If terrorists released Bacillus anthracis over a large city, hundreds of thousands of people could be at risk of the deadly disease anthrax – caused by the B anthracis spores – unless they had rapid access to antibiotic medical countermeasures (MCM). The spores can be inhaled, be ingested, or come into contact with the skin. Inhalational anthrax is considered the most severe bioterrorism threat because the spores can travel significant distances through the air, and it has the highest mortality rate – approaching 100 percent if untreated. Although plans for rapidly delivering MCM to a large number of people following an anthrax attack have been significantly enhanced over the last decade, many public health authorities and policy experts fear that the nation’s current systems and plans are insufficient to respond to the most challenging scenarios, such as a very large-scale anthrax attack or an attack on multiple cities.
The U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response commissioned the IOM to examine the potential uses, benefits, and disadvantages of strategies for prepositioning antibiotics. This involves storing antibiotics close to or in the possession of the people who would need rapid access to them should an attack occur. The IOM defined and evaluated three categories of prepositioning strategies that could complement existing, centralized stockpiling strategies, including the Strategic National Stockpile maintained by the Centers for Disease Control and Prevention:
Forward-Deployed MCM: MCM stored near the locations from which they will be dispensed
Cached MCM: MCM stored at the locations from which they will be dispensed, such as workplaces and health care facilities
Predispensed MCM: MCM stored by the intended users
While prepositioning strategies have the potential to reduce the time between an anthrax attack and when an individual receives antibiotics, this potential benefit should be weighed against increased costs of associated with prepositioning strategies, a lower degree of flexibility to change plans following an attack if needed, and possible health risks involved with home antibiotic storage. The IOM committee developed a decision-aiding framework to help state, local, and tribal health officials determine which prepositioning strategies—if any—would benefit their communities.
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