National Academies Press: OpenBook
« Previous: Appendix E: Committee Biosketches
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

Index

[Page numbers followed by b, f, n, or t refer to boxed text, figures, footnotes, or tables, respectively.]

A

Accountability

importance of, 165, 166

recommendations for, 12, 170, 209-210

Adherence to prophylactic antibiotic regimen

adverse events and, 131

concerns with predispensing strategies, 138

as determinant of prepositioning strategy effectiveness, 181

evidence, 84, 121, 128-130

Adverse events, 75, 130-132, 173

Al Qaeda, 23

Allergic reactions, 75, 132, 142-143

Alliance for Prudent Use of Antibiotics, 132

American Media Inc., 57

American Pharmacists Association, 108

Amoxicillin, 42, 131

Anthrax attack

animal models for studying effects of, 54-55

current state of response readiness, 2-3

danger of, 5, 23-24

data sources for MCM planning, 34-35

historical experience in the United States, 23, 24, 47, 48t, 56-57, 84, 125, 131

lethality, 23, 24-25, 41, 55

potential scenarios, 174-175

public health challenges, 1, 2, 21

See also Antibiotic prophylaxis, post-exposure; Prepositioning of anthrax countermeasures; Risk of anthrax attack

Anthrax vaccine adsorbed, 32, 42

Antibiotic prophylaxis, post-exposure animal studies, 55

approved agents, 5, 42

challenges in responding to aerosolized anthrax attack, 21

constraints on effectiveness of, 5-7

determinants of effectiveness, 13-14, 41

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

emergency use authorization, 86

expiration of medications, 85, 88, 114-115, 116

goals for timely distribution, 7, 21, 58, 61

impact of time to detection on, 57-61

incubation period of anthrax and, 6-7, 46, 55-57, 61

mechanism of action, 33

recommendations for research, 19, 215

response to anthrax attacks of 2001, 56-57

salient issues, 41

storage of medications, 114

treatment regimen, 42, 133

See also Adherence to prophylactic antibiotic regimen; Antibiotic- resistant anthrax

Antibiotic-resistant anthrax concerns with predispensing strategies, 132-133, 134-135, 136

