President Bush's pandemic flu response plan is a menu of hard choices the country will have to make in the event of an outbreak, setting out who will get scarce vaccines and influenza drugs first and laying the groundwork for curbs on civil liberties.
The plan assumes a worst-case scenario, that a pandemic flu strain evolves and rapidly sickens 1 in 3 Americans, a bug capable of killing nearly 2 million people in the United States.
Driving the concern is the spread of the H5N1 strain of avian influenza. Scientists fear the bird illness, carried by migratory fowl from Asia, could mutate into the pandemic strain, spreading readily among people.
"The reality is that if the H5N1 virus does not trigger a pandemic flu, there will be another virus at a later time,'' Secretary of Health and Human Services Michael Leavitt said at a Washington, D.C., news conference Wednesday as details of the $7.1 billion proposal were released.
The Bush administration's 396-page pandemic preparedness plan includes recommendations on how to ration flu drugs and vaccines in the likely event there won't be enough to go around.
It also offers guidelines on travel bans, quarantines and involuntary isolation of patients, actions that are drawn from the international experience in containing the SARS outbreak in 2003.
Leavitt said Wednesday that enough antiviral drugs to treat 81 million people could be readied as early as the summer of 2007 -- much sooner than any previous predictions -- but in the event of a deadly pandemic even that amount would be divvied out to priority groups first, leaving millions of others without the means to fight the illness.
Hospitalized flu patients would be at the top of the list for Tamiflu and Relenza, which are the only medications thought to be effective against the H5N1 strain.
Planners anticipate there could be 7.5 million such patients in a pandemic. If the outbreak happened tomorrow, two-thirds of them would go without.
Next in line for treatment would be health care workers and ambulance crews who come down with the flu while caring for others, followed by flu-stricken pregnant women and people at high risk of hospitalization or death, such as those with compromised immune systems.
The queue for flu drugs would wind down through vaccinators, police and firefighters and employees of the plants that make the drugs and vaccine.
Only then would the elderly and small children, typically the first to be rationed flu vaccine when in short supply, be allotted their share of the flu drugs, reports the AP. I.L.