    [Public Papers of the Presidents of the United States: George W. Bush (2005, Book II)]
    [November 1, 2005]
    [Pages 1630-1636]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks on the National Strategy for Pandemic Influenza Preparedness and
    Response in Bethesda, Maryland
    November 1, 2005

        Thank you all. Michael, thank you
    very much for your introduction. And thanks for the warm reception here
    at the National Institute of Health. It's good to be back here again.
        For more than a century, the NIH has been at the forefront of this
    country's efforts to prevent, detect, and treat disease, and I
    appreciate the good work you're doing here. This is an important
    facility, an important complex, and the people who work here are really
    important to the security of this Nation. The scientists who have been
    supported by the folks who work here have developed and improved
    vaccines for meningitis and whooping cough and measles and mumps and
    rubella and chicken pox and other infectious diseases. Because of the
    revolutionary advances in medicine, pioneered with the help of the NIH,
    Americans no longer fear these dreaded diseases; many lives have been
    saved.
        At this moment, the men and women of the NIH are working to protect
    the American people from another danger, the risk of avian and pandemic
    influenza. Today I have come to talk about our Nation's efforts to
    address this vital issue to the health and the safety of all Americans.
    I'm here to discuss our strategy to prevent and protect the American
    people from a possible outbreak.
        I appreciate members of my Cabinet who are here. More importantly, I
    appreciate the hard work you've done on this issue--Secretary
    Rice, Secretary Johanns, Secretary Mineta, Secretary
    Nicholson, Secretary Chertoff.
        I appreciate the fact that Dr. J.W. Lee,
    Director-General of the World Health Organization, has joined us. Dr.
    Lee, thank you for being here. I want to recognize Dr. David
    Nabarro, the Senior United Nations System
    Coordinator for Avian and Human Influenza. Thanks for being here. This
    is--you're about to hear me talk about the international scope of
    response and detection necessary to protect not only our own people but
    people around the world. And the fact that these two gentlemen are here
    is an important signal.
        I want to thank Dr. Elias Zerhouni,
    he's the Director of the NIH--doing a fine job. I want to thank Julie
    Gerberding, who's the Director of the
    Centers for Disease Control and Prevention. I appreciate Dr. Rich
    Carmona, the U.S. Surgeon General; Dr.
    Tony Fauci, Director of the National
    Institute of Allergy and Infectious Diseases. I want to thank Dr. Bruce
    Gellin, Director of the National Vaccine
    Program Office. I want to thank Dr. Andy von Eschenbach, who is the Acting Director of the FDA and the
    Director of the National Cancer Institute.
        I appreciate all the members of the health care community who have
    joined us today. I want to thank State and local officials who are here.
    I particularly want to thank Senators Specter
    and Kennedy for

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    coming, as well as Congressmen Linder,
    Burgess, and Price.NM/ Appreciate you all taking time to be here.
        Most Americans are familiar with the influenza or the ``flu'' as a
    respiratory illness that makes hundreds of thousands of people sick
    every year. This fall as the flu season approaches, millions of our
    fellow citizens are once again visiting their doctors for the annual flu
    shot. I had mine. For most, it's just simply a precautionary measure to
    avoid the fever or a sore throat or muscle aches that come with the flu.
    Seasonal flu is extremely dangerous for some, people whose immune
    systems have been weakened by age or illness, but it is not usually
    life-threatening for most healthy people.
        Pandemic flu is another matter. Pandemic flu occurs when a new
    strain of influenza emerges that can be transmitted easily from person
    to person and for which there is little or no natural immunity. Unlike
    seasonal flu, most people have not built up resistance to it. And unlike
    seasonal flu, it can kill those who are young and healthy as well as
    those who are frail and sick.
        At this moment, there is no pandemic influenza in the United States
    or the world. But if history is our guide, there is reason to be
    concerned. In the last century, our country and the world have been hit
    by three influenza pandemics, and viruses from birds contributed to all
    of them. The first, which struck in 1918, killed over a half-a-million
    Americans and more than 20 million people across the globe. One-third of
    the U.S. population was infected, and life expectancy in our country was
    reduced by 13 years. The 1918 pandemic was followed by pandemics in 1957
    and 1968, which killed tens of thousands of Americans and millions
    across the world.
        Three years ago, the world had a preview of the disruption an
    influenza pandemic can cause when a previously unknown virus called SARS
    appeared in rural China. When an infected doctor carried the virus out
    of China, it spread to Vietnam and Singapore and Canada within a month.
    Before long, the SARS virus had spread to nearly 30 countries on six
    continents. It infected more than 8,000 people and killed nearly 800.
    One elderly woman brought the virus from Hong Kong to Toronto, where it
    quickly spread to her son and then to others. Eventually, four others
    arrived with the virus, and hundreds of Canadians fell ill with SARS,
    and dozens died.
        By one estimate, the SARS outbreak cost the Asian-Pacific region
    about $40 billion. The airline industry was hit particularly hard, with
    air travel to Asia dropping 45 percent in the year after the outbreak.
    All this was caused by a limited outbreak of a virus that infected
    thousands and lasted about 6 months. A global influenza pandemic that
    infects millions and lasts from 1 to 3 years could be far worse.
        Scientists and doctors cannot tell us where or when the next
    pandemic will strike or how severe it will be, but most agree, at some
    point, we are likely to face another pandemic. And the scientific
    community is increasingly concerned by a new influenza virus known as
    H5N1 or avian flu that is now spreading through bird populations across
    Asia and has recently reached Europe.
        This new strain of influenza has infected domesticated birds like
    ducks and chickens as well as long-range migratory birds. In 1997, the
    first recorded outbreak among people took place in Hong Kong, when 18
    people became infected and 6 died from the disease. Public health
    officials in the region took aggressive action and successfully
    contained the spread of the virus. Avian flu struck again in late 2003
    and has infected over 120 people in Thailand, Cambodia, Vietnam, and
    Indonesia, and killed more than 60. That's a fatality rate of about 50
    percent.
        At this point, we do not have evidence that a pandemic is imminent.
    Most of the people in Southeast Asia who got sick were handling infected
    birds. And while the

