The 381-page draft plan, leaked by health officials who claim that it contains fundamental failures, predicts that a full-scale outbreak could kill as many as 1.9 million Americans and put 8.5 million in hospital at a cost of more than $450 billion (£256 billion).

Hospitals would quickly become overwhelmed, riots would break out at vaccine clinics, civil unrest would sweep the country, and power and food would be in short supply, according to the plan, which has been years in the making. It calls for quarantine and travel restrictions but concedes that those measures “are unlikely to delay introduction of pandemic disease into the US by more than a month or two”.

A large outbreak in Asia, because of modern travel patterns, would be likely to reach the US within “a few months or even weeks”. The plan, which was passed to The New York Times, calls for the ability to manufacture 600 million vaccine doses within six months, more than ten times the country’s current capacity.

The document, called the Pandemic Influenza Strategic Plan, also calls for a national stockpile of 133 courses of flu treatment. The Bush Administration has purchased only 4.3 million courses at present.

On Friday, President Bush met officials from the country’s top six vaccine producers at the White House to urge them to step up production and to discuss ways to increase their production capacity.

Health officials claim that the plan fails to place a central figure in charge of co-ordinating a national response to a bird flu outbreak. After the Bush Administration’s disastrous initial response to Hurricane Katrina, and Mr Bush’s subsequent admission that a lack of clear and unified central leadership exacerbated the disaster, the officials told The New York Times: “We don’t want to have a FEMA-like [Federal Emergency Management Agency] response, where it’s not clear who’s running what.”

The officials conceded, however, that the plan was a “major milestone”.

One of the most controversial parts of the plan addresses who should be given the vaccines first. The military and National Guard are not mentioned.

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