Order Code RS22576
January 23, 2007
Pandemic Influenza: Appropriations for
Public Health Preparedness and Response
Sarah A. Lister
Specialist in Public Health and Epidemiology
Domestic Social Policy Division
Summary
The spread of H5N1 avian influenza (“flu”) on three continents, and the human
deaths it has caused, raise concern that the virus could morph and cause a global human
pandemic. Congress has provided specific funding for pandemic flu preparedness since
FY2004, including $6.1 billion in emergency supplemental appropriations for FY2006.
These funds bolster related activities to prepare for public health threats, and to control
seasonal flu. This report discusses appropriations for pandemic flu, primarily to the
Department of Health and Human Services (HHS), and will be updated as needed.
Background
In 1997, a new avian (bird) flu virus emerged and jumped to humans in Hong Kong,
killing six people. It has since spread to other countries in Asia, Europe and Africa, where
it has infected more than 250 people, killing more than 150 of them. The situation has
created concern that the virus could change sufficiently to launch a global human
pandemic. Beginning in FY2004, and each year since, Congress has provided specific
funding for pandemic flu preparedness, through both regular and emergency supplemental
appropriations.
This report describes federal funding for pandemic flu preparedness, primarily to the
Department of Health and Human Services (HHS). Federal funding to control avian flu
in birds is generally provided to the U.S. Department of Agriculture (USDA) for activities
involving commercial poultry, and the Department of the Interior for activities involving
wildlife. The State Department and the U.S. Agency for International Development
(USAID) have also received funds for global avian flu control efforts, as have the
Departments of Homeland Security, Defense, and Veterans Affairs.1
1 For more information, see CRS Report RL33795, Avian Influenza in Poultry and Wild Birds,
by Jim Monke and M. Lynne Corn, and CRS Report RL33219, U.S. and International Responses
to the Global Spread of Avian Flu: Issues for Congress, by Tiaji Salaam-Blyther.

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Tracking federal funding for avian and pandemic flu preparedness is difficult for
several reasons. First, funds designated specifically for pandemic flu do not reflect the
sum of all relevant activities. For example, programs to improve health surveillance in
general, or to streamline federal coordination during disasters, are important for pandemic
preparedness. Also, the President has called on all federal agencies to develop continuity
plans specifically for a flu pandemic, activities that are typically funded through general
administrative accounts. Second, certain activities (e.g., the expansion of flu vaccine
production capacity) address preparedness for both seasonal and pandemic flu, and may
not be designated as pandemic spending, despite their relevance. Finally, federal agencies
may not prepare budget information, such as the presentation of base funding or annual
increases, in a consistent fashion.
This report provides information on appropriations, primarily to HHS, that the
Congress has specifically designated for influenza preparedness, including efforts to
expand seasonal flu vaccine production capacity and related activities. Amounts are
discussed in subsequent sections of the report, and are presented in Tables 1 and 2 at the
end. Pandemic flu funding for HHS has generally been provided in the Public Health and
Social Services Emergency Fund (PHSSEF), an account intended for one-time or short-
term activities. This report will be updated as events warrant.2
History of Recent Appropriations
FY2004. Specific appropriations for HHS pandemic flu activities were first
provided by Congress in FY2004. In February 2003, the Administration requested $100
million for activities to ensure an adequate supply of vaccine in the event of a pandemic.3
In P.L. 108-199, the Consolidated Appropriations Act, 2004, Congress provided $50
million to HHS for activities to enhance vaccine production capacity.4 Funding was used
in part to award a $10 million contract to a domestic manufacturer of injectable flu
vaccine to assure a year-round supply of eggs for vaccine production.5
FY2005 — Regular Appropriations. In February 2004, the Administration
again requested $100 million for HHS to expand vaccine production capacity.6 In
October 2004, while Congress was considering FY2005 appropriations, federal officials
were notified of a production failure at a plant supplying half of the nation’s supply of
injectable seasonal flu vaccine. The resulting vaccine shortage focused nationwide
2 For more information regarding pandemic flu preparedness in general, see CRS Report
RL33145, Pandemic Influenza: Domestic Preparedness Efforts, by Sarah A. Lister.
