Strategic National Stockpiles
Strategic National Stockpiles have had my focus the last few weeks. Each year Congress appropriates money (just under $600 million last year) so we can maintain stockpiles of medical supplies that would be needed in a national emergency. We have organized the system with the objective of being able to deliver basic supplies to the scene of an emergency within 12 hours.
The stockpile system became a serious undertaking following September 11, 2001. Our level of sophistication continues to increase. The procedures for prioritizing and executing the purchases are improving. We have a ways to go in my view.
It is easy to underestimate the challenge of keeping supplies current and ready to deploy. It involves advanced logistics and it is not inexpensive. In many cases, buying the item is a minor part of the cost. Warehousing has to be paid every year. Another challenge is shelf life. Most medical products have to be constantly monitored for currency and after an appropriate period they are no longer usable.
Some items are used and rotated constantly, but others don’t lend themselves to that pattern. Medical masks for example are not reusable and they just plain take up a lot of space. Medicines for certain emergencies would not be useful for any other purpose.
Another difficult issue is what and how much to stockpile. We have an interagency working group that makes those decisions. This group weighs the various categories of natural and man made emergencies that could occur and does its best to anticipate the supplies needed to recover from each. Careful priorities must be chosen because we can’t buy everything.
Among my biggest concerns related to the stockpile are two obvious ones. I worry about local and state governments and private entities relying on the federal government instead of preparing themselves. Our national stockpiles are set up to cover gaps, not to provide everything for everybody.
My second worry is distribution. The stockpile organization is able to get medicines, etc. to an airport within 12 hours. State and local governments are depended upon to have plans for distribution. We coordinate closely with them. The drills we have had in recent months with postal workers delivering medications to homes in Seattle, Philadelphia and Boston are examples.
Posted on October 22, 2007 in Preparedness
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Mr. Secretary,
Thank you once again for an inciteful and honest post. The issue of emergency stockpiles is of serious concern to myself and others who are worried about our nation's ability to respond to a severe flu pandemic. In trying to prepare local communities and individuals, I have heard all too many times that people plan to rely on the federal government for supplies in the event of an emergency. The message that these stockpiles are only to fill the gaps must be stressed at every level. I would be interested to know, with your limited budget, what percentage of these stockpiles are designated for pandemic flu? I understand that masks are hard to store and antivirals have a limited shelf life, but this disaster demands hard, expensive decisions in stockpiling. Thank you for your blog and all the work you do in this all too important field.
Sincerely,
Posted by: Justin | October 22, 2007 at 10:20 AMJustin
Congratulations on starting a blog. I hope you have time to write and read it (most of it, anyway). You've been very good to write about things that worry you. I'd like to respond with what worries me. Interesting that they are so different, so here's a view from the front lines.
My wife and I have 2 children: one autistic (15 years old) and one with bipolar disorder (18 years old). Last year we paid $106,000 out of our pocket for treatment and medication. This year we paid $164,000. I live in fear of losing our health insurance, and if I were to retire, no carrier would touch us. I believe our current system is criminal. Both my children suffer from organic, physical problems that are not "behavior" problems. They both have wonderful hearts and much to contribute to our world in their own way, yet the vast majority of effective treatments are not covered, and if my wife and I die, the only way to protect my children is to set it up so that neither have any assets so that they will be eligible for California State services like MediCal and social security. This make no sense, and is very difficult to do, and very expensive to set up. I feel as if the system is forcing me to "game" it. I have happily paid well over 3 million dollars in taxes (Fed and State) in the last 10 years but am afraid to retire and have overwhelming costs. I'm happy to say both my children are doing better, but the underlying issues remain the same.
I would like to find someone with your leadership and convictions to take a lead in offering solutions: no dropping people when they retire or change jobs; coverage for proven, effective treatment for autism and mental illness; access to State or Federal medical coverage in special circumstances; and a sensible way to leave assets to dependent, disabled people that does not negate the safety net that is only available to the destitute. I am happy to pay more taxes into such a system, and want nothing more than to invest in my children now so that State and Federal Government will not have to do so later.
I honestly don't think anyone in your government cares (I mean this as only an observation of words and actions) about this, and I have no way of impacting the debate, except my unimpressive note, which I hope finds you well, and gives you at least a short pause.
Keep blogging! Brooks Fisher brooks_fisher@intuit.com
Posted by: Brooks Fisher | October 22, 2007 at 02:38 PMattach a shop to the storehouse. Some people need the medication or masks immediately,
Posted by: gsgs | October 22, 2007 at 03:48 PMthey don't need long expiry dates. There could be a futures market on medicine...
Prices should depend on expiry date, I always wondered why they don't.
Sure, people could stockpile themselves, but as soon as there is synergy it makes
sense to organize it and stockpile on a community level.
Why aren't there private stockpiling companies to stockpile for those who
prefer to pay for it and rely on professional organization rather than doing
it by themselves ?
Quote:
"Among my biggest concerns related to the [federal] stockpile are two obvious ones. I worry about local and state governments and private entities relying on the federal government instead of preparing themselves. Our national stockpiles are set up to cover gaps, not to provide everything for everybody."
