[Congressional Record Volume 155, Number 66 (Friday, May 1, 2009)]
[Senate]
[Pages S5019-S5020]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN:
  S. 953. A bill to provide for the establishment of programs and 
activities to increase influenza vaccination rates through the 
provision of free vaccines; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. HARKIN. Mr. President, I am introducing the Seasonal Influenza 
and Pandemic Preparation Act of 2009. The bill was given the number S. 
953. This bill would establish a nationwide free, voluntary influenza 
vaccination program, under which any individual in this country may 
receive an annual influenza vaccine shot free of charge.
  I offered this bill 3 years ago because at that time we started the 
process of building up our vaccine capacity. I will have more to say 
about that. What is happening currently with H1N1 being almost at a 
pandemic stage now, it brings home again what we need to do in this 
country to be prepared, and that is what this bill is about. Offering 
free flu shots to everyone in the United States is a good idea in and 
of itself.
  The Centers for Disease Control and Prevention says an average of 
more than 40,000 Americans die each year from flu-related diseases and 
causes. Think about that: 40,000 Americans die every year due to flu-
related causes. Seasonal flu is responsible for more than 31 million 
outpatient visits and more than 3 million days annually in the 
hospital. Seasonal flu costs the U.S. economy nearly $90 billion 
annually, including $10 billion in direct medical costs--$10 billion a 
year just in direct medical costs. Think about that: 40,000 people 
dying every year, $10 billion in direct medical costs, $90 billion 
annually in lost productivity to our economy, over 3 million days in 
the hospital every year, and this is seasonal flu.
  We can significantly reduce all those numbers. In addition, there is 
some evidence that people who are vaccinated each year against seasonal 
flu viruses actually build up a limited degree of resistance to 
pandemic viruses. So strictly as a matter of prudent prevention, it is 
desirable to maximize the number of Americans who are vaccinated 
against flu each year. By offering the vaccinations for free and making 
them conveniently available, we would remove major barriers to more 
widespread participation.
  There is precedence for this. Medicare, right now, will pay for one 
seasonal flu shot for everybody on Medicare every year. So we already 
have that out there. We just need to get it to the rest of the 
population.
  There are other compelling reasons for establishing a nationwide 
voluntary free flu vaccination program. Let me explain.
  As chairman of the appropriations subcommittee that funds health 
programs, I have taken the lead in the past in providing funding to 
prepare for a future flu pandemic. Since 2006, my subcommittee has 
provided more than $6 billion to these activities.
  As a consequence, while public health authorities in the United 
States may have been surprised by the H1N1 virus outbreak, they have 
not been caught unprepared. To the contrary, since 2006 we have 
undertaken very robust measures to prepare for exactly this kind of 
outbreak and potential pandemic.
  First, we have made major investments in antivirals that can be given 
to a person once exposed and shows signs of the illness. We have made 
major investments in medical equipment, which are right now, as we 
speak, being distributed nationally to our local public health 
authorities across the country. Many of them are now in place. Many 
started going out earlier this week. I daresay that probably most, if 
not all, of them are probably out there right now--from the stockpiles 
that we built up. There are over 50 million doses of Tamiflu and 
Relenza that we built up in our stockpile. Well, not all of that, but 
most of it, has gone out around the country to be prepared.
  Second, we have stepped up our public health and surveillance 
activities, which helped us to detect the H1N1 virus earlier than we 
otherwise might have.
  Third, we have increased the capacity of the Centers for Disease 
Control and Prevention to identify viruses and respond aggressively and 
very immediately, including producing what is called a ``seed'' virus, 
necessary for the development of a vaccine. That is being done right 
now.
  Fourth, we have also made major investments in building up our 
vaccine production capacity in the United States. Mr. President, when 
we started on this in 2005, there was at that time only one plant in 
the entire United States of America that could produce flu vaccines--
one. I believe it is located in Pennsylvania, and that was making 
vaccines based upon an old methodology of using eggs. We had to use 
millions of eggs every year to produce that vaccine, and that takes a 
long time.
  There have been, in the research and development, processes by which 
we can make cell-based vaccines. We can shorten the timeframe. That is 
nice, but we don't have any cell-based plants in the United States. In 
the fiscal 2006 bill, we put over $3 billion out there to build these 
plants. They are being built now. So we are building up our vaccine 
production capacity and doing it in a way in which we can get the 
vaccines produced more rapidly.
  Fifth, we have funded research into adjuvants. These are agents that 
increase the vaccine's effectiveness. Let me put it this way. If we 
have one dose of a vaccine, we might actually be able to cut that dose 
down and give that one dose to four or five people by adding the 
adjuvant to it.
  Lastly, we have worked with State and local public health agencies to 
boost their capacity to respond to a flu pandemic. We have done that, 
but because of the economic downturn many of our State budgets have 
been slashed. In our States around the country, we were told at our 
hearing the other day, over 60,000 people have been laid off from our 
public health agencies. That makes it more difficult to get the 
antivirals out to people who may come down with H1N1 or any other kind 
of flu virus.
  Because of all these things we did, I think I can safely say there is 
no reason for anyone anywhere in the United States to panic because of 
the H1N1 flu virus. As I said, one of the most important things we have 
done is to build up our vaccine manufacturing capacity.
  Here is the problem. This really is the crux of this bill I have 
introduced today. Say we build up the vaccine manufacturing capacity 
and we build these plants that can respond aggressively and immediately 
to a pandemic outbreak. What happens the rest of the time? What 
happens? Do they sit there idle, not being utilized? We cannot have 
that.
  What we need to do is to use these plants, then, to make more of the 
seasonal flu vaccines every year. Well, if we have the plants out 
there, and they make more of the seasonal flu viruses but not everybody 
is using them, what do we do, just throw it away? We want the plant 
capacity to prepare for any

[[Page S5020]]

pandemic in the future, but they need to be active and they need to 
produce annually. If they are going to produce annually, then we have 
to find something to do with these vaccines.
  By offering annual free vaccines to every single person in America, 
we will keep our vaccine production capacity up and running. It will be 
ready to shift at a moment's notice, when necessary, from producing 
seasonal flu vaccines to a mass production of vaccines to fight any 
future outbreak or pandemic.

