[Congressional Record Volume 151, Number 124 (Thursday, September 29, 2005)]
[Senate]
[Pages S10652-S10656]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
AVIAN FLU PANDEMIC
Mr. HARKIN. I thank the Presiding Officer.
Mr. President, I come to the floor at this time to discuss a matter
of grave national security. If recent Hurricane Katrina and Hurricane
Rita have taught us anything, it is that we have to do a dramatically
better job of preparing for diseases before they strike so we are not
left picking up the pieces afterward.
I am very gravely concerned that the United States is totally
unprepared for an outbreak--and a subsequent international pandemic--of
avian flu. We have had two disasters in the last 4 years--9/11 and
Katrina followed by Rita. And the Federal Government was totally
unprepared for both, despite clear warnings. Similarly, we have been
warned in no uncertain terms about avian flu, but our preparations so
far have been grossly inadequate.
I think I got my first briefing on this about a year ago from CDC in
Atlanta. I have been following it closely in our Labor, Health and
Human Services, Education and Related Agencies Appropriations
Subcommittee.
As it has unfolded over the last several months, it is clear that it
is not a question of if avian flu is going to reach us, it is a
question of when--not if, just when.
As many of my colleagues know, avian flu--or as it is called in the
technical jargon, H5N1--has been known to pass first in bird species.
It was passed from bird to bird, chicken to chicken, and that type of
thing. It has then gotten into migratory waterfowl, which has spread
from countries such as Thailand, Cambodia, Vietnam, and Hong Kong. And
they have now found it as far away as Kazakhstan and as far north as
the northern regions of Russia. It is just a matter of time before it
gets here.
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We have known this passed from bird to bird. We now know it has
passed from birds to mammals, certain types of cats, particular tigers.
We also know now it has passed from birds to humans. We have some
cases. Now we have a few cases that have been reported of passing from
human to human.
So the virus is mutating. It is getting smarter. It knows that it has
now gone from bird to bird, bird to mammal, and bird to human, and now
from human to human.
Experts in virology at the Department of Health and Human Services
and others tell us that it is only a matter of time until the virus
mutates from human to human to human, and then it becomes widespread.
When that happens, we are in deep trouble.
An outbreak in China, Vietnam or Cambodia could trigger, within a
couple of weeks' time, a worldwide outbreak, facilitated by air traffic
and the mass movement of people across borders. And the data so far
shows that of the 150 cases of the human avian flu--H5N1--that we know
of, 54 have died. Almost 50 percent of the people infected have died.
This is a virulent form of the flu virus. It is a nightmare
scenario--a kind of 21st century Black Death.
It is not hard to picture that could happen within a few months'
period of time.
Again, as I say, many experts say it is not a matter of if, it is
when. We have to ask tough questions.
Where do our preparedness efforts stand? What could we be doing
better?
At some future time--I have it on charts, but I didn't have time to
put it together--I will have charts to show what happened with the last
great flu pandemic that hit the world in 1918 and 1919. Understand
this: 500 million people were infected worldwide. This was almost 100
years ago--20 million to 40 million deaths worldwide. There were over
500 deaths in the United States.
In one month alone, October 1918, 196 people died in the United
States from this influenza.
I have been told by experts that this H5N1 and how it manifests
itself mirrors the influenza of 1918 and 1919.
Where do our efforts stand, and what can we be doing better?
First, where do we stand?
The Centers for Disease Control, under the great leadership of Dr.
Gerberding, is doing a fine job working in cooperation with the World
Health Organization and governments in affected regions to detect the
disease and to help to stop its spread. Surveillance can alert us to an
outbreak and governments can then take measures to isolate the disease
so that widespread infection does not occur.
Again, we know how to do this. The CDC knows how to do this. They had
great success with surveillance, isolation, and quarantine during the
SARS outbreak, and they managed to control its spread. We never got
SARS in the United States because we were able to isolate it and
quarantine it in other countries.
