A Man With An Antiflu Plan
Former Utah Gov. Mike Leavitt, secretary of the Department of Health and Human Services, has become the point man for the Bush administration's efforts to combat a pandemic flu outbreak. He spoke with U.S. News last week after unveiling the administration's long-awaited $7.1 billion plan.
When you were nominated late last year, the focus was on bioterrorism. When did pandemic flu show up on your radar?
Even before I was confirmed, I started asking what could go wrong, and what we should be doing to prepare. Pandemic flu quickly came into focus as a potentially world-changing event.
You just testified on the Hill with John Barry, author of The Great Influenza, about the 1918 flu pandemic that killed at least 20 million people worldwide. What did that book tell you?
Barry's book added substantially to my scientific understanding of viruses and their complexity. What makes a pandemic dangerous is a world unprotected from a killer virus. Viruses are not a respecter of sovereignty; they don't respond to jurisprudence. They revere only antibodies. That was true in 1918, and it's true today.
SARS was an important learning experience for the world. It should have been a wake-up call. Eight thousand people contracted SARS; regrettably, 800 died. When you place that up against a 1918-like event, it was not large, and yet it crippled the Chinese economy for a lengthy period, and it paralyzed the world for a moment.
We've had another wake-up call lately--Hurricane Katrina.
When Katrina happened, and then Rita, I spent a couple of weeks traveling to the cities that were affected. I visited shelter after shelter and medical facility after medical facility. They were overrun by people who were traumatized by their experience. I could not help but feel that in a pandemic, we could have similar conditions happening in every part of the United States simultaneously. And over long periods of time. [And] it's likely that people would be reluctant to [help] because of the fear of being infected.
The federal plan calls for stockpiling Tamiflu for about one quarter of the population. Shouldn't we have more?
Would we want to? Tamiflu and other antivirals have a very important role in a comprehensive plan. But any idea that Tamiflu is synonymous with preparation is wrong. We have no certainty that Tamiflu will be effective against the H5N1 virus [the Asian strain of avian flu]. We have no certainty that it will be effective against the virus that ultimately creates the pandemic. By putting too much weight on antivirals, you have a situation where you cannot change your protective tool to match the threat. The foundation of our strategy is a vaccine.
Yet a pandemic flu vaccine wouldn't be available for all Americans until 2010 at the earliest. What do we do in the meantime?
Let's talk about the plan. The plan is not a plan for H5N1. It's a plan for pandemic readiness. We do not know what the likelihood is that H5N1 will make the transition to person-to-person transmission. We do not know if it will be the virus that sparks a pandemic. What I think history tells us is that there will be a virus at some point in the future that will. We need to be ready for that.
If by some chain of bad fortune it was H5N1 and we were dealing with it soon, we have limited tools. We are not as well prepared as we would like to be. We would be working with basic public-health measures. I believe we would do far better than they did in 1918, because healthcare is substantially better. By keeping people hydrated and clean, we would minimize substantially the harm that would otherwise happen.
What are you doing to get your family prepared for a pandemic?
We've had the conversation in our family of who would we call if we got separated, where would we reunite. We've begun thinking through, are there medications that would be necessary? Could we, if we needed to, stay at home for a time? We're just a few hundred feet from a convenience store, and we've come to depend on it as our pantry. That's not a good idea.
In the 1918 pandemic, many public officials were craven, or worse, and many people died as a result. What would you hope for your own performance if the worst happens?
My responsibility is to speak with clarity, where clarity is available. To inform but not inflame. To inspire preparation but not panic. One of the lessons of the Barry book for me is the missteps that occurred in withholding information. That is such an important balance in this business. Are we scaring people? This is scary stuff. I know that. It's clear to me that at some point if the H5N1 virus does not spark a pandemic, someone is going to say we overreacted. Someone is going to say [we] were crying wolf. Therefore, it's important to me that we have done our best to tell it straight and to let people be informed and draw their own conclusions.
This story appears in the November 14, 2005 print edition of U.S. News & World Report.