Nov. 2 (Bloomberg) -- A U.S. outbreak of avian flu may kill as many as 1.9 million people and hospitalize 9.9 million, according to estimates in a new U.S. plan released today to protect Americans against a pandemic.

Medical personnel and workers in drug manufacturing plants should receive vaccines first under the plan fleshed out by Health and Human Services Secretary Michael Leavitt. President George W. Bush yesterday proposed spending $7.1 billion on vaccines and drugs, medical research and training for public health officials worldwide. More than 90 percent of the money would go to Leavitt's department.

``We're in a race against nature,'' said Harvey Fineberg, president of the Institute of Medicine, a U.S. government advisory group. If a bird flu outbreak did occur, ``we would all be in jeopardy, and it is possible that millions of people would die,'' Fineberg said in an interview today.

Bush proposed spending as much as $1.5 billion for the government to buy and stockpile enough vaccine for 20 million people; $1 billion for stockpiling anti-viral drugs to reduce the flu's severity; $130 million to help drugmakers prepare for increased production capacity; $2.8 billion to develop news ways to manufacture vaccines; and $583 million to help state and local governments prepare response plans.