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Index
[Page numbers followed by b, f, n, or t Anthrax attack
refer to boxed text, figures, footnotes, animal models for studying effects
or tables, respectively.] of, 54–55
current state of response readiness,
2–3
A danger of, 5, 23–24
data sources for MCM planning,
Accountability
34–35
importance of, 165, 166
historical experience in the United
recommendations for, 12, 170,
States, 23, 24, 47, 48t, 56–57,
209–210
84, 125, 131
Adherence to prophylactic antibiotic
lethality, 23, 24–25, 41, 55
regimen
potential scenarios, 174–175
adverse events and, 131
public health challenges, 1, 2, 21
concerns with predispensing
See also Antibiotic prophylaxis,
strategies, 138
post-exposure; Prepositioning of
as determinant of prepositioning
anthrax countermeasures; Risk
strategy effectiveness, 181
of anthrax attack
evidence, 84, 121, 128–130
Anthrax vaccine adsorbed, 32, 42
Adverse events, 75, 130–132, 173
Antibiotic prophylaxis, post-exposure
Al Qaeda, 23
animal studies, 55
Allergic reactions, 75, 132, 142–143
approved agents, 5, 42
Alliance for Prudent Use of Antibiotics,
challenges in responding to
132
aerosolized anthrax attack, 21
American Media Inc., 57
constraints on effectiveness of, 5–7
American Pharmacists Association, 108
determinants of effectiveness,
Amoxicillin, 42, 131
13–14, 41
329
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330 PREPOSITIONING ANTIBIOTICS FOR ANTHRAX
emergency use authorization, 86 Assistant Secretary for Preparedness
expiration of medications, 85, 88, and Response, 108, 156
114–115, 116 Association of State and Territorial
goals for timely distribution, 7, 21, Health Officials, 108
58, 61 Aum Shinrikyo, 23
impact of time to detection on,
57–61
B
incubation period of anthrax and,
6–7, 46, 55–57, 61 BioWatch Actionable Result, 59
mechanism of action, 33 BioWatch monitoring system, 35,
recommendations for research, 19, 58–60
215 Brentwood postal facility, 56, 84
response to anthrax attacks of Business Executives for National
2001, 56–57 Security, 77
salient issues, 41
storage of medications, 114
C
treatment regimen, 42, 133
See also Adherence to prophylactic
Cached MCM
antibiotic regimen; Antibiotic-
advantages, 95–97t
resistant anthrax
appropriateness and consequences
Antibiotic-resistant anthrax
of, 15t, 199–202, 200t
concerns with predispensing
definition, 7, 8f, 29b, 93
strategies, 132–133, 134–135,
determinants of effectiveness, 13
136
in educational institutions,
creation of, 5, 43, 132–133
118–119
definitions, 43n
in hospitals and health care
flexibility of MCM system, 45, 46
facilities, 26, 103–106
implications for MCM planning,
infrastructure needs, 95–97t
5–6, 32, 43–46
key features, 94, 95–97t
laboratory testing for, 44b, 45n
organizational entities needed for,
threat of, 24, 43, 44b
95–97t
Antitoxin strategies, 26, 33
potential health risks, 172
Appropriateness of prepositioning
potential locations, 103
strategies, 14, 15t, 199–202,
private sector participation, 107
200t
recommendations for local
Assessment of distribution and
jurisdictions, 14–16, 18b, 203,
dispensing capacity
211
data from full-scale exercises,
role of community- and faith-based
162–163
organizations, 117–118
in decision-aiding framework for
See also Home storage of
prepositioning, 10b, 154b,
antibiotics; Personal stockpile;
158–163
Workplace caches
importance of, 10, 163
Centers for Disease Control and
measures for, 10, 11, 25, 159–161,
Prevention
164, 212
Cities Readiness Initiative, 7, 53b,
obstacles to, 10–11, 158, 163
58, 61, 73
recommendations for, 11, 164, 212
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INDEX
classification of anthrax as Community health centers, 105–106
bioterrorism agent, 24 Community organizations, 117–118
Countermeasure Inventory Tracking Consequences of anthrax attack, as
program, 108 risk assessment component, 155,
