[Congressional Record (Bound Edition), Volume 152 (2006), Part 9]
[House]
[Pages 12573-12577]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           AVIAN FLU PANDEMIC

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 4, 2005, the gentleman from Texas (Mr. Burgess) is recognized 
for the remainder of the hour as the designee of the majority leader.
  Mr. BURGESS. Mr. Speaker, may I inquire as to the amount of time that 
remains?
  The SPEAKER pro tempore. The gentleman from Texas has 34 minutes 
remaining.
  Mr. BURGESS. I thank the Speaker, and the gentleman from New Jersey 
for allowing me a little time on the floor tonight.
  I thought it was important to come to the floor and talk about an 
issue that pops up from time to time on our news shows and the American 
consciousness, and that is the issue of avian flu, or the bird flu.
  Mr. Speaker, as far as a little background is concerned, there are 
several types of influenza. There is the common flu, or seasonal flu, 
that we all receive inoculation against every year. Because of modest 
genetic changes that occur in this virus year over year, it is 
necessary to get a vaccination every year. But sometimes, instead of 
just that genetic drift that happens within the virus, there is a major 
change, a genetic shift; and when that happens, the stage is set for a 
world-wide pandemic. And, indeed, history tells us that that will occur 
about three times every century.
  Now, currently, the avian flu is present in birds; and a big genetic

[[Page 12574]]

