States Begin to Get in Line for Anti-Flu Medication

The Department of Health and Human Services last year set a deadline of July 1 for states to indicate whether or not they would seek help from the federal government in buying anti-flu medicine in preparation for a possible pandemic should the bird flu become a viable threat in the United States. Because not all states have made their decision yet, the deadline has been extended to August 1.

As part of the federal pandemic preparation program, the government is stocking up on anti-flu medications including Tamiflu. The government will pay 25% of the costs up to a specified amount for each state, and in all, states may use the subsidy to buy anti-flu medications for more than 30 million more people. The government is negotiating a price with Roche Laboratories, Inc., and the administration plans to buy enough to treat 44 million people.

The decision has been a controversial and difficult one for many states. Oklahoma lawmakers have allocated $500,000 to buy anti-flu medications, which would buy enough to treat about 35,000 of the 3.5 million people in the state. But if the state purchases medications through the federal program, they can probably buy at least ten times that amount. "We're struggling with how much do we need," said the state's epidemiologist, Dr. Brett Cauthen. "How much insurance do you need? Nobody knows what the best number is."

South Carolina, Utah, and Alabama have decided to take advantage of the federal program. "We figure it is certainly better to do it and move forward with the purchase and hope we never have to use it than not and wish that we had," said Jim Beasley, spokesman for South Carolina's Department of Health and Environmental Control. Other states, including Montana, Arizona, and Washington, plan to take full advantage of the extra time before the deadline to decide exactly how much of the drugs they want to purchase. "There's a lot to sort out with antivirals," said Tim Church, spokesman for the Washington state Department of Health. "It's not a black-and-white decision."

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said that states should have at least some anti-flu medication stockpiled in case a pandemic does hit. But there is no way to know ahead of time exactly how much will be needed. "These are all insurance policies we’re buying," Schaffner said. The amount of insurance necessary has to be balanced against other important considerations, such as funding roads, education, or other state maintenance issues. However, Schaffner thinks that a lot of states believe that the federal government should fund pandemic preparedness, and that isn’t practical. "When it comes down to funding, that's when a lot of states are saying, gee, maybe it should all come from Uncle Sam," said Schaffner. "I think that's not a reasonable idea, and that's why we at Vanderbilt have made an investment in our own stockpile, and have invested substantially in drills and planning."

But the federal government has made it clear that it won’t be able to protect everyone in a pandemic. Health and Human Services Secretary Michael Leavitt said, "Any community that fails to prepare with the expectation that the federal government will at the last moment be able to come to the rescue will be tragically wrong." During the past century, there have been three pandemics of different strains of influenza. Officials with the World Health Organization fear that a fourth is on its way, if the H5N1 avian flu mutates and begins to spread from human to human. At least 229 people worldwide have contracted bird flu since 2003, and 131 of those people have died.