creation of, 5, 43, 132-133

definitions, 43n

flexibility of MCM system, 45, 46

implications for MCM planning, 5-6, 32, 43-46

laboratory testing for, 44b, 45n

threat of, 24, 43, 44b

Antitoxin strategies, 26, 33

Appropriateness of prepositioning strategies, 14, 15t, 199-202, 200t

Assessment of distribution and dispensing capacity

data from full-scale exercises, 162-163

in decision-aiding framework for prepositioning, 10b, 154b, 158-163

importance of, 10, 163

measures for, 10, 11, 25, 159-161, 164, 212

obstacles to, 10-11, 158, 163

recommendations for, 11, 164, 212

Assistant Secretary for Preparedness and Response, 108, 156

Association of State and Territorial Health Officials, 108

Aum Shinrikyo, 23

B

BioWatch Actionable Result, 59

BioWatch monitoring system, 35, 58-60

Brentwood postal facility, 56, 84

Business Executives for National Security, 77

C

Cached MCM

advantages, 95-97t

appropriateness and consequences of, 15t, 199-202, 200t

definition, 7, 8f, 29b, 93

determinants of effectiveness, 13

in educational institutions, 118-119

in hospitals and health care facilities, 26, 103-106

infrastructure needs, 95-97t

key features, 94, 95-97t

organizational entities needed for, 95-97t

potential health risks, 172

potential locations, 103

private sector participation, 107

recommendations for local jurisdictions, 14-16, 18b, 203, 211

role of community- and faith-based organizations, 117-118

See also Home storage of antibiotics; Personal stockpile; Workplace caches

Centers for Disease Control and Prevention

Cities Readiness Initiative, 7, 53b, 58, 61, 73

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

classification of anthrax as bioterrorism agent, 24

Countermeasure Inventory Tracking program, 108

in development of guidance on public-private coordination, 110

measures of state and local dispensing capacity, 25, 159-160

postexposure antibiotic regimen recommended by, 42

Public Health Emergency Preparedness Cooperative Agreement, 105, 161, 162-163

recommendations for, 11, 164, 212

support for full-scale exercises, 162-163

See also Strategic National Stockpile

CHEMPACK Program, 71n, 100-101, 100b

Children

anthrax postexposure treatment regimen, 42

consideration of, in public health planning, 34, 167

dosing concerns with predispensed antibiotics, 135

risk of unintended ingestion of antibiotics, 133

Ciprofloxacin, 5, 42, 88, 114, 131

Cities Readiness Initiative, 7, 53b, 58, 61, 73

Communications

challenges in predispensing strategies, 136-138

importance of, 83, 136

instructions for use of predispensed medications, 137

POD information, 85, 104

for push strategy implementation, 78

recommendations for research, 19, 215

SNS: Supply Chain Dashboard for, 108

strategic planning for MCM dispensing, 83-84

Community Emergency Response Teams, 118

Community health centers, 105-106

Community organizations, 117-118

Consequences of anthrax attack, as risk assessment component, 155, 156

Costs

annual inventory maintenance, 193-194

components of, in prepositioning, 173, 191-193

consideration of, in decision-aiding framework, 10b, 154b, 173

to dispense MCM, 194-195

ethical decision making in public health, 166

evaluation of prepositioning strategies, 13, 173

expiration of medications, 88, 102

FDA-approved MedKit development, 141-142, 195-197, 199

forward deployment by Strategic National Stockpile, 99-100

full-scale distribution and dispensing exercises, 162

initial stocking, 193

multidrug strategies, 135

recommendations for evaluation of, 13, 202-203, 210-211

recommendations for research on, 19, 214-215

See also Health benefits and economic costs of prepositioning

Countermeasure Inventory Tracking program, 108

Critical infrastructure personnel definition, 28b

Executive Order on, 33

need for special consideration of, 197

predispensed MCM for, 139-142, 198-199

prepositioning strategies for, 198

risk of inappropriate use of predispensed antibiotics, 141

Cutaneous anthrax, 41, 60

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

D

Data sources for MCM planning animal studies, 54-55

anthrax incubation period, 46-47

current limitations, 34-35

drills and exercises, 162-163

ethical obligations to improve, 165

from H1N1 influenza pandemic response, 163

Department of Defense, 26

forward deployment of MCM at facilities of, 101

Department of Health and Human Services, 26

in emergency response system, 72, 86, 87, 108

recommendations for, 9, 19, 112, 211, 214-215

Department of Homeland Security, 5, 24, 26, 155, 156, 163

BioWatch monitoring system, 35, 58-60

Department of Justice, 26

Detection and surveillance system capabilities assessment, in decision- aiding framework, 10b, 154b, 157

case reports in, 60-61

as component of national security strategy, 26

cutaneous disease, 60

as determinant of dispensing system effectiveness, 187

environmental sensors, 58-60

impact on post-exposure prophylaxis, 57, 62

implications for dispensing decisions, 35, 85

mechanisms, 58

prophylaxis distribution and, 7

recommendations for capability assessment, 12, 18b, 202-203, 210-211

role of clinicians and first responders, 81

Diethylene triamine pentaacetic acid, 101

Disposal of antibiotics, 133-134, 193

Distribution and dispensing system capacity assessment, 10-11, 25, 35, 158-163

current concerns and shortcomings, 2-3, 24-25, 36, 82-85, 89

current goals, 7, 21, 58, 61

current structure, 69-71, 88-89

determinants of effectiveness of, 187-199

implications of antibiotic-resistant anthrax, 44-45

local dispensing capability as rate-limiting factor in attack response, 187-188

need for national guidance on public-private coordination, 109-111, 111b private sector participation, 9, 107, 108-109

public behavior as determinant of effectiveness of, 181, 188, 214t

recommendations for local jurisdictions to improve, 14-16, 18b, 203, 211

recommendations for national guidance on public-private coordination, 9, 18b, 112, 211

response to H1N1 influenza pandemic, 25

role of clinicians and first responders, 81

strategies for, 7. See also specific strategy

terminology, 28b

See also Medical countermeasures (MCM) for inhalational anthrax; Prepositioning of anthrax countermeasures; Time from release to dispensing