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    avian flu virus has spread from Asia to Europe, there are no reports of
    infected birds, animals, or people in the United States. Even if the
    virus does eventually appear on our shores in birds, that does not mean
    people in our country will be infected. Avian flu is still primarily an
    animal disease. And as of now, unless people come into direct, sustained
    contact with infected birds, it is unlikely they will come down with
    avian flu.
        While avian flu has not yet acquired the ability to spread easily
    from human to human, there is still cause for vigilance. The virus has
    developed some characteristics needed to cause a pandemic. It has
    demonstrated the ability to infect human beings, and it has produced a
    fatal illness in humans. If the virus were to develop the capacity for
    sustained human-to-human transmission, it could spread quickly across
    the globe.
        Our country has been given fair warning of this danger to our
    homeland and time to prepare. My responsibility as the President is to
    take measures now to protect the American people from the possibility
    that human-to-human transmission may occur. So several months ago, I
    directed all relevant departments and agencies in the Federal Government
    to take steps to address the threat of avian and pandemic flu. Since
    that time, my administration has developed a comprehensive national
    strategy, with concrete measures we can take to prepare for an influenza
    pandemic.
        Today I am announcing key elements of that strategy. Our strategy is
    designed to meet three critical goals: First, we must detect outbreaks
    that occur anywhere in the world; second, we must protect the American
    people by stockpiling vaccines and antiviral drugs and improve our
    ability to rapidly produce new vaccines against a pandemic strain; and
    third, we must be ready to respond at the Federal, State, and local
    levels in the event that a pandemic reaches our shores.
        To meet these three goals, our strategy will require the combined
    efforts of government officials in public health, medical, veterinary,
    and law enforcement communities and the private sector. It will require
    the active participation of the American people. And it will require the
    immediate attention of the United States Congress so we can have the
    resources in place to begin implementing this strategy right away.
        The first part of our strategy is to detect outbreaks before they
    spread across the world. In the fight against avian and pandemic flu,
    early detection is our first line of defense. A pandemic is a lot like a
    forest fire: If caught early, it might be extinguished with limited
    damage; if allowed to smolder undetected, it can grow to an inferno that
    spreads quickly beyond our ability to control it. So we're taking
    immediate steps to ensure early warning of an avian or pandemic flu
    outbreak among animals or humans anywhere in the world.
        In September at the United Nations, I announced a new International
    Partnership on Avian and Pandemic Influenza, a global network of
    surveillance and preparedness that will help us to detect and respond
    quickly to any outbreaks of the disease. The partnership requires
    participating countries that face an outbreak to immediately share
    information and provide samples to the World Health Organization. By
    requiring transparency, we can respond more rapidly to dangerous
    outbreaks.
        Since we announced this global initiative, the response from across
    the world has been very positive. Already, 88 countries and 9
    international organizations have joined the effort. Senior officials
    from participating governments recently convened the partnership's first
    meeting here in Washington.
        Together, we're working to control and monitor avian flu in Asia and
    to ensure that all nations have structures in place to recognize and
    report outbreaks before they spread beyond human control. I've requested
    $251 million from Congress to help

