spending public health dollars for interventions for which there is probably more immediate need and that, in some cases, have better efficacy data (IOM, 2007).

Most state plans have been revised since the announcement of the federal purchasing contracts in 2006 (although not all are public), and 21 states have already or plan to pre-position antivirals around their state. This year several states will use their Centers for Disease Control and Prevention (CDC) public health emergency preparedness grants to develop antiviral distribution plans as part of their priority projects for the year (IOM, 2007).

Most state plans can be grouped into one of four models for distribution planning of antivirals. The first model is to take the existing SNS plans and add a distribution plan for antivirals. This would involve using the state as the primary distributor with pre-designated distribution sites. A second model is having a formal agreement with local health departments. The third model involves the pre-positioning of antivirals at hospitals and other health care facilities for the treatment of ill persons and the prophylaxis of certain health care workers. The fourth model being employed by states is use of pre-determined points-of-distribution/ points-of-dispensing systems (PODs) (separate from their SNS plan), and distributing antivirals through those sites (some are considering drive-through distribution sites) (IOM, 2007).

Another issue that states need to address is how to work with the private sector. At the January 2008 meeting, the committee learned that eight states outsource storage and material management of their antivirals to the private sector. Virginia is incorporating retail pharmacies in its antiviral distribution plan. The Virginia Department of Health has designated a private distributor to work directly with pharmacies to fill daily orders based on maximum allotment of antivirals in the health district. The agency is working with the state pharmaceutical association to solicit participation. In Virginia’s plan, the treatment course would be provided to the patient at no cost, and the health department would track patients receiving medication. A challenge is to ensure that only the target population receives treatment (IOM, 2007).

At the committee’s second meeting, the ASTHO Executive Director presented a preliminary report based on a survey of seven states’ activities in regard to influenza antivirals.2 Some characteristics common to all seven plans include considerable state and local collaboration; planning for treatment of pandemic influenza, but little planning for prophylaxis; and prioritizing groups for treatment as identified in the 2005 Department


The seven states are Iowa, Missouri, New Mexico, North Dakota, Virginia, Washington, and Wyoming.

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