[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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