Senator Tom Harkin
731 Hart Senate Office Building
Washington, D.C., 20510-1502

To the Honorable Chairman of the Senate Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, Senator Tom Harkin, and to the Honorable Members of the Subcommittee, Senator Daniel Inouye, Senator Herb Kohl, Senator Patty Murray, Senator Mary Landrieu, Senator Richard Durbin, Senator Jack Reed, Senator Frank Lautenberg, Senator Arlen Specter, Senator Thad Cochran, Senator Judd Gregg, Senator Larry Craig, Senator Kay Bailey Hutchinson, Senator Ted Stevens, and Senator Richard Shelby,

We the undersigned believe that an influenza pandemic will occur in the near future, a pandemic that could be as severe as the 1918 Spanish Influenza Pandemic. According to the World Health Organization: "Three times in the last century, the influenza A viruses have undergone major genetic changes mainly in their H-component, resulting in global pandemics and large tolls in terms of both disease and deaths. The most infamous pandemic was Spanish Flu which affected large parts of the world population and is thought to have killed at least 40 million people in 1918-1919. More recently, two other influenza A pandemics occurred in 1957 (Asian influenza) and 1968 (Hong Kong influenza) and caused significant morbidity and mortality globally. In contrast to current influenza epidemics, these pandemics were associated with severe outcomes also among healthy younger persons, albeit not on such a dramatic scale as the Spanish flu where the death rate was highest among healthy young adults."

If this is a severe pandemic, in a worst case scenario it will overwhelm the health industry within weeks. Furthermore there will not be sufficient quantities of Tamiflu to dispense to the entire population, and it will take six to nine months to create a vaccine. Worker shortages could reach as high as 30\% to 40\%, 20\% to 30\% of the population could become infected, and low Case Fatality Rate estimates of 1\%-2\% would still be disastrous. This shortage of qualified personnel would have a severe impact upon the operation of our utilities, creating energy black-outs, communication problems, and compromised water systems. A severe pandemic will also disrupt transportation of goods, wreaking havoc with our just-in-time delivery system. A weakened delivery system will in turn create food, fuel, and supply shortages. Families, and in particular children and young people aged 10-20, will be the most vulnerable. Parents will endeavor to shelter their children at home during the waves that could last from six to eight weeks at a time and could reoccur every few months for as long as 12 to 18 months. During these waves and between waves, families will need food, water, medications, and household supplies which may not be readily available due to the above-mentioned reasons. If a worst case scenario should happen, the current government guidelines of storing two weeks of food and supplies will be inadequate for an event of this magnitude and duration.

We believe that despite all the good work that has been accomplished by this Committee, there is much that needs to be done. First and foremost, American citizens need to be informed by public officials as to the depth and breadth of this upcoming event.

Therefore we ask that the Committee commit to the following:
1. Request from all agencies under the jurisdiction of the Committee a detailed program for promoting, teaching, and publicizing individual and family pandemic preparedness.
2. Appropriate funds for all above agencies for the purposes of promoting, teaching,
and publicizing the unique nature of a severe influenza pandemic as opposed to other disasters and the necessity to have family preparations for two to three months or more. In order to reach the largest number of citizens, this promotion should be publicized through varied media resources, including television and radio PSAs, newspaper articles, posters, community seminars, and mailings.
3. Appropriate funds to set up a 20-member Citizen's Advisory Committee who will meet with the Committee a minimum of twice yearly to present their recommendations concerning Influenza Pandemic issues. This committee should be comprised of private citizens who are not employed by federal, state, county, or local government agencies, with the exception of first responders, teachers, and health care workers at the non-administrative level. Each Senator will appoint one person. The entire Committee will then appoint three additional members to be chosen from the various flu websites such as, but not limited to, Plan for Pandemic, Current Event's Flu Clinic, Pandemic Flu Information, Flutrackers, and Flu Wiki. The two remaining two would be chosen from border cities, one city that is contiguous with Canada and the other bordering Mexico.

We ask that the Committee implement and include appropriations for these recommendations during the coming year.