[Congressional Record Volume 151, Number 123 (Wednesday, September 28, 2005)]
[Senate]
[Pages S10626-S10629]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PANDEMIC INFLUENZA
Mr. REID. Mr. President, in 1918, the Spanish flu pandemic swept the
world for a number of reasons--not the least of which we had soldiers
coming from all over the world going places and coming home. As a
result, this pandemic that swept our world claimed the lives of about
50 million people, and 500,000 people in the United States alone before
it completed its deadly run.
Today, many public health experts are warning us that another flu
pandemic is not a matter of if, but when. They tell us that this next
pandemic has the potential to be every bit as devastating as what the
world witnessed nearly 100 years ago.
A flu pandemic occurs when a new strain of flu emerges in the human
population and causes serious illness and death and can easily spread
between humans.
The avian flu, referred to as H5-N1 flu strain by scientists, already
meets the first step: Roughly half of the 115 people who have been
diagnosed with this virus to date have died. At present, all that
stands between avian flu and pandemic status is the fact that
scientists do not believe the avian flu can easily be transmitted
between humans.
Scientists fear it is only a matter of time before the avian flu
virus mutates into a form that can spread easily from human to human.
According to the Centers for Disease Control Director Julie
Gerberding:
. . . many influenza experts, including those at CDC,
consider the threat of a serious influenza epidemic to the
United States to be high. Although the timing and impact of
an influenza pandemic is unpredictable, the occurrence is
inevitable and potentially devastating.
That was her word, ``inevitable.''
You do not have to be an expert to understand the dramatic toll a flu
pandemic could have on our Nation and on
[[Page S10627]]
the world. Given our capacity for rapid travel around the globe
compared to 1918 and the interdependence of our economic markets
compared to 1918, both of which have increased dramatically since the
last flu pandemic, the potential human and economic costs of the next
pandemic are unimaginable.
A respected U.S. health expert has concluded that almost 2 million
Americans would die in the first year alone of an outbreak. Pandemic
flu outbreak in the United States could cost our economy hundreds of
billions of dollars due to death, lost productivity and disruption in
commerce, and to our society generally.
Maybe the only thing more troubling than contemplating the possible
consequences of the avian flu pandemic is recognizing that neither this
Nation nor the world are prepared to deal with it. Administration
documents say it will take months to develop an effective vaccine
against the avian flu--some say as much as 9 months--once we have been
able to identify the particular flu strain in circulation.
Administration officials say one of the best opportunities to limit the
scope and consequence of any outbreak is to rapidly detect the
emergence of a new strain that is capable of sustained human-to-human
contact. Yet we are not devoting enough resources to effective
surveillance abroad.
The administration has acknowledged we need a detailed pandemic plan
outlining our national strategy to address this pandemic. Among other
matters, such a plan needs to address those who will spearhead our
response to pandemic.
How will our response be coordinated across all levels of Government?
And how will we rapidly distribute limited medical resources? Yet our
national preparedness plan is still in draft form.
We all know State and local health departments will be on the front
lines of a pandemic. They will need to conduct surveillance, coordinate
local responses, and help distribute the vaccines and antivirals. Yet
we are posed to approve a $130 million cut for State and local
preparedness funding at the Centers for Disease Control. At this time,
that is unconscionable.
We also know that once a flu strain has been identified, we will need
to develop an effective vaccine, as I have talked about, and produce
enough to eventually inoculate the entire 300 million people in
America. Yet our existing stockpile of vaccines, assuming they are
effective against the yet unidentified strain, may protect less than 1
percent of all Americans, and we have only one domestic flu vaccine
manufacturer located in the United States. It is estimated if our
capacity to produce vaccines is not improved, it could take 15 months
to vaccinate first responders, medical personnel, and other high-risk
groups.
