Budgeting for Bird Flu is a Bit of a Guessing Game
By Jenny Lim
SAN MATEO, California, Feb. 9 - Governor Arnold Schwarzenegger's $38.4 billion health services budget for 2007 includes $45.8 million to handle an emergency response to a natural or intentional disaster, including an outbreak of pandemic influenza.
The budget does not earmark funds specifically for an avian flu pandemic. It has targeted money to address an influenza pandemic of any kind.
The proposed fiscal 2007 budget would provide $17.8 million to local health departments for pandemic flu preparedness. According to a Jan. 10 CDHS document listing the department's budget highlights, the $17.8 million would fund regional efforts to plan and train for an outbreak, including instruction in isolation and quarantine practices and mental health crisis management.
While the state budget should be praised for including money for counties' responses to a pandemic, it is a thin amount to spread among the state's 61 public health departments, said Brian Zamora, San Mateo County public health director.
If a severe bird flu pandemic breaks out in the United States, 30 percent of the population could contract the virus, according to the nation's Health and Human Services Department.
If that pandemic strikes the Golden State, a little more than one percent of California's Department of Health Services' proposed budget for the next fiscal year is set aside to deal with it.
Each of California's 58 counties, along with the three cities of Berkeley, Pasadena and Long Beach, has a public health department. Each is formulating a pandemic influenza plan and budget for their territories. San Mateo and Santa Clara Counties' health departments are still working on their pandemic flu plans and the budgets are not yet devised. Both counties must put those budgets together by the start of the next fiscal year, July 1.
In San Mateo County, the health department will initially use taxpayer dollars to fund its pandemic flu plan. Zamora said the county's pandemic budget will be reimbursed with federal and state money, should Congress and the California Legislature approve the budgets recently proposed by the president and the governor.
President George W. Bush's proposed 2007 budget sets aside $2.3 billion for pandemic flu preparedness, according to the H.H.S. Web site. Last year, Congress appropriated $3.3 billion towards the president's $7.1 billion, three-year strategic plan to improve the nation's pandemic influenza readiness.
Governor Schwarzenegger proposed his spending plan to state lawmakers on Jan. 10. His budget includes $14.2 million for public education programs on pandemic influenza, including an emergency response hotline to deal with public inquiries about the H5N1 virus. Money would also be used to purchase advertising and media airtime for a public information campaign on ways to brace for an avian flu outbreak.
The proposed state budget emphasizes readiness more than treatment of bird flu. Compared to the $32 million tagged for pandemic preparedness and education, the budget allocates only $1.5 million to increase California's anti-viral supply. The money will be used to purchase 200,000 doses of Tamiflu, an anti-viral drug that has effectively treated some humans exposed to the H5N1 virus in Southeast Asia. The budget includes $460,000 from the current fiscal year to buy 70,500 doses of Tamiflu "for an initial ring containment of avian influenza," according to the CDHS' budget highlights document.
The governor's budget also allots $1.3 million to develop and maintain a program for surveillance and laboratory testing of any outbreak of infectious disease. Another $673,000 is designated for investigations of influenza outbreaks.
Zamora said the San Mateo health department will present the first segment of its two-part pandemic flu plan to the county Board of Supervisors on March 28. He said funding the plan will take $20,000 from this fiscal year's budget.
But Zamora said his best estimate for the fiscal 2007 pandemic flu budget would be in the hundreds of thousands of dollars. "It's a guesstimate right now, because we haven't done this before," he said.
California is fortunate to have a sophisticated emergency response system in place to deal with earthquakes and floods, the health director said. But Zamora pointed out a pandemic flu will be unlike those disasters, since the duration of a pandemic could extend over a long period of time.
It is not a matter of if, but "a matter of when avian flu is going to hit us," he said. Though it might not occur immediately, preparing for a pandemic will be a critical defense against its spread, Zamora said.
A bird flu pandemic may not be imminent but the threat it poses could be severe, according to Michael Earls of Trust for America's Health, a non-partisan health advocacy organization in Washington, D.C.
"It's important to be prepared but not panicked," Earls said. "But we need to plan for the worst-case scenario, because a pandemic would have some fairly dire impact on our day to day living."
"We don't know if this H5N1 strain will be a pandemic event, but we do know a pandemic event will be coming down the pipeline," Earls said.
Funding for avian flu preparedness was not listed in California's final budget for the 2005-06 fiscal year. However, the governor's proposed 2006 budget included a request for $2.7 million to address the threat of avian flu and mad cow disease to California's food supply.
The World Health Organization has confirmed 166 human cases of bird flu as of Feb. 9. Of those patients, 88 have died. A human case of bird flu was reported in Iraq in January. On Feb. 8, WHO confirmed the H5N1 virus had spread to domestic birds in Nigeria.
Contact Jenny Lim at jennylim@stanford.edu
