with an ease never before experienced in human history.
We worry; this virus looks and acts more like the virus of 1918 than any of its more moderate cousins.
Consequently, we have to assume that if there is an outbreak of a potential pandemic influenza anywhere, there is danger everywhere.
No nation can afford to ignore this threat.
That is why at the UN last month, President Bush launched the International Partnership on Avian and Pandemic Influenza.
The purpose is to create an international network of surveillance and preparedness that will be able to recognize and respond quickly to disease outbreaks.
Think about the world as a vast dry forest, susceptible to fire.
It only takes a spark to set off a fire.
If you are able to be where the spark ignites, you can simply put it out with your foot.
But if it is allowed to smolder and spread, it can grow beyond containment.
For many years, the U.S. Government has maintained a significant public health presence in southeast Asia.
We are now supplementing that commitment.
During my visit to Southeast Asia and in recent meetings with governments around the world, we have impressed leaders of the overarching need for transparency and timely data sharing to help us detect and treat the disease.
We especially need these countries to help us get a constant flow of virus isolates from humans and animals that help us track the evolution of the virus.
Our vaccine-making capacity depends on having those samples.
Being there however was a vivid reminder of the economic cross-pressures felt by small subsistence farmers and their governments.
Nor should we have an unrealistic view of the gaps created by the lack of a health care network.
In one country, the Minister of Health told me that last year 14,000 people died from Rabies.
Given that situation, I could not help but wonder what kind of priority farmers in remote villages would be giving to a few dead chickens.
That sense of realism dictates that while we must try to contain the disease abroad, our primary efforts must be preparing to fight it here at home � we must achieve a state of readiness and quick response.
If a pandemic hits our shores, it will affect almost every sector our society � not just health care, but transportation systems, workplaces, schools, public safety and more.
It will require a coordinated government-wide response, including federal, state and local governments � and it will require the private sector and all of us as individuals to be ready.
President Bush will soon be announcing the Administration�s national strategy for pandemic preparedness and asking Congress for the funding to implement it.
The Department of Health and Human Services will also be releasing details of our public health and medical response plan.
There are four major components of our preparedness and ready response efforts:
Intensifying surveillance and collaborating on containment measures � both international and domestic;
Stockpiling of antivirals and vaccines and working with industry to expand capacity for production of these medical countermeasures;
Creating a seamless network of Federal, state and local preparedness, including increasing health care surge capacity; and
Developing the public education and communications efforts that will be so critical to keeping the public informed.
I talked about surveillance overseas, but it is just as important to strengthen our capacity to monitor disease and report it here at home.
We will expand the BioSense program to gather data from emergency rooms in selected cities so we can improve our near real-time surveillance of disease outbreaks.
This is a �breakthrough initiative� in health information technology.
We are developing stockpiles of antiviral drugs, which can ease the effects of the disease once people get it.
We began ordering these drugs in December of 2003 and January of 2004.
We now have ordered more than 5 million doses, including Tamiflu and Relenza and we will continue to add to that number.
But Tamiflu alone must not be the measure of our preparedness.
Perhaps the most important tool � and our best hope � is a vaccine that prevents people from being infected.
The good news is that scientists at the National Institute of Health, working with sanofi Pasteur, have developed a vaccine that produce an immune response sufficient to provide that protection from H5N1 virus.
This augurs well for our ability to develop a vaccine against a pandemic virus that evolves from the current H5N1 strains.
In September, we awarded a $100 million contract to sanofi Pasteur to manufacture 3.3 million doses of H5N1 vaccine�two doses per person, which would be enough for 1.67 million people�and today we are announcing another contract of $62.5 million to Chiron for this vaccine as well.
Because we know that liability is an issue that keeps companies away from making vaccines, we need to resolve this, particularly when it comes to making vaccines for an influenza pandemic.
The cold, hard truth is that the capacity doesn�t exist within the United States to produce vaccines with sufficient speed and quantity to reach every American. That condition exists all over the world.
This needs to change.
Last month the President and I met with manufacturers to find ways to revive our domestic vaccine capacity.
We need to vigorously pursue the promise of cell-based vaccine production to augment the more cumbersome egg-based vaccine that we rely on today.
When you are growing vaccine in these specialized eggs, you have a rate-limiting factor.
You would need billions of eggs standing by. If you are growing the virus in cells, you can quickly expand quantities available when necessary.
This is a technology that is being used for other vaccines and we should apply this to flu vaccines.
Beyond vaccines, pandemic planning needs to incorporate every department of the federal government but must go deeper than that.
Every state and local government must have a pandemic plan.
Unlike most disasters we prepare for, with a pandemic, outbreaks can happen in hundreds or thousands of places simultaneously or over a very short period of time. And lasts for more than a year.
The Federal government will play an important role, but it cannot do it all.
In a series of actions that will be announced soon, I will be asking the governors, mayors and state and local health and preparedness officials to join me in a concern we all must share --- preparing for a pandemic should one happen.
Everyone in society has a role.
For example, the Federal government can deliver stockpiles of medication and supplies to a city in the U.S. in a matter of hours � but it is distribution at the State and local level that defines victory.
In a moment of crisis, if we are not able to deliver pills to people over wide areas in short time frames, lives will be lost.
We need to create a seamless preparedness network where we are all working together for the benefit of the American people.
Finally, communicating information to the public is so important in an emergency.
Even as we prepare for a pandemic, I am conscious of the fact that talk of a pandemic causes people to feel worried and unsure.
It is important to find the balance between informing people; and inflaming the situation�between preparing them, and panicking them.
It is a difficult balance, but people have a right to know and a need to know the truth so they can make informed decisions.
There is another matter we need to speak frankly about. What if it never achieves the feared human to human transmission? What if, H5N1 does not trigger a human pandemic?
Will our actions have been an over reaction?
Will critics say, we have been �crying wolf� and lose the sense of urgency we feel about this issue?
Scientists are clear about one thing. H5N1 is currently an animal disease.
If it isn�t the current H5N1 virus that leads to an influenza pandemic, at some point in our nation�s future another virus will.
History teaches us that everything we do for a pandemic today will have lasting benefits for the future.
For example, in order to have the surge capacity to manufacture a pandemic vaccine within six months for every American, we will need to develop technology and capacity.
This same technology can be used to make vaccine
But we don�t want this to be idle capacity standing by for a pandemic.
Instead we can use it to produce vaccine for the annual flu season.
When there is annual influenza vaccine available for every person in this country by a revitalized domestic vaccine industry we can save thousands more lives every year.
The Cell-based technology we will develop in the process of our preparation will change the world of vaccine production forever.
It will dramatically shorten the time it takes to create the vaccine for some new and unexpected virus.
The early warning of disease outbreaks at home and abroad will be important for a host of reasons, including the capacity to ascertain a bio-terrorism event.
State and local preparedness planning will ensure people in every community will get help quickly � even when the federal government cannot be on the scene.
Finally, we can have the peace of mind that comes from knowing that whenever the next pandemic comes, we are in a constant state of readiness.
No one in the world today is fully prepared for a pandemic, but we are better prepared today than we were yesterday � and we will be better prepared tomorrow than we are today.
If we take the steps necessary in the short-term and the long term, we will be able to save the lives of millions of people in our country and all around the world.
Last revised: October 27, 2005