President Bush said today that he was working to prepare the United States for a possibly deadly outbreak of avian flu. He said he had weighed whether to quarantine parts of the country and also whether to employ the military for the difficult task of enforcing such a quarantine.
"It’s one thing to shut down your airplanes, it’s another thing to prevent people from coming in to get exposed to the avian flu," he said. Doing so, Mr. Bush said, might even involve using "a military that’s able to plan and move."
The president had already raised, in the wake of Hurricanes Katrina and Rita, the delicate question of giving the military a larger role in responding to domestic disasters. His comment today appeared to presage a concerted push to change laws that limit military activities in domestic affairs.
Mr. Bush said he knew that some governors, all of them commanders of their states’ National Guards, resented being told by Washington how to use their Guard forces.
"But Congress needs to take a look at circumstances that may need to vest the capacity of the president to move beyond that debate," Mr. Bush said. One such circumstance, he suggested, would be an avian flu outbreak. He said a president needed every available tool "to be able to deal with something this significant."
I am hoping to write a longer piece on what we should do, but frankly Bush’s idea had not crossed my mind. For a start, quarantines don’t usually work, especially in a large, diverse, and mobile country. The Army would if anything spread the flu. A list of better ideas would include well-functioning public health care systems at the micro-level, early warning protocols, and good decentralized, robust plans for communication and possibly vaccine or drug distribution. Might the postal service be more important than the Army here? How about the police department, and the training of people in the local emergency room?
Stockpiling Tamiflu is worthwhile in expected value terms, but many strains of avian flu are developing resistance; we should not put all our eggs in this basket. We also should stockpile high-quality masks and antibiotics for secondary infections (often more dangerous than the flu itself), and more importantly have a good plan for distribution and dealing with extraordinary excess demand and possibly panic. Let’s not ignore obvious questions like: "if the emergency room is jammed with contagious flu patients, where will other (non-flu) emergencies go?"
A good plan should also make us less vulnerable to terrorist attacks, storms, and other large-scale disasters. Robustness and some degree of redundancy are key. You can’t centrally plan every facet of disaster response in advance; you need good institutions which are capable of improvising on the fly. In the meantime, let’s have betting markets in whether a pandemic is headed our way; that would provide useful information.
Addendum: It is Bird Flu Awareness Week in the blogosphere, Silviu has the appropriate links.