New Report - Tamiflu Is 'Useless' For Avian Flu

12-4-5

 

LONDON (UPI) -- A Vietnamese doctor with experience in treating avian flu says Tamiflu, the drug being stockpiled for treatment of avian flue is useless against the virus.   Dr. Nguyen Tuong Van of the Centre for Tropical Diseases in Hanoi has treated 41 victims of H5N1, following World Health Organization guidelines and administering Tamiflu to her patients. She told the Sunday Times of London the medicine had no effect.   "We place no importance on using this drug on our patients," she said. "Tamiflu is really only meant for treating ordinary type A flu. It was not designed to combat H5N1."   The newspaper said the finding casts doubt on the British government's pandemic flu policy. The nation's top medical official, Sir Liam Donaldson, has ordered 15 million doses of Tamiflu be stockpiled.   Van said the only way to keep avian flu patients alive is to "support" all their vital organs -- including the liver and kidneys -- with modern technology like ventilators and dialysis machines, the Sunday Times reported.   The WHO has acknowledge Tamiflu had not been "widely successful in human patients," but said it believes it would have been more effective in many Asian countries if it had been used earlier in the illness.   Copyright 2005 by United Press International. All Rights Reserved.

A three-day council of war on avian influenza opened here to warnings that a flu pandemic was inevitable, could kill millions and inflict up to 800 billion dollars in economic damage if the world failed to defend itself.

An influenza pandemic, potentially unleashed by a mutation of the H5N1 bird flu virus, "is only a matter of time," World Health Organisation (WHO) Director General Lee Jong-Wook said Monday.

"We don't know when this will happen, but we know it will happen," Lee said. "(...) If we are unprepared, the next pandemic will cause incalculable human misery... no society will be exempt and no economy will be unscathed."

Samuel Jutzi, director of the animal production and health division at the Food and Agricultural Organisation (FAO), said "the window of opportunity" remained open for tackling the threat at its source: on the farm.

"The virus has not yet reassorted or mutated," said Jutzi. "Action is required now. There is no time to lose here."

The Geneva confab is the seniormost global meeting of doctors, veterinarians and public-health officials since the avian influenza scare erupted in 2003.

It is also the first to gather the World Bank alongside the WHO, the FAO and World Organisation for Animal Health (OIE), a Paris-based agency that sets veterinary standards in farm trade.

The conference takes place against a backdrop of growing concern about the failure to roll back the H5N1 bird flu virus in Asia, its spread to Europe and the vulnerability of Africa, the world's poorest continent.

"We have experienced a relentless spread of avian flu," Lee said sombrely.

Lee said that 63 deaths, out of 124 known cases of human infection, had been reported to the WHO, 150 million fowl had been slaughtered and the economic cost of the virus was more than 10 billion dollars.

The World Bank's lead economist for East Asia and the Pacific, Milan Brahmbhatt, said that a major pandemic could clip between two or three percent off the global economy, inflicting costs of as much as 800 billion after a year.

For rich countries alone, the cost could be 550 billion dollars, the World Bank said separately in a report issued in Geneva.

At present, H5N1 is transmissible from bird to humans who are closely exposed to virus expelled by sickly fowl in their faeces and nasal secretions.

But it cannot be easily passed from humans to humans. The fear is that the more the virus spreads, the greater chance it has to mutate, picking up genes from ordinary flu that could make it highly contagious from humans to humans.

This feared mutation could occur if H5N1 is transmitted to a human or a pig that already has been infected by the conventional flu virus.

No-one would have any immunity against the new pathogen, which means a pandemic could swiftly spread in the modern era of jet travel and the globalised economy.

The Geneva meeting is looking at national and global preparations for coping with a pandemic.

These include stockpiling drugs and face masks, preparing hospitals for an emergency, setting up emergency transport and food supplies, and advising the public in order to avert a panic.

But a bigger priority is to target the risk of a virus mutation itself, among domestic fowl where H5N1 has holed up.

This means beefing up veterinary surveillance, culling infected poultry, protecting fowl with H5N1 vaccine and reporting cases of infection swiftly and accurately.

Another task is to compensate farmers for culls. If too little is offered, farmers may hide an outbreak of disease; if too much is offered, they may be tempted to deliberately infect their birds, said Brahmbhatt.