in development of guidance on 156
public–private coordination, 110 Costs
measures of state and local annual inventory maintenance,
dispensing capacity, 25, 159–160 193–194
postexposure antibiotic regimen components of, in prepositioning,
recommended by, 42 173, 191–193
Public Health Emergency consideration of, in decision-aiding
Preparedness Cooperative framework, 10b, 154b, 173
Agreement, 105, 161, 162–163 to dispense MCM, 194–195
recommendations for, 11, 164, 212 ethical decision making in public
support for full-scale exercises, health, 166
162–163 evaluation of prepositioning
See also Strategic National Stockpile strategies, 13, 173
CHEMPACK Program, 71n, 100–101, expiration of medications, 88, 102
100b FDA-approved MedKit
Children development, 141–142, 195–197,
anthrax postexposure treatment 199
regimen, 42 forward deployment by Strategic
consideration of, in public health National Stockpile, 99–100
planning, 34, 167 full-scale distribution and dispensing
dosing concerns with predispensed exercises, 162
antibiotics, 135 initial stocking, 193
risk of unintended ingestion of multidrug strategies, 135
antibiotics, 133 recommendations for evaluation of,
Ciprofloxacin, 5, 42, 88, 114, 131 13, 202–203, 210–211
Cities Readiness Initiative, 7, 53b, 58, recommendations for research on,
61, 73 19, 214–215
Communications See also Health benefits and
challenges in predispensing economic costs of prepositioning
strategies, 136–138 Countermeasure Inventory Tracking
importance of, 83, 136 program, 108
instructions for use of predispensed Critical infrastructure personnel
medications, 137 definition, 28b
POD information, 85, 104 Executive Order on, 33
for push strategy implementation, 78 need for special consideration of,
recommendations for research, 19, 197
215 predispensed MCM for, 139–142,
SNS: Supply Chain Dashboard for, 198–199
108 prepositioning strategies for, 198
strategic planning for MCM risk of inappropriate use of
dispensing, 83–84 predispensed antibiotics, 141
Community Emergency Response Cutaneous anthrax, 41, 60
Teams, 118
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332 PREPOSITIONING ANTIBIOTICS FOR ANTHRAX
D Disposal of antibiotics, 133–134, 193
Distribution and dispensing system
Data sources for MCM planning capacity assessment, 10–11, 25, 35,
animal studies, 54–55 158–163
anthrax incubation period, 46–47 current concerns and shortcomings,
current limitations, 34–35 2–3, 24–25, 36, 82–85, 89
drills and exercises, 162–163 current goals, 7, 21, 58, 61
ethical obligations to improve, 165 current structure, 69–71, 88–89
from H1N1 influenza pandemic determinants of effectiveness of,
response, 163 187–199
Department of Defense, 26 implications of antibiotic-resistant
forward deployment of MCM at anthrax, 44–45
facilities of, 101 local dispensing capability as
Department of Health and Human rate-limiting factor in attack
Services, 26 response, 187–188
in emergency response system, 72, need for national guidance on
86, 87, 108 public–private coordination,
recommendations for, 9, 19, 112, 109–111, 111b
211, 214–215 private sector participation, 9, 107,
Department of Homeland Security, 5, 108–109
24, 26, 155, 156, 163 public behavior as determinant of
BioWatch monitoring system, 35, effectiveness of, 181, 188,
58–60 214t
Department of Justice, 26 recommendations for local
Detection and surveillance system jurisdictions to improve, 14–16,
capabilities assessment, in decision- 18b, 203, 211
aiding framework, 10b, 154b, recommendations for national
157 guidance on public–private
case reports in, 60–61 coordination, 9, 18b, 112, 211
as component of national security response to H1N1 influenza
strategy, 26 pandemic, 25
cutaneous disease, 60 role of clinicians and first
as determinant of dispensing system responders, 81
effectiveness, 187 strategies for, 7. See also specific
environmental sensors, 58–60 strategy
impact on post-exposure terminology, 28b
