Academic journal article Homeland Security Affairs

Dispensing Mass Prophylaxis ? the Search for the Perfect Solution

Academic journal article Homeland Security Affairs

Dispensing Mass Prophylaxis ? the Search for the Perfect Solution

Article excerpt

INTRODUCTION

In this paper we examine Points of Dispensing (POD) and proposed alternate modes of dispensing for oral prophylaxis from the perspective of a local heath department (LHD) in a large metropolitan area. We include this geographic focus as the challenges LHD will encounter in rural or sparsely populated areas will most likely be different from those seen in large urban areas with a densely concentrated population. After presenting each mode of dispensing and its potential benefits and challenges, we summarize the choice facing the LHD and provide recommendations for enhanced planning. It is important for homeland security planning to consider the realistic limitations of each of the potential modes of dispensing and to explore options to supplement this system. To choose among the options, it is necessary to evaluate the benefits that each has to offer in alleviating the need for resources that are scarce within the community.

Starting with President Clinton's Executive Order 12938 in 1994, the funding for bioterrorism initiatives has increased significantly.1 Ten years later, in 2004, President George W. Bush signed Homeland Security Presidential Directive 10 to strengthen the nation's preparedness and defense against the use of biological and chemical weapons.2 Effective on March 1, 2003, the National Pharmaceutical Stockpile became the Strategic National Stockpile (SNS) and serves as a national repository of antibiotics, chemical antidotes, antitoxins, vaccines, medical equipment, and supplies to combat "Category A" Threat Agents as defined by the Centers for Disease Control and Prevention (CDC).3 The mission of the SNS is to help state and local jurisdictions prepare a strategic and uniform response to a large-scale natural disaster or an act of terrorism.4 It is the responsibility of local health departments to dispense SNS assets within their jurisdiction ? the SNS does not provide dispensing team personnel, facilities, or transportation support beyond the delivery of the supplies to a state-identified receiving site.5

Local mass prophylaxis plans are based on the concept of Points of Dispensing (POD) as a mechanism for dispensing medicine and medical supplies to the general population during a large-scale public health emergency.6 Although the POD-based model has shortcomings, the CDC and the Department of Health and Human Services (DHHS) still view POD as the cornerstone of dispensing during a bioterrorism event requiring oral prophylaxis.7 The CDC Division of the Strategic National Stockpile (DSNS) requires project areas to complete three of seven DSNS drills; of these, four are directly related to POD activation, set-up, and throughput and complete one functional or full scale exercise for each Cities Readiness Initiative Metropolitan Statistical Area (MSA) that tests key components of mass prophylaxis plans.8 These tests must be completed within each Public Health Emergency Preparedness Grant year (typically August 10, 20XX ? August 9, 20XX + 1). Failure to meet these benchmarks could result in withholding of funds or future funding under the Pandemic and All-Hazards Preparedness Act (PAHPA).9

The Cities Readiness Initiative (CRI), a part of the SNS, was established to enhance preparedness in the nation's largest cities. Through CRI, state and cities are required to develop plans in order to provide antibiotics to the entire population within their jurisdiction within forty-eight hours.10 This timeframe provides the optimum benefit of post-exposure prophylaxis among those people who have inhaled anthrax spores.11

While there have been no incidents requiring mass prophylaxis using the medical emergency model, the recent set of vaccination efforts in response to the H1N1 influenza outbreaks indicated that there are serious gaps in public health personnel, personnel available to administer vaccines, locations for the administration of the intervention, and necessary medical supplies. …

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