Homeland Insecurity - The Monster at Our Door: The Global Threat of Avian Flu - page 56

and death. NIH pointed to glaring racial and income disparities in flu vaccine coverage, attributing the
low vaccination rates among blacks (22 percent), Latinos (19 percent), and the uninsured (14 percent) to
federal cutbacks as well as the increased dependence of Americans upon tightwad HMOs for their med-
ical care. 242 Another study by researchers at the University of Rochester found that only 39 percent of
black people over age sixty-five received influenza vaccinations as compared with 71 percent of white
seniors. 243 There was—and is—still a color line in prevention of flu mortality.
As the GAO constantly reminded Congress, the U.S. hospital system could no longer deal with pan-
demics or mass casualties of any kind. The restructuring of health care around HMOs, with the attendant
closure of hundreds of hospitals across the United States, had left many big cities without the capacity
to deal with abnormal spikes in patient loads; the HMO ideal was to ruthlessly reduce the number of un-
used, and thus unprofitable, hospital beds to zero: an example of “just-in-time” management gone berserk.
Public hospitals, meanwhile, were caught between their chronic budgetary problems and soaring demand
by the more than 40 million poor and uninsured Americans. A 2003 survey by the American College of
Emergency Physicians found that 90 percent of the country's 4,000 emergency departments were seri-
ously understaffed and overcrowded, with little surge capacity. 244
Influenza experts point to the ominous experience of Los Angeles during the H3N2/Sidney epidemic
in the winter of 1997/98 as a precursor to things to come. Having lost 17 percent of their beds since 1990,
Los Angeles County hospitals were overwhelmed by an unexpected influx of flu patients, hardly reassur-
ing evidence of the system's capacity to deal with a real pandemic crisis. 245 After the 2002 election the
Institute of Medicine looked back glumly at the Bush senior and Clinton epochs. It found that many of its
past recommendations had never been implemented and that the public-health system “that was in disar-
ray in 1988 remains in disarray today.” 246
This “disarray,” including all the flaws in HHS's influenza program (particularly the lack of an anti-
viral stockpile and adequate vaccine manufacturing capacity), was inherited by Tommy Thompson, the
former governor of Wisconsin, described as a “pragmatic conservative” by his friend Ted Kennedy. The
Clinton administration's handling of public-health issues had certainly been disappointing, but the new
Bush administration was frightening to everyone who had been fighting to prevent the total meltdown
of urban public health. Then, in September 2001, a new dispensation suddenly arrived in the form of
poisoned letters contaminated with “weaponized” anthrax. DNA sequencing would later reveal that the
anthrax strain used in the attacks almost certainly originated from the Army's own laboratory at Fort Det-
rick, Maryland, yet this probable “inside job” became the principal justification for national hysteria about
the threat of “bioterrorism” supposedly posed by Iraq, al-Qaeda, and other alien enemies of the United
States. 247
With shockingly little debate and without any real evidence that such a threat even existed, most
public-health advocacy groups, as well as such leading Democrats as John Edwards and Ted Kennedy,
became ardent shareholders in the bioterrorism myth. Even the liberal Trust for America's Health glibly
talked of an “Age of Bioterrorism” as if malevolent hands were already opening little vials of botulism
and Ebola on Main Street. In fact, the irresistible attraction of the so-called “health/security nexus” was
the billions that the White House was proposing to spend on Project BioShield, Bush's “major research
and production effort to guard our people against bioterrorism.” Many well-meaning people undoubtedly
reasoned that, however farfetched the excuse, the Republicans were finally throwing money in a worth-
while direction and that some of the windfall would surely find its way to real needs after decades of
neglect. Because the defensive preparations against bioterrorism borrowed heavily from pandemic plan-
ning, there was hope that influenza (previously shortchanged in the design of the National Pharmaceutical
Stockpile in 1999) would be accorded its proper rank as a “most wanted” bioterrorist.