[Congressional Record (Bound Edition), Volume 152 (2006), Part 8]
[Senate]
[Pages 10396-10398]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              PANDEMIC FLU

  The PRESIDING OFFICER. Under the previous order, there will be 25 
minutes for debate, equally divided between the Senator from Kansas, 
Mr. Roberts, and the Senator from New York, Mrs. Clinton.
  The Senator from Kansas.
  Mr. ROBERTS. Mr. President, I rise today with my colleague, Senator 
Clinton, to talk about an issue that demands our attention and action: 
the potential for a pandemic flu outbreak and, more importantly, what 
we can do about it.
  Behind me I have a picture of a crowded emergency hospital at Fort 
Riley, KS, during the 1918 Spanish flu pandemic. That flu eventually 
took the lives of more than 600,000 Americans and 50 million people 
worldwide. However, my colleagues may not be aware that the first human 
cases of the Spanish flu in the United States were discovered in my 
home State of Kansas at Camp Funston in Fort Riley, KS.
  On the morning of March 11th, 1918, a company cook reported to the 
camp infirmary complaining about a bad cold. By noon, over 100 sick 
soldiers suffering the same bad cold also reported to the infirmary. 
These complaints of bad colds turned out to be the first cases of 
Spanish flu in America.
  Within weeks, that influenza had spread to places as far away as 
Camps Hancock, Lewis, Sherman, and even to several hundred prisoners at 
San Quentin. By the summer, the flu reached around the globe, killing 
tens of thousands of people.
  This flu was so severe and damaging that attack plans during World 
War I had to be altered or postponed because there were shortages of 
healthy men to battle. The Spanish flu continued to spread all 
throughout 1919. It reached its death toll of nearly 50 million people 
worldwide.
  I yield to my distinguished colleague.
  Mrs. CLINTON. Mr. President, I thank my colleague. Senator Roberts 
has outlined the impact the 1918 flu outbreak had on Kansas, our 
Nation, and the world. It is almost unimaginable that starting with 
that one company cook, 50 million people worldwide died.
  I will tell a different story about a public health success. In March 
of 1947, the City of New York faced an outbreak of smallpox when three 
cases appeared at a local hospital. On April 4, New York City began a 
mass vaccination campaign to prevent further cases from occurring.
  Behind me is a photograph of Red Cross volunteers waiting to receive 
a vaccination against this deadly disease. Over the next month, more 
than 6 million people were inoculated against smallpox, the largest 
mass vaccination in United States history. Even President Truman, who 
was scheduled to visit New York during this time, received a 
vaccination.
  Through the cooperative efforts of local government employees, public 
health workers and an army of volunteers, an outbreak was averted. 
Vaccinations took place at hospitals, schools, and police stations. 
Frequent press bulletins helped to ensure that people knew what was 
happening and where they could go to have themselves and their families 
vaccinated. Our national public health system was able to respond both 
quickly and efficiently to contain this disease.
  As the New York City Health Commissioner reported in the American 
Journal of Public Health later that year, never before had so many 
people in one city been vaccinated in such a short time and on such 
short notice. Thanks are due to the press and radio for giving so 
generously of their space and time to bring necessary information to 
the public. Had it not been for them and the intelligent cooperation of 
the public, the generosity of private physicians and volunteer workers, 
notably from the American Red Cross,

[[Page 10397]]

the American Women's Voluntary Services and former Air Raid Warden 
groups from World War II, it would have been impossible to have 
achieved this remarkable record.
  Senator Roberts and I are here today because we believe, half a 
century later, we face a similar public health issue. The looming 
threat of pandemic influenza has caused our Federal Government to begin 
mobilizing for when--not if--avian flu hits our shores. We are 
investing in research for a vaccine, stockpiling medications, and 
trying to develop plans for mass vaccinations.
  If recent history is any indication, we may not be able to muster the 
same response as we did in 1947 when Americans were still on a war 
footing or had a mentality of working together. What is worrisome to me 
when I think about our country's preparedness is the fact we are not 
even prepared to deal with the seasonal influenza we face every single 
year.
