Some health experts are concerned that the Bush administration's pandemic plan would cost more than overburdened state health departments can afford and divert resources from other programs. And it could affect public health officials' credibility if a pandemic doesn't occur.

The state public-health directors expressed their concerns at a meeting held here by two Bush Cabinet secretaries to kick off a series of "flu summits" to be held in every state over the next 120 days. Their goal: to help communities prepare for a pandemic that could strike up to 90 million people nationwide, killing 1.9 million of them, according to government estimates.

Under this worst-case scenario, modeled after the 1918 flu, 45 million people would need hospitalization, 1.4 million of them in intensive care. Absenteeism might engulf 40% of the workforce and schoolchildren, including those who are sick, those who care for them and those who stay home to stay healthy.

Government's Strategy

The H5N1 flu virus, or bird flu, that has infected flocks from Asia to Europe has infected about 130 people, killing about half of them. Public health experts fear that if it begins spreading readily from person to person, it could spark a pandemic.

"No nation on Earth can ignore this threat," said Secretary of Health and Human Services Michael Leavitt, who convened the meeting with Secretary of Homeland Security Michael Chertoff.

At the meeting, called "Pandemic Planning: Convening the States," Leavitt and other federal officials detailed the nature of the threat and the government's strategy for dealing with it. President Bush has asked Congress for $7.1 billion to buy at least 50 million doses of antiviral drugs, ramp up vaccine production, expand flu surveillance and generally prepare for the worst.

The flu summits are designed to generate support for the strategy and provide assistance to local officials, who would have to make sure people get needed medical care, oversee quarantine efforts and assure that homes, medical facilities and businesses receive critical supplies.

'Disease of the Month'

But some health experts expressed concerns that the administration plan would cost more than overburdened state health departments can afford and divert resources from other programs.

Oregon's public health director, Susan Allan, worried that the heavy emphasis on flu also could affect public health officials' credibility if a pandemic doesn't occur. "People have lurched from one 'disease of the month' to another for the past five years. We did our anthrax plan, we did a SARS plan, now it's pandemic flu," Allan said.

"I'm worried about that," Leavitt responded, noting "there's a better than 50% chance" that the H5N1 virus now spreading among birds worldwide won't cause a pandemic in humans.

"But, ultimately, it's going to happen."