We also learned valuable lessons from this SARS episode. We need to
be doing a better job of surveillance. We have had some problems with
some countries which do not have a very good public health
infrastructure. They may not report illnesses and deaths as do we or
some other places.
But we have CDC personnel on the ground in these countries. They know
what to do. But they are woefully inadequate in funds. They don't have
the funds needed to conduct adequate surveillance in these countries
such as Cambodia, Thailand, Vietnam, Russia, and places such as that.
They need some more support for surveillance. I will get into that in a
little bit.
In order for us to get the necessary vaccines for this drug, it is
going to take a few months.
The best thing we can be about in the initial stages is surveillance,
finding out where it is outbreaking, control it, isolate it, and
quarantine it.
As I said, the Centers for Disease Control and Prevention know how do
that. There are other things we can be doing better. The World Health
Organization is encouraging the purchase of antiviruses, medicines that
help mitigate the infectious disease once you have already gotten it.
Unfortunately, the United States only has enough antiviral medication
for 1 percent of our population. That is not enough. We need to invest
approximately $3 billion to build an adequate stockpile of antiviral
medications. That would get us enough for about 50 percent of the
population.
The experts tell us that we ought to be prepared for that kind of an
infectious rate in the United States; that it could be up to 50 percent
or more of our people in the United States affected by this--140
million people.
If we stay where we are, and we only have 1 percent or 10 percent,
then you raise the question: Who gets it? How is it distributed?
We need to reassure our people that we have enough of these
antivirals. These antivirals have a long shelf life--7 to 10 years, and
maybe even more.
It is not as if we are buying something that is going to disintegrate
right away. These antivirals have a long shelf life.
In addition, the President's budget cut $120 million from State and
public health agencies. These are the agencies that will be on the
front lines of both surveillance and disease prevention should an
outbreak occur. We have to restore this funding. But that is not
adequate.
In the future, our public health infrastructure would be stretched to
the limits by an outbreak of avian influenza.
We need to invest in more public health professionals,
epidemiologists, physicians, laboratory technicians, and others.
As I said, if we have an outbreak and it gets to the United States,
the first thing we want to do is have good surveillance, isolation, and
quarantine. That costs money.
Lastly, we also must take measures to increase our Nation's vaccine
capacity. Currently, there is only one flu vaccine manufacturing
facility in the United States.
I have wondered about that. Why is that so?
In meetings with the drug industry and others, I have learned that
vaccine production is not very profitable compared to other types of
drug development and manufacturing. Plus, they do not know if there is
going to be a market for it.
This is a classic point of market failure--where the market really
can't respond to a future need.
This is where the Government must step in to provide incentives for
more manufacturers to build facilities in the United States.
Many will remember what happened during the last flu season, when
overseas manufacturing facilities were shut down for safety reasons.
Because we had no manufacturing capacity domestically, we were stuck.
We should learn from this lesson. We cannot afford this problem when
faced with the threat of avian influenza. So the Federal Government can
and must do more to improve domestic vaccine capacity.
What does that mean? That means we are going to have to have some
kind of guarantee that if you make this vaccine, we guarantee we will
buy so many millions of doses of this vaccine.
Why is that important?
For this strain of the avian flu--in technological terms, H5N1--the
virus that we have isolated in people who have contracted it in
Thailand, Cambodia, Vietnam, and Hong Kong, the National Institutes of
Health and Infectious Disease, under Dr. Fauci, has been developing a
vaccine. The initial reports that came out in July were that this
vaccine has great promise. However, what we don't know is will the
virus that mutates and comes to this country be H5N1 or will it be H5N3
or H5N5? We don't know. Therefore, if a manufacturer were to
manufacture all these doses of vaccine for H5N1, that may not work for
the kind of viruses we might get later on. I am told it might work for
some; it might slow it down a little bit.