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    our foreign partners train local medical personnel, expand their
    surveillance and testing capacity, draw up preparedness plans, and take
    other vital actions to detect and contain outbreaks.
        A flu pandemic would have global consequences, so no nation can
    afford to ignore this threat, and every nation has responsibilities to
    detect and stop its spread.
        Here in the United States, we're doing our part. To strengthen
    domestic surveillance, my administration is launching the National Bio-
    Surveillance Initiative. This initiative will help us rapidly detect,
    quantify, and respond to outbreaks of disease in humans and animals and
    deliver information quickly to State and local and national and
    international public health officials. By creating systems that provide
    continuous situational awareness, we're more likely to be able to stop,
    slow, or limit the spread of the pandemic and save American lives.
        The second part of our strategy is to protect the American people by
    stockpiling vaccines and antiviral drugs and accelerating development of
    new vaccine technologies. One of the challenges presented by a pandemic
    is that scientists need a sample of the new strain before they can
    produce a vaccine against it. This means it is difficult to produce a
    pandemic vaccine before the pandemic actually appears, and so there may
    not be a vaccine capable of fully immunizing our citizens from the new
    influenza virus during the first several months of a pandemic.
        To help protect our citizens during these early months when a fully
    effective vaccine would not be available, we're taking a number of
    immediate steps. Researchers here at the NIH have developed a vaccine
    based on the current strain of the avian flu virus. The vaccine is
    already in clinical trials. And I'm asking that the Congress fund $1.2
    billion for the Department of Health and Human Services to purchase
    enough doses of this vaccine from manufacturers to vaccinate 20 million
    people.
        This vaccine would not be a perfect match to the pandemic flu
    because the pandemic strain would probably differ somewhat from the
    avian flu virus it grew from. But a vaccine against the current avian
    flu virus would likely offer some protection against a pandemic strain
    and possibly save many lives in the first critical months of an
    outbreak.
        We're also increasing stockpiles of antiviral drugs such as Tamiflu
    and Relenza. Antiviral drugs cannot prevent people from contracting the
    flu. It can--but they can reduce the severity of the illness when taken
    within 48 hours of getting sick. So in addition to vaccines, which are
    the foundation of our pandemic response, I am asking Congress for a
    billion dollars to stockpile additional antiviral medications, so that
    we have enough on hand to help treat first-responders and those on the
    frontlines, as well as populations most at risk in the first stages of a
    pandemic.
        To protect the greatest possible number of Americans during a
    pandemic, the cornerstone of our strategy is to develop new technologies
    that will allow us to produce new vaccines rapidly. If a pandemic
    strikes, our country must have a surge capacity in place that will allow
    us to bring a new vaccine on line quickly and manufacture enough to
    immunize every American against the pandemic strain.
        I recently met with leaders of the vaccine industry. They assured me
    that they will work with the Federal Government to expand the vaccine
    industry, so that our country is better prepared for any pandemic.
    Today, the NIH is working with vaccine makers to develop new cell-
    culture techniques that will help us bring a pandemic flu vaccine to the
    American people faster in the event of an outbreak. Right now most
    vaccines are still produced with 1950's technology using chicken eggs
    that are infected with the influenza virus and then used to develop and
    produce vaccines. In the event of a pandemic, this antiquated

