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getting buy-in from the community on any proposed dispensing plan through neighborhood councils. Another suggestion was to encourage prior credentialing and training of volunteers who could be deployed to respond to a pandemic.

Additional Participant Comments

At each of the community conversations, ideas emerged that either represented overarching themes for that session or were not directly within the scope of inquiry, but are relevant and worthy of acknowledgment nevertheless.

In Fort Benton, some participants raised the question of why the Food and Drug Administration or other federal agency could not simply approve the over-the-counter sale of antiviral medications during a flu pandemic as a way of resolving the prescribing bottleneck, considering the drugs to be relatively safe. Consistent with repeatedly voiced concerns that rural areas are at a disadvantage to the “big cities” when it comes to prompt allocation of critical resources like antivirals, several participants also questioned why rural public health agencies could not simply stockpile locally. But perhaps the most frequently repeated theme at this session was the high level of trust and cooperation that permeates rural communities, and the sense that Fort Benton would be among the best places to be during a major pandemic.

This theme of trust was also evident in Chattanooga, where the emphasis was on participants’ trust in the knowledge and character of health care professionals “to do the right thing” when prescribing and dispensing antivirals during a pandemic. However, some Chattanooga participants did voice worries about the sufficiency of medical stockpiles and concerns about access to treatment by the uninsured.

Many of the Los Angeles participants’ references to “trust” were cast differently than at the other two sessions. A general distrust was frequently expressed at this venue, attributed to minority communities’ interactions with the health care system. Beyond specific concerns about how and where critical resources would flow during a crisis, several participants—citing the neglect of patient consent in the 1932 Tuskegee syphilis study—shared their belief that minority groups would be used as “human guinea pigs” to test antivirals and vaccines, but would be the last to receive the benefit of these treatments. A few Los Angeles participants also voiced worries about the safety and components of antiviral medications themselves (the risk of “contamination”), and a desire both for al-



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