A year after President Bush's plan to track and treat a pandemic flu outbreak was unveiled, it still has not been fully implemented. In the next few weeks, the White House will release the priority list of who will receive the first flu shots in the event of an outbreak, but important elements of the strategy -- such as organizing and authorizing school closures -- are still being evaluated.

Such limited capacity by the state and federal governments to control an infectious disease outbreak could be particularly important for states like Texas, where proximity to the border is a major concern. The cities of Austin, Houston, and Dallas, perhaps, are standing at even more attention, as the healthcare systems there are not only already overburdened by a state where 25% of the population is uninsured -- the worst rate in the country -- but also lack an adequate number of qualified physicians to deal with such a problem. The sheer population density of cities, combined with these other factors, could prove to be a deadly combination for the state. The denser the population, the faster an infectious agent spreads. If such an outbreak were to occur, it might be nearly impossible to control, and just as hard to treat.

To compound the problem in Texas, the federal government has decided not to close the borders if a pandemic flu outbreak does occur internationally -- including in Mexico, Central, and South America -- instead opting only to "limit" the number of those arriving and detaining those suspected of carrying infection. Goods and people will still be allowed to "flow" across international lines.

The borders are difficult to close, said officials, as evidenced by past events. "It is inevitable that it [the flu] will arrive here in the U.S. irrespective of the actions taken at the borders," said Dr. Rajeev Vankayya, special assistant to the president for biodefense.

Significant planning and investments have been made, however, according to officials, who revealed updates on the plan earlier this month in a White House briefing. One billion dollars has been allocated for discovering new methods of manufacturing the flu vaccine, and the Department of Health and Human Services has released $897 million to states for emergency preparedness efforts, including $175 million for controlling a pandemic flu outbreak.

The U.S.'s system for tracking and controlling infectious diseases still needs a lot of work, however, according to Dr. Vankayya. There is still no uniform, effective biosurveillance system in place, and the country has little or no extra capacity in hospitals or other healthcare facilities to deal with such a problem. "We have a lot of trouble determining when we have an outbreak of disease in a community here in the U.S.," said Dr. Vankayya.

Additionally, allocating even more money to a pharmaceutical industry under scrutiny for too many government subsidies, overspending, and conflicts-of-interest, while millions of Americans are going without insurance and proper healthcare, doesn't sit well with many citizens. Spending another billion on developing new methods of manufacturing a flu vaccine may or many not solve the very real problem that the vaccine does not always work, due, in part, to the number of existing influenza strains, and their ability to mutate. For every strain, a new vaccine must be manufactured. By the time a vaccine is manufactured and distributed to the public, it may be useless. Many believe the money may be better spent on addressing the very real, very present problem of lack of health insurance and the statistical link between its lack and the availability of quality healthcare.

"I'm not sure how I feel about that," said Keith, a self-employed craftsman lacking health insurance. "So the government wants to give drug companies another billion for a vaccine I may or may not get, depending on my "priority listing," for an outbreak that may or may not happen, while I go without healthcare right NOW because I can't afford insurance? And I'm not the only one. I realize the possibility of an outbreak needs to be addressed, but I don't know, it just doesn't seem right to me."

Such limited progress could be of little comfort to a country that is obviously concerned, but growing tired of repeated warnings of possible terrorist attacks and disease outbreaks. Especially for residents of border states, to be told that there is a distinct possibility of a horrible, deadly, infectious disease spreading rampant throughout the country -- while also being informed that not only will the borders not be closed, but also that little is being done to increase their already overburdened healthcare systems' capacity to treat its current load, let alone a new influx of victims doesn't breed a lot of confidence in President Bush's ability to "protect and serve." The message for now seems to be, "hold on tight because we may or may not be able to help."

Preparing for a pandemic flu outbreak is an important part of watching out for your health, but so is taking care of yourself on an everyday basis. How you take care of yourself will certainly affect you as you age, and eventually your wallet, as well.