Welcome. CDC Science Seminar Partnering for Medical Countermeasures. Brought to you by the Northwest Preparedness & Emergency Response Learning Center

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Avice Newton
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1 Welcome CDC Science Seminar Partnering for Medical Countermeasures Brought to you by the Northwest Preparedness & Emergency Response Learning Center We will begin at 8:00 am (Pacific). If the audio through the computer is not clear, Please call in on the phone line, , passcode: #. Session Moderator Tao Sheng Kwan-Gett, MD MPH NWPERLC Principal Investigator NWCPHP Director SCHOOL OF PUBLIC HEALTH PERLC Network 1

2 Northwest Center for Public Health Practice Core Activities Training Communications Evaluation Research We re always available to collaborate and discuss your preparedness and emergency response needs

CDC Science Seminar Partnering for Medical Countermeasures Andy Stergachis, PhD, RPh Jenny Arnold, PharmD Carina Elsenboss, MS SCHOOL OF PUBLIC HEALTH The findings and conclusions in this

3 CDC Science Seminar Partnering for Medical Countermeasures Andy Stergachis, PhD, RPh Jenny Arnold, PharmD Carina Elsenboss, MS SCHOOL OF PUBLIC HEALTH The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of [the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry]. Medical Countermeasures Toolkit Andy Stergachis, PhD, RPh Professor School of Public Health and School of Pharmacy University of Washington 3

4 Medical Countermeasures Used to prevent, mitigate, or treat the adverse health effects of an intentional, accidental, or naturally occurring public health emergency Pharmaceutical interventions Vaccines Antimicrobials Antidotes Antitoxins Non-pharmaceutical interventions Ventilators Diagnostics Personal protective equipment Patient decontamination Medical Countermeasure Incidents 1995 Meningitis MN 30, , 2003 Hepatitis A PA 6, Smallpox vaccination program 2007 Pediatric flu deaths WA H1N1 pandemic millions 2001 Anthrax DC, FL, NJ > 30, Hepatitis A Boston 3, Hepatitis A Buffalo 10, Pertussis WA > 1,000 4

The Need Methods needed to quickly distribute medicines and services to large numbers in emergencies Public health agencies are increasingly limited in staff Few

5 The Need Methods needed to quickly distribute medicines and services to large numbers in emergencies Public health agencies are increasingly limited in staff Few pharmacists are employed by local or state health departments There is a pharmacy within 5 miles of most homes Pharmacists are mid-level practitioners in nearly every state 5

formalized relationships Coordination (especially when multi-jurisdictional)

6 During the H1N1 Pandemic, Pharmacies: Dispensed antivirals Administered vaccines Counseled patients Informed the community Working Together - Issues Emerged Lack of formalized relationships Coordination (especially when multi-jurisdictional) Differing expectations and processes Communications Need for clear guidance Clarification of roles 6

7 In response... A working group developed: Template Memorandum of Understanding (MOU) Operational plan Toolkit of additional resources available online Purpose of the MOU Use existing pharmacy infrastructure to assist in addressing health and medical needs during a public health incident, emergency, or disaster using coordinated and standardized protocols statewide. 7

Key Elements of MOU and Operational Plan How to invoke assistance Responsibilities of local health jurisdictions Responsibilities of pharmacies Cost and payment Immunity, indemnifications, and

8 Key Elements of MOU and Operational Plan How to invoke assistance Responsibilities of local health jurisdictions Responsibilities of pharmacies Cost and payment Immunity, indemnifications, and limitations Information sharing Invoking Assistance Expecting to exceed capabilities of public health response Emergency operations plan activated Operating under Incident Command System (ICS) Mission number received 8

9 Activation of MOU - Example Single Jurisdiction Multi-Jurisdiction King Snohomish Pierce Washington State Pharmacy Association MOU Activation: Request and Response Procedures WSPA coordination call WSPA forwards form to pharmacies Amendments made to form LHJ submits assistance request form WSPA sends approval notification 9

Responsibilities Local Health Jurisdictions Both Pharmacies Planning, technical assistance, and training Activate vaccination and

Dispose of unused medications Insure statewide consistency with screening forms, tracking, training Communicate number of doses can

information of individuals receiving medication Cost and Payment Local Health Jurisdictions provide medications at no cost to Pharmacy

10 Responsibilities Local Health Jurisdictions Both Pharmacies Planning, technical assistance, and training Activate vaccination and dispensing plans Request medication, vaccines, and supplies from local, state, or federal sources Manage public information activities Dispose of unused medications Insure statewide consistency with screening forms, tracking, training Communicate number of doses can administer Identify pharmacy sites to receive medication Receive and store medication Medical screening of individuals Track contact information of individuals receiving medication Cost and Payment Local Health Jurisdictions provide medications at no cost to Pharmacy Pharmacy will not charge for the supplied drug, vaccine or other medical product All other costs will be the responsibility of the respective agency 10

Health Jurisdictions Request information to protect the public s health

11 Immunity, Indemnifications, and Limitations MOU provides immunity to local health jurisdictions and pharmacies Information sharing Local Health Jurisdictions Request information to protect the public s health Pharmacy Provide documentation of actions taken and services provided under MOU 11

coordination call Local Health Jurisdictions provide regular updates to WSPA

12 Communications Contact list for authorized representatives Local Health Jurisdictions request WSPA to incorporate pharmacies WSPA convenes coordination call Local Health Jurisdictions provide regular updates to WSPA and pharmacies. 12

