Resources: Why the President’s Executive Order re Medical Countermeasures is bad medicine

Salado TX--The President’s Executive Order on medical countermeasures is an example where the President has been given terrible advice.

This executive order tasks HHS, DHS and the US Postal Service to develop the “national U.S. Postal Service model,” of distributing medical countermeasures to the American people during a biological attack. The idea is that the US Postal Service (USPS) mail carriers, with appropriate law enforcement escorts, would deliver pharmaceuticals and other medical countermeasures to postal route customers.

I believe this is a bad idea and advised against this back in a meeting I hosted with CDC in the early 2000s and on a number of occasions since. I also recommended using American healthcare distributors for the emergency distribution of medical materiel, including countermeasures. Here are the reasons for my views:

By mandating the USPS to drop off medications we will be creating a horrible mess.

Mail Carriers often:

1. Don’t know how many residents are living at each dwelling
2. Don’t know how many pediatrics doses are needed at each dwelling
3. Can’t answer any postal customer questions regarding administration (There will be information/education flyers, but this is really bad news from any competent Public Health prospective).
4. Won’t be able to discuss contraindications of using countermeasures with other medicines
5. May be afraid to enter infected areas of their routes when a disaster occurs
6. May call in sick due to fear of the unknown or concerns about their health

Bottom Line: This solution is only marginally better than dropping off lifesaving medications in the town square.

Our Established Supply Chain works beautifully and only requires the Federal Government to flow any emergency medications and other medical supplies and equipment into the existing supply chain for immediate release to normal end users in the affected jurisdictions. Medications can be rapidly shipped to pharmacies, public health clinics, physician offices, and home health organizations etc, (in other words the existing end users of medications) during a Public Health emergency. The distribution links are already established and dispensing procedures and safeguards are in place, are safe and are very refined. The existing civilian logistics networks like FedEx, UPS etc. are designed for next day service. The Public can be instructed to go to their normal pharmacy, their doctor’s office or to a public health clinic to acquire the emergency supplies. Our normal pharmacies have systems designed to detect any contraindications in medications, and our doctors, nurses and other professionals are infinitely better sources of medicine information and education than any information flyer.

For some reason, the CDC persists in trying to develop a shadow medical supply chain system, when we have an excellent healthcare supply and distribution system in place in America. The only problem with our existing healthcare supply chain is that it doesn’t have very much inventory in it. The reason for “lean” inventory levels is to reduce inventory carrying costs. This efficiency is the hallmark of our Just-In-Time paradigm for normal supplying and sustaining healthcare operations. This does not mean that our healthcare distributors can’t rapidly move Federal Reserve Inventories (FRI) through the supply chain. In fact, America’s healthcare distributors have the best and most efficient logistics network in the world.

I believe that the “USPS Solution” was a knee jerk reaction in the early 2000s, as a reaction to a mandate to deliver post-exposure antibiotics to population centers within 48 hours. I thought and hoped that this USPS distribution idea had died a dignified death long ago. Hal Newman published my suggestion on Big Medicine and I briefed my concept of operations so many times to so many people, I have lost count. Instead, this really bad idea has been dusted off and has emerged again.

I fear that this USPS distribution model will embarrass the President, HHS, DHS and USPS officials, as well as further undermine the Nation’s confidence in our Federal Government. More importantly, this USPS model will fail to protect the American people when we need medical countermeasures most. We saw the problems associated with H1N1 distribution, but still, we are apparently “going it alone” again with the distribution of medical countermeasures during future biological attacks. Whatever happened to Public Sector, Private Sector partnerships?

Besides sending my proposal to countless Federal officials for years, I have also advocated building Federal Reserve Inventories (FRI) consisting of items needed to provide the necessities of life during large-scale disasters or catastrophic events. If we have a biological attack, are mail carriers going to provide supplies and equipment to hospitals for those persons who become symptomatic? How are hospitals and medical centers going to admit the surge of symptomatic patients when the entire healthcare system operates on a Just-In-Time supply system? Does the Federal Government have Federal Reserve Inventories (FRI) of supplies and equipment to flow through the healthcare supply chain to care for these folks? Or… this just another partial solution thought up “on the fly” to meet a short suspense date? Make no mistake, the numbers of medical staff and the quantities of medical supplies, equipment, support services and other ancillary support products and services for any large-scale disaster are huge.

We have not taken the time to establish true requirements for the 15 Federal Planning scenarios to help state and local governments plan for their part of the Federal Planning Scenarios if appropriate to their jurisdiction. Instead, in many cases, we have shot from the hip in procuring medical products and have even stated “It’s a start.” The American people deserve much more than qualified statements regarding National Readiness to respond to the very scenarios the Federal Government have promulgated to state and local planning agencies. It is time to put our cards on the table and then develop Readiness programs to protect Americans and our society against all future catastrophic disasters. Many planners at all levels of government are still counting on the hundreds of millions of dollars in War Reserve Medical Materiel America had during the Cold War. The fact is the Defense Logistics Agency’s depots were scaled back to nearly nothing during the early 1990s.

This issue transcends politics or Federal bureaucracy perception issues. I don’t want the President or the HHS, DHS Secretaries or the Postmaster General to be embarrassed. More importantly though, I can’t stand the idea of subjecting Americans to this plan and the chaos and the potential loss of life it will cause.

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