All right then, Mr. Secretary (and thank you for continuing with your blog and for bringing up this issue).
Then WHY has DHHS not taken the lead -- perhaps in conjunction with Homeland Security -- to massively, seriously, and repeatedly to promote DIRECTLY to individual citizens and to local citizens' organizations (schools, churches, business fraternal groups, scouts, etc. -- there are many) that each and every one of us needs to be stockpiling at home -- in every home, and every neighborhood -- for the essentials that we would need to survive at least the first wave of pandemic flu? That we will need when the "just-in-time" economy devolves slowly or quickly devolves into the "just isn't there" economy? WHY HAS THIS NOT HAPPENED? We will all need medicines, storable food, water, and ways to disinfect water (in the event that municipal services fail). We all need education RIGHT NOW about how flu spreads, practical ways to mitigate spread as much as possible, information telling us that our schools and daycares are likely to close for LONG periods, that our overseas travels may leave us in the lurch unable to get back to our homes in the event of a spreading global pandemic.
Please, stop worrying about "scaring the public" and DO a little scaring. If the states and local public health departments will not get off their duffs and quit their handwringing long enough to do these things and educate the citizenry, then you folks at the federal level are going to have to do it for them. As a matter of fact, if you begin this process, they (the states and locals) will probably jump right onto the bandwagon.
AND, an added bonus, your "early adopter" citizens out here, your activitists, will begin to be taken seriously by their friends, co-workers, and acquaintances instead of receiving rebuff or scorn or being written off as "not having enough to do." You all -- you officials at federal, state, and local levels -- leave us hanging out here with the relative silence that echoes in the main streams of communication with the GENERAL PUBLIC. Not smart.
Posted by: flutracker | October 22, 2007 at 04:12 PMSecretary,
An excellent blog and I appreciate your candor.
The recent Trust for America's Health report on pediatric pandemic planning has to prompt HHS to address the issue of placing children's Tamiflu in quantity into the stockpile. The report mentions only 100,000 courses of childrens' doses of Tamiflu are in the stockpile, which is understandable since the FDA only recently approved the smaller capsules. It is my hope that stockpiling of the smaller doses will accelerate.
I also hope you are taking a very close look at the drug Probenecid as a way of effectively doubling the stockpile. I am sure you are aware of its use since WWII as a way to extend drug supplies. Potentially, according to Roche itself, Probenecid could increase the efficiency of Tamiflu by 2.5 times. Please do not disregard this time-honored drug as a way of optimizing the SNS of Tamiflu (heck, or of any other drug!).
Posted by: Scott McPherson | October 22, 2007 at 05:29 PMIt is impossible for citizens to prepare for an emergency, medication-wise, because prescription meds are tightly controlled. I can't have antibiotics stored in my basement along with the bottled water. Even medication for chronic conditions is difficult to stockpile because often it is only possible to obtain a 30 day supply at a time. Guess we'd best hope the disaster happens at the beginning of the month, not the end.
Posted by: Jodi | October 22, 2007 at 07:17 PM.." Once a pandemic starts,
vaccine will come rolling off the line in lots,
so there has to be a priority scheme on who would receive it first,"
says William Raub,
science adviser to Health and Human Services Secretary Michael Leavitt
(I'm sorry, but I don't have the source for this comment; please tell me if it is incorrect.)
When exactly would this vaccine be produced, and how much would be available? It's my impression that most vaccine plants use eggs for growing vaccine, and production can't even start until the strain of virus is delivered to the vax plants. We don't know how long that would take, or if the country where the first H2H cases pop up would send the sample or keep it secret. Also, the supply of eggs has to be secured. In the months it takes to make enough vaccine for ordinary people, not just the priority list (healthcare workers, utility workers and policemen, for examples), the strain could change and the vaccine production line will have to use the new strain.
I think there has been too much emphasis on vaccines and antivirals in discussions of getting ready to face a pandemic. Considering that it will be nearly a year before there is enough vaccine for most people, shouldn't the focus be on sustaining our families? After all, families sustain workers, so if families run out of food, what good are all the business Continuity of Operations Plans?
News stories about vaccines rarely tell the reader that he'll have to survive the pandemic for months before he'll get a vaccine, so he's reassured, Nothing to worry about, what's for dinner? We'd be stronger as a nation if we ALL knew we'll have to take care of ourselves
Posted by: Jane | October 22, 2007 at 08:43 PMMore about pandemic flu preparations:
I'd like to see a "family / home reunification" policy prepared and publicized now and implemented early in the pandemic -- before the virus even reaches U.S. soil if possible. Those who must travel to reunite with family or return to their own homes for riding out the pandemic should have a special regimen and reporting system to be observed for 4 to 7 days prior to travel to establish that they are well. Then they would be granted priority status for tickets on aircraft, trains, or buses to one destination only: HOME. This would include not only college students studying in the U.S. or outside of the country, but also business or tourist travelers abroad who are U.S. citizens.
