	Background

Influenza A/H5N1 is one of many strains of avian influenza that can cause illness in poultry. That year, 18 people in Hong Kong contracted the virus; of whom 6 died. Since 2003, when the virus resurfaced and killed 4 people, scientists have closely monitored resurgent H5N1 outbreaks. At last count, H5N1 has infected birds in more than 50 countries and infected 261 people, of whom 157 have died. More than 200 million birds in Europe, the Middle East and Africa have either died from H5N1 or have been culled in containment exercises. In 2006, human H5N1 cases were being reported outside of Asia for the first time. In some countries, H5N1 has only been found in wild birds. Congressional Response

P.L. 109-13 , FY2005 Emergency Supplemental Appropriations, provided the first appropriation for global avian flu efforts, though agencies and departments had already launched initiatives to combat the virus. USAID transferred $15 million of the funds to the Centers for Disease Control and Prevention (CDC). Congress provided $6.1 billion for those efforts in two supplemental appropriations; appropriating $3.8 billion in P.L. 109-148 , FY2006 Defense Appropriations and $2.3 billion in P.L. 109-234 , FY2006 Emergency Supplemental Appropriations. U.S. agencies and departments might contribute additional resources to global avian flu efforts not specifically provided through these appropriations. Of the $7.1 billion related to international activities, the President requested:
$200.0 million for HHS to undertake a number of activities, including international pandemic preparedness planning initiatives and pandemic influenza disease surveillance; $18.3 million for the U.S. Department of Agriculture (USDA) to undertake research and development initiatives and to provide avian influenza surveillance and prevention technical assistance globally; $120.0 million for the Department of Defense (DOD) to increase worldwide surveillance and upgrade related equipment; $10.0 million for DOD to assist military partner nations in procuring protective equipment, portable field assay testing equipment, and related laboratory equipment; $17.0 million for DOS to implement public diplomacy, training, and international outreach activities related to avian influenza and pandemic preparedness; $1.5 million for DOS International Visitors Program to provide 100 additional professional exchanges of doctors, health practitioners, and non-governmental organizations (NGOs); $75.2 million to USAID for efforts that encourage behavior change and raise awareness about avian flu awareness, diagnostic support initiatives, and pandemic preparedness and planning activities; and $56.3 million for International Disaster and Famine Assistance Funds of USAID to pre-position supplies and equipment, such as antiviral medication and protective equipment. 109-148 , FY2006 Emergency Supplemental Appropriations, provided $91.3 million to USDA for avian flu and pandemic preparedness initiatives, of which $19.5 million was committed to global efforts. Other U.S. Agencies and Departments

A number of other U.S. agencies and departments participate in global avian and pandemic influenza preparedness efforts, including the following:

			Department of Homeland Security (DHS)

DHS supports DOS in its coordination of U.S. global avian flu efforts. Many health experts hope that Tamiflu remains effective if H5N1 becomes effectively transmissible among people. Supporters of greater spending on global avian flu efforts urge Congress to provide additional funds for international efforts and to enact legislation in the 110 th Congress similar to those bills introduced in the 109 th Congress which sought to increase resources to global avian and pandemic influenza preparedness (for a list of the bills see Appendix ). H5N1 Cases, WHO Pandemic Phases, U.S. 5522 , FY2007 Foreign Operations Appropriations, would have provided $25 million for USAID's global avian flu efforts, $30 million below requested levels.
Influenza A/H5N1 is one of many influenza (flu) strains currently spreading throughout the world. Although it is a bird flu, it has infected some people and killed more than half of those infected. Since 1997, when the first human contracted H5N1 in Hong Kong, the virus has resurfaced and spread to more than 50 countries across Asia, Europe, the Middle East, and Africa—infecting more than 260 people and killing more than 150 of those infected. In February 2006, the virus spread from Asia and central Europe to western Europe. By March 2006, health experts had confirmed new bird flu cases in more than 20 countries across Europe, Asia, and Africa. The first human H5N1 fatalities outside of Asia occurred in that year, with Turkey and Iraq reporting H5N1-related human deaths for the first time in January and February, followed by Azerbaijan and Egypt in March.
Congress has provided funds for U.S. international avian flu efforts through three appropriations. P.L. 109-13, FY2005 Emergency Supplemental Appropriations, provided $25 million to combat the spread of avian influenza. The act also permitted the Secretary of State to transfer up to $656 million for U.S. avian flu initiatives. Ultimately, $6.3 million was transferred to USAID for those purposes, providing a total of $31.3 million for U.S. global avian flu activities from those appropriations. P.L. 109-148, FY2006 Defense Department appropriations, included $3.8 billion to address pandemic influenza. P.L. 109-234, FY2006 Emergency Supplemental Appropriations, provided $2.3 billion for avian and pandemic flu efforts, of which $30 million was appropriated to USAID for international avian flu efforts and $200 million was appropriated to the Centers for Disease Control and Prevention (CDC) for global and domestic disease surveillance, laboratory capacity, research, and other activities. Relevant FY2007 U.S. department and agency budget justifications included some $205 million for global H5N1 initiatives. As in previous fiscal years, U.S. agencies and departments might commit additional resources to global avian flu efforts that were not specifically appropriated for those purposes.
This report provides an up-to-date account of global H5N1-related human infections and deaths, outlines U.S. global avian flu programs, and presents some foreign policy issues for Congress. This report will be updated should Congress provides additional funds for global purposes, and then only if H5N1 becomes effectively transmissible from person-to-person. For information on U.S. domestic preparedness efforts, agricultural issues, and anti-avian flu efforts of overseas governments, see CRS Report RL33145, Pandemic Influenza: Domestic Preparedness Efforts, by [author name scrubbed]; CRS Report RL33795, Avian Influenza in Poultry and Wild Birds, by [author name scrubbed] and [author name scrubbed]; and CRS Report RL33871, Foreign Countries' Response to the Avian Influenza (H5N1) Virus: Current Status, coordinated by [author name scrubbed] (pdf).