The likelihood remains remote of an outbreak in the United States of what health workers say is the most dangerous strain of avian flu. But the White House - perhaps mindful of the fumbled federal response to hurricane Katrina - has decided that it's time to rally the nation behind pandemic flu preparedness.
Thus President Bush on Tuesday outlined a $7.1 billion strategy that would stockpile vaccines and antiviral drugs and urge preparation of US emergency plans to respond to any future avian flu outbreak.
That's all well and good, say some experts. The US may need to increase its internal capacity to deal with such a threat. But other nations, they add, need to develop flu defenses, too - and in this case the US might be able to help itself by helping others. Public health aid for countries such as Vietnam or Thailand, where experts say a pandemic would be most likely to start, could establish a perimeter defense against flu reaching the US.
Mr. Bush's strategy "is largely focused on creating capacity and resources within the US to deal with the risk of flu pandemic," says Brook Baker, a law professor and an expert on access to healthcare at Northeastern University School of Law in Boston. "It would do far less to develop capacity in other countries, especially countries where the flu is likely to originate."
Outlining his plan in a speech at the National Institutes of Health in Bethesda, Md., Bush said that no one knows when or where a pandemic of avian flu might strike.
At present, the kind of avian flu said to be the most deadly, the H5N1 strain, has affected humans only in extremely rare cases. All diagnosed cases have occurred in Southeast Asia. The strain, researchers say, would have to mutate significantly to become a serious danger to humans.
Yet it is right to be concerned, said Bush, given the scale of the potential danger. The 1918 flu pandemic affected one-third of the US population.
"At this moment there is no pandemic influenza in the United States or the world, but if history is our guide there's reason to be concerned," said Bush.
The White House plan would allot $2.8 billion to speed the development of new vaccines. A further $2.2 billion would pay for stockpiles of the vaccine against the current strain of bird flu and for antiviral drugs that health workers hope would alleviate flu symptoms.
A $583 million subsidy would pay for state and local governments to prepare emergency plans to respond in the event of an outbreak. Some $251 million would help fund a new international partnership on avian and pandemic influenza. This partnership would help other nations train personnel and improve surveillance and testing.
What the plan does not do is fund medicine for international use. Such drugs are expensive, as the billions earmarked for a possible US supply show.
Some public health organizations lauded Bush for taking the avian flu threat seriously, but said that state and local organizations deserve more funding.
Given the flu's limited impact to date, Bush's flu plan might be seen as alarmist, according to Dr. Marc Siegel, an associate professor at the New York University School of Medicine. "The potential widespread effects of an eventual pandemic are worthy of preparation, not panic," writes Dr. Siegel in a statement on the Bush plan.