Conducting an assessment of the supply chain’s integrity is one strategy to help HPP awardees and HCCs identify equipment and supply needs that will be in demand during an emergency and develop strategies to address potential shortfalls.
Public health departments coordinate medical material management and distribution when a public health emergency overwhelms the routine community supply chain. Public health’s role includes:
- Formalizing partnerships with private and public warehouse facilities and shipping companies
- Planning for potential nonmedical and medical distribution, dispensing, and administration
- Distributing and dispensing nonmedical and medical countermeasures
- Ensuring availability of medical countermeasures to individuals at greatest risk of morbidity and mortality from an influenza pandemic
These activities are described in more detail in CDC’s Public Health Preparedness Capabilities: National Standards for State and Local Planning, specifically, Capability 8: Medical Countermeasure Dispensing and Capability 9: Medical Materiel Management and Distribution..
As described in those capabilities, PHEP awardees must ensure they can support medical countermeasure distribution and dispensing (MCMDD) for all-hazards events ranging from a terrorist attack, an influenza pandemic, or an emerging infectious disease such as Ebola or Zika. CDC provides the 50 states and the four directly funded localities of Chicago, Los Angeles County, New York City, and Washington, D.C. with dedicated funding through CRI to ensure they have MCM distribution and dispensing plans in place and can effectively execute those plans in response to public health emergencies. Initially, CRI planning was specific to a large-scale biologic attack with anthrax as the primary threat consideration, which requires the dispensing of life-saving antibiotics or other countermeasures to affected populations within 48 hours. Current planning has evolved to encompass improved MCM planning and operational readiness for all hazards. Successfully executing an MCM mission is critical to ensuring the nation’s public health security during any large public health emergency.
To improve all-hazards MCM distribution and dispensing planning and response capabilities, CDC strongly encourages that PHEP awardees make 75% of their CRI funds available to CRI jurisdictions within 90 days of the start of the budget period, beginning in Budget Period 2. CRI jurisdictions are independent planning jurisdictions that include the counties and municipalities within the defined metropolitan statistical area (MSA). CDC recognizes that this funding allocation may present challenges to some awardees and will consider exceptions on a case-by-case basis.
To comply with PAHPRA and the priority resource planning and other elements specified in Capabilities 8 and 9, all 62 PHEP awardees must have plans in place for demonstrating operational readiness to receive, stage, distribute, and dispense MCMs including medications and medical supplies received from the SNS. PHEP awardees are required to complete the following MCM activities.
MCM Operational Readiness Reviews
In 2012-2016, with involvement from 19 awardee jurisdictions, national partners, and CDC SMEs, CDC developed, piloted, and implemented a new MCM operational readiness review (ORR) process for assessing state, local, and territorial ability to successfully execute a major public health response requiring the rapid distribution and dispensing of life-saving MCMs. The MCM ORR is intended to identify programmatic strengths and operational gaps for medical countermeasure response planning and operational readiness. CDC has updated the MCM ORR tool based on feedback received during its first full year of implementation in 2015-2016.
Beginning with Budget Period 1, CDC will conduct MCM ORRs on a two-year cycle, reviewing half of the 62 PHEP awardee jurisdictions every year. This process is designed to support and enhance state and local public health departments across the nation in strengthening their MCM capacity. PHEP awardees and local CRI jurisdictions must submit initial ORR self-assessment data in Budget Period 1 using the updated ORR tool to assess their continued progress in advancing MCM capabilities.
State awardees must conduct operational reviews for all CRI planning jurisdictions within a two-year period. State awardees must submit the resulting MCM ORR data from their CRI reviews to CDC using a web-based data collection system. CDC’s MCM regional field advisors will attend one MCM ORR per CRI MSA to observe and provide feedback.
As part of the operational readiness review process, awardees must provide CDC with supporting documentation regarding their public health preparedness capabilities, exercises, performance measures, program requirements, and other information relative to medical countermeasure distribution and dispensing. CDC encourages awardees to provide CDC with access to relevant documentation using their jurisdictions’ internal shared systems. By Budget Period 3, awardees must develop processes to enable CDC to access jurisdictional documentation using shared systems.
MCM ORR data, including status levels for PHEP awardees and local CRI jurisdictions, may be publicly released.
During interim years, CDC and awardees will address identified improvement areas based on the most recent MCM ORR findings. To help jurisdictions move toward “Established” status levels by June 30, 2022, CDC will work with all 62 PHEP awardees to complete the following activities designed to address identified planning and operational opportunities for improvement.
MCM Technical Assistance Action Plans
All PHEP awardees must submit updated MCM action plans twice each budget period and participate in quarterly conference calls with CDC to discuss action plan activities. The action plans focus on activities designed to address prioritized MCM operational gaps identified during the awardees’ most recent ORRs.
In addition, state awardees must develop MCM action plans for all of their CRI local planning jurisdictions, conduct quarterly conference calls with the CRI jurisdictions, and submit updated MCM action plans to CDC twice each budget period. Each action plan must summarize completed activities in response to areas of improvement identified in the jurisdiction’s most recent MCM ORR.
RSS Site Surveys
PHEP awardees must have updated receipt, stage, and store (RSS) site survey information available in CDC’s Online Technical Resources Assistance Center (On-TRAC) data center. RSS site information is required for the primary and back-up RSS sites (a minimum of at least two locations) and all potential RSS sites in their jurisdictions. Awardees must update RSS site information each year, and the U.S. Marshal Service and CDC must validate each RSS site at least once every three years.
PHEP awardees must have available online in CDC’s On-TRAC data center current operational information that identifies points of contact to facilitate time-sensitive, accurate information sharing before a public health emergency. Awardees must review and update the operational critical contact information that is in CDC’s On-TRAC data center at least every six months or as changes occur.
Inventory Management Tracking System and Data Exchange Annual Tests
PHEP awardees must provide inventory counts to CDC during a public health emergency. Awardees may use either CDC’s Inventory Management and Tracking System (IMATS) with the built-in reporting functionality or configure their own inventory management system (IMS) using the Inventory Data Exchange (IDE) Specification guide, enabling them to receive and respond to an inventory request from CDC. PHEP awardees must participate in annual tests that provide MCM inventory counts to CDC to ensure data reports of inventory levels are reliable. More specific details are provided in the 2017-2022 HPP-PHEP Supplemental Guidelines.
PHEP awardees should coordinate non-pharmaceutical interventions by developing and updating plans that include documentation of the applicable jurisdictional, legal, and regulatory authorities necessary for implementation in routing and incident-specific situations. Such plans must include necessary authorization for interventions with the following elements: individuals, groups, facilities, animals, food products, public works/utilities, and travel through ports of entry for state, local and territorial jurisdictions as appropriate. Plans should include consideration of the legal and planning issues for interventions such as isolation, quarantine, school and child care closures, workplace and community organization/event closure, and restrictions on movement.