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State and local health officials are pleased to receive some long-awaited guidance from the federal government on how to respond to a super flu pandemic, but some worry the $7.1 billion preparedness plan unveiled by the Bush administration Wednesday is coming too late.

Avian flu or any other super-influenza strain might kill as many as 1.9 million Americans and hospitalize another 9.9 million, according to increased estimates in the 396-page plan released yesterday by the U.S. Department of Health and Human Services during congressional testimony.

Such a pandemic could occur if the influenza strain decimating poultry flocks in Asia and Europe mutates into forms spread easily among humans, scientists say. Such genetic changes could happen tomorrow, or they might not happen for another 100 years.

"I'm very worried about it," said Dr. Judith Martin, an infectious disease specialist at Children's Hospital of Pittsburgh. "But it's hard, I'm sure, to dedicate huge amounts of resources and money to something that may or may not happen."

Among President Bush's spending proposals are as much as $4.7 billion to create vaccine production capacity and stockpiles; $1.4 billion for stockpiling anti-viral drugs to treat the flu; and $555 million for surveillance and public health infrastructure.

State health officials said they have been bracing for a potential avian flu pandemic.

"It's nothing surprising to us," said Pennsylvania Health Department spokesman Richard McGarvey. "But knowing the federal government is paying attention at the presidential level really is a step forward."

Pennsylvania already has its own "Influenza Pandemic Response Plan" that addresses the steps necessary to identify, monitor, track and prevent the spread of a deadly super flu bug, McGarvey said.

Dr. Bruce Dixon, director of the Allegheny County Health Department, said local health officials would be responsible for overseeing the initial response to a killer flu outbreak. His agency has called a meeting for Friday of experts from local hospitals to discuss what to do if an influenza pandemic strikes the Pittsburgh area.

The University of Pittsburgh Medical Center, the region's largest health care provider, has stockpiled anti-viral drugs to help treat doctors and nurses so they can continue to work in the event of a crisis, said Dr. Charles Mackett, who chairs a disaster management advisory committee at UPMC.

UPMC also is revising disaster plans, Mackett said. "We will prepare for the worst and hope for the best," he said.

Ultimately, the only way to protect people from a super flu pandemic is by developing, producing and distributing an effective vaccine, Martin said.

"Antivirals aren't foolproof, plus we don't have enough doses and we aren't going to get enough doses," Martin said. "So the best place we can spend our money is to have everything ready to go to start vaccine production as soon as this happens."

French pharmaceutical giant Sanofi-Aventis, the biggest supplier of seasonal flu shots for the U.S. market, has tested a vaccine that raises humans' immune protection to bird flu. Several other companies and academic groups also are working to develop a pandemic vaccine.

Dr. Andrea Gambotto and his colleagues at the University of Pittsburgh are trying to create a viral vector vaccine against the bird flu that shuttles certain genes from the virus into the body using a modified cold virus. Results from animal tests of the vaccine should be published soon, he said.

The next step would be to test its safety in people, said Gambotto, who has applied for grant money from the National Institutes of Health for these clinical trials.

But some say these efforts and the federal response could be coming too late to save lives as the bird flu continues its apparent westward progression. Thus far, it has infected about 120 people and killed 60, most of whom came in contact with infected poultry.

"The Bush plan is a good start," said molecular geneticist Henry Niman, founder of Recombinomics Inc., a Fox Chapel start-up company created to develop vaccines against avian influenza. "The question is how timely it is. Certainly it is better to start today than tomorrow, although it would've been better to start yesterday."

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