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There has yet to be a single case of bird flu in America, but fear of the disease is spreading rapidly. The often fatal disease caught from birds has killed about 60 people in Southeast Asia. The concern is that humans will begin catching it from other humans, setting in motion a worldwide epidemic or pandemic. Secretary of Health and Human Services Mike Leavitt has just returned from consulting with experts in Southeast Asia. He sat down with us to talk about the administration's soon-to-be released plan to deal with a possible outbreak of bird flu. The first step, Leavitt says, is surveillance, watching closely for the disease to emerge.

Secretary MIKE LEAVITT (Department of Health and Human Services): If you think of the world as a vast forest that's dry and susceptible to fire, if there's a spark and you're there, you can simply put it out with your foot. But if you're not there and it begins to burn over a long period of time, even an hour or two hours, it can become uncontrollable and uncontainable, and that's the same with a pandemic. If we can discover when the unique combination of factors come together, when birds and animals and people are in the same place and the virus mutates into a form that would become susceptible to people, if we're there at the moment when that's discovered, we're able to use good public-health techniques to stamp it out.

We also need to have antivirals. That's the kind of medication that can assist a person who's been infected. We need to have vaccines. That may be the best hope of being able to actually prevent a pandemic. Our vaccine manufacturing sector has essentially diminished to the point that we don't have the capacity to manufacture large doses of a new vaccine rapidly. That needs to change. In the meantime, we need to remember that this is essentially an animal disease right now. It's present in birds, and occasionally a person is able to have disease transmitted to them, but it's always in direct contact with the bird. The concern is that it could mutate into a form of virus that would be efficient. That hasn't occurred at this point. There's a low likelihood that it will, but we need to be prepared because the probability isn't zero.

MONTAGNE: There is one drug, Tamiflu, that has been touted as a good drug to use in the case of bird flu. You told NPR correspondent Richard Knox when you were in Hanoi last Friday that supplies of the flu drug would have to be rationed if it's needed anytime soon. Why didn't or can't the government order enough?

Sec. LEAVITT: We do have a stockpile, a growing stockpile. We have 4.3 million doses. That's enough for a lot of people, and I have every optimism that we will gain sufficient amount for our needs.

MONTAGNE: But European countries did stock up on this and now that's part of the reason why there's not so much available.

Sec. LEAVITT: Well, European companies placed orders. They don't have it in their hand.

MONTAGNE: But it is correct that European countries got on the list ahead of the US?

Sec. LEAVITT: Some European countries made orders. We had a stockpile. We have continued to add to it, as have they.

MONTAGNE: This particular bird flu virus, it's been circulating or known to have been circulating now for almost two years in birds and some humans. How could you be so confident that we're not on the verge of seeing that sort of sudden event?

Sec. LEAVITT: Well, scientists tell me that it's not likely that it will simply move from an inefficient virus, as it is today, to one that's highly efficient and virulent. Now it's not inconceivable that it could, but it hasn't yet. And I'm not trying to minimize it but at the same time I'm trying to give a sense of realism here that we have to be prepared for pandemics in general. It can be a serious enough problem that it changes entire cultures, because in the worst kinds of pandemics, like the one we had in 1918, millions of people died.

MONTAGNE: Is there such a thing as being overprepared, since we don't know when or even if bird flu will hit?

Sec. LEAVITT: I suspect that's a real worry, a real danger, that we could prepare and then, if it doesn't happen, people could look back and say, `Well, you were alarming us over something we really didn't need to be concerned about.' I feel certain that our preparation will not be perfect, but we are making substantial progress because ultimately another pandemic will come. And right now our preparation is not sufficient.

MONTAGNE: Thank you very much for joining us.

Sec. LEAVITT: You're welcome.

MONTAGNE: Secretary of Health and Human Services Michael Leavitt has just returned from a trip through Southeast Asia. And complete bird flu coverage is at npr.org.

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