Flu Flap

Remember before Anna Nicole Smith how people used to worry about bird flu?

Two years ago, U.S. epidemiologists reported bird flu in 10 countries. Today, that number is 56 countries, and human deaths have risen from 34 to 163 as the flu marches across Asia into Egypt and Eastern Europe.

In late January, Reuters quoted Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, as saying, "People who fail to prepare for a flu pandemic are going to be tragically mistaken."

Oregon state Rep. Brian Boquist (R-Dallas) worries that state health officials are among the "tragically mistaken." Dr. Susan Allan, director of public health for the state's Department of Human Services, strongly disagrees.

On Dec. 20, Allan declined a federal offer to sell the state 360,930 subsidized treatment courses of Tamiflu and Relenza, two antiviral drugs often described as being effective against bird flu, at a cost of $5.3 million.

The backdrop for Allan's decision began two years ago, when panic about the availability of Tamiflu in the event of a pandemic led to hoarding, counterfeiting and widespread fears that demand would outstrip supply.

But Boquist, a career Army Special Forces officer who formerly co-chaired the Legislature's Joint Emergency Preparedness Committee, went ballistic when he learned of Dr. Allan's decision.

In his committee work, Boquist sat through numerous presentations about the threats of a pandemic.

"In the future pandemic, we can expect 1,026,419 to fall ill in Oregon," Boquist wrote Gov. Ted Kulongoski on Feb. 12. "The death toll based on [federal] estimates could reach 21,677 citizens. Gambling on these lives is not an option."

Boquist notes that the decision not to spend $5.3 million on the drugs comes as Kulongoski is proposing a $2.24 billion general-fund budget increase.

Dr. Allan says she didn't reject the drugs cavalierly. After consulting local and federal experts, she decided it would be more cost-effective for the state to spend its money on things like providing life-savings services to the uninsured. She also says the benefits of Tamiflu have been overstated.

"It can shorten the duration of the flu slightly," Allan says. "The bigger value is in stopping the spread to people around those who get infected, like fire suppression."

Allan adds that it's far from clear if Tamiflu would be widely effective against whatever mutation bird flu might take by the time it reaches Oregon. She says experts consider it unlikely that a pandemic would occur here in the next four years, which is the drug's maximum shelf life.

Meanwhile, the feds are still holding an emergency allocation of the drugs for each state. For Oregon, the stockpile is currently about 460,000 treatment courses and will grow to 530,000, Allan says.

Oregon isn't alone in its decision. According to a Reuters report, Roche, the drug company that makes Tamiflu, told Congress in January that only 29 states had ordered the drug and few had taken their full allocation.

WWeek 2015