Once the antibiotics are distributed to the dispensing sites and the citizens are alerted, staff must screen each citizen for what type of antibiotic they should receive. The stockpile has two vaccinations against anthrax in case a person is allergic to one.
In each city, the CDC collects baseline data—overall population, seasonal population, number of dispensing points, and number of staff needed to give vaccinations. The agency also runs three drills a year to establish how many citizens can be vaccinated at each location. The data are constantly reviewed and procedures are tweaked depending on the results, Bowman says.
But the CDC doesn’t do all the work in the program. The CRI requires city officials to track population numbers and define the most efficient distribution locations. Local officials need to consider seasonal and out-of-town visitors staying within city limits. Often, health officials will establish dispensing locations at hotels to vaccinate tourists, which takes a load off the public dispensing areas, Bowman says.
The CRI also requires local officials to establish the paths of communication during a bioevent: how local hospitals and medical offices will handle the dispensing and how citizens would be notified. Planning is always important, but it is particularly critical in responding to a bioattack. “One thing that is different about this than a lot of disasters is the timeframe,” Bowman says. “The fact that you’re on a 48-hour clock, from the time you decide until you are essentially done with the first 10-day round for the entire population. The timeframe is so tight that almost every detail needs to be planned out.”
Volunteers and staff need to be identified and trained, agreements need to be made with all distribution areas, and numbers need to be analyzed—this isn’t something that can come together at the last minute, Bowman says.
“I’ve been doing disasters for a long time, so I’ve realized how critical it is,” explains Bowman. “There’s very little room for anything to go wrong, and that’s why it’s so important for communities to do this planning. In the anthrax model, the time from exposure to the time patients start having symptoms and dying, [the 48-hour window] is about as tight as we can get.”
The CRI has prepared cities for smaller health emergencies as well, Bowman says. During the 2009 H1N1 flu pandemic, antibiotics were issued through the same points of distribution that would be used during a bioattack, he notes.
However, like HSEEP, this program is suffering from shrinking funds. The Public Health Emergency Preparedness cooperative agreement has seen a steady decline in funding since it was established in 2002. There was a $55 million drop in funding from the prior year to the current fiscal year.
Spieldenner says that programs like the National Emergency Management Association are trying to fight for more funding, but in a time of congressional cutbacks and fading fears of terrorist attacks, advocates are finding it hard to win increased funding for preparedness programs such as HSEEP and CRI. “As funding has been reduced, it definitely affects what we can end up doing,” he says. The resulting reduction in readiness programs “will ultimately affect the quality of the real-world response.”