The state Department of Health is taking advantage of a massive emergency- response exercise today to "pre-position" some 10,000 courses of antiviral flu medication on Lana'i and Moloka'i, at district health offices and community health centers there.

While the DOH regularly conducts distribution exercises, today's operation, intended to test the state's ability to distribute medicine and medical supplies to the Neighbor Islands in the event of an emergency, is believed to be the first involving all of the main Neighbor Islands.

While faux medications will be used in the exercise, the DOH will also distribute real antivirals from the state's stockpile on O'ahu to Neighbor Island district health offices for greater availability in the event of a real emergency.

While the exercise has been planned for months, it comes just as the DOH is stepping up its preparations for an "expected resurgence" of the H1N1, or swine flu, virus this fall.

"It's not as simple as just getting the supplies there," said DOH director Dr. Chiyome Fukino. "We have to have a network of people involved. Supplies have to be accounted for. They have to be stored properly. There has to be adequate security and inventory. It's important to exercise this before there is an emergency."

While commercial antiviral medication such as Tamiflu is available for regular community distribution and use, the state also maintains an emergency stockpile of approximately 210,000 courses of antivirals, including approximately 40,000 courses acquired from the Strategic National Stockpile earlier this year.

The SNS, a federal program capable of rapidly deploying caches of medications and medical supplies to states in the event of bioterrorist attack or public health emergency, maintains an additional 120,000 courses of antivirals designated specifically for Hawai'i. Each state is required to ensure that it can distribute antiviral medications statewide in the event of an emergency.

Today's exercise is being conducted under the premise that a biological disease outbreak has occurred and the commercial supply system cannot meet the need for antiviral medications.

Also participating in the exercise are the DOH Disease Outbreak Control Division; district health offices on Maui, Kaua'i and the Big Island; the Healthcare Association of Hawai'i; the Hawai'i Primary Care Association; Courier Corp. of Hawai'i; AirMed Hawai'i; and the Coast Guard.

The state's preparations for a potential resurgence of swine flu have been helped by a $2.1 million grant from the U.S. Centers for Disease Control and Prevention.

Public Health Emergency Response grants were awarded to each state in anticipation of an outbreak.

An initial supply of H1N1 vaccine is expected to be released by early November. Fukino said the vaccines will first be made available to health care professionals, one of the high-risk groups identified by the CDC's Advisory Committee on Immunization Practices.

Subsequent allotments will be made available to other high-risk groups, including pregnant women; children and young adults (age 6 months through 24 years); household and caregiver contacts of children younger than 6 months; and those with medical conditions that make them especially vulnerable to the virus.

The DOH is also ramping up other efforts on swine flu prevention and treatment. The department is working with the Department of Education on plans for free, voluntary statewide H1N1 vaccination clinics in the winter and has established a pre-registration process for licensed physicians interested in administering the vaccine this fall and winter.

The H1N1 vaccine is different from the vaccine used to immunize against seasonal influenza.

The potential outbreak has been a key concern for President Obama's administration. Last week, a presidential advisory panel estimated that an H1N1 resurgence this fall could result in as many as 90,000 deaths in the United States.

Yesterday, Obama called on state and local governments to do whatever is necessary to prepare for a second surge of the virus and encouraged citizens to take "common-sense" measures to protect themselves.

More than 1,400 confirmed cases of swine flu have swelled overall flu numbers in Hawai'i, and seasonal flu is up as well.

Six people with swine flu have died here since the first cases were confirmed May 5. All six H1N1-related deaths in Hawai'i involved people who also had other health problems.