End of the Line

Two percent of the U.S. population covered

Scientists have been urging countries to stockpile Tamiflu for years. “The answer seems to be: Stockpile these drugs now,” a 2001 review concluded, “in huge quantities.”²⁴⁰⁹ How huge? From a joint position statement of the Infectious Diseases Society of America and Society for Health care Epidemiology of America: “We advocate a national stockpile with minimum treatment courses for at least 25% or ideally 40% of the U.S. population.”²⁴¹⁰ The National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices are calling for 45% coverage. The strategy is to have a circulating stockpile to cover priority populations like health care workers and first responders, with a contingency plan for rapid additional synthesis for the remaining two-thirds or so of any national population.²⁴¹¹ The United States has neither priority coverage nor a contingency plan.

Australia and New Zealand have national stockpiles for about 20% of their populations. The Australian Health Minister admits that this is glaringly insufficient.²⁴¹² New Zealand health care experts are calling for 100% coverage for every family in the country. “The costs of purchasing this drug cannot be compared,” one said, “with the costs that would occur if we have an outbreak of [pandemic] flu.”²⁴¹³ France,²⁴¹⁴ Great Britain,²⁴¹⁵ and some other European nations are reportedly approaching coverage of 25% of the populace.²⁴¹⁶

As of July, 2006, the United States has enough for 2% of Americans.^{2417 2418} The Bush administration ignored urgent warnings from the nation’s top scientists and waited too long to place their order. Given the global demand, the head of the pandemic task force at Roche explained, “The way we are approaching the discussions with governments is that we are operating on a first-come, first-serve basis.”²⁴¹⁹ According to Roche there were 40 countries in line ahead of the United States.²⁴²⁰ The richest country in the world can spend all the billions it wants; but, as Irwin Redlener, the director of the National Center for Disaster Preparedness put it, “now that they’re finally worked up about it, the store is closed.” “The U.S. is now in line,” he said, “behind much of the rest of the world.”²⁴²¹

Experts around the world are shocked at America’s delinquency. Royal London Hospital’s Professor John Oxford told ABC News, “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.”²⁴²² Redlener concludes, “We are in a terribly unprepared condition right now.”²⁴²³ Or, as Webster put it, given our inadequate stockpile, “we wouldn’t have a hope in hell.”²⁴²⁴

At a Congressional hearing, Roche pointed out how inferior the U.S. stockpile was and listed off the countries further ahead in the queue. “Unfortunately,” Roche’s Tamiflu medical director testified, “given…the increasing global demand, any government that does not stockpile sufficient quantities of Tamiflu in advance cannot be assured of an adequate supply at the outbreak of an influenza pandemic.”²⁴²⁵ The United States, essentially, was out of luck.

Congress was not happy. Representative Michael Ferguson grilled the head of the CDC about the critical delay leaving the United States with but a few million treatment courses of Tamiflu. “I’m sure you will agree with me that that is a mere pittance,” Ferguson said. “It’s nothing near what we will need to deal with a flu epidemic. We’re staring down a loaded gun.”²⁴²⁶ Had the Bush administration placed its order just a few months before, sources close to the negotiators told the New York Times, Roche might have been able to deliver much of the U.S. supply as early as 2006. As it exists now, substantial quantities won’t be coming in until 2007. Democrats complained that the delay put Americans in jeopardy. “The administration has just drug its feet through this whole process,” said Senator Tom Harkin.²⁴²⁷ Unfortunately, Democratic leadership on bird flu had also been lacking, heralding a plague on both their houses.

“There have been many who foresaw this and urged the country to begin preparations sooner, and it would have been better if we had done so,” admitted Bush’s Health and Human Services Secretary, Michael Leavitt.²⁴²⁸ “Do we wish we had ordered it sooner and more of it? I suspect one could say yes,”²⁴²⁹ When asked why the country didn’t place its order earlier, Leavitt replied, “I don’t know the answer to that.”²⁴³⁰

Secretary Leavitt said that negotiations with Roche for more Tamiflu are ongoing. “But it’s not a surrogate for preparation,” he told the New York Times. “It’s like saying that if we could get everyone in America to wear seat belts, we would solve auto accidents. It’s part of a comprehensive solution.”²⁴³¹ There is a flaw in Mr. Leavitt’s logic. Seatbelts and Tamiflu may both decrease mortality, but it’s not about getting people to use them—it’s providing them in the first place. Our current stockpile makes as much sense as installing seat belts in only 1% of cars though there may be as high as a 50% chance of dying unprotected in the coming crash.