3.2 Medical Countermeasures

Once the cause of disease is known, MCMs that effectively treat or prevent the disease can be utilized, if available. Effective use of MCMs during a biological incident will not only help reduce the spread of disease but also reduce incidences of illness, thus reducing the burden on healthcare systems; often, MCMs will be paired with NPIs. MCMs include materials used to prevent, mitigate, or treat adverse health effects, such as PrEP/PEP and therapeutics, diagnostic tests, and PPE. MCMs, such as antibiotics, antitoxins, vaccines, and antiviral drugs, can be used to treat patients with disease symptoms or to prevent and/or slow the development of disease in exposed or potentially exposed individuals. Prophylaxis may also be provided to individuals who are at high risk of being exposed during the response (e.g., first responders, human and veterinary healthcare providers, etc.) or those who were exposed but have yet to develop illness symptoms. PPE such as protective clothing (e.g., gloves, gowns, etc.), eye protection (e.g., face shields or goggles), and masks or respiratory protection (e.g., disposable filtering facepiece respirators and positive air purifying respirators) are additional examples of MCMs that may be employed during a biological incident. The type of PPE employed will depend on the characteristics of the biological agent involved (i.e., pathogens transmitted through inhalation versus environmental contact or other exposures).

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3.2.1 Access to Medical Countermeasures

State and local caches and hospital supplies can serve as sources of readily deployable MCMs that can be accessed quickly during emergencies. Hospital supplies may be available for immediate use while waiting for the arrival of supplies from other sources, but inventory generally is limited. Hospitals do not typically stock MCMs that are seldomly used (e.g., smallpox vaccines) and rarely have on hand more than a few weeks’ supply of an MCM that would be used during the course of normal operations. Therefore, even if an MCM is available in a hospital (e.g., broad spectrum antibiotics), existing supplies alone would be insufficient to treat a surge of patients during a major, prolonged biological incident.

States and localities may maintain their own MCM stockpiles, which may be forward-deployed within or near planned MCM dispensing sites.⁵⁵ Depending on the size and scope of a biological incident, the Strategic National Stockpile (SNS), managed by HHS ASPR, may be activated to provide speedy access to additional/alternative MCMs. Achieving efficient delivery of MCMs from storage sites to areas in need and then dispensing them to affected individuals requires carefully and comprehensively designed dispensing plans. Within the SNS, materials may be tracked by local and state public health leaders on the Inventory Management and Tracking System (IMATS). When thousands of people need MCMs quickly, dispensing of SNS and state/local MCM caches, such as vaccines, antibiotics, and PPE, to affected populations will likely occur through Points of Dispensing (PODs), which are pre-identified sites planned to serve the dispensing needs of specific areas or populations. Considerations for the utilization of PODs during a biological incident are discussed in the callout box that follows.

3.2.2 Plan for Medical Countermeasure Challenges

MCM use in a biological incident is not without challenges. For example, because many MCMs treat or prevent only one disease (such as most vaccines), the identity of the pathogen causing the outbreak must be known before some types of MCMs may be deployed. Additionally, the infectious agent may be intentionally (or, in some cases, naturally) altered to be resistant to available treatments, making the resulting disease more difficult to treat or untreatable with available MCMs. Alternatively, specific MCMs may not be available for the pathogen involved (e.g., a toxin or an emerging agent).

Limited capacity for pathogen-specific diagnostic testing in public health laboratories (state and federal) and in independent, hospital, or academic clinical laboratories can present significant challenges to surge testing during a widescale biological outbreak. Staffing shortages, limited access to supplies, and increased demand for testing can all contribute to increased turnaround times and slower test results. The type of testing sample (e.g., nasal swab or blood test) may require additional considerations for both sample collection and test site set up. Moreover, limitations in the availability and accessibility of community testing sites can hinder public health officials’ ability to track local infection trends. These challenges in diagnostic testing can impede efforts to control disease spread and may be exacerbated during major communicable disease outbreaks.

Not all biological incidents will require community-wide testing campaigns to control the spread of disease, such as incidents resulting from contaminated water or incidents involving non-contagious pathogens. When such campaigns are beneficial for controlling disease spread, their effectiveness will depend on the public’s willingness and ability to participate in testing. Further, the public’s willingness to comply with directives that hinge upon testing results (such as self-isolation or quarantine) will impact efforts to control disease spread. Perceived social stigma and potential threats to employment from positive results also can adversely affect compliance. Failure to provide clear and consistent messaging, coupled with the threat of individual social and economic impacts, can derail community-wide testing campaigns. (Refer to KPF 2: Communicate with External Partners and the Public, for messaging strategies that will promote the public’s confidence in the information they receive and their compliance with appropriate directives.)