• predispensed MCM—MCM stored by the intended users or by heads of households or other nonmedical caregivers for use by those in their care.

This chapter describes these three categories of prepositioning strategies. For each category, several example strategies, the potential roles for those strategies within a jurisdiction’s overall dispensing strategy, and potential health risks, if any, are discussed. Also discussed for each category are practical considerations, including logistics, communication needs, expected behavior and adherence, and legal and regulatory issues. Table 4-1 summarizes key features of the three categories of prepositioning strategies. This table is not intended to be comprehensive; other push and pull strategies (such as those described in Chapter 3) also could be employed to enhance distribution and dispensing.

In this chapter, the committee discusses the individual properties of different prepositioning strategies to highlight the specific uses of each and the associated advantages, disadvantages, and other considerations. However, these strategies are likely to be used in combination not only during initial prophylaxis, but also later when it is necessary to provide the exposed population with vaccine and a prolonged antibiotic course. This chapter focuses primarily on the qualitative considerations that should factor into jurisdictions’ decisions about whether to develop strategies for prepositioning prophylactic antibiotics in their communities. Chapter 5 outlines a decision-aiding framework and a model for quantifying and comparing health benefits and economic costs across the various prepositioning strategies and presents the committee’s recommendations on this topic.


Forward-deployed MCM are stored near the locations where they will be dispensed. The primary purpose of forward-deploying MCM is to decrease the transportation time associated with distributing the MCM from stockpiles to PODs. Several entities could potentially maintain forward-deployed stockpiles of antibiotics, including the Centers for Disease Control and Prevention (CDC)/Strategic National Stockpile (SNS); other federal agencies, such as the Department of Veteran Affairs (VA) and Department of Defense (DOD); state and local authorities; and commercial pharmaceutical distributors. These strategies are described below.


purposes of this report, and to enable clear discussion of the different properties associated with different types of prepositioning, the committee defines cache more specifically to denote storage of MCM in the locations from which they will be dispensed and uses the term stockpile to cover federal, state, and local stockpiles.

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