3 U.S. Department of Health and Human Services, Budget in Brief, FY2004, Feb. 2003, text on
p. 94 and table on p. 96, at [http://www.hhs.gov/budget/04budget/fy2004bib.pdf].
4 P.L. 108-199, 118 Stat. 251.
5 See HHS, “Secretary Thompson Announces Contract to Secure Future Egg Supply for Flu
Vaccines,” press release, Nov. 9, 2004; and HHS, “Pandemic Influenza Funding Activities,” Web
page, at [http://www.hhs.gov/ophep/ophemc/PanFlu/procurement_activities.html].
6 HHS, Budget in Brief, FY2005, Feb. 2004, p. 102, at [http://www.hhs.gov/budget/
05budget/fy2005bibfinal.pdf].

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attention on the frailty of the flu vaccine production system.7 At the same time, H5N1
avian flu was spreading through Southeast Asia, with a growing human death toll. In
December 2004, Congress passed P.L. 108-447, the Consolidated Appropriations Act,
2005, providing HHS with the requested $100 million to bolster flu vaccine production
capacity, including the purchase of flu vaccine.8
FY2005 — Supplemental Appropriations. In May 2005, Congress passed P.L.
109-13, the Emergency Supplemental Appropriations Act for Defense, the Global War
on Terror, and Tsunami Relief, 2005, providing $25 million to USAID for programs to
control the global spread of avian flu, and stipulating that $15 million of it be transferred
to the Centers for Disease Control and Prevention (CDC).9 The law also provided $58
million to CDC to purchase flu countermeasures (vaccines and antiviral drugs) for the
Strategic National Stockpile, and $10 million to HHS for sewer improvements to support
an expansion of the nation’s only domestic production facility for injectable flu vaccine.10
FY2006 — Regular Appropriations. In February 2005, the Administration
requested $120 million for HHS for pandemic preparedness for FY2006, including
continued efforts to expand vaccine production capacity.11 In July 2005, the
Administration requested an additional $150 million to purchase and stockpile pandemic
flu countermeasures, including antiviral drugs and prototype H5N1 vaccines.12 In
December 2005, Congress provided funding for pandemic flu in FY2006 emergency
supplemental appropriations (discussed below), using this vehicle, rather than regular
appropriations, to provide the bulk of pandemic funding for FY2006. Also in December
2005, Congress passed regular FY2006 appropriations for HHS in P.L. 109-149, the
Departments of Labor, Health and Human Services, and Education, and Related Agencies
Appropriations Act, 2006, providing $63.6 million to HHS for general public health
preparedness activities, including, but not limited to, efforts to bolster domestic flu
vaccine production capacity and to stockpile vaccine.13
FY2006 — Supplemental Appropriations. As Congress weighed regular
appropriations for FY2006, H5N1 avian flu spread to Europe, and Hurricane Katrina
raised concerns about the nation’s general level of disaster readiness. In November 2005,
the Administration requested $7.1 billion in emergency supplemental funds for avian and
7 See CRS Report RL32655, Influenza Vaccine Shortages and Implications, by Sarah A. Lister
and Erin D. Williams.
8 P.L. 108-447, 118 Stat. 3138. The act also provided $300,000 above the budget request to the
Food and Drug Administration (FDA), for flu vaccine activities.
9 H.Rept. 109-72, p. 144.
10 Ibid., pp. 149-150.
11 HHS, Budget in Brief, FY2006, Feb. 2005, text, p. 112, and table, p. 113, at [http://www.
hhs.gov/budget/06budget/FY2006BudgetinBrief.pdf].
