be about 36 to 48 hours, Murray suggested. However, if given notice, Murray said, that time could be shortened.

A key point emphasized by several panelists was that recruiting and retaining extra labor for the dispensing effort hinges on ensuring that the personnel and their families are among the first to receive countermeasures or that they are provided MedKits to store at home in advance. One panelist’s experience showed that personnel are far more likely to show up in an emergency if they and their families are assured of being protected. Several events of national significance were cited illustrating this point, including the response to Hurricane Katrina.

This point reinforced the concept of a civil defense for the 21st century, which was highlighted by workshop co-chair Matthew Minson, senior medical advisor in the Office of the Assistant Secretary for Preparedness and Response, HHS. Minson mentioned that one consistent feature in the initial response to the hurricane was that a neighbor or citizen was immediately on hand to support other citizens before formal response organizations arrived. In addition, to further support personal preparedness states like Florida use state tax holidays to encourage purchasing of water and other necessities in advance of a hurricane. Given the imperatives of the CRI, Minson suggested this investment in the public is well advised.

Public–Private Partnerships

Forging novel partnerships between government agencies and the private sector is not just an option but a necessity, spurred by the magnitude of the U.S. population and the gravity of the threat, according to many speakers. Multiple types of public–private partnerships have already begun to flourish, and many more possibilities were raised at the workshop. The partnerships are wide ranging (Boxes 5 and 6), from negotiating complex logistical agreements to creating closed PODs. They typically provide advantages for each party. The structure of the partnerships is equally broad, covering open or closed PODs, and PODs using other push or pull mechanisms. This section highlights the diversity and flexibility of those partnerships, but begins with the fundamental principles underlying them. A summary of ideas that were presented by individuals during the meeting is also highlighted in Box 6.

One principle is that a singular approach to dispensing is unrealistic. The most realistic approach is a layered one that combines several types



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