Given it will take months to develop, produce, and distribute a
vaccine once we have one that is effective, we know that antiviral
medication will be a crucial stopgap defense against a pandemic. The
World Health Organization recommended that countries stockpile enough
antiviral medication to cover 25 percent of their populations. Other
nations, including Great Britain, France, Norway, Portugal,
Switzerland, Finland, and New Zealand, have ordered enough Tamiflu, an
antiviral pill to cover between 20 and 40 percent of their populations.
We should have learned. It was only last year that we did not have
enough vaccine to take care of the people in America. We did not have
enough vaccine to take care of the flu strain last time, and everyone
knew what that was.
As important as this Tamiflu is, we now have only 2.3 million courses
of this pill. Given country, national, and international production
capacity, even if we were to increase our order of Tamiflu today, we
have been told the United States would have to wait until the end of
2007 before we could secure enough Tamiflu to cover 25 percent of our
population. The consequences of pandemic could be far reaching,
impacting virtually every sector of our society and our economy.
We also know our medical community needs to be trained to distinguish
between the annual flu and avian flu so that an outbreak could be
recorded immediately. Doctors, hospitals, and other medical providers
must develop surge capacity plans so they can respond to a pandemic.
Businesses, also, need to be prepared. They should be encouraged to
develop their own plans, establish or expand telecommunicating and
network access plans, update medical needs policies, and provide
suggestions on how to promote employee health to lessen the likelihood
of exposure. The American public also needs to be educated about the
importance of annual flu vaccines and steps they can take to prepare
for and respond to an avian flu outbreak.
Yet this administration has failed to take appropriate action to
prepare the medical community, business community, and the American
public. We can do better. We need to do better. Most importantly, we
cannot afford to wait to do better. America can do better.
The Federal Government's poor response to Katrina has only served to
exacerbate concerns about the toll such an outbreak would have on our
Nation and the world. Given the very real possibility of an outbreak,
its potentially severe consequences, and our relative lack of
preparedness, we need to take action on several fronts to prepare our
Nation and the American people for a potential outbreak and reduce its
impact, should it occur.
What are some of the steps necessary? We need to improve surveillance
and international partnerships so we may detect new flu strains and do
it early. We need to prepare for a pandemic by finalizing,
implementing, and funding pandemic preparedness response plans.
Remember, the director of the Centers for Disease Control has told us
this is going to happen. It is inevitable. We need to protect Americans
with the development, production, and distribution of an effective
vaccine. We need to plan ahead for pandemic by stockpiling antiviral
medications, medical, and other supplies. We need to strengthen our
public health infrastructure. We need to educate Americans by
increasing awareness of and education about this flu. Finally, we need
to commit to protecting Americans by devoting adequate resources to
pandemic preparedness.
Experts have warned that an avian flu pandemic is inevitable. But the
devastating consequences that can ensue from an outbreak are not--
provided this Nation and the world heed the science community warnings
and take action immediately.
I propose to start by committing the resources necessary to protect
Americans. We need to start today. We know today that funding certain
programs can make dramatic reductions for the consequences of a future
avian flu outbreak. We also know many of these programs are either
unfunded or massively underfunded.
Tomorrow, when we take up the Defense appropriations bill after we
finish the Roberts vote, Senators Harkin, Kennedy, Obama, and many
others, including myself and Senator Durbin, the two Democrat leaders
here who have been elected by our colleagues, will join in this.
This is important. We are going to offer an amendment that will
ensure that we begin making the investments necessary to make sure this
Nation and the world do everything possible to ensure that history does
not repeat itself and we do not have to relive the terror of 1918.
The PRESIDING OFFICER. Under the previous order, the Senate is
scheduled to adjourn at this time.
Mr. REID. I ask unanimous consent that the Senator from Illinois have
an opportunity to speak. I am happy to relieve the Chair if that is
necessary. We have two Senators on the floor to finish their
statements. I ask consent that the two Senators from Illinois be
recognized to speak.
The PRESIDING OFFICER. Could I ask if there is a time limit?
Mr. REID. How long does the senior Senator from Illinois wish to
speak?
Mr. DURBIN. No more than 10 minutes.
