Order Code RS22576
Updated March 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 strain — named H5N1 for its genetic makeup —
emerged in Hong Kong and killed six people. It has since spread to other countries in
Asia, Europe, and Africa, where it has infected more than 270 people, killing more than
160 of them. The situation has caused 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 influenza 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 disaster response, are important for pandemic preparedness. Also, the
President has called on all federal agencies to develop continuity plans for a flu pandemic,
activities that are typically funded through general administrative accounts. Second,
certain activities (e.g., the expansion of 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 pandemic flu preparedness. 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, a production
failure at a plant supplying half of the nation’s supply of injectable seasonal flu vaccine
resulted in a nationwide shortage of seasonal flu vaccine, and focused attention on the
frailty of the vaccine production system. At the same time, H5N1 avian flu was spreading
through Asia. In December 2004, Congress passed P.L. 108-447, the Consolidated
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. This amount was subject to a 0.59% rescission.
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, February 2004, p. 102, at [http://www.hhs.gov/budget/
05budget/fy2005bibfinal.pdf].

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Appropriations Act, 2005, providing HHS with the requested $100 million to bolster flu
vaccine production capacity, including the purchase of flu vaccine.7
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).8 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.9
FY2006 — Regular Appropriations. In February 2005, the Administration
requested $120 million for HHS for pandemic preparedness for FY2006, including
ongoing work to expand vaccine production capacity.10 In July 2005, the Administration
sought an additional $150 million to purchase and stockpile flu antiviral drugs and
prototype H5N1 vaccines.11 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 efforts to bolster
domestic flu vaccine production capacity and to stockpile vaccine.12
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
pandemic flu preparedness.13 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
7 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. These amounts was subject to
a 0.8% rescission.
8 H.Rept. 109-72, p. 144.
9 Ibid., pp. 149-150.
10 HHS, Budget in Brief, FY2006, Feb. 2005, text, p. 112, and table, p. 113, at [http://www.
hhs.gov/budget/06budget/FY2006BudgetinBrief.pdf].
11 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].
12 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.
13 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].

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several other departments and agencies. (See Table 2.) The bulk of the amount requested
for HHS was to support the expansion of domestic vaccine manufacturing capacity.14
First Supplemental. In December 2005, Congress provided $3.8 billion in
emergency supplemental appropriations, including $3.3 billion for HHS,15 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, the amounts for FY2007 and FY2008. 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 appropriators, and posted three updates on these
activities for public distribution.16
Second Supplemental. In February 2006, in its FY2007 budget request, HHS
repeated its November 2005 request for $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.”)17 In June 2006, Congress
provided $2.3 billion in supplemental funds to HHS (in the PHSSEF) in Title IV of P.L.
109-234, the Emergency Supplemental Appropriations Act for Defense, the Global War
on Terror, and Hurricane Recovery, 2006.18 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 $30 million be transferred to USAID for global disease control activities.
FY2007. In February 2006, in addition to supplemental funds noted above, the
Administration requested $352 million for HHS pandemic flu activities in regular FY2007
appropriations.19 Coincident with passage of the second FY2006 supplemental, the House
and Senate Committees on Appropriations each recommended $78.9 million in the
PHSSEF. The Senate committee recommended an additional $92 million for domestic
14 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.
15 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.
16 HHS, Report to Congress, “Pandemic Influenza Preparedness Spending, Conference Report
109-359,” June 15, 2006; and HHS, Pandemic Planning Updates I, II, and III, at
[http://www.pandemicflu.gov/plan/tab1.html].
17 HHS, Budget in Brief, FY2007, Feb. 2006, pp. 99-101, at [http://www.hhs.gov/budget/
07budget/2007BudgetInBrief.pdf].
18 P.L. 109-234, 120 Stat. 479-480.
19 HHS, Budget in Brief, FY2007, Feb. 2006, pp. 99-101.