Indonesia's state minister for national development planning, Sri Mulyani Indrawati, acknowledged that her country was wrestling with major problems, and "at sometimes we are quite overstretched."

The country lacks local veterinarians to check on flocks and epidemiologists to monitor and evaluate outbreaks and illegal vaccines are circulating, she said.

Mike Ryan, director of the WHO's epidemic and pandemic alert and response unit, said that fixing basic gaps in veterinary and human wealth would not come cheap.

"We need capital investment. This is going to cost money," Ryan said.

The World Bank said last Friday it would make up to 500 million dollars available to poor countries to help them meet the threat.

CHICAGO (AdAge.com) -- Amid rising fears of a bird flu pandemic, Kentucky Fried Chicken is preparing a consumer education plan to reassure customers that it’s safe to eat chicken.

Photo: AP

Although the bird flu virus is not known to have mutated into a form that can spread from human to human, there is a growing world fear that such an outbreak will occur.

China experience
Executives from the chain’s parent, Yum Brands, estimate sales could drop 10% to 20% in the U.S. based on its experience in China. They recently revealed their contingency plan to a small group of analysts and investors. The program is spearheaded by Yum Senior VP-Public Relations Jonathan Blum and includes TV advertising to educate consumers that eating cooked chicken is perfectly safe.

“We, like others, are watching this closely and have been developing contingency plans which we hope we won’t have to use,” the company said in a statement. “The World Health Organization has been clear that you can’t get the flu from cooked chicken, which is perfectly safe to eat.”

$50 billion business
Since chicken is a $50 billion retail business in this country -- each American will eat 90 pounds this year -- leading industry associations are also preparing educational efforts about poultry handling.

Larry Miller, restaurant analyst with Prudential Equity Group, said in a recent investors note that chicken demand is slipping 20% to 40% in parts of Europe and China on avian flu fears. In Guantang, Shanghai’s largest poultry wholesale market, sales have dropped by as much as 80%.

Through October, 122 people in Asia have been confirmed infected from contact with the H5N1 flu strain, and half have died, according to the World Health Organization. Should the bird flu mutate and become transferable from human to human, the pandemic could spread rapidly, affecting up to one-third of the population and it could kill up to two million Americans, according to a new report and response plan from the department of Health and Human Services.

No U.S. cases
No cases have reached the U.S. and the virus is not known to have mutated to pass from human to human. Still, industry and health leaders have been bracing for the worst while trying to avoid inciting public panic.

In an Oct. 26 technical briefing from the U.S. Department of Agriculture, Dr. Richard Raymond, undersecretary for food safety, said that theoretically people can be infected by eating undercooked, diseased poultry. “That’s why we continue to stress proper processing, handling and cooking,” he said.

A spokeswoman for the U.S. Poultry & Egg Association said it is prepared to “provide technical support and advice for companies who need assistance in implementing or developing” educational plans. “We would respond in an appropriate manner based on the perceived need or actual situation.”

National Chicken Council
The National Chicken Council has set up a Web site to address consumer concerns (avianinfluenzainfo.com) but has not taken other steps. “To date, we have not had any indications of great consumer concern about this,” said Richard Lobb, communications director. “American consumers are not usually inclined to panic. They know the chicken they eat is not a hazard. It’s pretty premature to put up posters saying your chicken is safe.”

Poultry marketers Perdue Farms and Tyson Foods have prepared press releases offering information on avian flu, trying to allay concerns that eating U.S. poultry is a danger. Perdue noted that no one has been known to have been infected by eating poultry. But the poultry industry is otherwise trying to keep its head low. “Why start making noise about a potential issue that Americans aren’t that concerned about so far?” said Credit Suisse First Boston analyst Dave Nelson.

James McCoy, senior analyst at Mintel, said that having a communications plan such as Yum’s is a good idea, but that implementing it could be tricky. “There is a risk if a company jumps the gun and starts screaming a bit too loud that something may be safe to eat because it may scare customers. If Yum came out now and said, ‘It’s OK to eat chicken,’ consumers probably would be wondering, 'Why are they telling us?'”