prophylaxis, 57, 62 See also Medical countermeasures
implications for dispensing (MCM) for inhalational anthrax;
decisions, 35, 85 Prepositioning of anthrax
mechanisms, 58 countermeasures; Time from
prophylaxis distribution and, 7 release to dispensing
recommendations for capability Distribution curve of incubation
assessment, 12, 18b, 202–203, period, 6, 46
210–211 Distributive justice, 12, 165, 166, 170,
role of clinicians and first 209–210
responders, 81 Dose effects in anthrax exposure,
Diethylene triamine pentaacetic acid, 51–52
101
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INDEX
F
Dosing concerns with predispensed
antibiotics, 135
Faith-based organizations, 118
Doxycycline
False alarms, 16
adverse event risk, 131
Federal Food, Drug, and Cosmetic Act,
allergic reactions, 132
86
anthrax post-exposure prophylaxis,
Federal government
5, 42
mission-essential personnel, 33
concerns about antibiotic-resistant
need for national guidance on
anthrax, 43–44, 45
public–private coordination,
emergency use authorization, 86
109–111, 111b
shelf life, 88
as provider of threat information,
storage requirements, 114
155–156
Drills and exercises
recommendations for, 2, 18b, 36,
data from, 10–11, 25, 162–163
164, 212
head-of-household dispensing
See also specific agency or
model, 75–77
department
push strategy, 78
First-order model, 175–180, 237–240
recommendations for, 11, 164, 212
First responders
See also Postal model of
anthrax vaccination for, 32
distribution, pilot program; St.
in current distribution and
Louis, Missouri, pilot study
dispensing system, 81
definition, 28b, 33–34
ethical obligations of communities
E
to, 166
Emergency use authorization, 72, MedKits for, 139
86–87, 114 need for special consideration of,
approval process, 79n, 86 197
definition, 28b predispensed MCM for, 139–142,
MedKit, 29b, 87, 119, 139, 142, 198–199
144t, 195–196 prepositioning strategies for, 198
for Postal Model pilot program, 79, recommendations for prepositioning
87, 139 strategies, 16, 203, 211
Environmental Protection Agency, risk of inappropriate use of
165–166 predispensed antibiotics, 141
Ethical principles and issues, 11–12, Flexibility of distribution and
18b, 154b, 164–170, 198, 203, dispensing systems
209–210, 211 concerns with predispensing
Ethnic/racial groups, 34, 158, 166 strategies, 134–136, 198
Expiration of medications, 85 to respond to drug-resistant
implications for predispensing anthrax, 45, 46, 136, 141
strategies, 88, 138 Food and Drug Administration
state-owned stockpiles, 102 emergency use authorization, 28b,
workplace caching and, 114–115, 72, 79n, 86–87, 114
116 MedKit approval, 17, 119, 139,
See also Shelf Life Extension 141–142, 144t, 195–197, 199,
Program 203
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334 PREPOSITIONING ANTIBIOTICS FOR ANTHRAX
prescription laws, 86 evaluation of potential
recommendations for, 17, 203 prepositioning strategies, 10b,
shelf life extensions, 88 154b
Forum on Medical and Public Health findings from cost–benefit modeling,
Preparedness for Catastrophic 186–202
Events, 83 incorporation of ethical principles
Forward-deployed MCM and community values, 10b,
advantages, 95t 154b, 164–170
appropriateness and consequences key elements, 9, 10b, 153, 154b
of, 15t, 199–202, 200t need for, 108–109
by commercial entities, 102–103 purpose, 2, 9, 35–36, 153
definition, 7, 8f, 29b, 93 recommendations for research to
at Department of Defense facilities, support, 19, 212–215
101 Fukushima, Japan nuclear accident,
determinants of effectiveness, 13 120, 125–126, 128–129
dispensing capacity, inventory levels
and, 102
G
examples, 95t
impact on response time, 99 Gastrointestinal anthrax, 41
infrastructure needs, 95t Georgia, 77
key features, 94, 95t Good manufacturing practice for
organizational entities needed for, pharmaceuticals, 86
95t
potential health risks, 172
H
