people feel the initial outbreak is likely to occur. That is something that should be worked out very early in the course of this.

The second point is with respect to modeling. I would encourage you to go beyond the national borders when you consider modeling. Look at the downstream effects of this, not only in terms of who takes care of the kids that are no longer in school, but going across international borders, what is the effect on this on our commerce, of our agriculture, of our energy supply? How does this come back to affect this country or the world in a fairly short-term perspective?

DR. FINEBERG: Thank you for your comment. If I may, I think your remarks focused on modeling but apply with equal force to our general discussion about research strategy. That is defining the research strategy also can benefit from looking at it from a global or different country perspective, as well as from any one national perspective. And I think the force of those comments apply equally to all of our thinking about research strategy.

PARTICIPANT: Just to follow-up on the issue of funding and how we are going to do this. I personally think that we have exhausted the situation of trying to get what we need on inter-pandemic flu preparedness. If you extrapolate the line of increase, it will be about 90 years from now that we will reach some kind of moderate worldwide capability of producing flu vaccines and antiviral drugs. I think we have to take a step back, because we are talking about an issue of international security and economic consequences that are unlike anything that humankind has seen. And you can say, well, do not say that, because you will scare people. I think we have to be willing today to say we are not going to say it is H5N1, but a pandemic influenza situation is going to occur unless somebody is convinced that water now flows uphill.It is Mother Nature. It has been there. It is going to happen. We have already discussed you do not need an H5N1 in a world of 6.5 billion people today to create economic chaos for 12-18 months.

As a world, we invest all the time in things that are insurance policies. Today, some of the best funded fire departments in this United States exist in our major metropolitan airports; airports that have not had a plane crash in 50 years. Airports that have incredible equipment, and never can leave the airport compound, because they have to be there. And we pay for that day in and day out, because we have made a decision if it ever does happen, you have to be able to respond in the force that is equivalent for a plane crash. We do that with our federal oil reserves. We have spent billions of dollars stockpiling oil in the salt domes of the Gulf States. I think we have to change our mind set to say that this is an insurance policy that we are not going to sit here and try to scare you and say this H5N1, although many of us think that still is a real possibility, but it is going to happen. And we need a Manhattan-like project that encompasses many of the issues that have been discussed here today; it is going to be an economic insurance policy.

To follow-up on the previous comment about the international piece, I would remind people that if we totally protected ourselves, if we had 300 million doses or 600 million, depending on the two dose regimen in the United States, we would still be devastated, because the economic consequences of a worldwide pandemic minus the United States would still have incredible implications. We saw it during SARS. The computer industry of this country shut down, because no one realized that 95 percent of the computer chips in the world were made in the Kwong Dong province of China. And when they couldn't travel, nothing else traveled. And if you start looking at the consequences here, we can demonstrate to our policymakers that this is in fact a very wise use of resources.



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