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and global pandemic flu activities at CDC.20 Similarly, the House passed Agriculture
appropriations for FY2007, including $28.1 million for pandemic flu activities at the Food
and Drug Administration (FDA), and the Senate committee reported Agriculture
appropriations, including a $50.5 million increase for FDA pandemic flu activities, to
make the FY2007 recommended total in excess of $60 million.21
The amounts recommended above were not subsequently enacted. In February 2007,
Congress passed FY2007 appropriations for HHS in H.J.Res. 20, the Revised Continuing
Appropriations Resolution, 2007 (P.L. 110-5). The law is not accompanied by a
conference report. Except for amounts specifically mentioned — including an amount
for pandemic flu — the law provides that departments be funded through FY2007 at the
FY2006 level, with adjustments for certain rescissions and for 50% of the cost of
increases in salaries and benefits. The law does not, in general, specify amounts below
the account level for departments, but requires that departments submit their FY2007
spending plans to the appropriations committees within 30 days of enactment.22 P.L. 110-
5 explicitly provides $100 million to the PHSSEF, to be transferred to CDC, for
preparedness and response to pandemic flu and other emerging infectious diseases. It also
rescinds $29.7 million from CDC regular appropriations for FY2006, intended for the
purchase of annual bulk monovalent influenza vaccine (to bolster supplies of seasonal flu
vaccine). It does not mention any additional HHS amounts for flu preparedness. HHS
is free to fund additional flu activities, beyond the $100 million specifically provided,
within the limited constraints provided in the law.
On March 20, 2007, the House Committee on Appropriations reported H.R. 1591,
the U.S. Troop Readiness, Veterans’ Health, and Iraq Accountability Act, 2007, which
would provide $970 million in emergency supplemental appropriations to the PHSSEF
for ongoing pandemic flu activities in HHS. The committee noted that this was the “third
installment of funds ... requested by the Administration.”23
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. In February 2007, in its annual budget proposal, the
Administration requested $1.19 billion for flu preparedness for FY2008, including $870
million for the PHSSEF to be available until expended, and $322 million for ongoing
agency activities, principally at CDC, FDA and the National Institutes of Health (NIH).24
As discussed above, in March 2007, the House Committee on Appropriations
recommended $970 million in FY2007 emergency supplemental appropriations for
pandemic flu preparedness. Regular appropriations for FY2008 are pending.
20 H.Rept. 109-515, June 20, 2006, p. 169; S.Rept. 109-287, July 20, 2006, pp. 7, 90, 96, and 221.
21 H.Rept. 109-463, May 12, 2006, p. 115; S.Rept. 109-266, June 22, 2006, p. 144. Amounts
reported include some carryover of the $20 million provided in P.L. 109-148.
22 The act was signed on February 15, 2007.
23 H.Rept. 110-60, Mar. 20, 2007.
24 HHS, Budget in Brief, FY2008, Feb. 2007, pp. 102-104, at [http://www.hhs.gov/budget/
08budget/2008BudgetInBrief.pdf].

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Table 1. HHS Appropriations Targeted for Pandemic Flu
(dollars in millions)
FY2008
Funding mechanism
FY2004
FY2005
FY2006
FY2007
request
Regular appropriations
$50a
$99b
$63d
$100f
$1,192g
Supplemental appropriations
0
83c
5,620e
0
0
TOTAL
$50
$182
$5,683
$100
$1,192
a. Reflects a 0.59% rescission.
b. Reflects a 0.8% rescission.
c. Includes $15 million transferred to CDC from USAID.
d. Amount is not restricted to avian and pandemic flu activities, and reflects a 1.0% rescission.
e. Includes $30 million to be transferred to USAID.
f. Additional amounts, if any, must be reported by HHS within 30 days of enactment of P.L. 110-5.
g. Of this amount, $870 million is requested to be available until expended.
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
2,300.0c
(Request for FY2007)
2,300.0
0
0
(Request for FY2008)
1,160.0
0
0
Total for three years
6,660.0b
3,320.0b
2,300.0c
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.
c. Includes $30 million to be transferred to USAID.

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