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If an influenza pandemic strikes the United States, the local response will be critical, according to Jeffrey Levi, senior policy adviser at the Trust for America's Health. Speaking to officials at the recent flu summit, he said, "The basic day-today, where the rubber hits the road for pandemic preparedness, is being left to state and local governments."

The Centers for Disease Control and Prevention advises states to create distribution plans for drugs and vaccines as well as policies on quarantine and isolation. The specifics for implementing those plans, however, are left in the laps of state and local health officials. "In the context of a pandemic, we cannot afford to have state-by-state variation," commented Levi. "We have a national interest in making sure that everyone is equally prepared and that we are using consistent strategies."

The bird flu virus, known as H5N1, found in Asia and Europe, has infected at least 152 individuals and killed 85, according to recent statistics. Nearly all of the worldwide cases can be traced to contact with sick poultry. The United States has stockpiled 4.3 million doses of the antiviral oseltamivir (Tamiflu) and anticipates acquiring enough to treat 75 million individuals.

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