change would have to occur for this to become a major health threat to 
humans. As of June 16 of this year, the World Health Organization has 
confirmed 227 human cases, with 129 deaths reported. The problem is, 
Mr. Speaker, if you do the math, that is a mortality rate that is in 
excess of 50 percent.
  Now, when you think of a worldwide pandemic, there are various 
trouble signs you encounter. The World Health Organization has 
identified five of those. Widespread distribution of the virus in 
nature, in this case in birds, an endemic carrying of the virus in 
birds. A wide geographic setting with involvement of other animals, in 
this case felines, cats and tigers have become infected, presumably 
from eating infected animals. Bird-to-human transmission occurs with 
inefficiency and then comes inefficient human-to-human transmission. 
The last step, efficient human-to-human transmission, has not yet 
occurred, but that is the step, the previous four have occurred, and 
that is the step that would signal the onset of a worldwide pandemic.
  Because the threat is so significant, our Secretary of Health and 
Human Services, Michael Leavitt, has designated the threat anywhere in 
the world, a threat anywhere in the world is a threat everywhere in the 
world, and that is why it is incumbent upon us to keep such a close 
watch on this illness.
  Steps one through four occurred between right now and 1997. The last 
step, which has not to date occurred, would trigger a human pandemic. 
One of our major problems with a worldwide pandemic is we, as humans, 
have no underlying immunity to this relatively new type of flu virus.
  Now, as I mentioned earlier, there are approximately three pandemics 
every century; and, indeed, last century there were exactly three. In 
1918, the Spanish flu killed 50 million people worldwide; in 1957, the 
Asiatic flu killed 170,000; in 1968, the Hong Kong flu killed 35,000 
people in the United States.
  If the pandemic flu were to hit, the Department of Health and Human 
Services estimates that 209,000 deaths in the United States for a 
moderate flu outbreak, such as occurred during the Asiatic flu outbreak 
of 1957, and 10 times that many, 1.9 million deaths in the United 
States for a severe epidemic, such as occurred when the Spanish flu 
broke out in 1918.
  Now, Mr. Speaker, I would like to draw your attention to this map 
that I have here. It is somewhat shocking to look at the eastern part 
of the world, several continents, in fact, that are totally covered in 
blue. And as you see from the key here, avian flu cases confirmed in 52 
countries, and again widespread distribution across the eastern half of 
the globe.
  The countries colored in in black are, in fact, where human cases 
have occurred; and we see originally China and Vietnam, Southeast Asia 
but more recently the addition of other countries that are moving more 
and more westward. There has been a gradual spread westward since 2004.
  Mr. Speaker, let me demonstrate that further on this second map. 
Gradual western spread since 2004, and since 2004 the avian flu has 
gone from China to Cambodia to Thailand to Russia and then to Turkey in 
2005.
  Mr. Speaker, there was an explosion of outbreaks in early 2006 to the 
Middle East and Eastern Europe; countries such as Iraq, Romania, Italy, 
Germany, France, Africa, Nigeria, and Egypt, just to name a few. We see 
these concentric circles indicating the year of the spread. Here we 
have June, 2004, affecting primarily China and Southeast Asia; December 
of 2004, June of 2005, January of 2006; and as you can see, the arrow 
is pointing ever, ever westward.
  From January to April, 2006, 35 new countries have reported avian flu 
outbreaks in poultry; and some of these have had their new first 
reported cases of H5-N1 virus in humans as well. So the total estimate 
of the World Health Organization for the number of countries affected 
is just over 50.
  The disease is indeed endemic in birds. Over 200 million birds have 
been culled in the last 3 years, both birds that were suspected of 
having the infection and those culled for preventive measures. One of 
the keys here, Mr. Speaker, is this virus can be stopped in birds; and, 
