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OCR for page R1
Public Engagement
on Facilitating
Access to Antiviral
Medications and
Information in an
Influenza Pandemic
Workshop Series Summary
Barbara Fain, Kristin Viswanathan,
and Bruce M. Altevogt, Rapporteurs
Forum on Medical and Public Health Preparedness for
Catastrophic Events
Board on Health Sciences Policy
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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board
of the National Research Council, whose members are drawn from the councils of the National
Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The members of the committee responsible for the report were chosen for their special compe-
tences and with regard for appropriate balance.
This study was supported by contracts between the National Academy of Sciences and the
American College of Emergency Physicians; the American Hospital Association; the Ameri-
can Medical Association; the American Nurses Association; the Association of State and Ter-
ritorial Health Officials; the Centers for Disease Control and Prevention (Contract No. 200-
2005-13434 TO #6); the Department of the Army (Contract No. W81XWH-08-P-0934); the
Department of Health and Human Services’ National Institutes of Health (Contract No. N01-
OD-4-2139 TO #198 and TO #244); the Department of Health and Human Services’ Office of
the Assistant Secretary for Preparedness and Response (Contract Nos. HHSP233200900680P,
HHS P23320042509X1); the Department of Homeland Security’s Federal Emergency Man-
agement Agency (Contract No. HSFEHQ-08-P-1800); the Department of Homeland Security’s
Office of Health Affairs (Contract No. HSHQDC-07-C-00097); the Department of Transporta-
tion’s National Highway Traffic Safety Administration (Contract No. DTNH22-10-H-00287);
the Department of Veterans Affairs (Contract No. V101(93)P-2136 TO #10); the Emergency
Nurses Association; the National Association of Chain Drug Stores; the National Association
of County and City Health Officials; the National Association of Emergency Medical Techni-
cians; the Pharmaceutical Research and Manufacturers of America; the Robert Wood Johnson
Foundation; and the United Health Foundation. The views presented in this publication do not
necessarily reflect the views of the organizations or agencies that provided support for the
project.
International Standard Book Number-13: 978-0-309-25694-0
International Standard Book Number-10: 0-309-25694-1
Additional copies of this report are available for sale from The National Academies Press, 500
Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313;
http://www.nap.edu/.
For more information about the Institute of Medicine, visit the IOM home page at
www.iom.edu.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures
and religions since the beginning of recorded history. The serpent adopted as a logotype by the
Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche
Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2012. Public engagement on facilitating ac-
cess to antiviral medications and information in an influenza pandemic: Workshop series
summary. Washington, DC: The National Academies Press.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating
society of distinguished scholars engaged in scientific and engineering research,
dedicated to the furtherance of science and technology and to their use for the
general welfare. Upon the authority of the charter granted to it by the Congress
in 1863, the Academy has a mandate that requires it to advise the federal gov-
ernment on scientific and technical matters. Dr. Ralph J. Cicerone is president of
the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the
charter of the National Academy of Sciences, as a parallel organization of out-
standing engineers. It is autonomous in its administration and in the selection of
its members, sharing with the National Academy of Sciences the responsibility
for advising the federal government. The National Academy of Engineering also
sponsors engineering programs aimed at meeting national needs, encourages
education and research, and recognizes the superior achievements of engineers.
Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions
in the examination of policy matters pertaining to the health of the public. The
Institute acts under the responsibility given to the National Academy of Sciences
by its congressional charter to be an adviser to the federal government and, upon
its own initiative, to identify issues of medical care, research, and education.
Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of
Sciences in 1916 to associate the broad community of science and technology
with the Academy’s purposes of furthering knowledge and advising the federal
government. Functioning in accordance with general policies determined
by the Academy, the Council has become the principal operating agency
of both the National Academy of Sciences and the National Academy
of Engineering in providing services to the government, the public, and the sci-
entific and engineering communities. The Council is administered jointly
by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and
Dr. Charles M. Vest are chair and vice chair, respectively, of the National Re-
search Council.
www.national-academies.org
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PLANNING COMMITTEE ON PUBLIC ENGAGEMENT FOR
DISTRIBUTION AND DISPENSING OF ANTIVIRAL
MEDICATIONS: WORKSHOP SERIES1
ARTHUR KELLERMANN (Co-Chair), RAND Corporation, Santa
Monica, CA
LISA KOONIN (Co-Chair), Influenza Pandemic Unit, Centers for
Disease Control and Prevention, Atlanta, GA
ALEX ADAMS, National Association of Chain Drug Stores, Alexandria,
VA
ROGER BERNIER, Centers for Disease Control and Prevention
(former), Atlanta, GA
JAMES BLUMENSTOCK, Association of State and Territorial Health
Officials, Arlington, VA
GREGORY BOGDAN, Rocky Mountain Poison and Drug Center,
Denver, CO
SUSAN COOPER, Tennessee Department of Health (former), Nashville,
TN
JACK HERRMANN, National Association of County and City Health
Officials, Washington, DC
RUTH LYNFIELD, Minnesota Department of Health, Minneapolis, MN
SUZET MCKINNEY, The Tauri Group, Alexandria, VA
JUDY MEEHAN, National Healthy Mothers Healthy Babies Coalition,
Washington, DC
ELENA RIOS, National Hispanic Medical Association, Washington, DC
CAROL RUTENBERG, Telephone Triage Consulting, Inc., Hot Springs,
AR
UMAIR SHAH, Harris County Department of Public Health and
Environmental Services, Houston, TX
Project Staff
BRUCE M. ALTEVOGT, Preparedness Forum Director
KRISTIN VISWANATHAN, Research Associate
ANDREW M. POPE, Director, Board on Health Sciences Policy
ALEX REPACE, Senior Program Assistant
BARBARA FAIN, Public Engagement Consultant
1
Institute of Medicine planning committees are solely responsible for organizing the
workshop, identifying topics, and choosing speakers. The responsibility for the published
workshop summary rests with the workshop rapporteurs and the institution.
v
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FORUM ON MEDICAL AND PUBLIC HEALTH
PREPAREDNESS FOR CATASTROPHIC EVENTS1
ROBERT KADLEC (Co-Chair), PRTM Management Consultants,
Washington, DC
LYNNE KIDDER (Co-Chair), Bipartisan WMD Terrorism Research
Center
ALEX ADAMS, National Association of Chain Drug Stores Foundation,
Alexandria, VA
DAMON ARNOLD, Association of State and Territorial Health
Officials, Arlington, VA (until November 2011)
GEORGES BENJAMIN, American Public Health Association,
Washington, DC
D. W. CHEN, Office of Assistant Secretary of Defense for Health
Affairs, Department of Defense, Washington, DC (until February
2012)
BROOKE COURTNEY, Food and Drug Administration, Silver Spring,
MD
JEFFREY DUCHIN, Seattle & King County and University of
Washington, Seattle
ALEXANDER GARZA, Department of Homeland Security,
Washington, DC
JULIE GERBERDING, Merck Vaccines, West Point, PA
LEWIS GOLDFRANK, New York University Medical Center, NY
DAN HANFLING, Inova Health System, Falls Church, VA
JACK HERRMANN, National Association of County and City Health
Officials, Washington, DC
JAMES JAMES, American Medical Association, Chicago, IL
PAUL JARRIS, Association of State and Territorial Health Officials,
Arlington, VA
JERRY JOHNSTON, National Association of Emergency Medical
Technicians, Mt. Pleasant, IA (until January 2012)
BRIAN KAMOIE, The White House, Washington, DC
LISA KAPLOWITZ, U.S. Department of Health and Human Services,
Office of the Assistant Secretary for Preparedness and Response,
Washington, DC
1
Institute of Medicine forums and roundtables do not issue, review, or approve
individual documents. The responsibility for the published workshop summary rests with
the workshop rapporteurs and the institution.