recommendations for local
jurisdictions, 14–16, 18b, 203,
H1N1 influenza pandemic, 3, 25, 71,
211
103, 108, 113, 163
state control of, 73, 101–102
Hamilton, New Jersey, postal facility,
by Strategic National Stockpile,
56
99–101
Hazard Vulnerability Analysis, 156
at Veterans Administration
Head-of-household dispensing model,
hospitals, 101
75–77, 82, 138
Framework for decision making
Health benefits and economic costs of
assessment of anthrax attack risk,
prepositioning
10b, 154–157
evaluation in decision-aiding
assessment of attack detection
framework, 10b, 154b, 171
capabilities, 10b, 154b, 157
findings from cost–benefit modeling,
assessment of current dispensing
191–199
capabilities, 10b, 154b,
modeling methodology, 174–186,
158–163
237–240
cost–benefit modeling, 174–186
recommendations for evaluation of,
evaluation of likely economic costs,
13, 171, 202–203, 210–211
10b, 154b, 173
Health care providers
evaluation of potential health
in closed workplace PODs, 114,
benefits, 10b, 154b, 172–173
115–116
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INDEX
MCM caching in nonhospital health MCM caching in, 26, 103–105
care facilities, 106 as PODs, 104
rationale for MCM caching in potential effectiveness of closed
health care settings, 103, 104 PODs, 188–191
recommendations for prepositioning
strategies, 16, 203, 211
I
High-risk jurisdictions
determinants of risk, 155 Inappropriate use
forward deployment of MCM to, estimated prevalence, 128–130
99, 101 form of predispensing and, 130
recommendations for assessment of medication use instructions and,
capabilities, 11, 164, 212 137
value of prepositioning strategies in, risk among first responders and
14, 197, 202 critical infrastructure personnel,
Home storage of antibiotics 141
in continuum of prepositioning risk in predispensed MCM, 2, 16,
strategies, 7 121, 128, 172–173
cost–benefit modeling of risk of antibiotic resistance in,
prepositioning strategies, 175, 132–133
181 Incubation period of anthrax
cost comparison of prepositioning animal studies, 54–55, 61
strategies, 195 cutaneous disease, 60
creation of multi-drug-resistant data sources, 6, 7, 34–35, 46–47,
anthrax and, 6, 45–46, 132–133 61
expiration of medications, 88 distribution curve, 6, 46
initial costs, 193 dose effects, 51–52
maintenance costs, 193–194 historical evidence, 47–52, 61–62
recommendations, 2 implications for distribution and
responsibilities of local jurisdictions, dispensing strategies, 6–7, 46,
138–139 55–57, 61
storage and disposal issues, minimum, 46, 61
133–134 theoretical modeling, 52, 53–54b
See also Predispensed MCM Insurance coverage, MedKit, 196
Hospital Preparedness Program, Investigational Device Exemption, 72
104–105, 156 Investigational New Drug, 72, 121
Hospitals and acute care facilities Israel, 120
cost–benefit modeling of
prepositioning strategies, 175,
J
181
cost comparison of prepositioning
Joint Commission, 104
strategies, 195
costs of MCM inventory
maintenance, 193–194 L
costs to dispense MCM from,
Legal issues
194–195
emergency use authorizations,
initial costs to stock MCM, 193
86–87
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liability protection in emergencies, emergency use authorization, 29b,
86, 87, 109, 114, 116–117 119, 139, 144t, 195–196
in predispensing strategies, 139 expiration of medications, 88
prescription laws, 86 FDA-approved, 8f, 17, 29, 119,
preservation of civil rights in 139, 141–142, 144t, 195–197,
emergency responding, 166–167 199, 203–204, 212
for private sector closed PODs, instructions for use, 137
115–117 legal issues, 139
scope of, 85 over-the-counter, 119–120
workplace caching, 114 pharmaceutical development costs,
Levofloxacin, 5, 42 196–197
pilot studies, 79, 121–124, 129–130
recommendations, 17, 18b, 203–
M 204, 212
replacement costs, 193
Material Threat Determination, 5, 43,
risk of inappropriate use of
44b, 155
contents, 129–130
