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Prepositioning Antibiotics for Anthrax (2012)

Chapter: Appendix B: Public Meeting Agendas

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Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

Appendix B

Public Meeting Agendas

PUBLIC WORKSHOP

Day 1: Monday, February 28, 2011

Washington Plaza Hotel
10 Thomas Circle
Washington, DC

Workshop Goals

1. Identify gaps and challenges in the existing infrastructure and strategies for dispensing antibiotics to protect the public against a terrorist attack using Bacillus anthracis or a similar pathogen.

2. Assess current prepositioning efforts and identify challenges.

3. Discuss appropriate target population groups, advantages, issues, and challenges associated with a range of prepositioning strategies, including workplace caches, hospital caches, caches in schools/universities/ daycares, caches in institutional facilities for older adults, and household stockpiles.

4. Examine ethical, legal, regulatory, and safety issues relevant to the development of prepositioning strategies.

5. Discuss methods, metrics, and available data for evaluating the cost and effectiveness of prepositioning strategies.

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

8:00 a.m. Welcome and Introductions
  ROBERT BASS, Committee Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
 
  TIA POWELL, Committee Vice-Chair
Director
Montefiore-Einstein Center for Bioethics

SESSION 1: FEDERAL STAKEHOLDER PERSPECTIVES

Session Objectives:

• Describe relevant federal efforts associated with prepositioning antibiotics for anthrax.

— Examine the gaps, challenges, and emerging issues that federal agencies are facing.

• Discuss which prepositioning strategies are likely to be successful under which circumstances and for which segments of the population, and the potential role of these strategies within an overall strategy for dispensing antibiotics.

8:15 a.m. ROBERT BASS, Session Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
 
  ELIN GURSKY
Senior Advisor
 

Office of the Assistant Secretary for Preparedness and Response

  Department of Health and Human Services
 
  GREG BUREL
Director, Division of Strategic National Stockpile
Office of Public Health Preparedness and Response
Centers for Disease Control and Prevention
 
  KATHRYN BRINSFIELD
Director, Workforce Health and Medical Support Division
Office of Health Affairs
Department of Homeland Security
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
9:10 a.m. Discussion with Committee
9:45 a.m. BREAK

SESSION 2: STATE AND LOCAL PERSPECTIVES

Session Objectives:

• Identify gaps, challenges, and emerging issues associated with current state and local strategies for dispensing antibiotics to the public: What evidence supports the need for further refinement of medical countermeasures dispensing plans?

• Describe relevant state and local efforts associated with prepositioning antibiotics for anthrax.

— Where available, examine data assessing current prepositioning strategies.

• Discuss which prepositioning efforts are likely to be successful under which circumstances and for which segments of the population, and the potential role of these strategies within an overall strategy for dispensing antibiotics.

• Discuss state and local needs associated with developing prepositioning strategies.

10:00 a.m. HERMINIA PALACIO, Session Chair
Executive Director
 

Harris County Public Health and Environmental Services, Texas

 
  SUSAN COOPER
Commissioner
Tennessee Department of Health
 
  DAVID STARR
Director, Countermeasures Response
Office of Emergency Preparedness and Response
New York City Department of Health and Mental Hygiene
 
  ANDREA MATHIAS
Deputy Health Officer
Worcester County, Maryland
 
10:50 a.m. Discussion with Committee
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

SESSION 3: PUBLIC ENGAGEMENT ON PREPOSITIONING

Session Objective: Discuss concurrent public engagement project on prepositioning, also sponsored by ASPR, and general considerations for engaging the public on prepositioning strategies.

11:30 a.m. KEVIN MASSEY, Session Chair
Director, Lutheran Disaster Response
Evangelical Lutheran Church of America
 
  ROGER BERNIER
Member
Medical Countermeasure Public Engagement Initiative
Steering Committee
 
11:45 a.m. Discussion with Committee
 
12:00 p.m. LUNCH
Note: The committee met in closed session from 12:00-1:00 p.m.