Restaurant analysts
Restaurant analysts were comforted. “While we believe that bird-flu-headline risk may increase in the near-term, we take some comfort in knowing that Yum management -- particularly in China -- is adept at handling these issues from a supply chain and consumer reaction standpoint," David Palmer, analyst with UBS Research, wrote in a Nov. 3 note. “This shows that Yum Brands management is adept at damage control ... in the face of a food scare.”

NPD Group has been monitoring public awareness of bird flu in its Food Safety Monitor, and in recent weeks the number of U.S. adults aware of and concerned about avian flu grew 16%.

Of six restaurant marketers contacted about their plans, only a handful responded. “McDonald’s has the highest food quality and safety standards in the industry," the world’s largest fast-food company said in a statement. Church’s Chicken also said it has put together a crisis communication strategy, but called it “premature” to discuss.

PR agency team
Public-relations agency Edelman’s crisis communications team is in the early stages of developing contingency programs for clients who may need advice on avian flu.

“We’re building on our experience with SARS and watching what’s happening, reassuring people and being ready to help clients get ready for this,” said Mike Seymour, global director-issues and crisis management. ”The best thing to do is to have a plan in place ahead of it. With the research we’ve done, there are lot of [marketers] realizing the need to get geared up for this.”

Scientists resurrect 1918 flu, study deadliness

By JENNIFER LOVEN
Associated Press Writer

WASHINGTON

President Bush, increasingly concerned about a possible avian flu pandemic, revealed Tuesday that any part of the country where the virus breaks out could likely be quarantined and that he is considering using the military to enforce it.

"The best way to deal with a pandemic is to isolate it and keep it isolated in the region in which it begins," he said during a wide- ranging Rose Garden news conference.

The president was asked if his recent talk of giving the military the lead in responding to large natural disasters such as Hurricane Katrina and other catastrophes was in part the result of his concerns that state and local personnel aren't up to the task of a flu outbreak.

"Yes," he replied.

After the bungled initial federal response to Katrina, Bush suggested putting the Pentagon in charge of search-and-rescue efforts in times of a major terrorist attack or similarly catastrophic natural disaster. He has argued that the armed forces have the ability to quickly mobilize the equipment, manpower and communications capabilities needed in times of crisis.

But such a shift could require a change in law, and some in Congress and the states worry it would increase the power of the federal government at the expense of local control.

Bush made clear that the potential for an outbreak of avian flu is much on his mind, and has him talking with "as many (world) leaders as I could find" and reading a book on the 1918 Spanish flu pandemic that killed 40 million and consulting staff and experts.

"I have thought through the scenarios of what an avian flu outbreak could mean," he said.

He acknowledged that a quarantine _ an idea sure to alarm many in the public _ is no small thing for the government to undertake and that enforcing it would be tricky.

"It's one thing to shut down airplanes," Bush said. "It's another thing to prevent people from coming in to get exposed to the avian flu."

He urged Congress to give him the ability to use the military, if needed.

"I think the president ought to have all ... assets on the table to be able to deal with something this significant," he said.

Bush also said he has been urging world leaders to improve reporting on outbreaks of the virus, and exploring how to speed the production of a spray, now in limited supply, that "can maybe help arrest the spread of the disease."

"One of the issues is how do we encourage the manufacturing capacity of the country, and maybe the world, to be prepared to deal with the outbreak of a pandemic?" he said.

Experts agree there will certainly be another flu pandemic _ a new human flu strain that goes global. However, it is unknown when or how bad that global epidemic will be _ or whether the H5N1 bird flu strain now circulating in Asian poultry will be its origin.

Just in case, experts are tracking the avian flu, which has swept through poultry populations in large swaths of Asia since 2003, jumped to humans and killed at least 65 people.

*************************************

In related news, predicted locations of bird flu outbreaks are indicated in blue on the map below.

Indonesia says bird flu outbreak an epidemic Sep 21 2:45 AM US/Eastern

By Telly Nathalia and Dan Eaton

JAKARTA (Reuters) - Indonesia called an outbreak of bird flu in its teeming capital an epidemic on Wednesday as health and agricultural experts from around the world converged on Jakarta to help control the virus.

Health Minister Siti Fadillah Supari said the emergence of sporadic human cases of bird flu in recent months in and around different parts of Jakarta, home to 12 million people, warranted the epidemic tag.

