Rising concerns about a widespread influenza pandemic have prompted state and local leaders to begin expanding existing emergency response plans to ensure they are equipped to cope with the devastating health and economic consequences of a possible outbreak. And with the grim assumptions of its effects on the population and the economy, federal officials are concerned.

Citing a report by the Congressional Budget Office, Senate Majority Leader and heart surgeon Bill Frist, R-Tenn., warns that a severe pandemic would infect 90 million Americans and cause a $675 billion hit on the economy. As for the actual risk of a pandemic in the near future, “we just don't know,” says John Thomasian, director of the National Governors Association Center for Best Practices. “It's still relatively less likely than likely, but it would have such an impact, you have to plan.”

Human cases of the H5N1 strain of the avian flu have increased overseas, and the virus's inability to spread from human to human is the only thing keeping a pandemic at bay, says the U.S. government. As of now, no cases have been reported in the United States.

Thomasian says that state plans for flu and other health pandemics are limited because they have focused on the public health aspect and have involved only state and local health departments. States now are focusing on involving the emergency response community, Thomasian says, bringing emergency responders, homeland security officials and emergency planning officials to the table.

“We are looking beyond the health response and focusing on larger issues,” he says. “While many people focus on the mortality, you have to remember that for every 100 people who are infected, 98 will live through it. But they will be very sick, so you have to plan for how to bring essential services into your state.”

Patrick Libbey, executive director of the National Association of City and County Health Officials, agrees that the planning should go beyond dealing with the health impacts. “We need to make sure all community assets are part of the plan,” he says, stressing the importance of partnerships and collaboration in developing a successful response plan. Libbey says leaders should determine how assets are going to be used collectively.

State and local leaders need to pay attention to detail, Libbey says. “We need to get past this idea of a broader policy plan and develop plans on a level of detail that they are truly actionable plans,” he says.

The federal government has begun meeting with state and local leaders to discuss pandemic planning. In early December, officials from the Department of Health and Human Services and the Department of Homeland Security discussed plans with state leaders and gave them planning checklists.

The federal government also is planning a series of state summits over the next few months. Plus, Thomasian says, the National Governors Association has proposed to HHS a series of regional meetings “to walk through best practices and maybe hold some simulations.” Libbey says those are all good steps, but a main concern among city and county leaders is that the available resources get to the local level where they are really needed and where actionable plans will be developed.

The author is Washington correspondent for American City & County.