12 White House Office of Management and Budget, Estimate No. 9, July 15, 2005, at
[http://www.whitehouse.gov/omb/budget/amendments/amendment_7_15_05.pdf].
13 P.L. 109-149, 119 Stat. 2857-2858. Pursuant to Section 3801 of P.L. 109-148, this amount was
subject to a 1% rescission.

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pandemic flu preparedness.14 This included $6.7 billion for HHS, for amounts to be
obligated over three years — $3.2 billion for obligation in FY2006, $2.3 billion for
FY2007, and $1.2 billion for FY2008 — and the remainder for FY2006 activities in
several other departments and agencies. HHS amounts were intended primarily to
promote the expansion of domestic vaccine manufacturing capacity.15
First Supplemental. In December 2005, Congress provided $3.8 billion in
emergency supplemental appropriations, including $3.3 billion for HHS, in Division B,
Title II of P.L. 109-148, the Department of Defense, Emergency Supplemental
Appropriations to Address Hurricanes in the Gulf of Mexico, and Pandemic Influenza
Act, 2006. The distribution of these funds to various federal departments and agencies
is presented in Table 2. Most of the shortfall between the $7.1 billion request and the
$3.8 billion appropriation resulted because Congress did not fund the “out years” of the
Administration’s HHS request for FY2007 and FY2008. Congress directed that HHS use
the $3.3 billion for FY2006 as follows:
! $350 million to CDC for state and local public health capacity;
! $50 million for CDC capacity;
! $150 million to CDC for domestic and global surveillance;
! $96 million to HHS for other international activities;
! $20 million to the Food and Drug Administration (FDA); and
! $2.654 billion for vaccine development and stockpiling.16
In report language (H.Rept. 109-359), conferees directed the Secretary of HHS to report
to the Appropriations Committees on a semi-annual basis regarding the use of the $3.3
billion provided. HHS has submitted a report to congressional appropriators17 and posted
three updates on these activities for public distribution.18
Second Supplemental. In its February 2006 FY2007 budget request, HHS
repeated its November 2005 request of $2.3 billion in FY2007 emergency supplemental
funds for pandemic flu, but sought the funds prior to the regular FY2007 appropriations
cycle. (HHS called the $2.3 billion amount an “allowance.”)19 In June 2006, Congress
provided $2.3 billion in supplemental funds to HHS in Title IV of P.L. 109-234, the
14 White House Office of Management and Budget, Estimate No. 15, Nov. 1, 2005, at
[http://www.whitehouse.gov/omb/budget/amendments/supplemental_11_01_05.pdf].
15 Testimony of Michael O. Leavitt, Secretary of Health and Human Services, hearing on
Pandemic Influenza before the House Committee on Appropriations, Subcommittee on Labor,
Health and Human Services, and Education, Nov. 2, 2005, 109th Cong., 1st Sess.
16 See P.L. 109-148, 119 Stat. 2783 for amounts to FDA, which is funded through Agriculture,
Rural Development, Food and Drug Administration, and Related Agencies Appropriations, and
119 Stat. 2786-2787 for the remaining HHS activities.
17 HHS, Report to Congress, “Pandemic Influenza Preparedness Spending, Conference Report
109-359,” June 15, 2006.
18 See HHS, Pandemic Planning Updates I, II, and III, at [http://www.pandemicflu.gov/
plan/tab1.html].
19 HHS, Budget in Brief, FY2007, Feb. 2006, pp. 99-101, at [http://www.hhs.gov/budget/
07budget/2007BudgetInBrief.pdf].

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Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and
Hurricane Recovery, 2006.20 No other departments or agencies received funds specifically
for avian or pandemic flu in the act. (See Table 2.) Congress authorized the Secretary of
HHS to use most of the funds to further federal domestic preparedness activities, the
vaccine initiative (including the construction or renovation of privately owned buildings),
and stockpiling of antiviral drugs and medical supplies. Congress directed that HHS use
portions of the funds as follows:
! $30 million for international disease control, through USAID;
! $250 million to CDC for state and local public health capacity; and
! at least $200 million for CDC capacity.