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    process would take many, many months to produce a vaccine, and it would
    not allow us to produce enough vaccine for every American in time.
        Since American lives depend on rapid advances in vaccine-production
    technology, we must fund a crash program to help our best scientists
    bring the next generation of technology on line rapidly. I'm asking
    Congress for $2.8 billion to accelerate development of cell-culture
    technology. By bringing cell-culture technology from the research
    laboratory into the production line, we should be able to produce enough
    vaccine for every American within 6 months of the start of a pandemic.
        I'm also asking Congress to remove one of the greatest obstacles to
    domestic vaccine production, the growing burden of litigation. In the
    past three decades, the number of vaccine manufacturers in America has
    plummeted as the industry has been flooded with lawsuits. Today, there
    is only one manufacturer in the United States that can produce influenza
    vaccine. That leaves our Nation vulnerable in the event of a pandemic.
    We must increase the number of vaccine manufacturers in our country and
    improve our domestic production capacity. So, Congress must pass
    liability protection for the makers of lifesaving vaccines.
        By making wise investments in technology and breaking down barriers
    to vaccine production, we're working toward a clear goal: In the event
    of a pandemic, we must have enough vaccine for every American.
        The third part of our strategy is to ensure that we are ready to
    respond to a pandemic outbreak. A pandemic is unlike other natural
    disasters; outbreaks can happen simultaneously in hundreds or even
    thousands of locations at the same time. And unlike storms or floods,
    which strike in an instant and then recede, a pandemic can continue
    spreading destruction in repeated waves that can last for a year or
    more.
        To respond to a pandemic, we must have emergency plans in place in
    all 50 States and every local community. We must ensure that all levels
    of government are ready to act to contain an outbreak. We must be able
    to deliver vaccines and other treatments to frontline responders and at-
    risk populations.
        So my administration is working with public health officials in the
    medical community to develop effective pandemic emergency plans. We're
    working at the Federal level. We're looking at ways and options to
    coordinate our response with State and local leaders. I've asked
    Mike Leavitt--Secretary Leavitt--to bring
    together State and local public health officials from across the Nation
    to discuss their plans for a pandemic and to help them improve pandemic
    planning at the community level. I'm asking Congress to provide $583
    million for pandemic preparedness, including $100 million to help States
    complete and exercise their pandemic plans now, before a pandemic
    strikes.
        If an influenza pandemic strikes, every nation, every State in this
    Union, and every community in these States must be ready.
        To respond to a pandemic, we need medical personnel and adequate
    supplies of equipment. In a pandemic, everything from syringes to
    hospital beds, respirators, masks, and protective equipment would be in
    short supply. So the Federal Government is stockpiling critical supplies
    in locations across America as part of the Strategic National Stockpile.
    The Department of Health and Human Services is helping States create
    rosters of medical personnel who are willing to help alleviate local
    shortfalls during a pandemic. And every Federal department involved in
    health care is expanding plans to ensure that all Federal medical
    facilities, personnel, and response capabilities are available to
    support local communities in the event of a pandemic crisis.
        To respond to a pandemic, the American people need to have
    information to protect themselves and others. In a pandemic, an

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    infection carried by one person can be transmitted to many other people,
    and so every American must take personal responsibility for stopping the
    spread of the virus. To provide Americans with more information about
    pandemics, we're launching a new web site, pandemicflu.gov. That ought
    to be easy for people to remember: pandemicflu.gov. The web site will
    keep our citizens informed about the preparations underway, steps they
    can take now to prepare for a pandemic, and what every American can do
    to decrease their risk of contracting and spreading the disease in the
    event of an outbreak.
        To respond to a pandemic, members of the international community
    will continue to work together. An influenza pandemic would be an event
    with global consequences, and therefore we'll continue to meet to
    develop a global response. We've called nations together in the past and
    will continue to call nations together to work with public health
    experts to better coordinate our efforts to deal with a disaster.
        Now, all the steps I've outlined today require immediate resources.
    Because a pandemic could strike at any time, we can't waste time in
    preparing. So to meet all our goals, I'm requesting a total of $7.1
    billion in emergency funding from the United States Congress. By making
    critical investments today, we'll strengthen our ability to safeguard
    the American people in the awful event of a devastating global pandemic
    and, at the same time, will bring our Nation's public health and medical
    infrastructure more squarely in the 21st century.
        The steps I've outlined will also help our Nation in other critical
    ways. By perfecting cell-based technologies now, we will be able to
    produce vaccines for a range of illnesses and save countless lives. By
    strengthening our domestic vaccine industry, we can help ensure that our
    Nation will never again have a shortage of vaccine for seasonal flu. And
    by putting in place and exercising pandemic emergency plans across the
    Nation, we can help our Nation prepare for other dangers, such as a
    terrorist attack using chemical or biological weapons.
        Leaders at every level of government have a responsibility to
    confront dangers before they appear and engage the American people on
    the best course of action. It is vital that our Nation discuss and
    address the threat of pandemic flu now. There is no pandemic flu in our
    country or in the world at this time, but if we wait for a pandemic to
    appear, it will be too late to prepare, and one day many lives could be
    needlessly lost because we failed to act today.
        By preparing now, we can give our citizens some peace of mind
    knowing that our Nation is ready to act at the first sign of danger and
    that we have the plans in place to prevent and, if necessary, withstand
    an influenza pandemic.
        Thank you for coming today to let me outline my strategy. Thank the
    United States Congress for considering this measure. May God bless you
    all.

    Note: The President spoke at 10:04 a.m. in the William H. Natcher
    Conference Center at the National Institutes of Health. The Office of
    the Press Secretary also released a Spanish language transcript of these
    remarks.

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