[Congressional Record (Bound Edition), Volume 151 (2005), Part 16]
[Senate]
[Pages 21482-21485]
[From the U.S. 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 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

[[Page 21483]]

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.
  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

[[Page 21484]]

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, 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

[[Page 21485]]

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.

                          ____________________