Can DHHS and DOT cooperate on something like this and get it together?
The current plan for Americans overseas is to leave them high and dry when pandemic breaks out, it seems... Don't ya just love a government that would do that to you after all the years you paid taxes?
Posted by: flutracker | October 23, 2007 at 12:01 AMI am a student at the University of Wisconsin - Stevens Point. In my microbiology class we have discussed some of the possible scenarios if a flu pandemic were to occur. We did not specifically discuss stockpiling or personal preparedness. I am not sure where to find resources that would tell me what exactly to stockpile. Does HHS have a recommendation or a prepared checklist for families or individuals? I would very much like to share this information with my class.
Thank you for stepping out into the blogosphere. (Your interview on NPR today was good too!)
Posted by: Eva Perri | October 23, 2007 at 09:59 PMAny feedback to the GAO report regarding the stockpile of aging and expired anthrax vaccine? Thanks. (Enjoyed your NPR interview).
Posted by: BNKhoa | October 24, 2007 at 10:59 AMThe question was asked about where one might find resources that would help people learn what items they should stockpile for their personal use in the event of a pandemic, or other national emergency. There are many online sites that focus on the possibility of pandemic influenza, such as: http://www.singtomeohmuse.com/
or http://www.newfluwiki2.com/frontPage.do
or the Flu Clinic at
http://www.curevents.com/vb/index.php
Any and all of these sites are full of information that could be invaluable to people who, rather than rely totally on gov't help, would prefer to take the initiative to help themselves prepare for a potential pandemic.
National stockpiles are all well and good, but until someone can demonstrate to my satisfaction that they are able and willing to provide me with whatever I might need, I feel compelled to protect me and mine as best I am able. I've been working at preparing for such an eventuality for two years now, and so have a lot of other people.
It's not too late to start.
Posted by: Claudia | October 24, 2007 at 02:31 PMMr. Secretary,
I was wondering when there will be more announcements on television about a pandemic coming? There are people in this country who still do not know to stock up. I have tried to tell people in my town but without a more official announcement no one takes the information seriously. Some of the cases in Indonesia now have me concerned that the Tamiflu blanket is failing. How can we get this information out so that people living pay check to pay check can have enough food in their homes to last 3 months or so without having to venture out for more supplies?
Posted by: standingfirm | October 24, 2007 at 03:36 PMI'd like to add another site to view and get more information on prepping for an emergency such as a pandemic.
Posted by: Reese | October 24, 2007 at 04:12 PMhttp://www.emergencyhomepreparation.org/
Heard about your blog on NPR yesterday.
I remember when postal workers were part of that medication distribution drill in Seattle...interesting way of using an already available and efficient system of distribution.
Seems like a difficult issue, given the coordination needed between federal and state/local governments. I can see your point about locals not necessarily getting themselves fully prepared when they know that the federal government is picking up the slack...how can you mitigate that? Help fund state/local preparedness projects? Something like emergency-preparedness block grants? That way, the federal government would have some oversight of the money, and the states would have some added funding to use in order to prepare...
Posted by: Bryan | October 24, 2007 at 04:58 PMBless you Mr. Secretary for building this Federal Stockpile. I feel so much better knowing there will be PPE for all our first responders and critical infrastructure workers, and Food and medical supplies for every person in the country. The Federal stockpile is a blessing....
We do have enough for everyone right? That is what people tell me.
Posted by: Roy | October 24, 2007 at 10:51 PMDear Secretary Leavitt,
Congratulations on the coverage from NPR and the AP. I'd like to think they first read about you on DemocracySpace, where I wrote about your blog on September 7. But with our dozens of daily readers ... maybe not. We've noted the additional coverage at DemSpace; click my name.
On another preparedness issue, I am curious to read a future post from you about MRSA, the "superbug" staph infection that has been in the news quite a bit this week. What are HHS and CDC doing to spread the word about MRSA and its dangers, especially the way it can spread in health-care settings?
Posted by: Julie Fanselow | October 25, 2007 at 02:03 PMMr. Secretary,
Being prepared is very important to all of us. Another person commented on the difficulty of being prepared for those needing prescription medications. I have a proposal for you to consider.
Right now prescriptions are filled for 30 days. Could we not mandate that life saving medications, such as heart, blood pressure, diabetes medications etc, and those that cannot be stopped abrupted be prescribed for 33 days? This would allow a person to build up a months extra medication without harming those most financially strapped who could not afford to purchase outright an extra month's medications. Professionals could review and decide which medications would be included. This would allow some breathing room in any emergency and keep our citizens in the greatest need safer.
Posted by: Lola Barrett | October 26, 2007 at 03:51 PMLola, from the great state of Utah.
If you do not know about PandemicFlu.gov already, it is the one-stop access to US government avian and pandemic flu information and is managed by the Department of Health and Human Services. It has all the preparedness checklists you need along with up to date information regarding avian influenza home and abroad. Spread the word about PandemicFlu.gov as it is a very valuable resource!
Posted by: Kevin | October 31, 2007 at 04:23 PM