Mr. REID. The junior Senator from Illinois?
Mr. OBAMA. I was not aware my senior colleague from Illinois was
going to speak so I don't want to unnecessarily hold up the entire
Chamber.
Mr. REID. The Senator should know I did use your name.
Mr. OBAMA. I am aware of that.
Mr. REID. You have the only comprehensive bill filed regarding the
avian flu and I commend you in that regard.
[[Page S10628]]
Mr. DURBIN. I will be glad to take 5 minutes and yield to my
colleague 5 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. I appreciate that. I know I have presided over a few of the
late nights.
Mr. DURBIN. Mr. President, I preface my remarks by saying that the
first person who brought the avian flu epidemic to my attention was my
colleague Senator Obama, who identified this issue before most other
Senators. I commend the Senator for his leadership on this issue. I am
glad he is here this evening to speak to it.
I have had two public health briefings in my time as a Congressman
and Senator which stopped me cold. The first one was about 20 years
ago. It was on the global AIDS epidemic. I knew it was a problem, but I
didn't know what kind of a problem. I left that briefing in the House
Committee on the Budget and went home to speak in very sincere terms to
my family about what I considered to be a real threat to all of us. It
was in the earliest stages.
Today, I had the second public health briefing which stopped me cold
again. We were briefed by Secretary Leavitt from the Department of
Health and Human Services, Dr. Gerberding from the Centers for Disease
Control, and Dr. Fauci, well-known doctor at the National Institutes Of
Health. They talked about the possibility of this avian flu epidemic.
Senator Reid has gone into detail.
Mr. President, the images from Katrina are still with us--children,
senior citizens, people with disabilities and chronic medical problems,
waiting for days for care and medicine. These are not images we hope to
see again anytime soon, and yet, we are told that these scenes will be
repeated, in larger numbers, in more cities, and for far longer when
the avian flu breaks out in this country.
Scientists and government officials alike, worldwide, agree that the
outbreak of avian flu is virtually inevitable and that, like we were
for Katrina, this country is woefully underprepared.
A few weeks ago at the U.N., the World Health Organization warned the
Assembly of a pending global pandemic. President Bush acknowledged,
``If left unchallenged, this virus could become the first pandemic of
the 21st century.'' Department of Health and Human Services Secretary
Leavitt and Senator Frist are as worried as I am. There is a general
sense that we are not prepared.
The only antiviral drug that appears to be effective in minimizing
the flu's effect is in short supply. The U.S. has enough doses in its
stockpile to treat just 2.3 million people. The only vaccine we have in
the pipeline is experimental. It may or may not be effective against
the mutation that breaks out in humans in this country. And supplies of
that vaccine are limited.
Right now, the avian flu primarily infects birds, but we are aware of
115 cases in which people have been infected by the flu. Fifty-nine of
them have died. If that pattern were to hold, 55 percent of the people
infected with this flu could die.
In many ways, we are better off than we were in 1918 when a flu
pandemic struck this country and took 675,000 lives. We know how germs
are spread and how to minimize that spread. In other ways we are far
more susceptible to this threat. The Wilderness Society believes the
avian flu could spread from China to Japan to New York to San Francisco
within the first week.
The Council on Foreign Relations dedicated its last volume of Foreign
Affairs to the impact of a global pandemic--the prospect of battling an
epidemic of flu in several countries at the same time. ABC News reports
that officials in London are quietly looking for additional morgue
space.
The Bush administration is preparing a plan for responding to an
outbreak of avian flu. I think there is more that we can do and that we
must do--now. If you listen to the leaders in infectious disease and
public health around the world, we may not have the luxury of time on
this one.
We need to step up surveillance of infectious disease here in the
U.S. and internationally, so that we can track this thing and begin to
contain it immediately. We need to invest in research and development
to pursue all possibilities for effective vaccines and antiviral drugs.
If the avian flu hits with a 55 percent mortality rate within days of
infection, as it appears to be doing, we could lose hundreds of
thousands of Americans in the first few months. We need to aggressively
pursue vaccines now--not after the outbreak has begun.