Distribution curve of incubation period, 6, 46

Distributive justice, 12, 165, 166, 170, 209-210

Dose effects in anthrax exposure, 51-52

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

Dosing concerns with predispensed antibiotics, 135

Doxycycline

adverse event risk, 131

allergic reactions, 132

anthrax post-exposure prophylaxis, 5, 42

concerns about antibiotic-resistant anthrax, 43-44, 45

emergency use authorization, 86

shelf life, 88

storage requirements, 114

Drills and exercises

data from, 10-11, 25, 162-163

head-of-household dispensing model, 75-77

push strategy, 78

recommendations for, 11, 164, 212

See also Postal model of distribution, pilot program; St. Louis, Missouri, pilot study

E

Emergency use authorization, 72, 86-87, 114

approval process, 79n, 86

definition, 28b

MedKit, 29b, 87, 119, 139, 142, 144t, 195-196

for Postal Model pilot program, 79, 87, 139

Environmental Protection Agency, 165-166

Ethical principles and issues, 11-12, 18b, 154b, 164-170, 198, 203, 209-210, 211

Ethnic/racial groups, 34, 158, 166

Expiration of medications, 85

implications for predispensing strategies, 88, 138

state-owned stockpiles, 102

workplace caching and, 114-115, 116

See also Shelf Life Extension Program

F

Faith-based organizations, 118

False alarms, 16

Federal Food, Drug, and Cosmetic Act, 86

Federal government

mission-essential personnel, 33

need for national guidance on public-private coordination, 109-111, 111b

as provider of threat information, 155-156

recommendations for, 2, 18b, 36, 164, 212

See also specific agency or department

First-order model, 175-180, 237-240

First responders

anthrax vaccination for, 32

in current distribution and dispensing system, 81

definition, 28b, 33-34

ethical obligations of communities to, 166

MedKits for, 139

need for special consideration of, 197

predispensed MCM for, 139-142, 198-199

prepositioning strategies for, 198

recommendations for prepositioning strategies, 16, 203, 211

risk of inappropriate use of predispensed antibiotics, 141

Flexibility of distribution and dispensing systems

concerns with predispensing strategies, 134-136, 198

to respond to drug-resistant anthrax, 45, 46, 136, 141

Food and Drug Administration emergency use authorization, 28b, 72, 79n, 86-87, 114