MCM. See Medical countermeasures
storage and disposal issues, 133, 134
for inhalational anthrax
Memoranda of understanding/
Meals on Wheels, 117
agreement, 110, 113–114
Medical countermeasures (MCM) for
Metropolitan statistical areas, 73
inhalational anthrax
Minneapolis–St. Paul, Minnesota,
antitoxin administration, 33
79–80, 120, 123–124, 129–130,
categories of strategies for, 7. See
139, 141
also specific strategy
Minnesota. See Minneapolis–St. Paul,
current plans, 1, 3, 24–25, 69–71,
Minnesota
88–89
Mission-essential personnel, 33
definition of MCM, 28b
Missouri. See St. Louis, Missouri, pilot
generalizability of findings from
study
research on, 30–32
Model Pharmacy Act, 114n
private sector role, 3, 9, 107
public engagement in planning for,
12, 167–168, 170, 209–210
N
schematic of strategies for, 31f
vaccination, 32 National Alliance of State Pharmacy
See also Distribution and dispensing Association, 108
system; Predispensed MCM; National Association of Chain Drug
Prepositioning of anthrax Stores, 108
countermeasures National Association of County and
Medical/nonmedical points of City Health Officials, 108
dispensing, 75 National Bioterrorism Hospital
MedKit Preparedness Program, 104n
antibiotic supply in, 137 National Community Pharmacists
cost, 193 Association, 108
definition, 8f, 29b National Voluntary Organizations
disposal options, 193–194 Active in Disaster, 117
Natural disasters, 25
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INDEX
Nerve agent antidote program, closed, 71, 75, 77, 109, 112–113
100–101, 100b, 120 costs to dispense MCM, 194–195
current concerns about plans and
New Tools for Assessing State
capabilities, 82–83, 85
and Local Capabilities for
Countermeasure Delivery, 161 current distribution and dispensing
New York state, 101–102 plans, 1, 3, 71, 73–74, 88–89
definition, 14, 28–29b
determinants of effectiveness, 74
O drive-through, 74
head-of-household model, 75–77
Oseltamivir, 196
hospitals and acute care facilities as,
104
P medical/nonmedical, 75
nonhospital health care facilities as,
Packaging
106
FDA-approved MedKit, 196
open, 73–74
predispensed MCM, 17, 130
potential effectiveness of
Pandemic and All-Hazards
prepositioning strategies,
Preparedness Act, 104n
188–191
Penicillin G, 5, 42, 131
private sector agreements with
Personal stockpile
jurisdictions, 110
definition, 8f, 29b
private sector locations, 109
indications for, 198
processing time, 85
individual purchase of, 198
rationale for forward deployment of
legality, 139
MCM, 99
misuse concerns, 130, 137, 144t
retail pharmacies as, 107
recommendations, 16, 203
security concerns, 82
storage and disposal issues, 134
sites for, 74–75, 85, 101
See also Home storage of
staffing, 74, 75, 83
antibiotics; MedKit
time needed to make ready, 99
Pharmaceutical Research and
transportation considerations in
Manufacturers of America, 108
selection of, 85
Pharmacies
See also Workplace caches
in coordinated response to H1N1
Postal model of distribution, 3, 74
influenza pandemic, 108
advantages, 79
MCM caching in, 106–107
in current distribution and
need for framework for
dispensing plans, 71
collaboration with government
Executive Order on, 26, 80
in response to anthrax attack,
follow-up monitoring of kits, 88
108–109
goals, 79
as POD sites, 74–75, 107
legal liability protections in, 87
private sector role in forward
obstacles to implementation,
deployment of MCM, 102–103
80–81
Philadelphia drill, 75, 82
pilot program, 26, 43–44, 79–80,
POD. See Points of dispensing
88, 120, 123–124, 129–130,
Points of dispensing (PODs)
135, 139, 141
benefits of prepositioning, 14
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predispensed MCM for families of risk of adverse drug events,
postal workers, 140 130–132
rationale, 78–79 risk of antibiotic resistance from
security issues in, 80–81 misuse of, 132–133
Postal system, anthrax attacks of 2001, risk of unintended ingestion, 133
