Better plans needed for emergency drug distribution

The federal government is prepared to quickly move massive quantities of drugs and medical supplies anywhere in the country in the event of a terrorist attack, but it will be up to the states to get those supplies to the people who need them, and many aren't yet up to the task, according to federal and state health officials.

Under the National Pharmaceutical Stockpile program, which is jointly managed by the Centers for Disease Control and Prevention and the Department of Homeland Security, federal officials are poised to move drugs and supplies anywhere in the country within 12 hours. But distributing the drugs as quickly as they might be needed is another matter altogether.

"States have to be prepared to receive and distribute everything the CDC brings, and we're going to bring it very quickly," said Mike Staley, who works for the stockpile program as a liaison to first responders. At a summit last week on bioterrorism sponsored by the National Governors Association, Staley encouraged state health officials to work with the CDC to develop and rehearse distribution plans for the drugs.

The stockpile program was created in 1999 to help states and cities respond to public health emergencies resulting from terrorist attacks or natural disasters. Under the program prepackaged shipments of pharmaceuticals, medical supplies and medical equipment are located throughout the United States for immediate deployment. The 12-hour push packs, so called because they are required to be on location within 12 hours, are designed to provide a range of support in the early hours of an emergency when the threat may not be well understood. In addition to the push packs, the stockpile includes additional supplies or drugs, such as smallpox vaccine, when a specific threat is identified.

"Our 12-hour push packs each include 50 tons of equipment. And our 12 push packs represent about 12 percent of our total capabilities," said Staley. The bottom line: "States are never going to run out. The trick is having the infrastructure developed and practiced to be able to get everything out to the community."

States must be prepared with a cadre of health professionals who can break down the 130 containers that arrive in every push pack and then distribute drugs and supplies. They also need adequate, climate-controlled facilities to store the drugs and supplies.

A mass casualty event could conceivably require hundreds of nurses and pharmacists working around the clock to screen, vaccinate or treat victims of a biological or chemical attack, and then provide follow-up care. Those workers need to be trained (and in some cases vaccinated themselves against certain diseases, such as smallpox) for a range of contingencies in both urban and rural areas.

States also need to be prepared to explain their plans to a nervous and skeptical public, often in many languages, depending on the diversity of the population.

The CDC will deploy a support team to advise state officials and help manage the material, but it does not have the manpower to dispense materials and manage the inventory once it is broken down, said Bob Snyder, another manager with the stockpile program.

In some cases, states have planned to use the National Guard to manage and distribute the stockpile materials, but that could be a dangerous assumption during a crisis, Snyder said. "If your plan is to use the National Guard at your distribution and breakdown sites, and the Guard is tasked with something else, you'd better have a back-up plan." The CDC prefers that the National Guard be considered only as a secondary capability, Snyder said.

In addition, not all states have considered the legal ramifications of a mass drug distribution program. "Does state law allow someone to pick up medication for someone else? Does state law allow you to use people who don't normally dispense medicine to give out pills in an emergency? In some states yes, in some states no. These are the things that need to be worked through and the things that need to be in place before an event happens," Snyder said.