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IOM Releases Summary of Workshop on Methods for Dispensing Medical Countermeasures

By Christine SooHoo, August 25, 2008

On August 15, 2008, the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events released a workshop summary entitled “Dispensing Medical Countermeasures for Public Health Emergencies.”¹ This workshop was held on March 3-4, 2008, and included representatives from federal, state, and local government, academia, think tanks, private sector organizations, and professional associations. The workshop objective was to “review a range of solutions to provide medical countermeasures rapidly to large numbers of people to protect them before or during a public health emergency, such as a bioterrorist attack or infectious disease outbreak.”

The workshop was framed around a scenario involving the release of Bacillus anthracis, the causative agent of anthrax. According to the Principal Deputy Assistant Secretary in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS), Dr. Gerald Parker, the scenario was chosen in part because an anthrax attack “brings to light the seriousness of the threat and the nation’s lack of preparedness in…dispens[ing] countermeasures within an extremely short time window to minimize morbidity and mortality from anthrax…” In addition, Dr. Parker noted that there is an “allure of anthrax…to terrorist groups because of [its] relatively low cost and ease of production and dispersal.”¹

Discussion focused on different types of strategies for getting medicines out to the population following an anthrax attack within the 24-48 hours. The committee considered both “push” and “pull” mechanisms for distributing medical countermeasures. “Push” strategies are those that utilize pre-existing service systems, such as Meals on Wheels and home health care, and the U.S. Postal Service, to deliver medicines to individuals.¹

Conversely, “pull” strategies for distributing medical countermeasures require people to actively pick up the countermeasures from Points of Distribution (PODs) that are open to the general public in locations such as drive-through clinics or schools. Workshop participants suggested that a layered approach to distributing medical countermeasures that relies on a mixture of both push and pull strategies could help to: 1) alleviate the strain on public health agencies during a health emergency; 2) dispense medication at a faster rate; and, 3) provide vulnerable populations, particularly those with limited mobility, greater access to medicines in an emergency.¹

The IOM workshop also addressed key challenges and considerations for dispensing the contents of the SNS to a population, recognizing that “if we do not have the mechanisms to get these lifesaving medicines in the hands of Americans after such an attack or multiple attacks within a very short timeframe, we have squandered an opportunity to save lives.” One of the key recommendations resulting from the workshop was to establish partnerships between government agencies and the private sector entities to dispense medical countermeasures quickly and effectively. Ideas for improving current planning efforts included:

• The public and private sector should work together to develop innovative plans for distributing medical countermeasures to the entire community within 48 hours of the decision to do so.
• States should work with local jurisdictions to streamline POD designs to increase the rate at which countermeasures are dispensed. 
• Public and private partners should develop plans for alternative POD designs (such as holding closed PODs at corporate facilities for employees and their families) in order to reduce pressure on PODs that are open to the general public.
• Public health agencies should consider tapping into the resources of private sector to more effectively manage dispensing operations. For example, private sector organizations may have technology systems that could be used to track and register medicines and the people who receive them.
• Government agencies should ensure liability protection for private-sector partners that dispense countermeasures.
• Public health agencies should recruit and train a large workforce in order to sustain functionality during an emergency.
• Agencies and organizations participating in the public-private partnership should perform planning exercises that permit and encourage improvised decision making during a mass dispensing event.
• Public health agencies should collaborate with the private sector to identify the best methods for communication during an emergency, as well as, where and how medical countermeasures will be obtained.
• Public agencies should explore partnerships with private security firms to help provide security at all dispensing locations, since there may be an insufficient number of law enforcement personnel to secure POD sites.¹

The workshop agenda and presentations from this workshop can be found at the Institute of Medicine website.

References

1. Davis M, Kammersall M, Altevogt B, Rapporteurs. Dispensing medical countermeasures for public health emergencies: workshop summary. Forum on Medical and Public Health Preparedness for Catastrophic Events, Institute of Medicine. Released August 15, 2008. http://www.iom.edu/CMS/3740/42532/57467.aspx. Accessed August 18, 2008.