13 Online Toolkit 1. MOU and Operational Plan templates 2. Resources to host a Facilitated Discussion 3. Private Medication Center Partnership Materials 4. Additional Resources Link to collaborative drug therapy agreement information and template Medical screening forms Education materials for the public Template of Standing Orders and Protocols Medication Dispensing Tracking Forms Medical Countermeasures Distribution Form List of Additional Supplies Available Medical Countermeasures Reference Table Acknowledgements Thank you to the members of the MOU and Operational Plan Working Groups: Snohomish Health District Whatcom County Health Department Kitsap Public Health District Board of Pharmacy, Dept. of Health Public Health Seattle & King County Tacoma-Pierce County Health Department QFC Washington State Pharmacy Association Spokane Regional Health District Walgreens WSU College of Pharmacy Deaconess Hospital and Rockwood Clinics Spokane Regional Health District Safeway Northwest Division- Seattle School of Public Health University of Washington Washington State Department of Health 13

14 Pharmacy Perspective Jenny Arnold, PharmD, BCPS Director of Practice Development Washington State Pharmacy Association Not So Long Ago 14

Pharmacists Doctoral degree, four years focused on drug knowledge Post graduate training is optional 1 or 2 year residencies, fellowship 3rd most common health care providers 2 nd most trusted

15 Pharmacists Doctoral degree, four years focused on drug knowledge Post graduate training is optional 1 or 2 year residencies, fellowship 3rd most common health care providers 2 nd most trusted professional 19.7% of American Adults received influenza vaccine in a pharmacy or store in (CDC) Pharmacies 93% of Americans live within 5 miles of a pharmacy On average Adults in the US visit a pharmacy or store with a pharmacy 1.9 times per week 15

16 Pharmacists Vaccinate in Every State With Limitations Differences Between States Age limits (18 years and older) Vaccine limits (influenza only, or only select vaccines) Route limits (injection only) Prescriptions required Legal ways pharmacist vaccinations are permitted (practice act, dependent prescribing) 16

17 Pharmacists Can Prescribe in Many States Dependent prescribing provided there is a formal protocol in place or collaborative drug therapy agreement (CDTA) An increasing number of states allow this practice Used in community settings, ambulatory clinics and in hospitals Fundamental To The Toolkit Pharmacists working at the full extent of their licensure In a declared emergency, laws can be suspended in states that do not permit pharmacist prescribing Pharmacies can help without CDTAs Pharmacies may be able to help with niche populations (e.g., LTC, elderly, non-english speakers) 17

18 Pharmacies Want Partnerships With Public Health H1N1 as an example A communications challenge for state leaders and chains Pharmacists want to be able to help in an emergency Frontline pharmacists Chain leaders Pharmacies request consistent and clear guidelines and documentation tools Considerations When Partnering Pharmacies may not have full internet access Business continuity Pharmacies are not non-profits Reasonable administration or professional fees Telephone game 18

19 A Local Health Jurisdiction Perspective Carina Elsenboss, MS Planning & Partnerships Program Manager Preparedness Section Public Health Seattle & King County Everyday Emergencies 19

language other than English spoken at home 10% below poverty level Boeing,

20 Everyday Systems Source: Steven Snodgrass Who Do We Need to Reach? 6% age 5 and under 21% age 18 and under 11% age 65 and older 23% speak a language other than English spoken at home 10% below poverty level Boeing, Microsoft, Amazon, Costco, etc. Universities King County, Washington Population: 1,931,249 20

21 How Will We Reach Them? Public Private Public Medication Centers Private Medication Centers Community Centers Gymnasiums First responders Utilities Public works Large employers Pharmacies Retail Chains Independent Stores Healthcare Providers Hospitals Long term care Ambulatory care In home services Increased Access & Opportunity Through Pharmacies Over 300 pharmacies 43% access medications at a pharmacy Dispense medical countermeasures every day Trusted and familiar 21

22 Tools to Support Pharmacies Help them to help you by providing: Fact sheets, signage, phone scripts Clinical guidance Screening forms and algorithms Supply lists Tracking and reporting tools Toolkit to Partner with Pharmacies Tools to help with the planning and implementation phases of a medication distribution plan Resources to identify eligible partners, establish a network of pharmacists and on-going communication mechanisms Guidelines and quick tips for activating the plan A step-by-step guide, examples of presentations, and talking points to help foster relationships with the pharmacy community 22

Benefits of Building Relationships With Pharmacies The relationships built over the past several years between Public Health and pharmacies were

Pharmacies were responsive to information requests and many agreed to participate in programs to distribute free or lowcost vaccine to the public.

23 Benefits of Building Relationships With Pharmacies The relationships built over the past several years between Public Health and pharmacies were an invaluable tool in this response. Pharmacies were responsive to information requests and many agreed to participate in programs to distribute free or lowcost vaccine to the public. Pertussis Outbreak Spring 2012 After Action Report Questions? Andy Stergachis Jenny Arnold Carina Elsenboss 23

Pharmacy Planning for Influenza Pandemics. Scott Coley Bureau of Immunization NYSDOH June 25, 2017

Pharmacy Planning for Influenza Pandemics Scott Coley Bureau of Immunization NYSDOH June 25, 2017 Overview 2 Background Influenza Publicly Purchased Vaccine Emergency Preparedness Why MOU? Pandemic Assumptions