SESSION 4: PREPOSITIONING EFFORTS IN OTHER DOMAINS

Session Objective: Examine successes and lessons learned through the implementation of prepositioning strategies in other domains, including prepositioning of atropine in Israel, potassium iodide provided to people living near nuclear facilities, and household antibiotic kits provided to postal workers and their families in Minneapolis-St. Paul.

1:00 p.m. DANIEL LUCEY, Session Chair
Adjunct Professor of Microbiology and Immunology
Georgetown University Medical Center
DANIEL LAOR (by teleconference)
Director
Emergency and Disaster Management Division
Ministry of Health, Israel
JAMES BLANDO
Assistant Professor
School of Community and Environmental Health
Old Dominion University
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
JAYNE GRIFFITH
State Bioterrorism Epidemiologist
Minnesota Department of Health
1:30 p.m. Discussion with Committee

SESSION 5: MODELING ANTHRAX

Session Objective: Examine data and models of inhalational anthrax: dose response, incubation period distribution, disease progression and clinical outcomes, and medical consequences of the timing of providing antibiotics. In particular, assess the evidence supporting the commonly used 48-hour goal for dispensing antibiotics to the affected population.

2:00 p.m. TONY COX, Session Chair
President
Cox Associates
 
  SID BACCAM
Senior Scientist
Innovative Emergency Management (IEM)
 
  DEAN WILKENING (by teleconference)
Senior Research Scientist
Center for International Security and Cooperation
Stanford University
 
  KENNETH RAPUANO
Director of Advanced Systems and Policy
 

Homeland Security Systems Engineering and Development Institute

  The MITRE Corporation
 
3:00 p.m. BREAK

SESSION 6: LEGAL AND REGULATORY ISSUES

Session Objective: Discuss federal and state legal and regulatory issues associated with prepositioning antibiotics using strategies such as workplace caches, hospital caches, and household stockpiles.

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

3:15 p.m. ERIN MULLEN, Session Chair
Assistant Vice President, Rx Response
Pharmaceutical Research and Manufacturers of America
 
  ELIZABETH SADOVE
Regulatory Counsel
Office of Counterterrorism and Emerging Threats
Food and Drug Administration
 
  DANIEL O’BRIEN
General Counsel, Dimensions Healthcare
(Formerly) Principal Counsel, Assistant Attorney General
 
 

Department of Health & Mental Hygiene, Office of the Attorney General, Maryland

 
  MITCHEL ROTHHOLZ
Chief of Staff
American Pharmacists Association
3:45 p.m. Discussion with Committee

SESSION 7: SAFETY ISSUES

Session Objective: Discuss safety concerns associated with prepositioning strategies, including workplace caches and household stockpiles. This may include both issues such as adverse effects of antibiotics as well as, for example, concerns related to health literacy.

4:15 p.m. ROBERT HOFFMAN, Panel Chair
Director
New York City Poison Control Center
 
  NADINE SHEHAB
Senior Service Fellow
Division of Healthcare Quality Promotion
National Center for Emerging and Infectious Zoonotic Disease
Centers for Disease Control and Prevention
 
  KENT SEPKOWITZ
Vice Chairman of Clinical Affairs
Director, Hospital Infection Control
Memorial Sloan-Kettering Cancer Center
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
 
  DANIEL FAGBUYI
  Medical Director, Disaster Preparedness and Emergency Management
  Assistant Professor of Pediatrics and Emergency Medicine
The George Washington University School of Medicine
Children’s National Medical Center
 
4:45 p.m. Discussion with Committee
 
5:15 p.m. Closing Remarks
 
  ROBERT BASS, Committee Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
 
  TIA POWELL, Committee Vice-Chair
Director
Montefiore-Einstein Center for Bioethics
 
5:30 p.m. ADJOURN DAY 1

Day 2: Tuesday, March 1, 2011

Washington Plaza Hotel
10 Thomas Circle
Washington, DC

8:00 a.m. Welcome and Summary of Day 1
 
  ROBERT BASS, Committee Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
 
  TIA POWELL, Committee Vice-Chair
Director
Montefiore-Einstein Center for Bioethics
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

SESSION 8: VULNERABLE POPULATIONS AND ETHICAL ISSUES

Session Objectives:

• Identify the specific needs of vulnerable populations with regard to prepositioning antibiotics (e.g., children, pregnant women, people with disabilities, people with chronic illnesses, older adults).