That is why we need to have incentives for vaccine manufacturers in
this country so they know if they manufacture the vaccine, it will be
purchased. We may not use it all. We may have to develop new vaccines
later on down the road. But at least we will have these vaccines in
case H5N1 is the virus that gets here because we know that virus. That
is why we have to move and we have to move right now. We do not have
much time to invest in preparation for avian flu.
Some may ask, Why wasn't this done before? Perhaps we should have
done
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something better before. But after Katrina, maybe a lot of our eyes
were opened that we were not prepared and that we have to do something
different from what we are doing. Also, the virulence and the spread of
avian flu has taken new leaps in the last several months that we had
hoped might not happen. So we are faced right now with an urgent
situation. We need to start right now.
Later on, I will be offering an amendment to this bill that will
basically do the following things: One, double our global surveillance
of the avian flu through the Centers for Disease Control to identify
and contain as soon as possible. In my conversation with CDC and
others, this figure is about $33 million to adequately do the
surveillance.
Second, to restore the budget cuts to local and State public health
departments and emergency preparedness activities to help communities
prepare to recognize, treat, and quarantine the avian flu virus if it
reaches our country. The President's budget cut $122 million from
grants to State and local public health departments for emergency
preparedness activities. These were grants that were first funded under
our Subcommittee on Labor, Health, and Human Services in 2001 in
response to the September 11 attacks.
Again, as best as we could determine in talking to those who
administer programs, in order to get it up to the point where they
would be prepared for an avian flu outbreak, it is about $600 million
nationally.
Next, we need to increase the stockpile of antivirals. I mentioned
earlier the World Health Organization recommended that each company
stockpile enough Tamiflu--that is a brand name made by Roche
Pharmaceuticals in Switzerland. They have the patent which has been
very effective. The World Health Organization recommended each country
stockpile enough for 40 percent of their population.
As I mentioned, right now we have enough for about 1 percent. Other
countries have heeded this warning and have gotten in line to purchase
this. The United States, as I said, has 2 million doses on hand, enough
for 1 percent of the population.
We need additional resources. We need to build this up to serve at
least 50 percent of our population. This comes at about $20 per dose as
it is a multidose vaccine. It is not just one vaccine, you have to take
a couple, three doses but only if you get infected. The tab for this is
about $3 billion.
Why, again, do we need to do that? Because we do not have any company
making it in this country. Roche has the patent. I want to be
respectful of patent rights, but other companies in America could,
under patent law, make an agreement with Roche, for example, to
manufacture it under their patent. Again, they are not going to do it
if there is no buyer out there. Who is buying it? If we are to have
enough of a stockpile to protect 50 percent of our population, we are
going to need to come up with the money right now to guarantee a buyer
out there to get more antivirals manufactured in a hurry.
Consider the nightmare scenario if next year, God forbid, avian flu
does mutate, it does reach the United States, and we only have enough
doses for a million or 2 million people? Who will get it? How will it
be distributed?
The next part of the amendment builds up and strengthens our vaccine
infrastructure. We only have one manufacturer of flu vaccine in the
United States, and they do not have the capacity to rapidly ramp up and
make enough vaccine for what we need. In the event of a pandemic, the
United States would have to rely on imported vaccines which countries
may be unwilling to export to us; They will want it for their own
people.
Again, the estimate to get a guaranteed order out for the vaccines
would be about $125 million. To provide new resources for outreach
educational efforts to health providers in the public, the estimate is
$75 million.
What this all adds up to, to be prepared for an outbreak of avian
flu, is going to require somewhere around $4 billion, a little bit less
than $4 billion. That is a big chunk of change. I remind my colleagues
that is less than what we spend in Iraq in 1 month in order to start
reassuring the people of this country that we are going to do whatever
is necessary to respond to this threat that is looming on the horizon.
I don't have my charts. I will have some later that will demonstrate
the kinds of deaths we can expect in this country. When we looked at
the flu epidemic of 1918 and 1919, there were about 500,000 deaths in
the United States, 20 to 40 million deaths worldwide. We are looking at
the possibility in the United States of deaths that can range anywhere
from 100,000 up to 2 million, anywhere in that range. Hospitalizations
could go anywhere from 300,000 to 10 million. Illnesses--we do not
really know, but it could go from 20 to 30 to 40 million up to 100
million or more. That is the kind of pandemic we are looking at.