23, 47, 56–57, 84 scope of concerns about, 127–128
Potassium iodide, predispensing of, screening for contraindications to
120, 124–127, 124b use, 135–136
Predispensed MCM special challenges in, 119
adherence issues, 84, 138 special packaging for, 17, 130
advantages, 97–98t state and local responsibilities,
appropriateness and consequences 138–139
of, 15t, 199–202, 200t storage, 114, 133
communications challenges, to targeted populations, 14–16,
136–138 16, 17, 33–34, 139–143, 197,
comparison of different forms of, 198–199, 203
143, 144t See also Home storage of antibiotics
in continuum of prepositioning Pregnancy, 135
strategies, 7, 119 PREP Act Declaration, 87
costs, 197 Prepositioning of anthrax
definition, 8f, 94, 119 countermeasures
determinants of risk associated annual maintenance costs, 193–194
with, 127 categories of strategies for, 7, 36,
dosing concerns, 135 93–94, 95–98t, 170–171. See
evaluation of risk associated with, also specific strategy
127 comparison of appropriateness and
expiration of medications, 138 consequences of strategies, 15t,
flexibility concerns, 134–136 199–202, 200t
forms of, 7, 119–120 as component of national security
to general public, 14, 16, 120, 126, strategy, 3, 26, 215
127–128, 130, 134, 136 concerns about negative
historical experience, 120–127 consequences, 2, 3, 14, 93
inappropriate use risk, 16, 17, 121, continuum of strategies, 7, 27, 29b
128–130, 172–173 cost components, 191–192
infrastructure needs, 97–98t, cost evaluation, 13, 173
138–139 cost to dispense, 194–195
key features, 94, 97–98t definition, 1, 3, 29b
legal issues, 139 ethical issues, 168–170
for patients with special medical expiration of medications, 88
needs, 142–143 findings from cost–benefit modeling,
multidrug model, 135 188–202
organizational entities needed for, health risks, 2, 172–173
97–98t implications of multi-drug-resistant
public understanding of proper use agents, 5–6, 43–46
of, 137 initial stocking costs, 193
recommendations for, 14–16, 203, issues of concern, 262
211
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INDEX
legal issues, 86–87 legal issues in MCM distribution
need for national guidance on and dispensing, 87, 115–117
public–private coordination, in MCM caching, 107
109–111 in MCM development and delivery,
potential effectiveness of strategies, 3, 26, 77, 107, 108–109
188–191 need for framework for
potential limitations to effectiveness collaboration with government
of, 2, 14, 172 in response to anthrax attack,
public behavior as determinant of 108–109
effectiveness of, 137–138, 188 need for national guidance on
rationale, 1, 3, 13–14, 26, 93, 171, public–private coordination,
172 109–111, 111b
recommendations for evaluation obstacles to participation in
of strategies for, 12–13, 18b, distribution and dispensing
202–203, 210–211 system, 9, 107, 109–110, 112
recommendations for integration obstacles to successful collaboration
of ethical principles and public with government, 77, 117
engagement in, 11–12, 18b, 170, potential POD sites, 74, 77, 109
209–210 recommendations for national
recommendations for national guidance on public–private
guidance on public–private coordination, 9, 18b, 112, 211
coordination, 9, 18b, 112, 211 state push strategy experiment, 78
recommendations for research to understandings and agreements with
inform decision making on, 18b, jurisdictions, 110, 117
19, 212–215 See also Pharmacies; Workplace
recommendations from cost–benefit caches
modeling, 202–204 Public, defined, 29b, 33
resource demands, 2, 191–193, 197 Public health
risk-related information for, challenges in responding to
156–157 aerosolized anthrax attack, 1, 2,
strategies for, definition and scope 21
of, 29b, 171 ethical framework for MCM
study goals, 4, 21–22 planning, 11–12, 164–170,
study process, 4–5, 22–23, 27 209–210
See also Framework for decision recommendations for local