She was speaking before announcing that an initial local test on a five-year-old girl who died on Wednesday after suffering from bird flu symptoms was negative for the virus.

"This can be described as an epidemic. These (cases) will happen again as long as we cannot determine the source," Supari told reporters, but she insisted it would be wrong to label it a "frightening epidemic."

Four Indonesians are already confirmed to have died since July from the highly pathogenic H5N1 strain of bird flu, which has killed a total of 64 people in four Asian countries since late 2003 and has been found in birds in Russia and Europe.

Six other patients are still in a government-designated hospital in Jakarta suspected of having avian flu.

The U.N. World Health Organization last week warned bird flu was moving toward a form that could be passed between human beings and the world had no time to waste to prevent a pandemic, an outbreak that spreads far more widely than an epidemic.

Supari said the girl who died had been suspected of suffering from the virus. She said more local testing needed to be done, while blood samples would also be sent to a laboratory in Hong Kong for confirmation.

Georg Petersen, the WHO representative in Jakarta, said many foreign experts were helping Indonesia, including a high-level delegation from the United States that was currently here.

"Definitely the whole international community is very much present," Petersen told Reuters in a telephone interview.

The WHO was also working with the government to source new stocks of the anti-viral drug Tamiflu from India to bolster local stocks, he said.

"It's not very much, it's rather puny. They definitely need some more," Petersen said, adding that stocks being rushed from India were less than 1,000 doses.

Tamiflu is an anti-viral tablet that can help against infection. Several companies are working on a vaccine, but tests are not expected to begin until later this year.

Supari said Indonesia had 10,000 Tamiflu tablets.

MASS CULL

Agriculture Minister Anton Apriyantono said Indonesia would conduct a mass cull of poultry where any outbreak of bird flu was serious.

"We haven't identified the high-intensive areas but once it is done then there will be (a mass cull). According to the president, funds will not be a problem, if it needs to be done then we will do it with all our resources," he told Reuters.

Officials have previously said the government did not have enough money for a mass cull or to compensate farmers.

The government has appealed for public calm over the virus, which has dominated local media reports in recent days.

On Monday, the government imposed a state of high alert, which gives authorities the power to order people showing symptoms of the virus to be hospitalized.

Despite growing alarm about bird flu in Indonesia, Fauzi Ichsan, an economist at Standard Chartered in Jakarta, said there was no immediate concern it would hit Southeast Asia's largest economy.

"The fact that we are an archipelago means, geographically, the disease might not be as problematic...," he said.

The latest suspected cases in Indonesia included a worker and two food vendors at the city's main zoo, which was closed this week after tests found some exotic birds in the zoo's collection were infected.

Besides Indonesia, bird flu has killed 44 people in Vietnam, 12 people in Thailand and four in Cambodia.

World has slim chance to stop flu pandemic Sep 20 1:48 AM US/Eastern

By Michael Perry

NOUMEA, New Caledonia (Reuters) - The initial outbreak of what could explode into a bird flu pandemic may affect only a few people, but the world will have just weeks to contain the deadly virus before it spreads and kills millions.

Chances of containment are limited because the potentially catastrophic infection may not be detected until it has already spread to several countries, like the SARS virus in 2003. Avian flu vaccines developed in advance will have little impact on the pandemic virus.

It will take scientists four to six months to develop a vaccine that protects against the pandemic virus, by which time thousands could have died. There is little likelihood a vaccine will even reach the country where the pandemic starts.

That is the scenario outlined on Tuesday by Dr Hitoshi Oshitani, the man who was on the frontline in the battle against SARS and now leads the fight against avian flu in Asia.

"SARS in retrospect was an easy virus to contain," said Oshitani, the World Health Organization's Asian communicable diseases expert.

"The pandemic virus is much more difficult, maybe impossible, to contain once it starts," he told Reuters at a WHO conference in Noumea, capital of the French Pacific territory of New Caledonia. "The geographic spread is historically unprecedented."

Oshitani said nobody knew when a pandemic would occur, it could be within weeks or years, but all the conditions were in place, save one -- a virus that transmitted from human to human.

The contagious H5N1 virus, which has killed 64 people in four Asian countries since it was first detected in 2003, might not be the one to trigger the pandemic, he said. Instead a genetically different strain could develop that passes between humans.

