Public health and emergency preparedness officials from across the United States gathered in Washington Monday to begin coordinating a national response to a possible influenza pandemic. The Bush administration has issued a list of planning activities that U.S. states and cities should consider to be ready if a pandemic emerges from the H5N1 bird flu virus or another virus.

The meeting was convened by U.S. Health and Human Services Secretary Michael Leavitt, who told the assembly that a rapidly spreading global flu pandemic could infect more than 90 million Americans in four months, hospitalize 10 million, and kill nearly two million.

"Pandemics happen. It is a fact of biology. When it comes to a pandemic, we are overdue and underprepared," he said.

The U.S. official in charge of homeland security, Michael Chertoff, told the meeting that the need for preparation is the key lesson of the recent hurricanes that devastated a large part of the U.S. Gulf of Mexico coast. The Bush administration, and his agency in particular, were heavily criticized for not being prepared for the storms.   Mr. Chertoff says that the hurricanes were limited in their territorial scope, but that health pandemics affect entire nations by cutting sharply into the manpower needed to keep them operating.

"We recognize because of the wide scope of the consequences that can ensue from a pandemic that we have to draw upon a very wide spectrum of expertise and capabilities within the federal government and within our state and local first responder and public health communities. More than ever, partnership and collaboration are going to be critical," said Mr. Chertoff.

The U.S. government took its first major step in developing a pandemic flu plan with President Bush's request to Congress last month for more than $7 billion to better detect outbreaks at home and abroad and expand domestic production of flu vaccines and antiviral medicines. Each agency of the national government is writing its individual plan to confront a pandemic, to be coordinated by the Homeland Security Department. Health secretary Leavitt says state and local governments and the private sector should do the same. He is calling for each of the 50 U.S. states to hold its own pandemic planning summit within the next several months to link private and public resources and to educate politicians and the public about the importance of the issue.

"We have to maintain the level of urgency that is apparent right now," said Mr. Leavitt.

As a guide to planning, Mr. Leavitt's Health and Human Services Department has issued a checklist of activities that state and local officials can undertake, such as assigning responsibilities for specific tasks, linking the animal and human health sectors, procuring vaccines and medicines, and testing the readiness of health care facilities to cope with a surge of sick and dying patients. The department is also preparing voluntary checklists for schools, businesses, families, and individuals.

President Bush's special assistant for biological defense policy, Rajeev Vankayya, says government agencies must determine how they will maintain essential functions and staffing if a flu pandemic hits.

"The good news is that we're doing this now in the federal government," said Mr. Vankayya.  "But this same activity needs to be replicated at every level of government. It needs to be replicated in communities."

Health Secretary Leavitt says a broad national program to respond to a flu pandemic would also help prepare to cope with other public health threats.