making; Recommendations jurisdictions to improve
Presidential Executive Orders, 26, 33, dispensing capabilities, 14–16,
80 18b, 203, 211
Private sector Public Health Emergency Preparedness
arrangements with local Cooperative Agreement, 105,
jurisdictions for distribution and 161, 162–163
dispensing, 110 Public Health Law Network, 115
collaboration in response to H1N1 Public Health Preparedness
influenza pandemic, 108 Capabilities, 159–160
in forward deployment of MCM, Public Health Preparedness
102–103 Capabilities, 25
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340 PREPOSITIONING ANTIBIOTICS FOR ANTHRAX
Public knowledge and understanding rationale for forward deployment of
adherence to prophylactic antibiotic MCM, 99
regimen, 84 time needed to make ready for
concerns about antibiotic-resistant distribution, 99
anthrax, 44b Reciprocal obligations, 12, 165, 166,
of dispensing system, 85, 104 170, 209–210
dosing concerns with predispensed Recommendations
antibiotics, 135 against development of FDA-
participation in MCM planning, 12, approved MedKit, 17, 18b, 212
165, 167–168, 170, 209–210 for assessment of distribution and
for predispensing strategies, dispensing systems, 11, 164, 212
136–137 for evaluation and development of
role of clinicians and first prepositioning strategies, 12–13,
responders in MCM system, 81 18b, 202–203, 210–211
strategic planning for MCM for federal government, 9, 11, 17,
dispensing, 83–84 18b, 19, 112, 164, 204, 211,
use of MCM in response to 212, 214, 215
perceived threat, 125–127, for integration of ethical principles
128–129, 137 in prepositioning strategies,
Public Readiness and Emergency 11–12, 18b, 170, 209–210
Preparedness Act, 85, 86, 87, for large-scale exercises, 11, 164, 212
110, 114, 116–117 for national guidance on public–
Pull strategies, 73–74 private coordination, 9, 18b,
Push Packages, 43, 72, 88, 159 112, 211
Push strategies for public engagement in MCM
advantages, 78 planning, 12, 18b, 170, 209–210
definition, 73–74, 78 for research to inform MCM
disadvantages, 78 decision making, 18b, 19,
recommendations, 14, 203 212–215, 213–214t, 215b
state experiments, 78 Red Cross, 117
See also Points of dispensing Regional distribution centers, 71
(PODs), closed; Postal model of Research needs, to inform decision
distribution making about prepositioning
strategies, 18b, 19, 212–215,
213–214t, 215b
Q Risk of anthrax attack
assessment of, for decision-aiding
Q-fever, 52, 54b
framework, 154–157
Quarantines, 168
components of risk, 155
Department of Homeland Security
R assessments, 156
high-risk jurisdictions, 11, 14, 99,
RAND-CDC Performance Metrics
101
Project, 161
implications for prepositioning
Receiving, staging and storage centers
strategies, 156–157, 186
in current distribution and
recommendations for assessment of,
dispensing system, 71, 72
12, 18b, 202–203, 210–211
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INDEX
S local dispensing capability as
rate-limiting factor in attack
Schools, cached MCM in, 118–119 response, 187–188
Security issues recommendations for, in
closed workplace PODs, 114 development of national
concerns about current dispensing guidance for public–private
system, 82 coordination, 9, 112, 211
in postal model of distribution, recommendations for assessment
80–81 of MCM planning and
Shelf life. See Expiration of implementation, 11, 164, 212
medications recommendations for evaluation of
Shelf Life Extension Program, 85, 88, prepositioning strategies, 12–13,
99, 101, 102 18b, 202–203, 210–211
Skilled nursing facilities, 105–106 recommendations for improving
SNS: Supply Chain Dashboard, 108 dispensing capabilities, 14–16,
Socioeconomic status, access to MCM 18b, 203, 211
and, 34, 117–118, 158, 166, 169 recommendations for integration
Special need patients, 142–143 of ethical principles in MCM
St. Louis, Missouri, pilot study, 120, planning, 11–12, 18b, 170,
