NCPA - National Center for Policy Analysis


April 28, 2009

Swine flu has presented the Obama administration with its first major public-health crisis. Fortunately for the Obama team, the Bush administration developed new tools that will prove critical in meeting this challenge, says Tevi Troy, deputy secretary of Health and Human Services (HHS) from 2007 to 2009, and now a visiting senior fellow with the Hudson Institute.

Under President Bush, the federal government worked with manufacturers to accelerate vaccine development, stockpiled crucial antivirals like Tamiflu, war-gamed pandemic scenarios with senior officials, and increased the Centers for Disease Control and Prevention's (CDC) sample identification capabilities.  These activities are bearing fruit today, says Troy:

  • The Department of Health and Human Services (HHS) has already deployed 12.5 million courses of antivirals -- out of a total of 50 million -- to states and local agencies.
  • In addition, CDC's new capacities have allowed Mexican officials to send flu samples to CDC for quick identification, a capability that did not exist a few years ago.
  • Collaboration between the government and the private sector on vaccines -- which Bush and his HHS team actively encouraged -- could potentially allow manufacturers to shepherd a vaccine to market within four months of identifying the strain and getting the go-ahead from CDC or the World Health Organization.

But new tools aside, top health officials must answer difficult questions about response efforts, explains Troy.  One is when and where to deploy antivirals.

The Bush administration considered a "forest fire" approach to pandemic outbreaks abroad:

  • This strategy calls for sharing some of our precious supply of antivirals with a foreign country in order to stop a small flame from becoming a forest fire.
  • The risk is that we have only a limited number of courses, and the use of antivirals increases the odds that the flu strain in question will become resistant to that antiviral.
  • With 37.5 million courses remaining in the federal stockpile, the administration needs to think very carefully about how to use them.

Most importantly, the federal government must figure out how to reassure a nervous public.  It doesn't help that none of the 20 top officials at HHS has been confirmed.  Some of them, like FDA commissioner-designate Dr. Margaret Hamburg, are experts in biopreparedness and could help reassure Americans, says Troy.

Source: Tevi Troy, "How Bush Prepared for the Outbreak; Tools developed in the last few years will help the Obama administration fight back," Wall Street Journal, April 28, 2009.

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