indeed, stopping the virus in birds has to be the first line of 
defense.
  The reason this is so important, and let me go to an additional map, 
if we look at the migratory flyways throughout the world, this disease 
is spread by migratory birds and infected poultry. Countries with 
outbreaks, this map shows the concentration of poultry worldwide and 
the migratory bird flyways.
  The darker the color here, the greater the concentration of humans 
and poultry. You see the eastern United States, starting in my State of 
Texas, east Texas eastward, we have several significant concentrations 
of poultry juxtaposed to human populations.
  Countries with outbreaks in general have a high concentration of 
poultry populations. There are some concerns over two flyways that go 
from Africa to North America, the so-called East Atlantic flyway, and 
the one that goes from Asia to Alaska, the East Asia-Australian flyway. 
Countries in both Africa and Asia have reported outbreaks and are 
countries that are directly on that flyway.
  Now it is not for sure the virus will be carried this way, but the 
fact that the distribution has occurred in migratory birds, and those 
are the migratory pathways, certainly that is going to bear careful 
watching.
  Some of the other unknowns is what is the behavior of the virus in 
very cold climates. I don't think anyone knows that yet, but, indeed, 
it is around this time of year that those bird populations are in fact 
returning to the Arctic areas. So increased testing across the United 
States, starting with Alaska, and indeed over nearly 100,000 samples 
have been taken from both live and dead wild birds as well as from 
high-risk waterfowl habitats.
  On the World Health Organization scale of pandemic alerts, you go 
from low risk of human cases to efficient and sustained human-to-human 
transmission; and there are six stages on that World Health 
Organization pandemic alert chart. Currently, we are at a level three, 
no or very limited human-to-human transmission.
  As of June 6, 2006, there have been 227 cases and 129 deaths. H5-N1, 
the virus that causes bird flu, has been cited first in 1997 in Hong 
Kong, with 18 human cases, six died, all poultry were culled. From 2002 
to 2003, there was a reemergence of the virus in Asia. There was a high 
incidence of cases in a few countries. Vietnam accounts for 40 percent 
of the human cases; and Indonesia, so far, accounts for 20 percent of 
the human cases.
  The problem is that, in Indonesia, avian flu has not yet been 
contained, compared to Vietnam. Indonesia has had outbreaks since early 
2004, and new outbreak reports are coming out all the time. Last week 
or the week before, the 50th case of the human infection, which was 
fatal, was confirmed.
  Let's look for just a minute at a map of Indonesia. There has been a 
steady rise in reported cases and a high correlation between poultry 
and human outbreaks. On the map, the triangles represent human cases. 
It is a little misleading, because more cases have occurred and many of 
the triangles overlap. Since these cases occur in clusters, they are 
very close together geographically. But look at how close the triangles 
are and take notice of Singapore and Malaysia and the close geographic 
location.
  Indonesia is densely populated. It is the world's fourth most densely 
populated country. Indonesia is still suffering from the effects of the 
tsunami that occurred in December of 2004. In May of this year, an 
earthquake in the central Java region left as many as 1.5 million 
people homeless. The country of Indonesia raises about 1\1/4\ billion 
chickens a year, about 7\1/2\ percent of the global total. About 70,000 
villages, spread across 17,000 islands, raise poultry. Poultry is 
raised in the backyards of about 80 percent of the country's 55 million 
households.
  Mr. Speaker, I am going to put a chart up here that is a little busy, 
but it illustrates a very important point for us to keep in mind. This 
chart shows only a sample of the human

[[Page 12575]]

cases in Indonesia, some 15 of the now 51 cases. Information confirmed 
by scientists and field researchers from the World Health Organization 
is present on this graph.

