Planning Considerations for State, Local, Tribal, and Territorial Partners to Receive Medical Countermeasures From CDC’s Strategic National Stockpile During a Public Health Emergency

摘要

The Centers for Disease Control and Prevention’s Strategic National Stockpile is a national repository of potentially life-saving medical countermeasures including pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local, regional, and state supplies to run out. Several planning considerations can assist state, local, tribal, and territorial jurisdictions in preparing to receive, distribute, dispense, and administer medical countermeasures from the Strategic National Stockpile. These considerations include, but are not limited to, issues surrounding regulatory requirements, controlled substances, cold chain management, and ancillary supply needs. Multiple aspects to consider for each of these functions are discussed here to assist partners in their planning efforts. The Strategic National Stockpile (SNS) of the Centers for Disease Control and Prevention (CDC) is a national repository of medical countermeasures (MCMs) that includes pharmaceuticals (antimicrobials, biologics, vaccines, and antitoxins) and nonpharmaceuticals (medical supplies, personal protective equipment, and durable medical equipment) that could be used to support state, local, tribal, and territorial (SLTT) jurisdictions during large-scale biological, chemical, radiological, or nuclear incidents; natural disasters; or public health emergencies related to emerging infectious diseases. 1 SNS medical countermeasures are intended to supplement SLTT jurisdictions when their pharmaceutical or medical supplies are diminished as a result of a large-scale public health incident or when the countermeasures needed for the incident require SNS-specific products that may not be locally available or are not available readily in the commercial market. SNS medical countermeasures can be used to protect individuals from or treat illnesses caused by a specific threat or disease. The CDC’s guidance includes recommendations for safe and effective use of MCMs for all affected populations (e.g., children, pregnant and postpartum women, elderly individuals, and immunocompromised individuals) to the extent supportive data are available. 2 The SNS can deploy MCMs to SLTT partners in support of an isolated or a large-scale incident. In some cases, MCMs may already be pre-positioned in jurisdictions so that they are accessible for immediate use and administration. For example, through the Strategic National Stockpile CHEMPACK program, antidotes to specific agents are placed in various jurisdictions to ensure their accessibility in case of a chemical nerve agent attack or organophosphate poisoning. 3 The process of identifying and incorporating MCMs into the SNS is coordinated through a federal interagency governing body known as the Public Health Emergency Medical Countermeasure Enterprise, 4 established in 2006 by Congress to coordinate federal efforts to enhance preparedness from an MCM perspective. This governing body sets SNS medical countermeasure type and quantity requirements based on material threat determinations generated by the Department of Homeland Security, with subsequent health consequence modeling performed by the Department of Health and Human Services. Partners in this interagency effort use this information, in addition to other factors such as funding and market availability, to prioritize MCMs for procurement during annual reviews of the SNS medical countermeasure formulary. SNS medical countermeasures may be released to support a public health emergency after a formal state request and federal approval to deploy. SNS medical countermeasure needs will be specific to the incident and the jurisdictional request, with the goal of protecting and saving lives. The time frame for receiving these MCMs is dependent on the situation in question: delivery to an affected locale may occur almost immediately for products pre-positioned nearby, up to 24 hours or more after the federal decision to deploy SNS assets, or over time depending on SLTT needs and incident durations. In the case of certain threats such as anthrax that require rapid dispensing to the public, SNS assets may arrive in 12 hours or less, especially in high-risk and heavily populated areas (e.g., large metropolitan areas). SLTT planning efforts must be considered prior to any incident occurring to ensure timely and effective MCM deployment, distribution, dispensing, and administration. Response planning will be tailored to and conducted by each jurisdiction; however, in preparation for initial SNS medical countermeasure delivery and receipt, all jurisdictional response plans should incorporate considerations including but not limited to regulatory requirements, controlled substances, cold chain management, and ancillary supply needs.