— Discuss mechanisms for prepositioning antibiotics in environments where these populations will most likely be during an event (e.g., school, child care, at home, care facility).

• Discuss ethical issues relevant to developing prepositioning strategies, including those related to equity and health literacy.

8:15 a.m. TIA POWELL, Session Chair
Director
Montefiore-Einstein Center for Bioethics
 
  MICHAEL ANDERSON
Vice President and Associate Chief Medical Officer
University Hospitals and
Associate Professor of Pediatric Critical Care
Rainbow Babies & Children’s Hospital, Cleveland, Ohio
 
  ALEXIS SILVER
Vice President of Policy and Clinical Affairs
Home Care Association of New York State
 
  KEVIN SMITH
Emergency Disaster Services Director
Florida Division of The Salvation Army
9:05 a.m. Discussion with Committee
 
9:45 a.m. BREAK

SESSION 9: PRIVATE-SECTOR PERSPECTIVES AND WORKPLACE CACHES

Session Objectives:

• Review current private-sector efforts to preposition antibiotics within the organization.

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

• Discuss development and implementation of workplace caches:

— What kind of companies would be appropriate for the strategy?

— What are the advantages associated with the strategy?

— How could challenges and issues associated with the strategy be addressed?

— Would private sector organizations be interested in additional involvement in prepositioning? What barriers would need to be addressed?

• Consider lessons learned from private-sector initiatives to stockpile antivirals that may apply to stockpiling antibiotics.

10:00 a.m. BRAD BREKKE, Panel Chair
Vice President of Assets Protection
Target Corporation
 
  ANDREW SHULMAN
Chief Operating Officer
Affiliated Physicians
 
  JOCELYN STARGRGEL
Business Assurance Principal
Southern Company Services, Inc.
 
  PENNY TURNBULL (by teleconference)
Senior Director, Business Continuity
Marriott Hotels International, Ltd.
 
10:30 a.m. Discussion with Committee

SESSION 10: HOSPITAL AND COMMUNITY HEALTH CENTER CACHES

Session Objectives:

• Review current efforts to preposition antibiotics within hospitals, community health centers, or other health care institutions.

• Discuss development and implementation of caches within health care institutions:

— What kind of health care settings would be appropriate for the strategy?

— What are the advantages associated with the strategy?

— How could challenges and issues associated with the strategy be addressed?

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

— Would health care institutions be interested in additional involvement in prepositioning? What barriers would need to be addressed?

• Consider lessons learned from initiatives to stockpile antivirals that may apply to stockpiling antibiotics.

11:00 a.m. JEFFREY UPPPPERMAN, Panel Chair
Director of Trauma, Children’s Hospital of Los Angeles
Associate Professor of Surgery, Keck School of Medicine
University of Southern California
 
  MICHAEL ROBBINS
Strategic National Stockpile Director
Chicago Department of Public Health
 
  THOMAS TIGHE
President and Chief Executive Officer
Disaster Relief International
 
  AMELIA MUCCIO
Director of Disaster Planning
New Jersey Primary Care Association
 
11:30 a.m. Discussion with Committee
 
12:00 p.m. LUNCH
Note: The committee met in closed session from 12:00-1:00 p.m.

SESSION 11: OTHER PREPOSITIONING STRATEGIES

Session Objective: Discuss development and implementation of additional strategies for prepositioning antibiotics. For each strategy, discuss:

• Who would be appropriate targets for the strategy (e.g., population groups, geographic factors, threat status)?