FY2007. In February 2006, in addition to the supplemental funds discussed above,
the Administration requested $352 million in regular appropriations for HHS pandemic
flu activities.21 In June and July 2006, respectively, the House and Senate Committees
on Appropriations reported FY2007 appropriations for HHS, including amounts targeted
for pandemic preparedness. Shortly before emergency supplemental appropriations were
enacted in June, the House committee provided $78.9 million in regular FY2007
appropriations for HHS, through the PHSSEF.22 The committee did not provide requested
amounts for several specific agency programs, noting that Congress was weighing the
supplemental spending bill at the time. In July, after supplemental appropriations were
enacted, the Senate committee also provided $78.9 million for the PHSSEF and the
following additional amounts for pandemic preparedness:
! $24.7 million to CDC’s Infectious Diseases Control budget;
! $8 million to CDC’s Health Marketing budget, for risk communication;
! $59 million to CDC’s Global Health budget, for disease detection.23
In May 2006, the House passed Agriculture appropriations for FY2007, including $28.1
million for pandemic flu activities at FDA.24 In June, the Senate committee reported
Agriculture appropriations, including a $50.5 million increase for FDA pandemic flu
activities, to make the FY2007 total in excess of $60 million.25
Further congressional action on FY2007 appropriations for HHS, including FDA,
is pending.
FY2008. As discussed earlier, the Administration requested, in November 2005,
$7.1 billion in supplemental funds for pandemic preparedness, of which $1.16 billion was
to be available to HHS in FY2008. Congress has not provided appropriations for the
20 P.L. 109-234, 120 Stat. 479-480.
21 HHS, Budget in Brief, FY2007, Feb. 2006, pp. 99-101.
22 H.Rept. 109-515, June 20, 2006, p. 169.
23 S.Rept. 109-287, July 20, 2006, pp. 7, 90, 96, and 221.
24 H.Rept. 109-463, May 12, 2006, p. 115.
25 S.Rept. 109-266, June 22, 2006, p. 144. Amounts reported include some carryover of the $20
million provided in the first supplemental, P.L. 109-148.

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requested amount for FY2008. The Administration may repeat its request for this amount,
or request other amounts, in its budget proposal for FY2008, expected in February 2007.
Table 1. HHS Appropriations Targeted for Pandemic Flu
(dollars in millions)
FY2006
Funding mechanism
FY2004
FY2005
enacted
Regular appropriations
$50
$99a
$64c
Supplemental appropriations
0
83b
5,620
TOTAL
50
182
5,684
a. Reflects a 0.8% rescission.
b. Includes $15 million transferred to CDC from USAID.
c. Amount is not restricted to avian and pandemic flu activities.
Table 2. FY2006 Supplemental Appropriations for
Avian and Pandemic Flu
(dollars in millions)
Supplemental
Department or Agency
requesta
P.L. 109-148
P.L. 109-234
Agriculture
$91.4
$91.4
0
Defense
130.0
130.0
0
HHS
(Request for FY2006)
(3,200.0b)
(3,320.0b)
0
(Request for FY2007)
(2,300.0)
0
(2,300.0)
(Request for FY2008)
(1,160.0)
0
0
Total for three years
6,660.0b
3,320.0b
2,300.0
Homeland Security
47.3
47.3
0
Interior
11.6
11.6
0
State
38.5
31.0
0
Veterans Affairs
27.0
27.0
0
USAID
131.5
131.5
0
TOTAL
7,137.3
3,789.8
2,300.0
a. White House Office of Management and Budget, Estimate No. 15, Nov. 1, 2005, at [http://www.
whitehouse.gov/omb/budget/amendments/supplemental_11_01_05.pdf].
b. Includes $20 million for FDA, provided in Agriculture appropriations.

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