Concerns about the current system for dispensing MCM include the dispensing capacity of state and local jurisdictions, security, workforce issues, the need for effective communication and public education, adherence, and transportation and site selection issues. These concerns have led to increased interest in prepositioning strategies. The costs associated with the current POD model of dispensing are discussed in detail in Chapter 5.
Dispensing Capability of State and Local Jurisdictions
As noted earlier, initial supplies are delivered from the SNS to designated RSS sites within 12 hours of the decision to deploy (CDC, 2010a). The timing of distribution from the RSS sites to the PODs and end-users, however, is dependent on the local jurisdictions and is highly variable (Burel, 2011). Although evidence and metrics are lacking, the scope of the challenge and the resources required have raised concern that most U.S. communities still lack adequate capability to dispense MCM quickly to all exposed and potentially exposed populations (see, for example, HSPD-21, 2007). This concern is amplified by recent and ongoing cuts to funding for state and local public health departments (TFAH, 2010). The Executive Order mandating a national USPS MCM dispensing model was issued based on the need to supplement state and local capabilities (Obama, 2010).
Although all PODs have security plans that anticipate the participation of law enforcement, there is concern that during a terrorist attack, local law enforcement personnel would be unable to guarantee the safety of stockpiles and staff because of other priorities during and after the attack (IOM, 2010). In a field test of a head-of-household POD dispensing model in Philadelphia, discussed above, participants who were scripted to try to steal extra antibiotics were successful in doing so (Agócs et al., 2007). While anecdotal evidence from recent disasters provides a spectrum of potential population reactions to a crisis, from relative calm to concentrated looting and potential rioting, there nonetheless exists a perception that safety is a significant concern for MCM dispensing plans. As discussed below, personal safety at potentially overcrowded PODs was one reason respondents in a survey gave for choosing not to go to a POD when advised to do so by public health officials (SteelFisher et al., 2011). Concern also has been raised specifically with respect to the security requirements of the postal model, as discussed previously (Willis et al., 2009).