  There is another reason for this bill. If we are faced with a flu 
virus pandemic, we are going to have to mobilize people. We are going 
to have to get the vaccines out in a hurry and get the vaccines right 
down to the individual people all over this country--people in small 
towns and communities, in rural areas, and in cities. Well, by having 
an annual free flu vaccination, we will give public health agencies 
across America valuable experience in administering vaccines to masses 
of people, local agencies that will have a reason to develop trained 
cadres of people who are capable of administering vaccines.
  We will also develop an established network of sites that might 
include grocery stores, shopping malls, schools, places of worship, and 
senior centers where people can conveniently go to get vaccinated in 
case of an outbreak. These annual activities will significantly 
increase State and local public health readiness to fight a pandemic. 
Not all these people are going to be employed by the Government. These 
will be volunteers, but they will be trained. They will know where to 
go and how to administer a vaccine because they will be doing it on an 
annual basis, free of charge, to people. We will build up a network of 
sites and a cadre of people who can be relied upon in case we face a 
pandemic.
  On Tuesday, in response to the H1N1 outbreak, I chaired an emergency 
hearing on the Health Appropriations Subcommittee. We heard assessments 
of the outbreak from top medical experts, including Dr. Anthony Fauci, 
the renowned and remarkable Director of the National Institute of 
Allergy and Infectious Diseases at NIH.
  Years ago, when we first started this, back in 2005, Dr. Fauci warned 
us that it is not a matter of ``whether'' there will be a flu pandemic 
but rather ``when'' it will happen. It is not a matter of whether but 
when.
  When the Senate drafted its version of the American Recovery and 
Reinvestment Act this year--the stimulus bill--I included an additional 
$870 million for pandemic preparedness. Most of that funding was to be 
used to complete the work of building up our vaccine production 
capacity; in other words, to get these plants built more rapidly. 
Unfortunately, it was taken out in the final bill. Again, what we are 
trying to do is shift from egg-based production to cell-based 
production, so we can get these vaccines developed more rapidly. Taking 
it out of the stimulus bill was the typical shortsighted resistance 
that I have often encountered when I talk about this.
  Some accused me a couple years ago of crying wolf. The wolf is here. 
One day in the future we can encounter an even worse wolf, such as the 
flu pandemic of 1918, which was the Spanish flu. It infected one out of 
three people worldwide and killed more than 50 million people. It would 
be the height of folly not to do what we can to prepare for such a 
possibility. The harsh reality is that we have repeatedly experienced 
flu pandemics. I mentioned the one of 1918 and 1919.
  There was the Asian flu pandemic of 1957 and 1958 that killed over 
1.5 million people.
  The Hong Kong flu pandemic of 1968 and 1969 killed over 1 million 
people. Not only did it kill over 1 million people, it caused hundreds 
of millions of illnesses and hospital stays all across the globe.
  We cannot predict the future course or severity of the current H1N1 
outbreak, but clearly it is one more wake-up call.
  Again, I am reintroducing the Seasonal Influenza and Pandemic 
Preparation Act today as a stand-alone bill. I first introduced it in 
2005, as I said. It is now a stand-alone bill. We either pass it that 
way or, if not, I plan to incorporate it into the prevention and public 
health title of comprehensive health reform legislation that we will 
hopefully pass this year. A program offering annual free flu shots to 
every American is exactly the kind of smart, cost-effective, 
prevention-focused public health that must be at the center of our 
reformed health care system in America. It will save lives and money. 
When--when not whether--a pandemic flu strikes the U.S. in the future, 
we will be ready.
  I encourage Senators to cosponsor the legislation. I think this is 
one more wake-up call and we have to move ahead aggressively in 
preparing for these pandemics. As Dr. Fauci said, it is not a question 
of whether, it is only a question of when and how severe it will be. We 
don't know.
  I remind people that a few years ago when we started this, back in 
2005, we were confronting the possible pandemic of an avian flu or H5N1 
flu, which started in Southeast Asia. Thanks to surveillance, to the 
CDC, and to a lot of people working on it, we were able to contain it. 
That H5N1 avian flu is one of the most deadly we have confronted, with 
over a 50-percent mortality. One out of every two persons who 
contracted it died. Now we have contained it and tamped it down. That 
H5N1 virus is still out there and, periodically, we pick it up in 
places such as Southeast Asia.
  There was a thought that because of migratory birds, it may be spread 
to other places, but we don't know that.
  But because it has reared its ugly head, because we know that virus 
is out here someplace, it behooves us to do everything we can to 
protect the people of this country and in doing so to prepare. I hope 
it doesn't happen. I hope when there is a pandemic flu, it will be just 
a mild one and will not kill people. But we don't know. The best way to 
prepare for it is to build up our vaccine-manufacturing capacity as 
rapidly as possible; secondly, make sure our public health agencies on 
the State and local levels are ready to go, that they are trained, that 
they are equipped; and thirdly, that we have some experience, that we 
know how to do this.
  One of the best ways is to give everyone a free flu shot every year--
everyone, a voluntary free flu shot every year. To me, that will set us 
up well to prepare for and to protect the American people against any 
flu pandemic that may come our way in the future.
                                 ______