Synopsis
Rapid access to antibiotics can prevent people who are exposed to aerosolized Bacillus anthracis from developing anthrax; once symptoms of anthrax emerge, the disease progresses rapidly and can prove fatal. Since the anthrax attack in 2001, the nation’s public health system has made great strides in developing plans to deliver antibiotics quickly to all potentially exposed people. However, concerns remain about the nation’s ability to respond to an anthrax attack scenario of the most dire proportions—for example, a large-scale attack impacting hundreds of thousands of people and carried out in multiple cities.
Prepositioning (storage closer to intended users, before an attack occurs) is one of the mechanisms that have been discussed over the past several years for helping to ensure that all members of a community have rapid access to medical countermeasures (MCM) such as antibiotics. Antibiotics could be prepositioned in many different venues, including local stockpiles, workplace caches, caches in health care settings, and even in the home. The Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, asked the Institute of Medicine (IOM) to convene a committee to examine the potential role of these different prepositioning strategies in the overall MCM dispensing strategy. The committee was tasked to examine a wide range of factors, including benefits, costs, safety, and ethical issues.
The committee found that, under particular circumstances, prepositioning strategies can reduce the time within which individuals in a community can receive prophylactic antibiotics, and certain strategies can help alleviate the burden on the public health dispensing system. Relative to existing, more centralized distribution and dispensing strategies, however, prepositioning provides less flexibility to change plans following an attack if necessary. For example, prepositioning may not be helpful if an attack occurs in a location other than anticipated or uses a strain of anthrax that is resistant to the prepositioned antibiotic. The committee also found that costs are likely to increase as antibiotics are prepositioned closer to the intended users.