• What are the advantages associated with the strategy?

• How could challenges and issues associated with the strategy be addressed?

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

1:00 p.m. Panel A: Household MedKits
 
  ANDREW PAVIA, Session Chair
George and Esther Gross Presidential Professor
University of Utah School of Medicine
Division of Pediatric Infectious Diseases
 
  DEBRA YESKEY
Director, Regulatory and Quality Affairs Division
Biomedical Advanced Research and Development Agency
 

Office of the Assistant Secretary for Preparedness and Response

  Department of Health and Human Services
 
  MICHAEL ROBBINS
Strategic National Stockpile Director
Chicago Department of Public Health
 
  ELAINE VAUGHAN (by teleconference)
 

Research Professor and Professor Emerita of Psychology and Social Behavior

  School of Social Ecology
University of California, Irvine
 
1:30 p.m. Discussion with Committee
2:00 p.m. Panel B: Other Prepositioning Strategies
 
  ROBERT BURHANS, Panel Chair
(Retired) Director of Health Emergency Preparedness
New York State Department of Health
 
  JAMES TURNER
Immediate Past President
American College Health Association
 
  TIM STEPHENS
Public Health Advisor
National Sheriff’s Association
 
2:30 p.m. Discussion with Committee
 
3:00 p.m. BREAK
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

SESSION 12: MODELS, COST, AND EFFECTIVENESS

Session Objectives: Identify currently available economic evidence regarding prepositioning strategies. What potential models exist that may be helpful? Discuss appropriate measures and metrics (e.g., cost, efficacy, effectiveness).

 

3:15 p.m. Panel A: Modeling Prepositioning Strategies
 
STEPHEN POLLOCK, Panel Chair
Herrick Emeritus Professor of Manufacturing
University of Michigan
 
JEFFREY HERRRRMANN
Associate Professor

Department of Mechanical Engineering and Institute for Systems Research

University of Maryland
 
NATHANIEL HUPERT
Director, Preparedness Modeling Unit
Centers for Disease Control and Prevention and
Associate Professor of Public Health and Medicine
Weill Medical College, Cornell University
 
SID BACCAM
Senior Scientist
Innovative Emergency Management (IEM)
 
3:45 p.m. Discussion with Committee
 
4:15 p.m. Panel B: Evaluating Cost and Effectiveness of Prepositioning Strategies
 
MARGRGARET BRANDEAU, Panel Chair
Coleman F. Fung Professor of Engineering
Stanford University
 
FADIA T. SHAYA
Associate Professor
University of Maryland School of Pharmacy
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×
FRED SELCK
Doctoral Student in Health Economics
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
 
NIKHIL NATARAJAN
Associate Director
Office of Health Emergency Preparedness
New York State Department of Health
 
4:45 p.m. Discussion with Committee
 
5:15 p.m. Closing Remarks
 
ROBERT BASS, Committee Chair
TIA POWELL, Committee Vice-Chair
 
5:30 p.m. ADJOURN DAY 2

Open Session at Committee Meeting #3

Day 1: Wednesday, April 20, 2011

The Beckman Center, Board Room
100 Academy Drive
Irvine, CA 92617

Open Session Goals

1. Examine ethical issues and considerations for at-risk populations relevant for the development of prepositioning strategies such as (1) hospital and pharmacy caches; (2) caches in locations such as workplaces, educational institutions, and care facilities; and (3) household MedKits.

2. Receive updated briefing on ASPR’s public engagement project and discuss how ASPR anticipates using the results of that project in conjunction with the IOM report.

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

8:00 a.m. Welcome and Introductions
 
  ROBERT BASS, Committee Chair
Executive Director
Maryland Institute for Emergency Medical Services Systems
 
  TIA POWELL, Committee Vice-Chair
Director
Montefiore-Einstein Center for Bioethics

SESSION 1: ETHICAL ISSUES AROUND PREPOSITIONING

Session Objective: Discuss ethical issues associated with the development of prepositioning strategies, including caches in workplaces, educational institutions, care facilities, and household MedKits.

