Prepositioning Antibiotics for Anthrax (2012) / Chapter Skim
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1 Introduction
1 Introduction
Pages 21-40
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From page 21... ...
. Yet the logistics of effectively delivering antibiotics to prevent anthrax infection pose a tremendous challenge because such an attack could potentially expose a large number of people who would require antibiotics within a relatively brief time window.
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From page 22... ...
. To respond to this charge, the IOM appointed the Committee on Prepositioned Medical Countermeasures for the Public, bringing together 16 experts with a broad spectrum of expertise, including state and local public health preparedness, emergency medicine and response, infectious disease, pediatrics, toxicology, systems analysis and operations research, materials management and supply chains, economics, health systems, the B OX 1-1 Statement of Task In response to a request from the Department of Health and Human Services (HHS)
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From page 23... ...
The committee developed this report to assist federal policy makers and state, local, and tribal public health officials, as well as their private-sector and community partners, in evaluating the potential health benefits, health risks, costs, and practical considerations of implementing strategies for prepositioning antibiotics in their communities as a complement to existing, more centralized dispensing strategies. STUDY CONTEXT In the fall of 2001, the United States experienced its first -- and thus far only -- bioterrorism attack involving B
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From page 24... ...
from the SNS arrive, state and local public health authorities assume responsibility for distributing and dispensing them to their population. Because of the scope of the challenge and the resources required, many public health authorities and other policy experts fear that most communities still lack adequate mechanisms and capacity to dispense antibiotics rapidly to all exposed and potentially exposed populations following a large anthrax attack (HSPD-21, 2007)
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From page 25... ...
There is little evidence to suggest that mounting a mass MCM dispensing campaign after a major bioterrorism attack would not reveal challenges of a similar magnitude. Prepositioning and Other Novel Dispensing Strategies In response to the concerns outlined above, the past few years have seen a burgeoning interest in exploring novel dispensing strategies to complement
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From page 26... ...
Prepositioning and other novel dispensing strategies, as described above, are just one potential component of a larger endeavor to enhance the nation's capability to prevent illness and death from an anthrax attack. Other components include national security efforts to prevent an attack or mitigate its effects, efforts to enhance detection and surveillance capability, further development of anthrax vaccine and antitoxin strategies, continuous refinement of the current MCM distribution and dispensing system, and efforts to engage the private sector in both the development and the delivery of MCM.
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From page 27... ...
In its approach to this study and the formulation of its recommendations, however, the committee focused on how public health officials should use assessment of the current risk of an anthrax attack in their individual communities to inform decisions about prepositioning. Strategies for positioning MCM lie along a continuum based on proximity to the location of the anticipated event.
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From page 28... ...
Dispensing: The act of providing medical countermeasures (MCM) to individuals who will take them immediately or at some future defined/ declared time of need.
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From page 29... ...
-- MedKit: A medical kit containing prescription pharmaceuticals that is dispensed pre-event to families or individuals for use only as directed during a public health emergency. – EUA MedKit: A medical kit allowed by the FDA for off-label use under conditions specified in an Emergency Use Authorization (EUA)
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From page 30... ...
as noted above, the threat of anthrax currently is considered to be among the highest-priority threats; and (2) the brief time window within which antibiotics must be dispensed to protect effectively against anthrax infection is among the greatest challenges facing the MCM distribution and dispensing system as a whole.
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From page 31... ...
Workplace caches and personal stockpiles may allow for more immediate access, but far more MCM are needed. NOTE: The Strategic National Stockpile (SNS)
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Widespread pre-event anthrax vaccination could potentially impact the selection and design of strategies for postexposure prophylaxis using antibiotics, including strategies for prepositioning the antibiotics, because it could decrease the size of the population needing postexposure prophylaxis with antibiotics. Currently, the use of anthrax vaccine adsorbed (AVA)
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From page 33... ...
. The SNS stockpiles anthrax antitoxin, but not in a quantity sufficient to treat the population that could be exposed in a large anthrax attack, and the drug is not approved by the FDA for the treatment or prophylaxis of anthrax (FDA, 2011; HHS, 2010)
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From page 34... ...
For this reason, the committee defined the public broadly as "all members of a community who are not already adequately covered by separate specialized programs, such as those for federal mission-essential personnel." This usage recognizes the interrelated nature of all programs to dispense MCM within a community while avoiding interfering with any specialized dispensing programs that a jurisdiction may already have. Additionally, the committee wishes to highlight the importance of giving specific attention to the needs of children and other vulnerable or at-risk populations, including those who, by virtue of socioeconomic status and/ or demographic characteristics, may be at systemically increased risk for lower access to disaster mitigation response.
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From page 35... ...
Development of a Decision-Aiding Framework for State, Local, and Tribal Jurisdictions Many factors associated with decision making vary significantly across communities, including the risk of attack, capabilities, resources, and current public health infrastructure. Therefore, the committee concluded that it would not be possible, or advisable, for it to prescribe a specific set of prepositioning strategies to complement the traditional POD system.
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From page 36... ...
These chapters provide the foundation for Chapter 5, which sets forth a decision-aiding framework to assist federal, state, and local policy makers and public health officials in evaluating the potential benefits and costs of implementing prepositioning strategies to complement existing dispensing strategies and to address specific gaps or overall capacity limitations. This framework encompasses the assessments that jurisdictions should perform to provide the evidence base to inform decision making about prepositioning, the need for ethical principles and public engagement, and a modeling approach that can be used to weigh health benefits and economic costs associated with the alternative prepositioning strategies.
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From page 37... ...
The report also includes five appendixes: Appendix A is a list of acronyms used in the report; Appendix B contains agendas for the committee's public meetings; Appendix C presents a first-order model developed by the committee to estimate health outcomes for any prepositioning strategy; Appendix D is a paper commissioned for this study containing a cost and speed analysis of prepositioning strategies; and Appendix E provides biosketches of the committee members. REFERENCES ASTHO (Association of State and Territorial Health Officials)
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From page 38... ...
2011. National Postal Model for the delivery of medical countermeasures.
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2010b. Medical countermeasures dispensing: Emergency use authorization and the postal model.
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From page 40... ...
Congres sional Research Service Report to Congress, Order Code RL 32152. Washington, DC: Library of Congress, http://www.fas.org/sgp/crs/terror/RL32152.html (accessed June 24, 2011)
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