MedKit approval, 17, 119, 139, 141-142, 144t, 195-197, 199, 203

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

prescription laws, 86

recommendations for, 17, 203

shelf life extensions, 88

Forum on Medical and Public Health Preparedness for Catastrophic Events, 83

Forward-deployed MCM advantages, 95t

appropriateness and consequences of, 15t, 199-202, 200t

by commercial entities, 102-103

definition, 7, 8f, 29b, 93

at Department of Defense facilities, 101

determinants of effectiveness, 13

dispensing capacity, inventory levels and, 102

examples, 95t

impact on response time, 99

infrastructure needs, 95t

key features, 94, 95t

organizational entities needed for, 95t

potential health risks, 172

recommendations for local jurisdictions, 14-16, 18b, 203, 211

state control of, 73, 101-102

by Strategic National Stockpile, 99-101

at Veterans Administration hospitals, 101

Framework for decision making assessment of anthrax attack risk, 10b, 154-157

assessment of attack detection capabilities, 10b, 154b, 157

assessment of current dispensing capabilities, 10b, 154b, 158-163

cost-benefit modeling, 174-186

evaluation of likely economic costs, 10b, 154b, 173

evaluation of potential health benefits, 10b, 154b, 172-173

evaluation of potential prepositioning strategies, 10b, 154b

findings from cost-benefit modeling, 186-202

incorporation of ethical principles and community values, 10b, 154b, 164-170

key elements, 9, 10b, 153, 154b

need for, 108-109

purpose, 2, 9, 35-36, 153

recommendations for research to support, 19, 212-215

Fukushima, Japan nuclear accident, 120, 125-126, 128-129

G

Gastrointestinal anthrax, 41

Georgia, 77

Good manufacturing practice for pharmaceuticals, 86

H

H1N1 influenza pandemic, 3, 25, 71, 103, 108, 113, 163

Hamilton, New Jersey, postal facility, 56

Hazard Vulnerability Analysis, 156

Head-of-household dispensing model, 75-77, 82, 138

Health benefits and economic costs of prepositioning

evaluation in decision-aiding framework, 10b, 154b, 171

findings from cost-benefit modeling, 191-199

modeling methodology, 174-186, 237-240

recommendations for evaluation of, 13, 171, 202-203, 210-211

Health care providers

in closed workplace PODs, 114, 115-116

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

MCM caching in nonhospital health care facilities, 106

rationale for MCM caching in health care settings, 103, 104

recommendations for prepositioning strategies, 16, 203, 211

High-risk jurisdictions

determinants of risk, 155

forward deployment of MCM to, 99, 101

recommendations for assessment of capabilities, 11, 164, 212

value of prepositioning strategies in, 14, 197, 202

Home storage of antibiotics

in continuum of prepositioning strategies, 7

cost-benefit modeling of prepositioning strategies, 175, 181

cost comparison of prepositioning strategies, 195

creation of multi-drug-resistant anthrax and, 6, 45-46, 132-133

expiration of medications, 88

initial costs, 193

maintenance costs, 193-194

recommendations, 2

responsibilities of local jurisdictions, 138-139

storage and disposal issues, 133-134

See also Predispensed MCM

Hospital Preparedness Program, 104-105, 156

Hospitals and acute care facilities cost-benefit modeling of prepositioning strategies, 175, 181

cost comparison of prepositioning strategies, 195

costs of MCM inventory maintenance, 193-194

costs to dispense MCM from, 194-195

initial costs to stock MCM, 193

MCM caching in, 26, 103-105

as PODs, 104

potential effectiveness of closed PODs, 188-191

I

Inappropriate use

estimated prevalence, 128-130

form of predispensing and, 130

medication use instructions and, 137

risk among first responders and critical infrastructure personnel, 141

risk in predispensed MCM, 2, 16, 121, 128, 172-173

risk of antibiotic resistance in, 132-133

Incubation period of anthrax animal studies, 54-55, 61

cutaneous disease, 60

data sources, 6, 7, 34-35, 46-47, 61

distribution curve, 6, 46

dose effects, 51-52

historical evidence, 47-52, 61-62

implications for distribution and dispensing strategies, 6-7, 46, 55-57, 61

minimum, 46, 61

theoretical modeling, 52, 53-54b Insurance coverage, MedKit, 196

Investigational Device Exemption, 72

Investigational New Drug, 72, 121

Israel, 120

J

Joint Commission, 104

L

Legal issues

emergency use authorizations, 86-87

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

liability protection in emergencies, 86, 87, 109, 114, 116-117

in predispensing strategies, 139

prescription laws, 86

preservation of civil rights in emergency responding, 166-167

for private sector closed PODs, 115-117

scope of, 85

workplace caching, 114

Levofloxacin, 5, 42

M

Material Threat Determination, 5, 43, 44b, 155

MCM. See Medical countermeasures for inhalational anthrax

Meals on Wheels, 117

Medical countermeasures (MCM) for inhalational anthrax

antitoxin administration, 33

categories of strategies for, 7. See also specific strategy

current plans, 1, 3, 24-25, 69-71, 88-89

definition of MCM, 28b

generalizability of findings from research on, 30-32

private sector role, 3, 9, 107

public engagement in planning for, 12, 167-168, 170, 209-210

schematic of strategies for, 31f

vaccination, 32

See also Distribution and dispensing system; Predispensed MCM; Prepositioning of anthrax countermeasures