When I first had my briefing on this at CDC last year, it was perhaps
hoped that this avian flu would not mutate as rapidly as it has. But it
has. So now we are in a situation of waiting until that next shoe drops
when we find it has gone from a human to a human to a human. When that
happens, we have to be able to react immediately. It is almost the
midnight hour right now.
I hope it never hits, obviously; but since the experts say it is not
a matter of if but is only a matter of when because this is a virulent
virus, I hope it is put off long enough so we can get the vaccines
made, buy the antiviral, and put in place the surveillance and
quarantine that we need so that when it does happen--because we are
assured by the experts that it will--we can respond, we can quarantine,
we can isolate, and if it starts to spread we can give the people who
are infected the antivirus they need and we can vaccinate other people
so they do not get it.
I am hopeful we can reach some agreement on an amendment to do that.
I hope to be offering that sometime later. It is being worked on right
now. I hope we can find the money to do this. This is an emergency
basis because I think this is an emergency basis. We passed an
emergency to respond to Katrina; no one objected to that. We passed
emergencies to respond to September 11; no one objected to that. I am
tired of looking in the rearview mirror. I don't want to have us
looking in the rearview mirror a couple of years from now when the
avian flu has struck. It is time to look ahead. That is what this is
geared to do, start putting these things in place.
Keep in mind, it is less than 1 month's expenditure of money in Iraq.
I yield the floor.
The PRESIDING OFFICER. The Senator from Illinois.
Mr. OBAMA. I am happy to defer to Senator Stevens if he has something
he would like to say.
Mr. STEVENS. We are still in morning business, are we?
The PRESIDING OFFICER. We are.
Mr. STEVENS. I will wait for the Senator's statement.
The PRESIDING OFFICER. The Senator from Illinois is recognized.
Mr. OBAMA. Mr. President, I thank the distinguished Senator from
Alaska. I will try to be brief.
I just want to offer my strong support for the amendment Senator
Harkin is going to propose and state why I think this is such an
important issue.
Let me first say, that I am generally of the view that we should not
be tacking on unrelated amendments to the defense bills.
The money in this legislation is badly needed by our men and women in
uniform and I do not want to slow this bill down.
But, this amendment dealing with the avian flu pandemic is so
important to our public health security--and our national security--so
important to the lives of millions of people around the world, that it
simply cannot wait. In fact, the situation is 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].''
In light of these developments, I believe it is worth the U.S. Senate
spending just a few hours on this critical issue, even if it is not
directly related to the underlying legislation.
Over the last few months, we have heard alarming reports from
countries all over Asia--Indonesia, China, Vietnam, Thailand--about
deaths from the avian flu.
International health experts say that two of the three conditions for
an
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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. Second, this strain has shown that it can jump between
species.
The last condition--the ability for the virus to travel efficiently
from human to human--has not been met, and it is the only thing
preventing a full blown pandemic. Once this virus mutates and can be
transmitted from human to human, because of global trade and travel, we
will not be able to contain this disease. We learned this lesson from
SARS, which took less than 4 months to get from Asia to Canada, where
it caused human and economic devastation.
When I started talking about this issue 7 months ago, many people
thought that the avian flu was a mild concern, an Asian problem, an
unlikely threat to Americans here in the U.S.
As time has progressed, the Nation's top scientists and experts have
focused greater attention on the possibilities of an avian flu
pandemic, and they have rapidly come to consensus that it is not a
matter of if the pandemic will hit but when? It is not a question of
whether will people die but how many? And the main question, the
question that keeps me awake at night, is whether the United States
will be able to deal with this calamity?
From what we have seen with the lack of readiness and dismal response
to Hurricane Katrina, I think that all of us would have to conclude
that the answer, at this point in time, is no.
