Pandemic preparations vary widely by state

AP/CNN

Trailers packed with cots and medical supplies are parked in secret locations around Colorado, ready for doctors to open makeshift hospitals in school gyms if a flu pandemic strikes.

Parts of southeastern Washington are considering drive-thru flu shots during a pandemic -- although a practice run this fall showed they'd better hire traffic cops.

If Alabama closes schools amid a super-flu, students may take classes via public television. In Dallas, city librarians may replace sick 911 operators.

States and communities are getting creative as they struggle to answer the Bush administration's call to prepare for the next influenza pandemic, whether the culprit is the much-feared Asian bird flu or some other super-strain. (See how much anti-flu medication each state is getting. )

The Associated Press took a closer look at those preparations and found wide differences in how far along states are -- and little consensus on the best policies, even among neighboring states, on such basic issues as who decides whether to close schools.

Almost half the states haven't spent any of their own money yet to gird against a super-flu, relying instead on grants from the federal government.

Ethical queries abound about how to ration scarce drugs and vaccine. As Oklahoma epidemiologist Dr. Brett Cauthen puts it, that's "the toughest question out there."
Readiness hard to measure

Some states are debating whether to purchase the recommended anti-flu medications to store for their citizens, or to gamble that they'll receive enough from a federal stockpile.

And while some states proudly list other pandemic supplies they've stockpiled in guarded warehouses -- 4.5 million protective face masks, touts New York -- others, such as West Virginia, still are putting final drafts of their plans to paper.

"How are states doing, and how do we know how states are doing?" asked Dr. Pascale Wortley of the Centers for Disease Control and Prevention. "There's a lot of important things that are very hard to measure. It's a real challenge."

Indeed, when the government's first official assessment of state readiness begins in a few weeks, officials expect few states will have tackled some of the toughest issues: How will you keep grocery stores stocked? Will you reserve enough anti-flu drugs for utility workers so the water and electricity stay on? If you close schools, will local businesses let parents stay home with their children, or fire them?

When the feds fly in your state's share of vaccine and medicine, can you store it properly and get it to patients without being mobbed?

"Nothing, we think, is better than having 5,000 communities right now wrestle with this," said Dr. William Raub, emergency planning chief at the Department of Health and Human Services. "What will seem to work happily in one community is probably not going to work in some others."
Report card coming

Super-strains of the easy-to-mutate influenza virus cause worldwide outbreaks every few decades or so, three in the last century. Worst was the 1918 pandemic that killed about 50 million people worldwide, more than 500,000 in the U.S. alone. If a 1918-style pandemic struck today, up to a third of the population could fall ill and 1.9 million Americans could die.

With another pandemic overdue, the CDC began telling states to prepare years ago, plans that have taken on greater urgency with the simmering H5N1 bird flu. In 2004, just 29 states had pandemic plans of some sort. Today, all have at least a draft on paper.

Next spring, federal health officials will have their first report card on the quality of those preparations, based on a questionnaire that Raub hopes to ship to the states by month's end -- questions that will go beyond health care to ask how communities would keep the economy and society in general running.

Raub said he's not playing "gotcha," but that the responses are key to helping less prepared states catch up, and identifying best practices that neighbors can copy.

"I feel pretty confident we will have covered far and away all the important things," he said.

It's an assessment that public health advocates, worried at varying state investments, call long due.

"Where you live shouldn't determine your level of preparedness," said Jeff Levi, executive director of the Trust for America's Health. "This is not a question of letting 51 flowers bloom. The federal government, as the primary payer and the entity that can see the biggest picture, needs to define a minimum standard of protection that every American can expect."
Vaccine dilemmas

Because it will take months to custom-brew a vaccine once a pandemic begins, flu-treating medicines, mostly Tamiflu, form the backbone of the nation's preparations. World flu authorities recommend stockpiling enough for a quarter of the population, or 75 million Americans.

The Bush administration is in the process of buying enough to treat 44 million people, and will hold each state's share in a national stockpile.

States are supposed to buy enough to treat the remaining 31 million people, doses they would store. The federal government negotiated a cheap price and offered to chip in 25 percent of the cost, but told states "we need you to come the rest of the way," Raub said.

Most states say they do plan to buy at least some of those outstanding doses, although at least nine still are awaiting money for the purchases from their state legislatures.

And at least four states don't know if they'll spend their own scarce dollars for the extra purchases, saying the drugs might not work against a super-flu -- or expire before they're needed.

"There's a chance that it might be useful, but there's also a chance that it might not be useful at all," frets Arizona assist health director Will Humble. The state used a $1 million federal grant to purchase enough medicine for 66,000 people; he isn't sure if it will buy more.

Whether they buy their own stocks or not, many states don't yet know how they'll successfully dispense their share of the nationally stockpiled Tamiflu and other supplies once federal workers deliver it. A new requirement heading for the states: Figure out exactly how they'll handle the supplies so they get to doctors or pharmacies for proper dispersal.

"Some of these pallets weigh more than 350 pounds," noted Raub. "We think it (the plan) ought to be something more than 'Stick it in the back of the state police car and drive it somewhere."'
Help for other disasters

What if states do all this planning and the next pandemic never arrives? Much of the work is applicable to other disasters, too, from earthquakes to bioterrorism.

"People forget that you're supposed to be doing all-hazards preparedness," said Washington Secretary of Health Mary C. Selecky.

"We're trying to be prepared for a range of events," agreed Alabama emergency planner Kent Speigner, his voice echoing in a cavernous warehouse where the state stores flu supplies right next to smallpox supplies. "We really don't know what's coming next."