Anthrax antibiotics pre-position plan needed, says report

Public health officials on a state and local level should determine where and how antibiotics for anthrax should be stored in their communities in the event of a large-scale anthrax attack, says a new report from the Institute of Medicine.

The report, funded by the Department of Health and Human Services, recommends research to provide stronger evidence for where best to pre-position supplies.

Ever since the 2001 anthrax attack, questions have been raised about developing plans to deliver medicine quickly to those who might be exposed.

The committee created to look into the issue found “under particular circumstances, pre-positioning strategies can reduce the time within which individuals in a community can receive prophylactic antibiotics, and certain strategies can help alleviate the burden on the public health dispensing system.” The committee examined a range of factors including benefits, costs, safety and ethical issues.

“Rapid access to antibiotics can prevent people who are exposed to aerosolized Bacillus anthracis from developing anthrax; once symptoms of anthrax emerge, the disease progresses rapidly and can prove fatal,” the report says.

In the preface to the 369-page report, the study pointed out “concerns remain about the nation’s ability to respond to an anthrax attack scenario of the most dire proportions – for example, a large-scale attack impacting hundreds of thousands of people and carried out in multiple cities.”

“Current federal, state and local plans for dispensing antibiotics rely heavily on post-attack delivery from state stockpiles or the Centers for Disease Control. The goal is to get antibiotics to all individuals in need within 48 hours of a decision to dispense,” the committee said.

The report suggested pre-positioning provides less flexibility to change plans following an attack. “For example, pre-positioning may not be helpful if an attack occurs in a location other than anticipated or uses a strain of anthrax that is resistant to the pre-positioned antibiotic,” said Robert Bass, chair of the committee that wrote the report.

The committee also found that costs are likely to increase as antibiotics are pre-positioned closer to the intended users. “In the current climate of dramatic cuts in public health funding, the issue of how communities use their limited resources is critically important,” the report stated.

The study acknowledged communities have different needs, capabilities and priorities. It said strategies employed by public health officials should be tailored to what works best for each area “considering the benefits, costs and trade-offs involved in developing alternative pre-positioning strategies appropriate to their particular communities.”

The report said when it comes to public health planning and pre-positioning strategies, officials should follow an ethical framework. It said supplies should be distributed “without unduly imposing burdens on any one population group.”

The report stated priority research is needed to better understand the anthrax incubation period and the minimum time before symptoms begin to show to determine when to administer antibiotics. It raised concerns about pre-dispensing medicine and the potential misuse and cost of stockpiling antibiotics at home.

The report concluded that pre-positioning antibiotics is just one part of a strategy to prevent illness and death from an anthrax attack. “Other components include national security efforts to prevent an attack or mitigate its effects; efforts to enhance detection and surveillance capability,” the survey said.