Medical/nonmedical points of dispensing, 75

MedKit

antibiotic supply in, 137

cost, 193

definition, 8f, 29b

disposal options, 193-194

emergency use authorization, 29b, 119, 139, 144t, 195-196

expiration of medications, 88

FDA-approved, 8f, 17, 29, 119, 139, 141-142, 144t, 195-197, 199, 203-204, 212

instructions for use, 137

legal issues, 139

over-the-counter, 119-120

pharmaceutical development costs, 196-197

pilot studies, 79, 121-124, 129-130

recommendations, 17, 18b, 203204, 212

replacement costs, 193

risk of inappropriate use of contents, 129-130

storage and disposal issues, 133, 134

Memoranda of understanding/ agreement, 110, 113-114

Metropolitan statistical areas, 73

Minneapolis-St. Paul, Minnesota, 79-80, 120, 123-124, 129-130, 139, 141

Minnesota. See Minneapolis-St. Paul, Minnesota

Mission-essential personnel, 33

Missouri. See St. Louis, Missouri, pilot study

Model Pharmacy Act, 114n

N

National Alliance of State Pharmacy Association, 108

National Association of Chain Drug Stores, 108

National Association of County and City Health Officials, 108

National Bioterrorism Hospital Preparedness Program, 104n

National Community Pharmacists Association, 108

National Voluntary Organizations Active in Disaster, 117

Natural disasters, 25

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

Nerve agent antidote program, 100-101, 100b, 120

New Tools for Assessing State and Local Capabilities for Countermeasure Delivery, 161

New York state, 101-102

O

Oseltamivir, 196

P

Packaging

FDA-approved MedKit, 196

predispensed MCM, 17, 130

Pandemic and All-Hazards Preparedness Act, 104N

Penicillin G, 5, 42, 131

Personal stockpile

definition, 8f, 29b

indications for, 198

individual purchase of, 198

legality, 139

misuse concerns, 130, 137, 144t

recommendations, 16, 203

storage and disposal issues, 134

See also Home storage of antibiotics; MedKit

Pharmaceutical Research and Manufacturers of America, 108

Pharmacies

in coordinated response to H1N1 influenza pandemic, 108

MCM caching in, 106-107

need for framework for collaboration with government in response to anthrax attack, 108-109

as POD sites, 74-75, 107

private sector role in forward deployment of MCM, 102-103

Philadelphia drill, 75, 82

POD. See Points of dispensing

Points of dispensing (PODs) benefits of prepositioning, 14

closed, 71, 75, 77, 109, 112-113

costs to dispense MCM, 194-195

current concerns about plans and capabilities, 82-83, 85

current distribution and dispensing plans, 1, 3, 71, 73-74, 88-89

definition, 14, 28-29b

determinants of effectiveness, 74

drive-through, 74

head-of-household model, 75-77

hospitals and acute care facilities as, 104

medical/nonmedical, 75

nonhospital health care facilities as, 106

open, 73-74

potential effectiveness of prepositioning strategies, 188-191

private sector agreements with jurisdictions, 110

private sector locations, 109

processing time, 85

rationale for forward deployment of MCM, 99

retail pharmacies as, 107

security concerns, 82

sites for, 74-75, 85, 101

staffing, 74, 75, 83

time needed to make ready, 99

transportation considerations in selection of, 85

See also Workplace caches

Postal model of distribution, 3, 74

advantages, 79

in current distribution and dispensing plans, 71

Executive Order on, 26, 80

follow-up monitoring of kits, 88

goals, 79

legal liability protections in, 87

obstacles to implementation, 80-81

pilot program, 26, 43-44, 79-80, 88, 120, 123-124, 129-130, 135, 139, 141

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

predispensed MCM for families of postal workers, 140

rationale, 78-79

security issues in, 80-81

Postal system, anthrax attacks of 2001, 23, 47, 56-57, 84

Potassium iodide, predispensing of, 120, 124-127, 124b

Predispensed MCM

adherence issues, 84, 138

advantages, 97-98t

appropriateness and consequences of, 15t, 199-202, 200t

communications challenges, 136-138

comparison of different forms of, 143, 144t

in continuum of prepositioning strategies, 7, 119

costs, 197

definition, 8f, 94, 119

determinants of risk associated with, 127

dosing concerns, 135

evaluation of risk associated with, 127

expiration of medications, 138

flexibility concerns, 134-136

forms of, 7, 119-120

to general public, 14, 16, 120, 126, 127- 128, 130, 134, 136

historical experience, 120-127

inappropriate use risk, 16, 17, 121, 128- 130, 172-173

infrastructure needs, 9 7-9 81, 138-139

key features, 94, 97-98t

legal issues, 139

for patients with special medical needs, 142-143

multidrug model, 135

organizational entities needed for, 97-98t

public understanding of proper use of, 137

recommendations for, 14-16, 203, 211

risk of adverse drug events, 130-132

risk of antibiotic resistance from misuse of, 132-133

risk of unintended ingestion, 133

scope of concerns about, 127-128

screening for contraindications to use, 135-136

special challenges in, 119

special packaging for, 17, 130

state and local responsibilities, 138-139

storage, 114, 133

to targeted populations, 14-16, 16, 17, 33-34, 139-143, 197, 198- 199, 203

See also Home storage of antibiotics

Pregnancy, 135

PREP Act Declaration, 87

Prepositioning of anthrax countermeasures

annual maintenance costs, 193-194

categories of strategies for, 7, 36, 93-94, 95-98t, 170-171. See also specific strategy