  Since 2000, we have had four shortages of seasonal influenza vaccine. 
We have seen senior citizens line up for hours to get flu shots. 
Unfortunately, we have seen some unscrupulous distributors trying to 
sell the flu vaccine to the highest bidder. Millions of Americans have 
chosen not to get vaccinated, despite the clear preventive effects of 
the vaccine.
  This is something we want to stress and that Senator Roberts and I 
have been working on together to try to come up with some practical 
solutions. This is a matter of preparedness, not a partisan issue. This 
is a matter of planning. It is a matter of ensuring that our health 
care system can respond both to the annual flu outbreak and to the 
threat of a pandemic flu. We believe we have a lot of work to do.
  Mr. ROBERTS. As Senator Clinton has highlighted, the need to be 
prepared for both seasonal flu and a potential avian flu pandemic is 
absolutely critical. Some believe the potential avian flu outbreak 
could be as lethal as the 1918 Spanish flu. One cannot watch or read 
the news without a report on the concern of flu reaching our shores.
  In reality, human cases of avian flu have been discovered in 10 
countries. Three years ago there were only three confirmed cases of 
avian flu in humans. Today these numbers have grown to over 224 human 
cases, 127 deaths.
  In February, I took part in an avian flu exercise at the National 
Defense University. That exercise was called Global Tempest--aptly 
named. The exercise simulated a worst-case scenario flu pandemic, and 
participants from several Federal agencies, and Members of Congress, 
took part in the event. We all served as advisers to the President.
  The exercise showed firsthand how quickly our public health system 
and real critical infrastructure services can be simply overwhelmed, 
how communication can easily break down and how panic can take hold 
amongst the public. We were forced with the difficult decision of 
having to determine where limited medical supplies and personnel should 
be targeted, how the Federal Government can sustain the private sector 
and try to mitigate the real economic effects of the pandemic, and if 
and when the Department of Defense should be called in to assist with 
the civilian efforts.
  This Global Tempest exercise and experience, along with understanding 
the strength and the force of the Spanish flu in recent natural 
disasters such as Hurricane Katrina, have taught us a valuable lesson. 
We must be prepared at all levels to deal with the large-scale public 
health emergency such as the pandemic flu. This system must be able to 
respond in any type of crisis. But, more importantly, this system must 
be ready to respond before the crisis begins.
  As chairman of the Senate Committee on Intelligence and a member of 
the Senate Agriculture and Health, Education, Labor, and Pensions 
Committees, I take the threat of a flu pandemic seriously and view it 
not only as a public health concern but a concern in regard to our 
national security.
  Senator Clinton is a fellow member of the HELP Committee. She shares 
these concerns. However, we do not want to stand before our colleagues 
and our constituents, those watching today, and cause panic or alarm. 
There have been no cases of the avian flu virus in the United States, 
nor has there been a human transmission of the disease in a form that 
could fuel a pandemic. Instead, we stand together before all of our 
colleagues hoping to motivate them to take the necessary steps to make 
sure we are adequately prepared, should avian flu take hold in the 
United States. We believe there are some weaknesses in our system that 
we must strengthen so we can respond to a crisis.
  Last week, I hosted a pandemic flu planning conference in Kansas with 
Senator Brownback and Governor Sebelius. The conference included other 
Federal, State, and local officials, the business community, 
university, health providers, hospitals, school administrators, many 
other stakeholders who came together to make sure that Kansas is 
prepared in the event of an influenza pandemic. We identified the steps 
that must be taken at the State and local level to plan for and respond 
to a flu pandemic.
  At the Federal level, Senator Clinton and I took the lead last 
October and introduced legislation to help strengthen our Nation's flu 
vaccine system. The Influenza Vaccine Security Act takes a 
comprehensive approach and includes several provisions to improve our 
vaccine market and delivery system for the seasonal flu. It also 
provides the framework that is absolutely critical during a pandemic 
flu.
