FINAL REPORT: Medical Countermeasures for Large-Scale Biological Attacks

Following a large-scale biological attack, the rapid delivery of effective medical countermeasures to the affected population is vital for saving lives and preserving the public’s confidence in the federal government’s ability to respond effectively. The Department of Health and Human Services (HHS) launched the Cities Readiness Initiative (CRI) in 2004. The CRI objective is to prepare major U.S. cities and metropolitan areas to respond effectively to large-scale biological attacks by, among other things, dispensing antibiotics to the targeted population within 48 hours. However, despite and after more than five years of federal funding and support, few if any CRI jurisdictions can meet this 48-hour goal.

Because of the perceived shortfalls, President Obama signed an executive order (EO 13527), in December 2009, “Establishing Federal Capability for the Timely Provision of Medical Countermeasures Following a Biological Attack.”  This EO explicitly acknowledges the urgent necessity of establishing a federal response capability to augment existing state and local plans for the distribution and administration of oral antibiotics. In addition, the Advisory Committee on Immunization Practices (ACIP) published recommendations, also in 2009, governing use of the anthrax vaccine (anthrax vaccine adsorbed) in the United States.

Anthrax is considered to be the most likely agent to be used in a potential biological attack. Studies and modeling indicate that pre-exposure vaccination with the anthrax vaccine approved by the U.S. Food and Drug Administration (FDA) or the immediate administration of oral antibiotics can reduce the likelihood of morbidity and mortality in exposed individuals. The U.S. Strategic National Stockpile holds sufficient quantities of anthrax vaccine and oral antibiotics to treat up to 60 million individuals.

In a recent Harris poll – conducted in December 2010 – 54 percent of respondents said they believe that a terrorist attack in the United States is likely to happen within the next 10 years, with 29 percent of respondents believing it will be a chemical or biological attack. The Harris poll serves as an important backdrop to the results that were obtained when DomPrep40 (DP40) members and DomPrep readers responded to a survey about the appropriateness of: (a) enhancing current mechanisms to deliver medical prophylaxis in the event of a biological attack; and (b) possible approaches to provide or pre-position such countermeasures before an attack.

Key Findings:

The results show a generally strong concordance between responses by DP40 members and DomPrep readers. The majority of respondents believe both that pre-event anthrax vaccinations should be provided to persons at risk and that there should be prepositioning of antibiotics to prepare for a bioterrorist attack. The respondents also believe that other establishments should be enlisted to assist in the delivery and distribution process, but do not support making these antibiotics available to the general public for stockpiling at home.

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