Structural Contradictions - The Monster at Our Door: The Global Threat of Avian Flu - page 62

would come first, frontline health workers or their most vulnerable patients? Elderly people or babies?
Young mothers or policemen? Or perhaps the imperial legions should be protected first? In late September
the Pentagon circulated its own pandemic planning guidelines which emphasized that the Tamiflu “supply
is extremely limited world wide, and its use will be prioritized.” The military's “top priority for use of
vaccine or antiviral medications is in forward deployed operational forces. . . . We are currently working
with HHS on agreements to share in the HHS/CDC Strategic National Stockpile (SNS).” 274 Soldiers first,
children last?
Such questions deeply trouble the medical community. At a 2002 meeting of public-health officials
from forty-six different states, participants were hopelessly divided when they tried to choose which of
five goals (reduce deaths, reduce disease, limit impact, ensure essential services, or “equitable distri-
bution”) should be paramount in allocation of scarce antivirals. 275 More recently, in August 2004, the
American College of Physicians and the American Society of Internal Medicine jointly expressed con-
cerns about the CDC's proposal to ration any future avian flu vaccine among vulnerable groups, stating
a “strong consensus among our group that limiting vaccine to specific target groups suggested by CDC
may be less than optimal.” In October Dr. Andrew Parvia, the chair of the Infectious Diseases Society
of America's pandemic influenza taskforce, reported similar concerns to the society's annual conference.
He emphasized the need for clear, consistent guidelines for “triage,” and he proposed that pneumococcal
vaccines that reduce the likelihood of secondary infections be added to the pandemic stockpile. He also
criticized the Bush administration's miserly budget for pandemic influenza: Pavia stated that the proposed
$100 million “seriously underestimates the amount of funds realistically needed to effectively respond to
the next pandemic.” 276
Meanwhile, grim audits of the nation's real biosecurity situation were piling up at Tommy Thompson's
doorstep. Michael Osterholm, the director of the University of Minnesota's Center for Infectious Disease
Research and Policy, garnered much press attention with a warning that the H5N1 vaccine that the Na-
tional Institutes of Health had been developing with Aventis-Pasteur had “poor immunogenicity” (ability
to trigger an immune response). Osterholm warned: “The earlier versions of this vaccine are not protect-
ive against the current [H5N1] strains.” He doubted that the government's slow-motion vaccine program
would provide a safety net in advance of a pandemic. “In the early stages of a pandemic I don't believe
we will have a pandemic influenza vaccine of any substantive nature.” 277 (This echoed the offical pan-
demic plan's own pessimistic prediction that in the beginning of an outbreak “there will likely be no or
very limited amounts of vaccine available. This period could last for up to six months.”) 278 Keiji Fukuda,
the CDC's top flu epidemiologist, direly predicted that at the beginning of a pandemic “there would be
panic” and that hospitals would be unable to find room for all the acute cases. 279
Similarly, in the aftermath of the vaccine fiasco, both the Washington Post and the nonprofit Trust
for America's Health published devastating balance-sheets revealing Project BioShield's failure to en-
hance the country's biological security. The Post reporters, who interviewed former administration offi-
cials, found that the “great majority of U.S. hospitals and state and local public health agencies would be
completely overwhelmed trying to carry out mass vaccinations.” And indeed, during a May 2003 mock
casualty exercise to test Chicago's capacity to cope with a bioterror attack or a pandemic, the emergency
infrastructure collapsed. Richard A. Falkenrath, a former chief advisor on homeland security, told the Post
that “the government's reliance on state and local health agencies to speedily distribute vaccines and drugs
is the 'Achilles heel' of U.S. biodefenses.” In obvious understatement, the Post characterized as “vast”
the task of “redirecting cash-starved hospitals and local health agencies into the unfamiliar field of mass
casualty response.” 280
The Trust for America's Health was equally pessimistic. One-third of states had cut back their public-
health budgets in 2003-4, and a majority were woefully unprepared to undertake high biosecurity lab