  Mrs. CLINTON. Senator Roberts is absolutely right. We believe it is 
critical to ensure that our basic seasonal flu vaccine production and 
distribution system is capable of delivering vaccines to all who need 
them, especially with the threat of an avian flu pandemic moving over 
us. Thousands of people die in our country every year from seasonal 
flu. It makes sense to us that we need to get that system absolutely as 
efficient as it needs to be so that then we could handle a rapid 
vaccine production, mobilization, and delivery challenge in the event 
of pandemic flu. Because we don't have a system through which to track 
vaccines, we cannot ensure that supplies reach the highest priority 
populations--including seniors and the chronically ill, those who 
should get vaccinated as early as possible in any given flu season. 
Many physicians and other providers have contacted us to express 
frustration at their continuing inability to accurately predict at 
which point they may be able to provide needed supplies of influenza 
vaccine to their patients. We do this in other parts of our economy. We 
routinely use tracking devices to trace deliveries of other goods in 
the private market. But yet we still cannot predict when a vaccine 
order placed in the summer might actually be provided to a doctor's 
office or a hospital or another place where the flu vaccine can be 
administered.
  Our legislation, the Influenza Vaccine Security Act, would establish 
a tracking system through which we could better trace the distribution 
of vaccine from the factory to the provider, and we could identify 
counties with high numbers of priority populations. Then with that 
system in place, we could easily determine, in times of shortage, where 
the vaccine was most needed and facilitate distribution to those areas. 
All of this could take place in a matter of hours, rather than days or 
weeks, as it does now.
  The tracking system in our legislation builds upon the current 
private system of distribution. It has received support from vaccine 
manufacturers and public health groups. Linking information through a 
national database can be done in a manner that does not jeopardize 
free-market competition but actually assists it.
  It simply makes sense to establish a tracking system for vaccine 
distribution that can be used in both seasonal and pandemic events, to 
have that system already operational rather than to rely on untried 
mechanisms in emergency situations when we would already be facing all 
the multiple challenges of delivering health care.

[[Page 10398]]

  We recognize that many entities in our States as well as around the 
country may not have the technology or infrastructure in place for a 
vaccine tracking system. That is why our bill also creates a 
demonstration program that authorizes the Centers for Disease Control, 
working together with State and local health departments, to provide 
demonstration grants to health care institutions to assist them in 
information technology upgrades to allow these institutions to improve 
their ability to report and track flu vaccine dissemination.
  Mr. ROBERTS. Senator Clinton and I also recognize the very critical 
need for domestic-based vaccine manufacturers and an increased 
production capacity in the event of a flu vaccine shortage or some kind 
of a public health emergency that would require a mass need for 
vaccines or any other countermeasure. That is why our bill improves the 
ability of the current manufacturers to remain in the U.S. market and 
encourages more companies to enter the market with domestic-based 
production facilities. We provide grants to manufacturers for technical 
assistance from the Food and Drug Administration and grants for capital 
improvements in technology or production capacity.
  Our bill also addresses the need to quickly find the medical 
professionals in the event of an emergency. We require the Centers for 
Disease Control and Prevention to work with our State and local health 
departments to develop a registry, if you will, of medical personnel 
who can provide services during a public health emergency. Such a 
system was required under the Bioterrorism Act passed by Congress 4 
years ago. But there is still no working system in place. This is 
unacceptable. We must have a system that can easily identify doctors 
and other health professionals who can assist during a public health 
emergency--that is common sense--especially during an emergency that 
affects many areas across State lines. This will allow our Federal, 
State, and local officials to move quickly and efficiently to provide 
Medicare to those in need.
  During Hurricane Katrina and its aftermath, I heard from many doctors 
and other health professionals across Kansas--I am sure the Senator 
from New York did as well--who wanted to volunteer their time in the 
gulf coast area. However, their desire to help those in need was 
hampered by the inability of Government officials to easily identify a 
doctor who was credentialed or other health providers from other States 
who could provide care. This is why Senator Clinton and I now stand 
before our colleagues to stress that we can no longer wait for the 
development of such a registry of medical personnel. We are working and 
will continue to work with the HELP Committee to make sure this is a 
priority in the bioterrorism reauthorization.
