WASHINGTON --South Carolina is in. Utah and Alabama, too. New Hampshire is out, at least for now.

States have three more weeks to indicate whether they will seek help from the federal government in buying anti-flu medicine for a possible pandemic. Some already have made up their minds.

"We figure it is certainly better to do it and move forward with the purchase and hope we never have to use it than not and wish that we had," said Jim Beasley, spokesman for South Carolina's Department of Health and Environmental Control.

As part of its pandemic preparations, the federal government is stockpiling Tamiflu and other anti-flu medications, which can reduce the symptoms associated with influenza. The Bush administration plans to buy enough to treat 44 million people.

States can buy more if they want. The government is negotiating a price with Roche Laboratories, Inc., which makes Tamiflu, and will pay a quarter of the costs, up to a prescribed amount for each state. In all, states could use the subsidy to buy anti-flu medications for an additional 31 million people.

Rhode Island was allocated up to 112,981 additional doses, and the state plans to purchase them all, said Dr. L. Anthony Cirillo, interim director, of the department's Center for Emergency Preparedness and Response.

The Department of Health and Human Services had set a July 1 deadline for states to indicate whether they would move forward with the purchase, but some states wanted more time, said spokesman Bill Hall. The deadline was moved to Aug. 1.

Hall stressed that the deadline does not obligate states to a specific course of action. Rather, it serves as guidance to HHS for its planning.

Montana and Arizona want only a little extra help. Meanwhile, states such as Washington say they plan to take full advantage of the next few weeks to determine the right amount of drugs to purchase.

"There's a lot to sort out with antivirals," said Tim Church, spokesman for the Washington state Department of Health. "It's not a black-and-white decision."

Oklahoma lawmakers this spring allocated $500,000 to buy anti-flu medications. That's enough to pay for enough medicine to treat about 35,000 of the state's 3.5 million people. But that's less than 7 percent of the amount HHS estimates the state could purchase through the federal subsidy.

"We're struggling with how much do we need," said the state's epidemiologist, Dr. Brett Cauthen. "How much insurance do you need? Nobody knows what the best number is."

Other states also indicated they probably won't use their full allotment. Montana, population 918,000, plans to buy enough anti-flu medication to treat 8,100 people. It could have bought enough to treat about 96,000.

David Engelthaler, epidemiologist for the Arizona Department of Health Services, said the state had plans to spend $1 million on 70,000 courses of the 585,780 available to Arizona, population 5.6 million, but would talk to local health officials to see if more should be purchased.

Engelthaler said it wasn't prudent to use public money to stockpile Tamiflu for every man, woman and child. "It's not likely to be a good drug for general prevention like a vaccine would," he said.

Meanwhile, Dr. Jose Montero, state epidemiologist for New Hampshire, says the state will not buy additional anti-flu medication unless the Legislature appropriates funds for the purchase. And that couldn't happen until the Legislature comes back in January.

Other states say they will take advantage of the federal government's offer.

"We are authorized to buy as much as we can get by the governor," said Dr. Fred Jacobs, New Jersey's health commissioner.

New Jersey has told HHS it wants enough to treat about 900,000 people.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University's medical school, recommends that states have some anti-flu medication stockpiled in case of a pandemic. However, he said there's no right answer when it comes to just how much the states should have on hand.

"These are all insurance policies we're buying," Schaffner said.

How much insurance a state wants has to be weighed against other pressing matters, such as funding better education or roads, he said.

Schaffner said he does sense, however, than many states still rely too much on the premise that the federal government should fund pandemic preparedness.

"When it comes down to funding, that's when a lot of states are saying, gee, maybe it should all come from Uncle Sam," said Schaffner. "I think that's not a reasonable idea, and that's why we at Vanderbilt have made an investment in our own stockpile, and have invested substantially in drills and planning."

The federal government has made clear that it won't be able to protect everyone in a pandemic.

"Any community that fails to prepare with the expectation that the federal government will at the last moment be able to come to the rescue will be tragically wrong," said Health and Human Services Secretary Michael Leavitt.

There have been three influenza pandemics in the United States during the past century. Officials fear that a virus in birds, the H5N1 virus, could mutate and spread from human to human. The World Health Organization reports that at least 229 people are known to have contracted bird flu since 2003, of which, 131 died.

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On the Net:

Government's pandemic flu site: http:http://www.pandemicflu.gov

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By Kevin Freking, Associated Press Writer

© Copyright 2006 The New York Times Company