In bringing the workshop to a close, O’Toole invited all of the panelists to take seats at the table and spend several minutes highlighting areas that in their opinions needed additional exploration based on the workshop discussions. Several speakers raised the question of validating or confirming the scope and mission of the Strategic National Stockpile (SNS) in the current environment, with Inglesby commenting that an SNS focused only on chemical, biological, radiological, and nuclear (CBRN) threats pushes the bounds of sustainability, and that all hazards and emerging infectious diseases (EIDs) being included in the paradigm increases the pressure even further. Carlin expanded on the pressure caused by EIDs, adding “we need to think about what a stockpile for EID actually means though. It seems like we’re getting one a year at this stage, and how sustainable would having a stockpile for EID be?” Addressing the topic of scope and mission pressures from a different perspective, Parker provided that participants, therapies, and preventative measures can change over time as the science underpinning them evolves. Parker suggested that a “deep breath” was needed, that assumptions be reassessed and validated as part of any reviews of SNS products. Skivington took the revalidation idea in a parallel direction, suggesting that a similar administrative and governance “deep breath” might be of value in such a complex structure.
Other speakers raised the question of trade-offs in decision making as an enduring topic. Brandeau offered that it may be valuable to decision makers to frame the possible expansion of the SNS mission in terms of both financial and operational cost-benefit trade-offs, while Carlin suggested
that there may be ethical questions to be considered with some of those trade-offs as well.
O’Toole closed out the workshop by reminding participants that the threats and hazards that prompted the creation of the SNS remain as extant and challenging currently as they have ever been and suggested that continued enhancement of the SNS be considered from a national security perspective in addition to a public health perspective.