State officials want more money to fight a potential pandemic of the H5N1 avian influenza (bird flu), should it make its way into the United States. State as well as local health officials complained about the financial impact upon the recent release of the federal government's action plan for a flu outbreak.

The 227-page plan estimates that a third of the population could become infected, 2 million individuals could die, 40% of employees might be absent from work during each wave of the outbreak, and $600 million in income could be lost for the United States. Aside from increasing the stockpile of antiviral drugs and vaccines, the government will increase the stockpile of poultry vaccines to 110 million doses.

The plan, divided into 9 chapters, includes a list of actions the federal government will fulfill as the virus spreads. A major bone of contention in the past year has been who should lead the government's response. The plan specifies that the secretary of health and human services would head the federal health and medical response. The coordination of federal operations and resources would fall to the secretary of homeland security.

Although Josh Sharfstein, MD, commissioner of the Baltimore Health Department, is in favor of the plan, he said that it offered "new expectations without new resources." Local governments would handle the flood of hospital patients, care for ill patients at home, and spend millions of dollars on antiviral medications, he said.

Congress has allocated $3.8 billion to cover preparations such as drug and vaccine purchases. Of the money appropriated, the Bush administration has spent $1.8 billion. Currently, there is a bill before Congress asking for an additional $2.3 billion for flu preparations, and the president is expected to ask for another $1 billion in 2008, according to Fran Townsend, the president's homeland security adviser.