DUMMERSTON, Vt. For all the talk about "homeland security" in the four years since the Sept. 11, 2001, attacks, our nation has been woefully unprepared in many areas. Nowhere is this more evident than in the area of public health. Since 9/11, the federal Department of Health and Human Services and the Pentagon have spent more than $12 billion on measures to combat hypothetical threats such as smallpox and anthrax and spent almost nothing to deal the most dangerous and most likely threat to the public health and safety, the flu virus H5N1 avian influenza, otherwise known as "bird flu." H5N1 is anything but hypothetical. It is a lethal flu strain new to the human immune system. First spotted in east Asia about a decade ago, it is jumping from chickens to migratory birds to humans with ease. Officially, only about 100 people worldwide have died from bird flu in the past couple of years, but many medical experts believe the H5N1 virus is mutating rapidly and is about to acquire the genetic traits that could turn it into a fast-spreading flu pandemic in humans. The World Health Organization estimates that as many as 150 million people worldwide could die in a H5N1 pandemic. It could be the deadliest flu outbreak since the 1918 Spanish flu outbreak that killed up to 40 million people around the world, including about 850,000 in the United States. Health experts in America have known for several years that the likelihood of another big flu pandemic is great. Because of the Bush administration's focus on the "war on terror," almost nothing has been done to prepare for something that will kill infinitely more people than another 9/11 attack. In the United States, there has been little development of new flu vaccines and antiviral medicines, because the big drug companies are making more money selling the medications you see over-advertised on television. Last fall's shortages of flu vaccine was a dramatic example of how little margin for error there is if a vaccine is needed quickly. The most effective anti-viral medicine against H5N1 is oseltamivar, sold by Roche under the brand name of Tamiflu. It is made in a single factory in Switzerland and Roche will not be able to meet global demand if a flu pandemic breaks out. There is very little Tamiflu stockpiled in the U.S. There's enough to treat about 2.3 million Americans and medicine is on order to treat another 2 million by the end of the year. Unfortunately, about 90 million would need the drug if a pandemic broke out in the U.S. Given the current production capacity, it would take years to make enough to go around. There is no guarantee that Tamiflu will be effective against bird flu, and it will take years to develop a specific and effective vaccine. Lacking a magic bullet from the laboratory, the last line of defense, if there is a pandemic, is the nation's public health infrastructure. However, the resources needed to cope with a pandemic in the United States simply aren't there. The combination of staffing shortages, overcrowded hospitals and inadequate funding leave many urban hospitals without enough staff to handle an average night of emergency room visits, let alone a flu outbreak. In any given year, worldwide, a flu virus kills about 800,000 people. Is our nation prepared for hundreds of thousands, or perhaps even millions, of deaths? And how much faster will a pandemic spread if there are more than 40 million Americans without health insurance and millions more who don't have adequate coverage? Judging from the response of the Bush administration last week, when it finally acknowledged that a bird flu pandemic was a possibility, our nation is not prepared and will not be prepared any time soon. Aside from outlining scenarios for martial law to enforce quarantines and begging the drug companies to step up vaccine research and production, President Bush has no real plan. As with every other response to a crisis, Bush is once again offering too little, too late. It's too late to be stockpiling anti-flu drugs or asking the drug companies to come up with a new vaccine. Martial law will do nothing to stop the spread of bird flu. The only thing that can be done is to rapidly rebuild our public heath infrastructure. More doctors and nurses, more hospital beds and more money are all urgently needed, not just to deal with the threat of bird flu, but with other health problems as well. If the Bush administration truly cares about the health and safety of its citizens, doing this would be a priority. Sadly, because they have demonstrated time and time again that they don't care, nothing will be done and many people will needlessly die.