  Mrs. CLINTON. Senator Roberts and I also believe that reforming the 
flu vaccine system requires increasing demand for vaccinations. This 
bill increases the funding for CDC's educational initiatives and sets 
up grants through State and local health departments, in collaboration 
with health care institutions, insurance companies, and patient groups, 
to increase vaccination rates among Americans but particularly among 
priority populations--the elderly, the chronically ill, and those for 
whom the seasonal flu is a particular risk. We have made progress. 
Between 1989 and 1990, flu vaccination rates among senior citizens 
doubled from 33 percent to 66 percent of the population. But we need to 
get those numbers up even higher to try to meet the Healthy People 2010 
goal of having 90 percent of our seniors receive an annual flu vaccine. 
We have to get more information out to people about why this is 
important.
  This is especially critical if we are confronted with pandemic flu. 
Many people last year wanted to get a seasonal flu vaccine, because 
they thought it would protect them against pandemic flu. The 
information was not clear. It wasn't getting out in the right ways. We 
need to do more to help find reliable sources of information in 
communities.
  I want to add another point about the funding for research that we 
are advocating. We think we should have new vaccine-based technologies, 
such as cell-based technology. We rely on production methods that 
haven't kept pace with the advances in medical science. In order to 
make a vaccine today, strains of influenza virus are cultivated in 
chicken eggs. That is a nonsterile environment. Many of the 
contamination problems we have seen over the last several years have 
resulted because of this cultivation process. Although we still have to 
rely on this technology, Senator Roberts and I would like to expedite 
the efforts to increase research into safer, faster, more reliable 
methods of vaccine production.
  I have to emphasize again, however, it is not research alone that 
will help us. We can't do great research in the laboratory but then not 
know where the vaccine is, how to track it and to get it where it needs 
to be, how to have good information sources. Senator Roberts discussed 
the war game he participated in. There was a lot of confusion. We are 
trying to cut through that to couple research efforts with the 
development of a system to track and distribute both seasonal and 
pandemic influenza vaccine.
  Mr. ROBERTS. Over the last several months, the distinguished Senator 
from New York and myself have worked with our colleagues in the HELP 
Committee to include the provisions of the bill we discuss today in the 
Public Health Security and Bioterrorism Preparedness and Response Act--
the reauthorization of that bill--or the BioShield II bill to be 
considered by the committee and the full Senate.
  I thank especially Senators Burr, Enzi, and Kennedy, and their staffs 
for their willingness to work with us. Senator Clinton and I strongly 
believe that the provisions of the bill we discuss today are absolutely 
relevant and critical to these discussions.
  We hope--it is not hope; we are going to insist--that these 
provisions will be included in any legislation approved by the 
committee and Senate. As a matter of fact, were it parliamentarily 
correct, I would ask unanimous consent that the bill be read three 
times and passed now. We are thankful for all the attention and focus 
on planning for a pandemic flu, but we also believe a few more steps 
need to be taken to make sure we are ready. This is why we are urging 
our colleagues to consider our legislation, the Influenza Vaccine 
Security Act, and support our efforts on the bioterrorism and BioShield 
II bills.
  I thank Senator Clinton for her hard work, dedication, and leadership 
on this issue. I urge my colleagues to think about this and to support 
this legislation.
  I yield the floor.
  Mrs. CLINTON. Mr. President, I thank Senator Roberts. He brings to 
this issue the concern that he faces every day on the Intelligence 
Committee. I agree with him absolutely. This is a national and homeland 
security issue, as well as a health and economic one. I hope, working 
with our colleagues on both sides of the aisle in the HELP Committee, 
we can ensure that the provisions from our legislation will be included 
within the reauthorization of the bioterrorism and public health 
emergency legislation. We believe an ounce of prevention is truly worth 
a pound of cure. We stand ready to work to move this as quickly as 
possible so we can get a system in place that we can then work on 
during seasonal influenza time and be prepared for a pandemic flu.
  I thank Senator Roberts and yield the floor.

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