vii
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ALI KHAN, Centers for Disease Control and Prevention, Atlanta, GA
MICHAEL KURILLA, National Institute of Allergy and Infectious
Diseases, Bethesda, MD
JAYNE LUX, National Business Group on Health, Washington, DC
ANTHONY MACINTYRE, American College of Emergency
Physicians, Washington, DC
NICOLE MCKOIN, Target Corporation, Minneapolis, MN (from April
2012)
MARGARET MCMAHON, Emergency Nurses Association,
Williamstown, NJ
MATTHEW MINSON, Texas A&M University, College Station, TX
ERIN MULLEN, Pharmaceutical Research and Manufacturers of
America, Washington, DC
CHERYL PETERSON, American Nurses Association, Silver Spring,
MD
STEVEN PHILLIPS, National Library of Medicine, Bethesda, MD
LEWIS RADONOVICH, Veterans Health Administration, Washington,
DC
JOSHUA RIFF, Target Corporation, Minneapolis, MN (until April
2012)
KENNETH SCHOR, Uniformed Services University of the Health
Sciences, Bethesda, MD (since April 2012)
ROSLYNE SCHULMAN, American Hospital Association,
Washington, DC
SARAH SEILER, Carolinas Medical Center, Charlotte, NC
RICHARD SERINO, Federal Emergency Management Agency,
Washington, DC
MICHAEL SKIDMORE, U.S. Department of Defense, Washington,
DC
SHARON STANLEY, American Red Cross, Washington, DC
ERIC TONER, University of Pittsburgh Medical Center, Pittsburgh, PA
REED TUCKSON, UnitedHealth Group, Minneapolis, MN
MARGARET VANAMRINGE, The Joint Commission, Washington,
DC
GAMUNU WIEJETUNGE, National Highway Traffic Safety
Administration, Washington, DC
IOM Staff
BRUCE ALTEVOGT, Project Director
ANDREW M. POPE, Director, Board on Health Sciences Policy
viii
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KRISTIN VISWANATHAN, Research Associate
ALEX REPACE, Senior Program Assistant
ix
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Reviewers
This workshop summary has been reviewed in draft form by
individuals chosen for their diverse perspectives and technical expertise,
in accordance with procedures approved by the National Research
Council’s Report Review Committee. The purpose of this independent
review is to provide candid and critical comments that will assist the
institution in making its published summary as sound as possible and to
ensure that the summary meets institutional standards for objectivity,
evidence, and responsiveness to the study charge. The review comments
and draft manuscript remain confidential to protect the integrity of the
process. We wish to thank the following individuals for their review of
this summary:
Terri Hyduke, Children’s Physician Network, Minneapolis, MN
Meredith Li-Vollmer, Seattle & King County, WA
Paul Petersen, State of Tennessee Department of Health, Nashville
Jo Ellen Warner, National Association of County and City Health
Officials, Washington, DC
Although the reviewers listed above have provided many
constructive comments and suggestions, they did not see the final draft of
the summary before its release. The review of this summary was
overseen by Herminia Palacio, Executive Director, Harris County
Public Health and Environmental Services. Appointed by the Institute of
Medicine, she was responsible for making certain that an independent
examination of this summary was carried out in accordance with
institutional procedures and that all review comments were carefully
considered. Responsibility for the final content of this summary rests
entirely with the rapporteurs and the institution.
xi
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Contents
INTRODUCTION 1
Background, 3
About This Summary, 5
DESCRIPTION OF THE “COMMUNITY CONVERSATIONS” 6
Planning and Participant Recruitment, 6
Agenda and Tools, 8
Personnel, 10
Process for Small-Group Discussions, 10
SESSION SUMMARIES 11
Session Characteristics, 12
Scenario Discussion Points and Themes, 14
Nurse Triage Lines, 17
Antiviral Pick-Up and Delivery by Community Contacts, 22
Collaborative Practice Agreements Between Pharmacies
and Physicians, 25
Strategies to Inform the Public About Pandemic Flu and Treatment
with Antiviral Medications, 28
When Antiviral Medications Are in Short Supply, 31
Individual Participants’ Ideas for Prescribing and Dispensing
Antiviral Medications in a Flu Pandemic, 35
Additional Participant Comments, 37
Participant Evaluations, 38
DISCUSSION 39
xiii
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xiv CONTENTS
FINAL REMARKS 40
APPENDIX: Recruitment Flyer 41
