Einstein Montefiore Bioethicist Helped Shape New Institute of Medicine Report on Staging Antibiotics for Possible Anthrax Attack

October 3, 2011 — (BRONX, NY) — The Institute of Medicine (IOM) released a report last Friday that provides guidance to U.S. public health officials to develop plans to pre-position antibiotics that can be distributed to the general public in the case of a large-scale anthrax attack. Tia Powell, M.D., director of the Montefiore Einstein Center for Bioethics and the Einstein-Cardozo Master of Science in Bioethics program, was vice-chair of the 16-member Committee Prepositioned Medical Countermeasures for the Public, which issued the report.

Tia Powell, M.D., M.S.
Tia Powell, M.D.
The report recommends that public health officials work with the federal government to assess the benefits and costs of strategies that pre-position antibiotics close to or in the hands of people who will need quick access to them should an attack occur. The goal is to get antibiotics to all individuals in need within 48 hours of a decision to dispense. The report recommends that each jurisdiction assess the benefits and costs of different strategies for storing antibiotics locally and determine which ones would be most appropriate for their communities.  

The committee came out against pre-positioning antibiotics in the home for the general public because this measure requires enormous outlays in terms of cost, along with an increased risk of inappropriate use, with fairly limited benefits in terms of access.  However, communities may assess whether specific groups, such as cancer patients, those with mobility limitations, or first responders might benefit from pre-positioning. Read complete IOM report.

A key issue in the report is that the ethics framework is as central to the development of sound policy as are technical data and considerations. 

"If you don’t know what your goals or values are, then data on safety and efficacy don’t really help you," said Dr. Powell.  She noted that one particularly vital ethics issue for the committee was the stewardship of public health resources.

"The need to provide appropriate stewardship of resources is a crucial ethics issue in this era of limited public health funds," Dr. Powell continued. “Public health entities today need to consider the benefit of every dollar they spend, and to know that it is best spent on one strategy to protect public health rather than another. The committee looked especially carefully at data that estimated the cost and added benefit of various strategies.” Dr. Powell is also professor of clinical epidemiology & population health and of clinical psychiatry and behavioral sciences at Albert Einstein College of Medicine.

The report notes that different communities need to assess their values and preferences, along with the risk of attack and public health capabilities, in order to determine which strategies are most likely to benefit them.

The study was sponsored by the U.S. Department of Health and Human Services. Robert Bass of the Maryland Institute for Emergency Medical Services Systems chaired the committee.