comparison of appropriateness and consequences of strategies, 15t, 199- 202, 200t

as component of national security strategy, 3, 26, 215

concerns about negative consequences, 2, 3, 14, 93

continuum of strategies, 7, 27, 29b

cost components, 191-192

cost evaluation, 13, 173

cost to dispense, 194-195

definition, 1, 3, 29b

ethical issues, 168-170

expiration of medications, 88

findings from cost-benefit modeling, 188-202

health risks, 2, 172-173

implications of multi-drug-resistant agents, 5-6, 43-46

initial stocking costs, 193

issues of concern, 262

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

legal issues, 86-87

need for national guidance on public-private coordination, 109-111

potential effectiveness of strategies, 188-191

potential limitations to effectiveness of, 2, 14, 172

public behavior as determinant of effectiveness of, 137-138, 188

rationale, 1, 3, 13-14, 26, 93, 171, 172

recommendations for evaluation of strategies for, 12-13, 18b, 202-203, 210-211

recommendations for integration of ethical principles and public engagement in, 11-12, 18b, 170, 209-210

recommendations for national guidance on public-private coordination, 9, 18b, 112, 211

recommendations for research to inform decision making on, 18b, 19, 212-215

recommendations from cost-benefit modeling, 202-204

resource demands, 2, 191-193, 197

risk-related information for, 156-157

strategies for, definition and scope of, 29b, 171

study goals, 4, 21-22

study process, 4-5, 22-23, 27

See also Framework for decision making; Recommendations

Presidential Executive Orders, 26, 33, 80

Private sector

arrangements with local jurisdictions for distribution and dispensing, 110

collaboration in response to H1N1 influenza pandemic, 108

in forward deployment of MCM, 102-103

legal issues in MCM distribution and dispensing, 87, 115-117

in MCM caching, 107

in MCM development and delivery, 3, 26, 77, 107, 108-109

need for framework for collaboration with government in response to anthrax attack, 108- 109

need for national guidance on public-private coordination, 109- 111, 111b

obstacles to participation in distribution and dispensing system, 9, 107, 109-110, 112

obstacles to successful collaboration with government, 77, 117

potential POD sites, 74, 77, 109

recommendations for national guidance on public-private coordination, 9, 18b, 112, 211

state push strategy experiment, 78

understandings and agreements with jurisdictions, 110, 117

See also Pharmacies; Workplace caches

Public, defined, 29b, 33

Public health

challenges in responding to aerosolized anthrax attack, 1, 2, 21

ethical framework for MCM planning, 11-12, 164-170, 209-210

recommendations for local jurisdictions to improve dispensing capabilities, 14-16, 18b, 203, 211

Public Health Emergency Preparedness Cooperative Agreement, 105, 161,162-163

Public Health Law Network, 115

Public Health Preparedness Capabilities, 159-160

Public Health Preparedness Capabilities, 25

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

Public knowledge and understanding adherence to prophylactic antibiotic regimen, 84

concerns about antibiotic-resistant anthrax, 44b

of dispensing system, 85, 104

dosing concerns with predispensed antibiotics, 135

participation in MCM planning, 12 165, 167-168, 170, 209-210

for predispensing strategies, 136-137

role of clinicians and first responders in MCM system, 81

strategic planning for MCM dispensing, 83-84

use of MCM in response to perceived threat, 125-127, 128-129, 137

Public Readiness and Emergency Preparedness Act, 85, 86, 87, 110, 114,116-117

Pull strategies, 73-74

Push Packages, 43, 72, 88, 159

Push strategies

advantages, 78

definition, 73-74, 78

disadvantages, 78

recommendations, 14, 203

state experiments, 78

See also Points of dispensing (PODs), closed; Postal model of distribution

Q

Q-fever, 52, 54b

Quarantines, 168

R

RAND-CDC Performance Metrics Project, 161

Receiving, staging and storage centers in current distribution and dispensing system, 71, 72