8:15 a.m. TIA POWELL, Panel Chair
Director
Montefiore-Einstein Center for Bioethics
 
  DRUE BARRRRETT
CAPT, U.S. Public Health Service
Lead, Public Health Ethics Unit
Office of Science Integrity
Office of the Associate Director for Science
Centers for Disease Control and Prevention
 
  NANCY KASS (by videoconference)
Phoebe R. Berman Professor of Bioethics and Public Health
Johns Hopkins Bloomberg School of Public Health

SESSION 2: PREPOSITIONING FOR AT-RISK POPULATIONS

Session Objectives: Discuss how effective the prepositioning strategies under consideration would be for reaching at-risk populations. Highlight any equity issues that may arise, and discuss how members of these groups may view the development and implementation of these strategies.

Note: This session will focus specifically on populations who, by virtue of socioeconomic status and/or demographic characteristics, may be at systemically increased risk for lower access to disaster mitigation response— for example, people with low incomes/limited transportation outcomes, people with no or limited English proficiency, historically underserved ethnic/racial groups, people with disabilities (especially vision impaired,

Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

hearing impaired, mobility impaired), people who are homeless, and people who are homebound.

9:15 a.m. HERMINIA PALACIO, Panel Chair
Executive Director
 
 

Harris County Public Health and Environmental Services, Texas

 
  MANDI JANIS (by videoconference)
Program Director
Catholic Charities USA
 
  ROBERTA CARLIN (by videoconference)
Executive Director
American Association on Health and Disability
 
  BOB SPEARS
Director of Emergency Services
Los Angeles Unified School District
 
10:15 a.m. BREAK

SESSION 3: PUBLIC ENGAGEMENT ON PREPOSITIONING

Session Objective: Receive updated briefing on ASPR public engagement project and discuss how ASPR anticipates using the results of that project in conjunction with the recommendations in the IOM report.

10:30 a.m. ELIN GURSKY
Senior Advisor
Office of the Assistant Secretary for Preparedness and Response
Department of Health and Human Services
 
11:00 a.m. ADJOURN OPEN SESSION
Suggested Citation:"Appendix B: Public Meeting Agendas." Institute of Medicine. 2012. Prepositioning Antibiotics for Anthrax. Washington, DC: The National Academies Press. doi: 10.17226/13218.
×

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If terrorists released Bacillus anthracis over a large city, hundreds of thousands of people could be at risk of the deadly disease anthrax-caused by the B. anthracis spores-unless they had rapid access to antibiotic medical countermeasures (MCM). Although plans for rapidly delivering MCM to a large number of people following an anthrax attack have been greatly enhanced during the last decade, many public health authorities and policy experts fear that the nation's current systems and plans are insufficient to respond to the most challenging scenarios, such as a very large-scale anthrax attack. The U.S. Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response commissioned the Institute of Medicine to examine the potential uses, benefits, and disadvantages of strategies for repositioning antibiotics. This involves storing antibiotics close to or in the possession of the people who would need rapid access to them should an attack occur.

Prepositioning Antibiotics for Anthrax reviews the scientific evidence on the time window in which antibiotics successfully prevent anthrax and the implications for decision making about prepositioning, describes potential prepositioning strategies, and develops a framework to assist state, local, and tribal public health authorities in determining whether prepositioning strategies would be beneficial for their communities. However, based on an analysis of the likely health benefits, health risks, and relative costs of the different prepositioning strategies, the book also develops findings and recommendations to provide jurisdictions with some practical insights as to the circumstances in which different prepositioning strategies may be beneficial. Finally, the book identifies federal- and national-level actions that would facilitate the evaluation and development of prepositioning strategies.

Recognizing that communities across the nation have differing needs and capabilities, the findings presented in this report are intended to assist public health officials in considering the benefits, costs, and trade-offs involved in developing alternative prepositioning strategies appropriate to their particular communities.

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