121–123, 129–130, 133, 137, 209–210
141 regional distribution centers, 71
Staffing responsibilities in predispensing
clinicians and first responders in strategies, 138–139
distribution and dispensing state control of forward-deployed
system, 81 MCM, 101–102
concerns about current dispensing variations among, effectiveness of
system, 83 prepositioning and, 14, 35, 153,
points of dispensing, 74, 75, 83 154b, 197
role of medical professionals in State Homeland Security Program, 156
closed workplace PODs, 114, State Mitigation Plan, 156
115–116 Stewardship, 12, 165, 166, 170,
Stafford Act, 110 209–210
State, local, and tribal jurisdictions Storage of medications, 114, 133
arrangements for private sector Strategic National Stockpile
collaboration in distribution and anthrax antitoxin stockpile, 33
dispensing, 110 assessing time to delivery from, 159
assessment of distribution and CHEMPACK Program, 100–101,
dispensing capabilities, 10–11, 100b
35, 82 contents, 43, 45, 71–72
current MCM plans for anthrax, 3, in current MCM plans, 1, 3, 7, 24,
73–74, 88–89 69–72, 88–89
decision making on prepositioning definition, 30b, 71
strategies. See Framework for forward deployment of MCM by,
decision making 99–101
legal issues for private sector PODs, process for withdrawals from, 72
115–116 recent deployments, 71
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342 PREPOSITIONING ANTIBIOTICS FOR ANTHRAX
recommendations for assessment of Strategic National Stockpile delivery
capabilities, 11, 164, 212 time, 159
response to antibiotic-resistant Transparency
anthrax attack, 45 importance of, 165, 166
stock rotation and replacement recommendations for, 12, 170,
program, 88 209–210
Technical Assistance Review, 25, Transportation issues, 85, 158
160 Tularemia, 52, 54b
warehouse locations, 99
Sverdlovsk incident, 7, 23, 34–35, 43,
U
49–52, 53b, 54b, 61
UPS, 78
Urban Areas Security Initiative, 99,
T
156
Technical Assistance Review, 25, 160
Threat and Hazard Identification and
V
Risk Assessment, 156
Tier 1 cities, 99, 156, 159 Vaccine, anthrax, 26, 32, 42
Tier 2 cities, 156 Vendor-managed inventory, 72, 159
Time from release to dispensing Veterans Administration hospitals, 101
assessment of detection capabilities, Virginia, 78, 103
157 Vulnerability of jurisdictions,
benefits of prepositioning, 3, 13–14, assessment of, 155, 156
93, 172, 202 Vulnerable and at-risk populations
data sources for MCM planning, assessment of distribution and
35, 127 dispensing system capability, 158
detection technology and, 35, ethical obligations in prepositioning
58–61, 85 planning, 166, 169–170
establishment of POD sites, 99 predispensed MCM for, 139–140,
forward deployment of MCM and, 198–199
99 role of community organizations in
impact of time to detection, 57, 61, MCM dispensing, 117–118
62 types of, 34
importance of timely decision
making, 13–14, 61, 187, 188
modeling of prepositioning
W
strategies, 176–181, 187,
237–240
Washington State exercise, 75–77
POD processing time, 85
Workplace caches, 1, 2, 3, 22, 29, 73,
potential effectiveness of
74, 107
prepositioning strategies in
advantages, 112–113, 198
reducing, 188–191
antiviral stockpiles, 113
predispensed MCM risk assessment,
cost–benefit modeling of
127
prepositioning strategies, 175,
stages, 57
181
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343
INDEX
cost comparison of prepositioning medication shelf life issues, 114–
strategies, 195 115, 116
costs to dispense MCM, 195 potential effectiveness, 188–191
current implementation, 113 public seizure of, 117
for first responders and critical role of medical professionals in
infrastructure personnel, 140 operations of, 114, 115–116
initial stocking costs, 193 security concerns, 114
legal issues, 115–117 storage space, 114
logistical arrangements, 113–115 supply sources, 112
maintenance costs, 193–194
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