rationale for forward deployment of MCM, 99

time needed to make ready for distribution, 99

Reciprocal obligations, 12, 165, 166, 170, 209-210

Recommendations

against development of FDA-approved MedKit, 17, 18b, 212

for assessment of distribution and dispensing systems, 11, 164, 212

for evaluation and development of prepositioning strategies, 12-13, 18b, 202-203, 210-211

for federal government, 9, 11, 17, 18b, 19, 112, 164, 204, 211, 212, 214, 215

for integration of ethical principles in prepositioning strategies, 11-12, 18b, 170, 209-210

for large-scale exercises, 11, 164, 212

for national guidance on public- private coordination, 9, 18b, 112, 211

for public engagement in MCM planning, 12, 18b, 170, 209-210

for research to inform MCM decision making, 18b, 19, 212- 215, 213-214t, 215b

Red Cross, 117

Regional distribution centers, 71

Research needs, to inform decision making about prepositioning strategies, 18b, 19, 212-215, 213- 214t, 215b

Risk of anthrax attack

assessment of, for decision-aiding framework, 154-157

components of risk, 155

Department of Homeland Security assessments, 156

high-risk jurisdictions, 11, 14, 99, 101

implications for prepositioning strategies, 156-157, 186

recommendations for assessment of, 12, 18b, 202-203, 210-211

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

S

Schools, cached MCM in, 118-119

Security issues closed workplace PODs, 114

concerns about current dispensing system, 82

in postal model of distribution, 80-81

Shelf life. See Expiration of medications

Shelf Life Extension Program, 85, 88, 99, 101, 102

Skilled nursing facilities, 105-106 SNS: Supply Chain Dashboard, 108

Socioeconomic status, access to MCM and, 34, 117-118, 158, 166, 169

Special need patients, 142-143

St. Louis, Missouri, pilot study, 120, 121-123, 129-130, 133, 137, 141

Staffing

clinicians and first responders in distribution and dispensing system, 81

concerns about current dispensing system, 83

points of dispensing, 74, 75, 83

role of medical professionals in closed workplace PODs, 114, 115-116

Stafford Act, 110

State, local, and tribal jurisdictions arrangements for private sector collaboration in distribution and dispensing, 110

assessment of distribution and dispensing capabilities, 10-11, 35, 82

current MCM plans for anthrax, 3, 73-74, 88-89

decision making on prepositioning strategies. See Framework for decision making

legal issues for private sector PODs, 115-116

local dispensing capability as rate-limiting factor in attack response, 187-188

recommendations for, in development of national guidance for public-private coordination, 9, 112, 211

recommendations for assessment of MCM planning and implementation, 11, 164, 212

recommendations for evaluation of prepositioning strategies, 12-13, 18b, 202-203, 210-211

recommendations for improving dispensing capabilities, 14-16, 18b, 203, 211

recommendations for integration of ethical principles in MCM planning, 11-12, 18b, 170, 209-210