While bird flu cases continued to spread throughout Asia, with Indonesia this week placed on alert after reporting four deaths, Oshitani said the winter months of December, January and February would see an acceleration in cases, and the more human cases the greater risk that the virus would mutate.

Vietnam, Indonesia and Cambodia were most vulnerable due to the large domestic poultry populations, he said.

MASSIVE, RAPID CAMPAIGN

When a pandemic is first detected, health authorities will need to carry out a massive anti-viral inoculation campaign within two to three weeks to have any chance of containment, said Oshitani.

"Theoretically it is possible to contain the virus if we have early signs of a pandemic detected at the source," he said.

Scientists estimate that between 300,000 and one million people will immediately need anti-virals, but there are only limited stocks. WHO will receive one million doses by the end of 2005 and a further two million by mid-2006.

Even when an avian flu vaccine is fully developed, production limitations will mean there will not be enough vaccine.

"Right now we have a timeframe of four to six months to develop and produce a certain quantity of vaccine and that may not be fast enough," said Oshitani.

Last week French drug maker Sanofi-Aventis won a $100 million contract to supply the United States a vaccine against H5N1. The United States has also awarded a $2.8 million contract to Britain's GlaxoSmithKline for 84,300 courses of an antiviral. The purchases are part of a U.S. plan to buy vaccine for 20 million people and antivirals for another 20 million.

Oshitani said the early vaccines were unlikely to protect against the pandemic virus. "The vaccine should match the pandemic strain. So a vaccine developed for the virus in Vietnam now may not protect you from another virus," he said.

But Oshitani fears that once a pandemic occurs, the world's rich nations may dominate vaccine supply.

"The distribution of a vaccine will be a major issue when a pandemic starts. There is no mechanism for distribution," he said. Asked whether poorer Asian nations such as Cambodia and Vietnam would get a vaccine, Oshitani said "probably not."

Avian flu has moved west from Asia and into Russia, with many fearing migratory wild birds will spread the virus to Europe and possibly the United States via Alaska.

But Oshitani casts doubt on the impact migratory birds are having on the spread of avian flu, saying different sub-types of the H5N1 virus are in Asia and Russia.

"There are so many uncertainties about the pandemic. We don't know how it will start. We don't know exactly how it is spreading," he said.

Oshitani said that the successful containment measures used against SARS, such as quarantining those infected and cross-border checks, would fail against an avian pandemic, as people spreading bird flu may not show early symptoms.

"The pandemic is likely to be like the seasonal influenza, which is much more infectious than the SARS virus," he said.

Avian Flu: Is the Government Ready for an Epidemic?

Virus Poses Risk of Massive Casualties Around the World

Sep. 16, 2005 - It could kill a billion people worldwide, make ghost towns out of parts of major cities, and there is not enough medicine to fight it. It is called the avian flu.

This week, the U.S. government agreed to stockpile $100 million worth of a still-experimental vaccine, while at the United Nations Summit in New York, both the head of the U.N. World Health Organization and President Bush warned of the virus' deadly potential.

"We must also remain on the offensive against new threats to public health, such as the Avian influenza," Bush said in his speech to world leaders. "If left unchallenged, the virus could become the first pandemic of the 21st century."

According to Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health, Bush's call to remain on the offensive has come too late.

"If we had a significant worldwide epidemic of this particular avian flu, the H5N1 virus, and it hit the United States and the world, because it would be everywhere at once, I think we would see outcomes that would be virtually impossible to imagine," he warns.

Already, officials in London are quietly looking for extra morgue space to house the victims of the H5N1 virus, a never-before-seen strain of flu. Scientists say this virus could pose a far greater threat than smallpox, AIDS or anthrax.

"Right now in human beings, it kills 55 percent of the people it infects," says Laurie Garrett, a senior fellow on global health policy at the Council on Foreign Relations. "That makes it the most lethal flu we know of that has ever been on planet Earth affecting human beings."

No Natural Immunity

The Council on Foreign Relations devoted its most recent issue of the prestigious journal, Foreign Affairs, to what it called the coming global epidemic, a pandemic.

