BOX 5-1
Key Elements of the Decision-Aiding Framework

Communities across the United States differ in their needs and capabilities. Different communities may benefit most from different strategies for prepositioning antibiotics for anthrax, or may not benefit from prepositioning strategies at all. The committee developed a decision-aiding framework to assist state, local, and tribal jurisdictions in deciding which prepositioning strategies, if any, to implement in their community. The key elements of this framework are:

• Assessment of risk and current capabilities

Consideration of the risk of an anthrax attack

Assessment of current capability for timely detection of an attack

Assessment of current dispensing capability, including (1) overall dispensing capability, and (2) specific gaps in dispensing capability, such as particular subpopulations not well served by current plans

• Incorporation of ethical principles and community values

• Evaluation of potential prepositioning strategies for medical countermeasures for anthrax

Evaluation of potential health benefits, including evaluation of potential effectiveness in reaching specific populations or filling other specific gaps in dispensing capability

Evaluation of potential health risks

Evaluation of likely costs

Consideration of practicality, including (1) communications needs and expected social behavior and adherence, (2) logistics, and (3) legal and regulatory issues


To evaluate whether alternative prepositioning strategies would be appropriate for their communities, jurisdictions must consider the risk of an anthrax attack in their community and assess their current capability to detect such an attack in a timely manner and to distribute and dispense postexposure prophylactic antibiotics to their population. This section describes these assessments.

Risk of an Anthrax Attack

A community’s risk assessment for an anthrax attack is important for prioritizing funding for dispensing capabilities within the context of

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