We need to help states develop their own preparedness plans so that
our response is coordinated and organized and will save lives. Where is
the medicine stored? How do we make decisions about who gets treatment
when there is too little to go around? How will the distribution
systems work? This is work we must help states and localities complete
now--not during a time of crisis.
Last flu season, we lost about half of our expected supply of flu
vaccine at the same time the Centers for Disease Control and Prevention
began encouraging everyone to go and get one. It was a mess. We had
senior citizens waiting for hours for a vaccine, often to learn that
they were too late. We saw people waiting for a flu vaccine standing in
lines that snaked through K-Mart parking lots.
I hope we don't have to learn these lessons again the hard way. It is
our responsibility to ensure that states and localities are prepared.
We need to aggressively pursue effective treatments now--not when flu
victims are overwhelming our hospitals before our eyes. And we have to
invest now--not later--in the capability to track this flu so we can
stop its spread as quickly and effectively as possible.
If we don't--if we simply wring our hands and hope for the best--when
the avian flu hits this country, it will make the scenes of Katrina
pale in comparison
Before I turn it over to my colleague, I will not repeat the remarks
of Senator Reid, but I will say if you believe you can survive this flu
epidemic because you are not an infant or sickly or elderly, that is
not the situation. It turns out we have no resistance to this flu
strain, and as a consequence we are all in the same situation in terms
of vulnerability. That is why this is so serious.
We had a briefing today, and I am sure Senator Obama will go into
detail on it, but it raises questions as Senator Reid raised.
I will yield the rest of my time to my colleague and thank him for
his leadership.
I close by saying, we left the Defense appropriations bill, brought
it out of committee today. It contains $50 billion for our continuing
efforts in Iraq. I will provide and vote for every penny our service
men and women need, but I also believe we have an obligation to
Americans here. A stronger America starts at home. That means being
prepared for the next challenge we face, and this avian flu pandemic
could easily be that challenge.
The PRESIDING OFFICER (Mr. DeMint). The Senator from Illinois.
Mr. OBAMA. Thank you very much, Mr. President. I will be brief. I
know we have gone way over the time here today.
Mr. President, in the midst of so much difficulty that our Nation is
facing--Katrina and Rita, the ongoing challenges in Iraq and
Afghanistan--I recognize it is hard to get the public, the leadership
in Congress, and senior administration officials to focus on yet one
more challenge.
But as has already been stated by the Democratic leader, Harry Reid,
and my senior colleague, the minority whip, Senator Dick Durbin, this
is a crisis to which the entire country simply must awaken itself.
When I started talking about this 7 months ago, not too many folks
paid attention. Perhaps because the shorthand for this looming crisis
is the ``bird flu,'' people assume it is just going to get birds and
animals sick.
In reality, however, what is at stake here is the potential of a
pandemic that we have not seen in the United States since 1918, 1919.
As has already been stated here tonight, our top scientists and medical
personnel, including the heads of the NIH, CDC, and the Department of
Health and Human Services, all agree that it is almost inevitable that
an avian flu pandemic will strike.
The key question is the extent of the damage, especially in terms of
lives lost. The answer to this question will,
[[Page S10629]]
in large measure, depend on our level of preparedness and the amount of
resources we are willing to immediately commit to deal with this
looming crisis.
Over the last few months, we have seen alarming reports from
countries all over Asia--Indonesia, China, Vietnam, Thailand, and
Russia, just to name a few--about deaths that have resulted from the
avian flu.
The situation has turned so ominous that Dr. Julie Gerberding, the
Director of the CDC, said that an avian flu outbreak is ``the most
important threat that we are facing [today].''
International health experts say that two of the three conditions for
an avian flu pandemic in Southeast Asia already exist.
First, a new strain of the virus, called H5N1, has emerged, and
humans have little or no immunity to it. Second, this strain has
demonstrated the ability to jump between species.