                              {time}  1945

  Mr. Speaker, there is a family cluster from the Kubu Simbelang 
Village in North Sumatra. Many of the recent news headlines had to do 
with concern that the avian flu virus might have become effective at 
transmitting from human to human. When you just look at the number of 
cases involved, you would have to ask yourselves that question.
  Now, this outbreak has been extensively investigated. The outbreak 
investigation showed that this cluster is, indeed, what is called a 
contained cluster, meaning that no other individuals, no other health 
care workers, no neighboring villagers, were, in fact, becoming 
infected.
  In the initial case, a 37-year-old woman was most likely infected by 
sick and dying chickens that she was keeping in her backyard. Indeed, 
on the chart there, you see she kept them in indoors with her at night. 
Because no specimen was taken before she was buried, it can't be 
confirmed that the illness from which she died was indeed the avian 
flu, or the H5N1 virus, more specifically.
  However, seven of her relatives have tested positive for the H5N1 
virus. The relatives most likely became ill due to close contact with 
the initial case, the woman who initially became ill. Six of these 
seven individuals have since died. So there is currently limited human-
to-human transmission of avian flu.
  If we look at this chart of those, indeed, who are sick or who have 
died from this illness, spent the night with a sick index patient on 
April 29, spent the night with the index patient on April 29. Spent the 
night with the index patient on the 29th. Took personal care of the 
sick index patient. Took personal care of the patient. Often visited 
the patient, was there April 29. Took care of a sick son in the 
hospital on May 9 through 13.
  Another thing that I would like to point out are the ages of these 
individuals, and how very young they are. This is not a disease of the 
old and infirm. This is an illness of the young and robust. The ages 
span that of an 18-month-old baby to a 43-year-old man. This disease, 
when it strikes, is extremely virulent. On average, it is about a week, 
from 5 to 10 days from the onset of symptoms until the disease claims 
its victim or the victim recovers.
  The illness itself is characterized by an intensely consolidated 
process in the lung, basically a pneumonia, a hemorrhagic pneumonia. 
There may be bleeding into lung tissue, and it is a very striking 
picture from these patients when they are ill with this disease.
  Mr. Speaker, my main purpose in being here tonight is not to discuss 
how frightening the disease is, because, indeed, it is frightening, but 
to talk about what weakened it, what we can do as a country, what we 
can do as a partner in the world, what we can do as a Congress to place 
in motion those things that are going to be responsible for 
preparedness, particularly preparedness at the Federal level, because, 
after all, that is our responsibility.
  There are medicines available that are known as antivirals. In the 
1918 Spanish flu epidemic there were no antiviral medications. They had 
not yet been invented, but we have antiviral medications today.
  Now, an antiviral is different from a vaccine or an immunization. An 
antiviral is a medicine like an antibiotic would be administered for a 
bacterial infection. An antiviral is administered after an onset of 
symptoms. It does, indeed, reduce the severity of symptoms, but it must 
be administered within 24 to 48 hours of the onset of the symptoms.
  Having proper stockpiles of antiviral medications is going to be of 
critical importance. Even just as critical is going to be the 
distributive network to get those antivirals into the hands of 
communities where the virus may be present.
  It does reduce the severity of symptoms. The New England Journal of 
Medicine indicated that the treatment with an antiviral reduced the 
median duration of illness from nearly 5 days to 3 days, and the 
severity of the illness by about 40 percent. When you have got an 
illness that has a 55 to 58 percent mortality rate, that reduction in 
severity is extremely critical.
  In another study, the antiviral Tamiflu, given within the first 12 
hours after the onset of fever, shortened the illness duration by more 
than 3 days as compared with the treatment that was started at 48 
hours.
  Vaccines are the other tool in the armamentarium against this 
illness. Vaccines also were not available in the 1918 flu epidemic, but 
obviously vaccines were available with the outbreak of the Hong Kong 
flu and the more recent pandemics.
  Vaccines are of such critical importance that it is mandatory that we 
move the production of vaccine manufacture from foreign countries back 
into this country. We have seen an exodus of vaccine manufacturing out 
of this country. The vaccine needs to be manufactured within our 
shores, within our borders. We can't very well go around to other 
countries who may be suffering also with this disease and ask them to 
supply our vaccinations for us. It just simply won't happen.
  It is going to be necessary, although a vaccine has been developed, 
reverse genetics were used to take one of the virus samples from one of 
these early cases in Vietnam and create a vaccine to the H5N1 as it 
exists today. The vaccine appears to be safe and effective, but it does 
require a lot of that vaccine in order to immunize any one of us, 
because we have no native immunity to this particular type of flu.
  But since the flu is constantly changing, since it is constantly 
evolving, indeed it is going to be one of those changes if a pandemic 
occurs and it changes from a disease that is very bad in birds to a 
disease that is very bad in people, there will be of necessity another 
shift that has occurred in that virus.
  Therefore, the virus that is present today, if we make vaccine in 
large quantities against that, it may or may not be effective against 
the virus that would go easily from human to human. So we do to some 
degree have to wait and develop the correct vaccine for the correct 
strain of flu.
  But within the past 6 months, in fact our Department of Defense 
appropriation bill that we passed last December, had money in it for 
the development of a flu vaccine. Recently, the Department of Health 
and Human Services was awarded a total of $1 billion and a request for 
proposals for companies to develop cell-based vaccines manufactured in 
this country. Those contracts were let in May of 2006.
  Mr. Speaker, when you look at vaccine manufacture in this country, 
not only have we suffered because companies have gone offshore, our 
method of creating vaccines is somewhat antiquated. We are still stuck 
back in the 1950s. We use an egg-based system to create our vaccines.
  Well, you can just imagine, you have got an illness that is primarily 
affecting chickens, and we are culling chickens from chicken farms. 
Where are we going to get the eggs to manufacture the vaccines? Newer 
type of vaccine technology, the so-called cell-based vaccine 
technology. It is critical that the companies that manufacture the flu 
vaccine, not just for avian flu but for our seasonal flu, it is 
critical that we develop the companies and the capability of 
manufacturing those vaccines with a cell-based system much less prone 
to contamination and to all the other difficulties that have been much 
encountered by the egg-based system.
  To some degree we may have to consider streamlining the FDA 
regulation and emphasize teamwork amongst our various research teams, 
not only at the NIH, but across the country and indeed across the 
world. We have to explore the promise that a universal vaccine holds.
  When we talk about flu vaccines, the reason we are always changing is 
because the virus will change various parts of its outside protein 
coat, if you

