U.S. officials are building up the National Pharmaceutical Stockpile (see GSN, Jan. 14) and reconsidering distribution methods to reflect lessons learned from Sept. 11 and the following anthrax attacks (see related GSN story, today).  The national stockpile received $644 million this year to increase supplies — far more than the $50 million spent annually since its creation in 1999.

“We’re going to be expanding very rapidly this year,” said Steven Bice, director of the stockpile program at the U.S. Centers for Disease Control and Prevention. 

Some of the recent measures to increase the stockpile reflect recent events.  For example, health officials bought $95 million worth of Cipro, the primary antibiotic used to treat anthrax (see GSN, Jan. 11).

Other efforts signal increased concern about future terrorist attacks.  The United States purchased millions of doses of potassium iodide last month to protect against certain consequences of radioactive fallout (see GSN, Jan. 14).  Authorities also have moved medical supplies to Salt Lake City in preparation for the upcoming winter Olympics (see GSN, Jan. 22).

“We have a lot of antibiotics out there just in case .… We’re prepared, if necessary, to deal with hundreds of thousands of victims,” Bice said.  In addition to antibiotics, authorities also have stored treatments for mustard gas and other potential terrorism agents to the area.

CDC officials, health experts and intelligence agents will meet in March to create a new list of the agents that terrorists would probably use.  Meanwhile, the No. 1 priority is preparing for a smallpox attack, which has raised concerns because the virus could quickly infect large numbers of people.

“Smallpox is at the absolute top of the A-list,” Bice said.  The United States plans to spend $428 million to prepare for a smallpox epidemic and to have smallpox vaccine stockpiled by early 2003 (see GSN, Jan. 14).  There are no plans, however, for preventive mass inoculation (see GSN, Nov. 9, 2001).

The CDC has also prepared to stockpile antitoxin to treat botulism in the case of an attack.  Other diseases that authorities consider on the top of the list of potential threats include plague, tularemia and hemorrhagic fevers. 

Managing the Stockpile

Maintaining a stockpile of drugs is difficult.  Equipment requires constant maintenance, and some drugs require refrigeration while others expire quickly. 

“It will probably take between $200 million and $300 million a year to maintain the stockpile,” Bice said.  “As long as we face threats like this, it will need an annual infusion of funds.”

The CDC uses a “just-in-time” strategy to avoid keeping perishable products stored for lengthy periods.  Health officials leave 80 percent of the stockpile in the hands of pharmaceutical companies.  The companies sell drugs in the stockpile that approach expiration and replace them with new drugs.  Bayer, the company that produces Cipro, provided most of the antibiotic that authorities used to treat people after the anthrax attacks directly from its stocks.

Response and Distribution

The CDC has 12 50-ton packages of equipment and drugs to respond to emergencies located in 10 cities.  Authorities can deliver the packages anywhere in the United States within 12 hours (Mike Toner, Atlanta Journal-Constitution, Jan. 29).

For example, the national stockpile sent one package, called a “push package,” to New York City in four hours after the second hijacked airplane hit the World Trade Center on Sept. 11.  A second package and CDC staff arrived by that night.

The responders learned several lessons from that day, including a need for more burn and trauma material in the packages and new means of communication.  “The cell phones we had were pretty useless,” Bice said.

The anthrax attacks and attempts to distribute Cipro that followed provided more lessons, such as the importance and difficulty of repackaging bulk quantities of medicine for distribution.

“In the future, every push package is going have a repacking machine so we can take bulk supplies and get them ready for distribution quickly … We’re also going to be buying more individually packaged drugs,” Bice said.

Authorities also learned they needed more responders.  The CDC was able to distribute anti-anthrax drugs to 40,000 people because the attacks spread gradually.

“But it’s a good thing it died down when it did … We were getting thin,” Bice said.  Stockpile officials plan to increase the staff from 40 to 80 people this year.

“In retrospect, we were lucky with anthrax this time.  I worry about how we would deal with 500 letters with anthrax blossoming in 5,000 places and a million people exposed,” Bice said.

Pre-Sept. 11 studies indicated the need to expand the stockpile’s capabilities.  In an exercise called TOPOFF, authorities had difficulty distributing medicine when a mock plague outbreak occurred in Denver.  The result would have been 3,000 people sick with plague within five days.  In a simulation involving smallpox called Dark Winter, vaccine stockpiles were inadequate, and the federal and state governments argued over supplies (see GSN, Nov. 30, 2001).

“Just delivering a stockpile package doesn’t solve the problem,” said Elin Gursky of the Johns Hopkins University Center for Civilian Biodefense Studies.  “Getting its contents delivered requires an integrated community response plan.”

U.S. President George W. Bush’s budget request for 2003 includes $3.5 billion to equip and train first responders, $245 million for drills and $105 million for improving emergency plans (Mike Toner, Atlanta Journal-Constitution II, Jan. 29).

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