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Countermeasures and Emergency Management Considerations

Countermeasures and Emergency Management Considerations. Matthew Minson, MD OPSP/ASPR/OS/USDHHS. Countermeasure Distribution, Dispensing, and Delivery. Current strategies for countermeasure delivery are generally classified by the following:

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Countermeasures and Emergency Management Considerations

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  1. Countermeasures andEmergency Management Considerations Matthew Minson, MD OPSP/ASPR/OS/USDHHS

  2. Countermeasure Distribution, Dispensing, and Delivery • Current strategies for countermeasure delivery are generally classified by the following: - Post Exposure Prophylaxis PEP (Given to the public after exposure or presumed exposure during a window of incubation) - Therapeutic or Corrective (Given once disease has begun, requiring professional administration) • This presentation focuses on the former or mass prophylaxis campaigns • This is best described in the CRI context

  3. CRI Intelligence • In general the threat consideration is substantial • Aerial dispersion of anthrax over a large geographic area can be accomplished with commercially-available equipment

  4. AnthraxExposure: ProportionofPopulationSaved DELAYin Initiation DURATION of Campaign Immed. 2 Days 3 Days 4 Days 5 Days 6 Days 7 Days 1 Day 10Days 84% 78% 71% 62% 54% 45% 36% 28% 7 Days 95% 91% 85% 78% 69% 59% 49% 39% 6 Days 97% 94% 89% 83% 75% 65% 54% 43% 5 Days 98% 96% 92% 87% 80% 71% 60% 49% 4Days 99% 98% 95% 91% 85% 76% 66% 54% 3Days 100% 99% 97% 94% 89% 81% 72% 60% 2Days 100% 99% 98% 96 92% 86% 77% 66% 1Day 100% 100% 99% 97% 94% 89% 82% 72%

  5. CitiesReadinessInitiative • CRI GOAL: • distribute antibiotics to the at-risk population – up to the entire community • within 48 hours of the decision to do so, (from time of exposure) • Doxycycline, Ciprofloxacin • CRI Preparedness Indicators: • robust local capability to dispense antibiotics rapidly over a large geographic area

  6. CRI MSA Tables 2006-2007

  7. Countermeasure Cascade: Generic FED SNS PUSH PACKAGE, MI F F STATE Receiving Staging Storing S S S S L. Dist. Center pod L L L pod pod pod pod pod Locals

  8. Cities Readiness Initiative: Goal • An initiative to expedite the timeframe to dispense prophylaxis • Increase Point of Dispensing (POD) throughput • Modified Medical Screening (Non-Medical Model) • U.S. Postal Service Delivery • Alternate Dispensing Modalities • Drive thru clinics • Establish PODS with large employers, universities, etc. • Using existing delivery services- Meals on Wheels, Home Healthcare, etc. • Community strike teams

  9. Model assumptions Staff per shift Staff per POD Campaign staff

  10. Countermeasures: PODS

  11. Medical PODs vs. Non-Medical PODs Model assumptions Staff per shift Staff per POD Campaign staff

  12. CRI Challenges/Issues • Staffing (Volunteer) • State/Local Leadership • Resistance to Planning (Difficult) • Security Resources • Assessment Process • Population Dynamics (Cooperation) • Untried Scenario (Battle Conditions)

  13. CRI: Dispensing/Delivery • PODS • POD Standards Project- ASPR, RAND and the DSNS are working together to establish core standard for POD planning and operations • MedKit: • 8 month study indicated . • 97% efficacy First Responders, Clinic, Corporate • FDA working in parallel to address ‘commercialization’ of MedKits • CRI/Postal: • Postal Option is only “one component of a mass prophylaxis plan, … meant to buy time for a more thorough Public Health response” • Greater questions facing the Emergency Management community is how SNS assets will be distributed in a POD structure. • Federal, Corporate, Open and Closed PODs 2008, Institute of Medicine Forum for Public Health and Medical Disasters

  14. Countermeasures USPS STRIKE

  15. Countermeasure Distribution and Dispensing: USPS Delivery • 3 Exercises • Operational Development: MSP/MN (pilot) • Collaborative • Dependent on Home stockpiling requirement by the USPS volunteers • Threat Designation (DHS), PHED (HHS), EUA (FDA): Oct, 2008 • Future Cities have expressed interest

  16. USPS and Public Health Emergency Response • During the recent combined ice storm debilitation of some communication resources and the need to inform the public of the potential for contaminated peanut products, the USPS successfully delivered print material to residences thus protecting the population of three Midwestern states.

  17. Countermeasures HOME STOCKPILING MEDKIT

  18. Countermeasure Distribution, Dispensing, and Delivery: Personal Stockpiling • MedKit: • 8 month study . • 97% efficacy First Responders, Clinic, Corporate • FDA/BARDA working in parallel to address ‘commercialization’ of MedKits • NBSB rendered opinion: Formalized kit preferable to Discretionary Prescriptions

  19. CRI MEDKIT

  20. CRI First Responder Issues • Based on discussions with the USPS Carrier Union Leadership and Service Management certain requirements for participation were determined • PPE (per OSHA/NIOSH) • Physical Security (LE) • In advance provisioning of Antibiotics for Carrier Volunteers and their families

  21. Countermeasure Distribution, Dispensing, and Delivery: Personal Stockpiling • Medkit (Home Antibiotic Kits) • USPS (HHS Lead) EUA • HHS Responder (HHS Lead) EUA • DHS Responder (DHS Lead/HHS Support) EUA • Traditional First Responder (as above) EUA • Greater Population (HHS Lead) Commercial Strategy :NDA

  22. CRI RESPONDERS • Subsequent Discussions with MSP in have indicated that for POD function and USPS strike team preparations that similar considerations should be provided for their local responders • Homeland Security Council undertaking specific countermeasure outreach to FR • HSC/DOL/DHS/HHS consideration of unique environmental challenges in CRI

  23. Countermeasure Delivery RECENT DEVELOPMENTS

  24. PH SUMMIT Countermeasures Strategy • In the Fall of 2007 a Forum to address issues related to a successful countermeasure campaign was conducted • It determined that “dispensing, and delivery” held the greatest impediments to success and workshops were scheduled for Spring and Summer of 2008 to address same.

  25. PH SUMMIT Countermeasures Strategy • Consensus conclusions rendered included: • Reducing impediments to Public- Private Collaboration • Liability-PREP ACT • Forward positioning of assets- cache, personal stockpiling • USPS amplification • Enhancing communication strategies

  26. PH SUMMIT Countermeasures Strategy • Since the workshop, a multidisciplinary group has continued to meet and work on these issues • State and Local • HHS-CDC, FDA, ASPR, OGC, DSNS • Industry • Academia • Non-Governmental organizations

  27. PH SUMMIT Countermeasures Strategy • Actions: • DHS Determination, HHS PH Emergency Declaration, FDA Provision of EUA in October, 2008 • MN/MSP/HHS/USPS Operationalizing USPS • PREP ACT Declaration • Discussion of issues with NBSB, on going • Expanded capability at DSNS (first 12 hours)

  28. PH SUMMIT Countermeasures Strategy • Continued issues • Worker protection • Medkit • POD EUA • Communications Strategies • Increased interest and Federal amplification of USPS option (BARDA Modeling Conclusion)

  29. Countermeasures The Future

  30. Countermeasures QUESTIONS? Matt.Minson@hhs.gov

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