[[Page 12576]]

will. But there are several of the genes of the virus that don't 
change, from flu type to flu type, the so-called more pedantic or 
housekeeping genes within the core of the virus. If there is a way to 
develop a vaccine that will target those genes, it is going to be a 
much more effective vaccine because it will have that cross-reactivity 
across many different strains of the flu virus.
  The current H5N1 vaccine clinical trials with Sanofi are of 
necessity. Those are going to continue. It will be critical, even 
though it may not be the final genetic result that they are developing 
the vaccine for. This vaccine is going to be critical as far as 
providing a pool for vaccinating our first responders, our nurses, our 
doctors, our firefighters, our ambulance personnel, if the virus were 
to make a sudden appearance in this country.
  It is important again to remember, let me stress, that a much higher 
dosage of this vaccine is needed than for the average flu inoculation. 
Generally up to 90 micrograms of this vaccine are necessary to immunize 
one individual, where typically you need only 15 micrograms for the 
more common seasonal flu.
  Other things that we need to do around our country, we need to be 
sure that we have the surge capacity of our vital workforce thought 
about and in place, identifying those key players, and ensuring their 
safety during the crisis and their ability to get and help people who 
have been harmed by the illness. Strengthening the health care 
infrastructure in general is a worthwhile thing that we should 
consider, really, on a daily basis here in this Congress.
  Protecting first responders, I alluded to wanting to have a vaccine 
stockpile available, even if it is not the correct vaccine that we will 
end up with at the time when the flu virus mutates for that last time. 
But some immunity will be imparted by that early vaccine, and we need 
to be certain that we have that early vaccine to have for our first 
responders to allow them to have some measure of protection as they are 
on the first lines fighting this illness if the worst were to develop.
  Offering support services, even including mental health support 
services. Remember the flu epidemic that occurred in 1918, it didn't 
just happen around the globe in 3 weeks and then it was over. It came 
in waves and wave after wave would affect communities, and basically 
the virus encircled the globe three times before it eventually died 
out.
  We are going to have to be able to rotate workers, not just health 
care workers, but workers in various lines of work so that they don't 
become fatigued, give up, and we have to be able to sustain their 
efforts.
  The economic impact of this illness is pretty hard to tell. In some 
countries already it has had a significant impact. Some of the maps I 
showed earlier of Africa, the country of Nigeria, where chickens are 
basically used as currency, this has had a significant economic impact. 
It may well have significant economic impact in this country as well.
  We just go back to one of the earlier maps and point out, as the 
disease spreads westward. Look at where the chicken populations are 
concentrated in this country and other countries. There could be a 
devastating effect on the poultry industry, and some compensation for 
poultry farmers, especially if they involve themselves in early 
reporting and maintaining the livelihood of those individuals.
  Safe cooking practices to kill the virus and, let me stress at this 
point, the virus has not been found in the Western Hemisphere, and 
United States chicken populations at this juncture are not affected or 
infected with this virus, but early containment of any outbreaks to 
prevent paralysis of a whole economy that is based on poultry.
  We have got to encourage understanding. Panic is not going to be a 
solution for a pandemic, but proper planning is going to be one of the 
keys. The focus of the messaging, the World Health Organization, has 
already put out outbreak communication tips for public officials. I 
encourage my colleagues to become familiar with those. Enhance the 
public's compliance if a quarantine is needed and a quarantine is 
required, and common prevention techniques are going to go a long way 
towards preventing the spread of this illness; then we must be prepared 
to not only talk about them, but mandate them if indicated.
  Our Federal, State, and local community officials will help play a 
big role in the preparedness. I know my officials back in north Texas 
have done a great job as far as preparing themselves for some of the 
things that would happen or could happen in the even of a pandemic. 
Bear in mind, this may be one of those things just like Y2K. We get all 
concerned about it, and it never happens.
  But the manufacture of vaccine within the shores of this country is 
critically important. We should be doing that anyway and not just if we 
are faced with the threat of avian flu. Stockpiling of antiviral 
medications and indeed our Nation's stockpile of critical medicines, we 
need to look at that and be sure we have the distributive networks in 
place.
  It doesn't matter if it is a hurricane, an earthquake or a terrorist 
strike. Preparedness should just be one of the bywords of this United 
States Congress for the rest of this decade and likely for many decades 
to come.
  There are places on virtually every congressional committee where 
steps towards preparedness can be undertaken and, in fact, should be 
undertaken. Certainly we will look at a committee like Armed Services 
and what happened during the Spanish flu outbreak of 1918 and how it 
affected the returning troops from World War I. Armed Services needs to 
pay a good deal of attention to observing the outbreaks globally and 
implementing quarantine plans when is necessary.
  The Committee on Agriculture, tracking avian populations as they 
disperse throughout the United States; my own committee of Energy and 
Commerce, and they have. I want to thank the committee on Energy and 
Commerce. They have done a great deal as far as the hearings on avian 
flu and as far as providing information for our committee.

                              {time}  2000

  The Committee on Homeland Security will have critical oversight over 
border security and, in fact, coordinating efforts should a pandemic 
hit across the country.
  The Committee on Judiciary will have to decide some jurisdictional 
issues; and, indeed, they will have to decide whether or not we relax 
some of the liability as it pertains to vaccine manufacture as well as 
indemnifying first responders if they are harmed by vaccines or new 
antiviral medicines that are developed.
  The Committee on Science, of course, will have an integral role in 
encouraging research on vaccines, vaccine development and rapid testing 
to detect is this just a cold or is this, indeed, a more serious type 
of flu.
  The Committee on Veterans Affairs will be involved with educating 
veterans and combating the spread of the illness, as well as providing 
very educated, organized local spokespersons for educating the public 
should this disease become a problem.
  The Committee on Ways and Means will have significant oversight of 
trade issues as they become important. Look at the countries that could 
possibly be affected by this, as well as issues in countries that are 
currently experiencing an outbreak.
  Integration from the Federal, State and local levels is going to be 
critical. The global health threat is important. It should not, indeed, 
it cannot be ignored. But preparing for the threat within our own 
country is certainly critical.
  The virus, H5N1, could appear in the bird population as early as this 
fall in the Western Hemisphere; and even if it does appear in birds it 
doesn't mean that a pandemic has started. But because of the natural 
flyways that exist, that is a possibility that we need to be, we, in 
Congress, need to be prepared for how we educate our constituents and 
how we help our State and local officials adjust to that.

[[Page 12577]]

  Preparedness is going to be the greatest single tool at our disposal 
to mitigate what might otherwise be a disaster of worldwide 
proportions.
  Mr. Speaker, this is an important issue. I thank you for the time and 
letting me come to the House and talk about this tonight. I know I have 
covered a lot of these issues relatively quickly. I know a lot of the 
maps are somewhat involved, and they have gone by quickly. They are 
available on my Web site at burgess.house.gov.

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