Whether we are talking about having adequate surveillance capacities
in our State and local health departments, having enough doctors and
hospital beds and medical equipment for infected individuals, or having
a vaccine or treatment that is guaranteed to work, I don't want to be
an alarmist, but here in the U.S., we are in serious trouble.
Several of us here in the Congress--on a bipartisan basis--have taken
the first steps needed to address this looming crisis. In April of this
year, I introduced the AVIAN Act, S. 969 that would increase our
preparedness for avian flu pandemic. Senators Lugar and Durbin and
several others have cosponsored this act and I thank them for that. We
need to move this bill as quickly as possible.
In May, I and Senators Lugar, McConnell, and Leahy included $25
million for avian flu activities as part of the Iraq supplemental.
Today, this money is helping the World Health Organization to step up
its international surveillance and response efforts.
In July, I included an additional $10 million to combat avian flu in
the Foreign Operations assistance bill. That bill is currently in
conference, and I hope this funding will be retained.
I am also working with Senate Defense authorizers on an amendment to
require the DOD report to Congress on its efforts to prepare for
pandemic influenza.
This report must address the procurement of vaccines, antivirals and
other medicine; the protocols for distributing such vaccines or
medicine to high priority populations; and how the DOD intends to work
with other agencies, such as HHS and State, to respond to pandemic flu.
Today, with leadership by Senator Harkin, we are introducing an
amendment to the DOD appropriations bill to provide $3.9 billion in
emergency funds for avian flu activities. Senator Harkin has already
outlined what this amendment does, so I will not rehash what he has
already said.
The bottom line is that this amendment needs to be passed and passed
as quickly as possible.
I know that $3.9 billion is a lot of money--especially given our
fiscal situation today. But this is one issue on which we cannot be
penny-wise and pound-foolish. If we don't invest the money now, this
pandemic will hit America harder, more lives will be lost, and we will
have to spend significantly more in resources to respond after the
fact.
As we learned the hard way after Hurricane Katrina, the failure to
prepare for emergencies can have devastating consequences. This nation
must not be caught off guard when faced with the prospect of the avian
flu. This amendment will help the Federal agencies to prepare the
Nation to prevent and respond to avian flu.
America is already behind in recognizing and preparing for a
potentially deadly and economically devastating avian flu pandemic that
public health experts say is not a matter of if but when. We must face
the reality that in this age when you can get on a plane in Bangkok and
arrive in Chicago in hours, this is not a problem isolated half a world
away but one that could impact us right here at home.
The need is great, and the time to act is way overdue. I urge my
colleagues to vote ``yes'' and support this amendment.
To reiterate, Senators Lugar, McConnell, and Leahy already worked
with me to include $25 million for avian flu activities as part of the
Iraq supplemental. I included an additional $10 million to combat avian
flu in the foreign operations assistance bill. But as Senator Harkin
noted, we need much more based on the briefing we received from the
administration yesterday. We have to move now on this issue. It has to
be moved rapidly. We have to build an infrastructure to create vaccines
and to purchase enough antiviral drugs. I strongly urge that on a
bipartisan basis we make this one of our top priorities. This is a
crisis waiting to happen. If we are not prepared for it now, we will
all be extraordinarily sorry.
The only other comment I will make is, I know times are tough with
respect to our budget. I am working with my colleagues across the aisle
to figure out ways we can come up with the money for Katrina and Iraq.
This is a sound investment. If we don't make this investment now, we
will pay much more later.
So I hope the amendment Senator Harkin is going to offer will get
bipartisan support and receive the utmost consideration from this
Chamber.
Thank you very much, Mr. President.
The PRESIDING OFFICER. The Senator from Alaska.