"Each year different flus come, but your immune system says, 'Ah, I've seen that guy before. No problem. Crank out some antibodies, and I might not feel great for a couple of days, but I'll recover,'" Garrett says. "Now what's scaring us is that this constellation of H number 5 and N number 1, to our knowledge, has never in history been in our species. So absolutely nobody watching this has any natural immunity to this form of flu."

Like most flu viruses, this form started in wild birds -- such as geese, ducks and swans -- in Asia.

"They die of a pneumonia, just like people," says William Karesh, the lead veterinarian for the Wildlife Conservation Society. "When you open them up, you do a post-mortem exam. Their lungs are just full of fluid and full of blood."

Karesh has been tracking this flu strain for the last several years as it has gained strength, spreading from wild birds to chickens to humans.

"We start at a market somewhere in Guangdong Province in China," explains Karesh. "And it's packed with cages, and you'll have chickens, and you'll have ducks. You might have some other animals -- cats, dogs, turtles, snakes -- and they're all stacked in cages, and they're all spreading their germs to each other."

In response, Asian governments have killed millions of chickens in futile attempts to stop the flu's spread to humans.

"The tipping point, the place where it becomes something of an immediate concern, is where that virus changes, we call it mutates, to something that is able to go from human to human," says Redlener, director of the National Center for Disaster Preparedness.

Echoes of the 'Spanish Flu' Epidemic

Scientists in Asia and around the world are now working around the clock as they wait for that tipping point.

"Unlike the normal human flu, where the virus is predominantly in the upper respiratory tract so you get a runny nose, sore throat, the H5N1 virus seems to go directly deep into the lungs so it goes down into the lung tissue and causes severe pneumonia," says Dr. Malik Peiris, the scientist who first discovered the so-called SARS virus, which killed 700 people and drew worldwide attention.

To date, there have been 57 confirmed human deaths, and another suspected one last week in Indonesia. Scientists say the humans have only been infected by birds. However, they add, every infected person represents one step closer to the tipping point.

"Once that virus is capable of not needing the birds to infect humans, then we have the beginnings of what can turn out to be this worldwide epidemic problem that the experts call 'pandemics,'" Redlener says.

That is exactly what happened in 1918 when the global epidemic called the Spanish flu struck.

"The Spanish flu was killing people in two or three days once they got sick," said Bill Karesh of the Wildlife Conservation Society.

"In 1918, my now-quite-elderly uncle was a young boy, living in Baltimore, Maryland," says Garrett of the Council on Foreign Relations. "And the flu came through, and his family insisted that he could not go outside for any reason until the whole epidemic was over. He spent afternoons looking out the window and counting the hearses going up and down the neighborhood and trying to guess which of his schoolmates had died."

Disaster Would Require Massive Quarantines

Unlike the avian flu, the Spanish flu spread long before the international air travel routes of today. At that time, there were no nonstop flights from flu ground zero to the United States. But not anymore.

Karesh believes the avian flu could travel from China to Japan to New York to San Francisco within the first week.

"It's on people's hands. You shake hands. You touch a doorknob that somebody recently touched," Garrett says, referring to how the flu is spread.

Redlener, who is stationed at Mailman School of Public Health at Columbia University, has been working with New York City officials to get ready for the deadly epidemic.

"The city would look like a science fiction movie," according to him. "It's extremely possible we'd have to quarantine hospitals. We'd have to quarantine sections of the city."

"I could imagine that you could look at Grand Central Station and not see much of anybody wandering around at all," Garrett agrees. "People would be afraid to take the subways, because who wants to be in an enclosed air space with a whole lot of strangers, never knowing which ones are carrying the flu?"

As for the hospitals, there would be scenes like the ones this past month in the stadiums of New Orleans and Houston after Hurricane Katrina.

"There wouldn't be equipment and personnel to staff them adequately that you could really call them a hospital," Garrett predicts. "You might more or less call them warehouses for the ailing."

And, as happened in New Orleans, there would be no place for the dead.

"If you look at the expected number of deaths that could occur in cities across the United States, we are wholly unprepared to process those bodies in a dignified and respectful way," asserts Michael Osterholm, director of the Center for Infectious Disease Research and Policy. "We will run out of caskets literally within days."

The prospects have become so bleak that in planning meetings held in New York City, veteran emergency responders have walked away.

