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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

INSTITUTE OF MEDICINE
         OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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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