governments distribute antibiotics within their borders to pre-designated sites established primarily by local governments as “points of dispensing” (PODs). Most local governments, their partners, or other organizations expect to dispense the majority of countermeasures from PODs to large groups of people. Each locally designated POD, in other words, receives its countermeasures from state authorities, which in turn have received them from the SNS (CDC, 2008).

This workshop focused on the final step in the process: medical countermeasure dispensing from PODs and via alternative mechanisms to their populations. Public health planners have used PODs as the major framework for planning countermeasures dispensing, yet PODs pose some of the greatest challenges, including their location, design, operations, capacity, workforce, and a host of other factors.

The foremost problems arise from delays in starting and completing the initial dispensing of prophylaxis. Speaker Baccam illustrated that even short delays have striking effects on morbidity and mortality, according to various models (Baccam and Boechler, 2007). At the local level, where dispensing occurs, the degree of morbidity and mortality is impacted by at least three factors: (1) the time of onset of a post-exposure prophylaxis campaign (i.e., the time to deliver the initial pill), (2) the capability in completing the campaign (i.e., the time to deliver the last pill), and (3) the capacity of nearby hospitals to treat symptomatic patients. Symptomatic people need to be treated in hospitals. A community with limited hospital bed capacity will be completely overwhelmed with a high caseload and thereby experience greater mortality.

The three local factors were modeled by Baccam in hypothetical scenarios shown in Figure 1. In Case A, which is the most effective case, the prophylaxis campaign starts on Day 1 and is completed by Day 2. In Case B, the campaign starts on Day 2.5 and is less efficient, taking 4 days to complete. The unmarked black line in Figure 1 illustrates the time frame over which infected people, if there is no prophylaxis campaign, will progress from the incubation period to becoming symptomatic. In the absence of PEP, all infected people become symptomatic (Inglesby et al., 1999). In Case A, 100 percent of infected people are still in the incubation stage when they receive prophylaxis; they are prevented