"They just don't know how we're going to get through," says Osterholm of those responders. "If we have a repeat of the 1918 life experience, I can't imagine anything to be closer to a living hell than that experience of 12 to 24 months of pandemic influenza."

If the flu does strike, victims at first would not know if it is the kind of easily treated flu that comes every year or the killer flu, known as H5N1.

The man in charge of making sure Americans are prepared in the event of a killer flu epidemic is the secretary of Health and Human Services.

"We would do all we could to quarantine," says Secretary Michael Leavitt. "It's not a happy thought. It's something that keeps the president of the United States awake. It keeps me awake."

The preparedness plan calls for Leavitt to run operations out of a crisis room in Washington.

When pressed as to how ready the country actually is, Leavitt replied, "Not as prepared as we need to be. We're better prepared than we were yesterday; we'll be better prepared tomorrow than we are today."

The draft report of the federal government's emergency plan, obtained and examined by ABC News' "Primetime," predicts as many as 200,000 Americans will die within a few months. This is considered a conservative estimate.

"The first thing is everybody in America's going to say, 'Where's the vaccine?' And they're going to find out that it's really darned hard to make a vaccine. It takes a really long time," said Garrett of the Council on Foreign Relations.

In fact, the draft report says it will not be until six months after the first outbreak that any vaccine will be available, and then only in a limited supply.

"I imagine that not a lot of poor people will get vaccinated," Garrett says. "If you think about New Orleans, this is a similar situation."

'Inadequate' Stockpile of Medicine

While there is no vaccine to stop the flu, there is one medicine to treat it. Called Tamiflu, it is made by the Roche pharmaceutical company in Switzerland. Roche has been selling Tamiflu for years.

Only recently, however, did scientists learn of its potential to work against the killer flu, H5N1. That has since created a huge demand and a critical shortage.

"All of the wealthiest countries in the world are trying to purchase stockpiles of Tamiflu," says Garrett. "Our current stockpile is around 2.5 million courses of treatment."

According to Leavitt, that is a long way from the country's ideal stockpile. "Our objective is to have 20 million doses of Tamiflu or enough for 20 million people," he says.

He later admitted that only 2 million are currently on hand, but asserted that no other country is in a better position.

Officials in Australia, however, have 3.5 million courses of treatment, and in Great Britain, officials say they have ordered enough to cover a quarter of their population.

"I think at the moment, with 2.5 million doses, you are pretty vulnerable," warns professor John Oxford of the Royal London Hospital.

"The lack of advanced planning up until the moment in the United States, in the sense of not having a huge stockpile I think your citizens deserve, has surprised me and has dismayed me," he admits.

Faced with worldwide demand, the Roche company, which produces Tamiflu, has organized a first-come, first-served waiting list. The United States is nowhere near the top.

"The way we are approaching the discussions with governments is that we are operating on a first-come, first-serve basis," says Dr. David Reddy, head of the pandemic task force at Roche.

"Do we wish we had ordered it sooner and more of it? I suspect one could say yes," admits Leavitt. "Are we moving rapidly to assure that we have it? The answer is also yes."

When asked why the United States did not place its orders for Tamiflu sooner, Leavitt replied, "I can't answer that. I don't know the answer to that."

Even leading Republicans in Congress say the Bush administration has not handled the planning for a possible flu epidemic well.

Senate Majority Leader Bill Frist, R-Tenn., says the current Tamiflu stockpile of 2 million could spell disaster.

"That's totally inadequate. Totally inadequate today," says Frist, who is also a physician. "The Tamiflu is what people would go after. It's what you're going to ask for, I'm going to ask for, immediately."

Leavitt says deciding who gets the 2.5 million doses of Tamiflu currently on hand in the United States is part of the federal government's response plan. However, he also admits that thought has motivated the government to move rapidly in securing more doses of the medicine.

"It isn't going to happen tomorrow, but if it happened the day after that, we would not be in as good as a position as we will be in six months," he says.

However, in the end, even the country's top health officials concede that a killer flu epidemic this winter would make the scenes of Katrina pale in comparison.

"You know, I was down in New Orleans in that crowded airport now a couple weeks ago," Frist says. "And this could be not just equal to that, but many multiple times that. Hundreds of people laid out, all dying, because there was no therapy. And a lot of people don't realize for this avian flu virus, there will be very little effective therapy available early on."