Medical Countermeasures: A Stitch in Time Saves Nine

HOW MANY "STITCHES" TO KEEP AT THE READY In a previous editorial, "Public Health Disasters: Be Prepared," I outlined the dilemma public health emergency preparedness professionals and societies face in paying the price for preparedness and noted that societies ultimately must make conscious decisions of how much preparedness they can afford to "buy" in light of resources being finite and competing priorities.3 Even within the "price" of preparedness, professionals must choose among priorities such as stockpiling of MCMs, hardening communities (e.g., seismic retrofitting of buildings to prepare for earthquakes; building and maintaining levees to prepare for flooding), deploying earlywarning systems (e.g., the BioWatch monitoring system of highly specialized sensors positioned by the US Department of Homeland Security; Centers for Disease Control and Prevention's National Syndromic Surveillance Program BioSense Platform), and funding research for new vaccines, medications, and devices that may be used as MCMs in the future. WHERE TO KEEP THE FIRST "STITCH" Some MCMs, when needed, may be needed immediately. [...]conceivably, such MCMs could be prepositioned in every home. [...]problems arise with this approach, including unintended consequences (e.g., poisoning of children caused by accidental ingestion of MCMs) and expenses (e.g., the cost of MCMs distributed to every home is very high given that the most likely scenarios for their ever being needed are in an unpredictable locality, and unused MCMs will ultimately expire and need to be replenished). [...]preparedness and response planners attempt to achieve rapid access to MCMs through a mixture of national and regional stockpiles of MCMs, rapid transport and deployment mechanisms, and close coordination among the preparedness and response personnel at national, state, regional, and local levels to be able to receive and dispense MCMs.