Mr. STEVENS. Mr. President, I want the Senate to know I welcome the
attention of Senators to the problem of the avian virus. In 1997,
because of information I discovered concerning what Senator Obama just
mentioned--the intersection where wild birds come to Alaska from the
Chinese mainland and other places in the world, including Russia--we
began a series of funds in the Agriculture bill to study the process of
this virus being transmitted. As Senator Obama has mentioned, so far it
has always been bird to bird or animal to animal. There has been no
transmutation to take it from human to human or bird to human. It is
one of the dangerous problems of the world, no question about it.
When I first heard of Senator Harkin's amendment, I said I might--I
said I would cosponsor it. As I read it, it is not just about the
virus. It is reversing the President's decision with regard to State
and local public health agencies. It is starting an addition to the
domestic vaccine infrastructure. All of that, I understand, was part of
the briefing some Senators had yesterday and I am informed others will
soon get.
There is a BioShield group working in the administration,
particularly in the agencies that are dealing with disease control and
various other subjects. There will undoubtedly be a presentation by
them to the Congress. There has not been such a presentation yet. The
briefing the Senators got was for the information concerning what those
people are doing who are working on that plan.
This is an amendment that sort of short circuits the concept of
dealing with it and asks for some of the money they ask for, but I am
told the amendment will not distribute the money the way the BioShield
proposal will distribute it. It is brought to us as an emergency
measure. It may well be that the BioShield people bring us a bill that
is partially emergency and partially funded. We do not know yet.
But very clearly we do know there is no current human-to-human
transmission that has been known of in the world. For us to say this is
the greatest problem we have and is superior to some of the things we
are doing, particularly in Iraq or in the war on terror, I think is a
totally misplaced comparison, as far as I am concerned. I am just back
from Iraq. I have seen some of the dangers over there and have talked
to some of the people who have been injured over there. To compare the
money we have in this bill to fund them with funding a proposal to deal
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with a virus, for something that has not yet become a threat to human
beings, I believe is wrong.
The BioShield proposal will be before the Congress, I am told, in
this Congress. I want to announce now that I will ask the chairman of
the Budget Committee to raise a point of order to this amendment. It is
an emergency declaration. It is not the recommendations of the
BioShield group who briefed the Senator last night. It is a premature
attempt to bring it to the floor on the Defense bill where it does not
belong. So I hope the Senate will agree with us and not make this an
emergency appropriations at this time.
Now, there is no question in my mind this could well develop into a
political argument. I have been on this floor now since 1981 as one of
the managers of this bill. I cannot remember a time when we had a
political argument on a nongermane amendment to this bill. This is a
bill to fund the people in uniform overseas. It is not the
authorization bill where there are amendments from time to time offered
which are nongermane. We have had a policy of no nongermane amendments
on this bill. I intend to pursue that policy.
This is not a germane amendment. This is an amendment that is
premature in terms of avian flu. Again, I say no one has a greater
interest in this avian flu than I do. When I go home on weekends and I
go to a restaurant I love, I know I am sitting next to people who have
just come back from Russia. We go to Russia daily from my State. We go
to China daily from my State. We have pilots who fly planes throughout
China, throughout Russia, living right there in the community in which
I live. We know there is an avian flu potential over there. The birds
that come from over there intersect with our birds. We know that. We
have been studying that since 1997. Just yesterday, I talked to a
doctor about avian flu vaccine and when we would be able to get it for
Alaska. I was told we will get it in time.
But now I come out here and I have an amendment to be offered when we
take up the bill that makes it an emergency to appropriate almost $4
billion, and not on the basis of recommendations of the experts but on
the basis of some Senators who were briefed yesterday, prematurely, at
their request, of studies that are going on at the administration.
Now, I am not one who takes lightly bringing subjects to this bill
that do not pertain to protecting people in uniform. We had a similar
situation once with regard to anthrax and other studies, and we acted
very promptly because that did apply to people in uniform. But this is
not something that pertains to the defense of the United States. It
could very well be in the future a very vital issue to our Nation and
to the world, but right now we ought to wait for the scientists to come
and tell us what needs to be done, how it needs to be done, where it
needs to be done, and who is going to do it. But this is throwing money
at a wall. I will oppose that.
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