regional distribution centers, 71

responsibilities in predispensing strategies, 138-139

state control of forward-deployed MCM, 101-102

variations among, effectiveness of prepositioning and, 14, 35, 153, 154b, 197

State Homeland Security Program, 156

State Mitigation Plan, 156

Stewardship, 12, 165, 166, 170, 209-210

Storage of medications, 114, 133

Strategic National Stockpile anthrax antitoxin stockpile, 33

assessing time to delivery from, 159

CHEMPACK Program, 100-101, 100b

contents, 43, 45, 71-72

in current MCM plans, 1, 3, 7, 24, 69-72, 88-89

definition, 30b, 71

forward deployment of MCM by, 99-101

process for withdrawals from, 72

recent deployments, 71

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

recommendations for assessment of capabilities, 11, 164, 212

response to antibiotic-resistant anthrax attack, 45

stock rotation and replacement program, 88

Technical Assistance Review, 25, 160

warehouse locations, 99

Sverdlovsk incident, 7, 23, 34-35, 43, 49-52, 53b, 54b, 61

T

Technical Assistance Review, 25, 160

Threat and Hazard Identification and Risk Assessment, 156

Tier 1 cities, 99, 156, 159

Tier 2 cities, 156

Time from release to dispensing assessment of detection capabilities, 157

benefits of prepositioning, 3, 13-14, 93, 172, 202

data sources for MCM planning, 35, 127

detection technology and, 35, 58-61, 85

establishment of POD sites, 99

forward deployment of MCM and, 99

impact of time to detection, 57, 61, 62

importance of timely decision making, 13-14, 61, 187, 188

modeling of prepositioning strategies, 176-181, 187, 237-240

POD processing time, 85

potential effectiveness of prepositioning strategies in reducing, 188-191

predispensed MCM risk assessment, 127

stages, 57

Strategic National Stockpile delivery time, 159

Transparency

importance of, 165, 166

recommendations for, 12, 170, 209-210

Transportation issues, 85, 158

Tularemia, 52, 54b

U

UPS, 78

Urban Areas Security Initiative, 99, 156

V

Vaccine, anthrax, 26, 32, 42

Vendor-managed inventory, 72, 159

Veterans Administration hospitals, 101

Virginia, 78, 103

Vulnerability of jurisdictions, assessment of, 155, 156

Vulnerable and at-risk populations assessment of distribution and dispensing system capability, 158

ethical obligations in prepositioning planning, 166, 169-170

predispensed MCM for, 139-140, 198-199

role of community organizations in MCM dispensing, 117-118

types of, 34

W

Washington State exercise, 75-77

Workplace caches, 1, 2, 3, 22, 29, 73, 74, 107

advantages, 112-113, 198

antiviral stockpiles, 113

cost-benefit modeling of prepositioning strategies, 175, 181

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

cost comparison of prepositioning strategies, 195

costs to dispense MCM, 195

current implementation, 113

for first responders and critical infrastructure personnel, 140

initial stocking costs, 193

legal issues, 115-117

logistical arrangements, 113-115

maintenance costs, 193-194

medication shelf life issues, 114-115, 116

potential effectiveness, 188-191

public seizure of, 117

role of medical professionals in operations of, 114, 115-116

security concerns, 114

storage space, 114

supply sources, 112

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

This page intentionally left blank.

Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 329
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 330
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 331
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 332
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 333
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 334
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 335
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 336
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 337
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 338
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 339
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 340
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 341
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 342
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 343
Suggested Citation:"Index." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
Page 344
Prepositioning Antibiotics for Anthrax Get This Book
×
Buy Paperback | $64.00 Buy Ebook | $49.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

If terrorists released Bacillus anthracis over a large city, hundreds of thousands of people could be at risk of the deadly disease anthrax-caused by the B. anthracis spores-unless they had rapid access to antibiotic medical countermeasures (MCM). Although plans for rapidly delivering MCM to a large number of people following an anthrax attack have been greatly enhanced during the last decade, many public health authorities and policy experts fear that the nation's current systems and plans are insufficient to respond to the most challenging scenarios, such as a very large-scale anthrax attack. The U.S. Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response commissioned the Institute of Medicine to examine the potential uses, benefits, and disadvantages of strategies for repositioning antibiotics. This involves storing antibiotics close to or in the possession of the people who would need rapid access to them should an attack occur.

Prepositioning Antibiotics for Anthrax reviews the scientific evidence on the time window in which antibiotics successfully prevent anthrax and the implications for decision making about prepositioning, describes potential prepositioning strategies, and develops a framework to assist state, local, and tribal public health authorities in determining whether prepositioning strategies would be beneficial for their communities. However, based on an analysis of the likely health benefits, health risks, and relative costs of the different prepositioning strategies, the book also develops findings and recommendations to provide jurisdictions with some practical insights as to the circumstances in which different prepositioning strategies may be beneficial. Finally, the book identifies federal- and national-level actions that would facilitate the evaluation and development of prepositioning strategies.

Recognizing that communities across the nation have differing needs and capabilities, the findings presented in this report are intended to assist public health officials in considering the benefits, costs, and trade-offs involved in developing alternative prepositioning strategies appropriate to their particular communities.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!