Bush administration officials have repeatedly stressed that local authorities including governments, businesses, schools and hospitals must have individual plans to deal with a pandemic like the one threatened by avian flu.

A national pandemic readiness plan due out this week from the White House is expected to reinforce the strategy.

"There is no way that (Washington) can respond to every home town in America at the same time" if a pandemic occurs, Health and Human Services Secretary Michael Leavitt said Tuesday at a disaster preparedness summit sponsored by the magazine U.S. News & World Report.

"The foundation of pandemic preparedness is local planning. It has to be," Leavitt said.

But directors of some large hospitals expected to act on the front lines of such a response say they don't have the financial resources needed to beef up readiness.

Concerns cover a range of hospital operations, including increasing numbers of clinic beds, securing additional medical machines, and ensuring that personnel will show up for work during a disaster.

"The problem is, we are just good enough for what happens now," said W. Frank Peacock, IV, chairman of emergency preparedness at the Cleveland Clinic.

Peacock said his hospital has to double its number of staffed hospital beds to be ready to treat potentially tens of thousands of sick Clevelanders expected if a pandemic hit. But operating margins are too thin to allow for a sustained scale-up, he warned.

"To ask any industry to double its infrastructure with no funding is really a hard row," Peacock said.

The Bush administration asked Congress for $7.1 billion in funding for a national pandemic plan. But the vast majority of the money goes toward programs to speed vaccine and medicine development and to boost the capacity of the U.S. vaccine industry.

Only a fraction is targeted toward cities and states to fund preparedness. Leavitt says tha communities must formulate their own plans without relying on Washington.

But other hospital leaders say they've funded preparedness efforts at the expense of other functions. Edward Miller, chief executive officer of the Johns Hopkins University School of Medicine, said the hospital has spent $11 million on disaster readiness, only $1 million of which came from outside the university.

"It comes out of other programs that we're not funding," he said.

Miller warned that most hospitals cannot afford extra respiratory ventilators and other medical equipment that would become essential to treat a surge in people with a respiratory illness like the flu.

"It's nice for the secretary to say we should stockpile ventilators, but most of us don't have the money to buy two, three, four hundred ventilators," he said. "This is not a sustainable business plan."

Congress has agreed to half the $7.1 billion requested by the White House for pandemic plan. The administration is expected to request the second half in the coming weeks. "I expect that Congress will respond when it's presented," Leavitt said.

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