The only thing preventing a full blown pandemic is a lack of
efficient transmission of this strain from human to human. Once that
happens, as a consequence of international travel and commerce, there
is not going to be any way to effectively contain this pandemic.
Moreover, the news on this last point is not good. In recent months,
the virus has been detected in mammals that have never previously been
infected, including tigers, leopards and domestic cats. This suggests
that the virus is mutating and could eventually emerge in a form that
is readily transmittable among humans.
Mr. President, Senator Reid and Senator Durbin both outlined some of
the measures that have to be put in place here domestically to protect
our population. We have to drastically ramp up our stockpiles of
Tamiflu, which, if taken properly, could act as a treatment from the
avian flu once a person is infected. Right now, we only have a couple
of million doses. We need 80 million to 100 million doses in order to
be adequately prepared. That is going to cost us significant amounts of
money, as the cost of Tamiflu is approximately $20 per dose.
In addition, we are going to have to develop flu vaccines of a sort
we have not seen in the past. In order to create sufficient quantities,
we are going to have to go push the boundaries of existing technologies
and science--going beyond the agricultural mechanisms of developing
vaccines that we have used in the past.
Third, we are going to make sure that local and State governments
understand how urgent this is. We have to ensure there are clear plans,
coordination mechanisms, and lines of authority--that will stand up in
a time of crisis. Right now, we do not have sufficient plans in place
to make sure local and State agencies are able to generate the kinds of
rapid responses that are going to be necessary in the case of a flu
outbreak.
After Katrina, I hope that local and State governments understand
they have to work with the Federal agencies more effectively to deal
with these kinds of emergencies.
Another issue I would mention is that we are going to have to
establish international protocols to ensure we can alert ourselves
rapidly if we have confirmed cases of human-to-human transmission of
the avian flu anywhere in the world. Why do I mention this? If we
detect efficient human-to-human transmission, it is likely that we are
going to have only weeks before we are going to see those first cases
in the United States.
This means placing effective trigger mechanisms in all these
countries to make sure everyone is cooperating and providing rapid
information, which could mean the difference in terms of tens or
hundreds of thousands of lives.
Now I don't want to suggest that nothing is being done. For example,
months ago, Congress, on a bipartisan basis including myself, Senator
Lugar, Senator McConnell, and Senator Leahy--included $25 million as
part of the Iraq supplemental to make contribute to an urgent WHO
appeal on this issue. Today, this money is making a difference in the
field trying to set up some of the international measures I just
described.
I, along with Senators Lugar, Durbin and others, introduced
legislation, S. 969, to enhance our ability to deal with this potential
crisis. But that was months ago, and we need to broaden the number of
people involved in this effort.
Moreover, these is are modest first steps. Going forward, we are
going to need significantly more resources. I am eager to work with
leaders on health issues, including Senator Harkin and Senator Reid, as
well as others across the aisle.
I hope we can work not only to make sure we have an effective
international regime to deal with this problem overseas but that we
also invest the time, the energy, and the resources needed to put in
place effective measures well before we have a full blown crisis on our
hands.
An outbreak of the avian flu could occur in a year, 5 years, 10
years, or if we were incredibly lucky not happen at all. But the one
good thing about investing in measures to deal with this looming crisis
is--and I will end on this point--if we spend the money now, it will
pay dividends, even if this particular strain of the avian flu outbreak
does not occur.
Why is this the case? The risk of some sort of pandemic, and the
mutations of flus for which we have no immunity, is almost inevitable.
The H5N1 strain may not be the strain that leads to a full blown
pandemic. But, another strain could easily come along a cause serious
damage in the future.
Presently, we simply do not have the public health infrastructure to
deal adequately with this contingency.
My point is this: undertaking these measures is going to be a wise
investment that will help protect the lives of millions of people here
in the United States and across the globe.
Mr. President, I appreciate your patience very much and look forward
to working with you on this issue.
The PRESIDING OFFICER. I thank the Senator.
____________________