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Mass Distribution and Dispensing/Administration of Medical Countermeasures
Topic Collection
September 6, 2024

Topic Collection: Mass Distribution and Dispensing/Administration of Medical Countermeasures

This Topic Collection provides links to federal, state, local, and tribal programs and resources, lessons learned, plans, tools, and templates, courses, and guidance that can help planners address the need to effectively distribute and administer medical countermeasures (MCMs) to a large number of persons in a short period of time. 

There are two primary goals of MCMs. First, mass dispensing modalities may prevent individuals exposed to a biological, chemical, or radiological agent from becoming ill through their receipt of post-exposure prophylaxis. This “mass prophylaxis” is most often provided to affected individuals through “open” or public points of dispensing (PODs). “Closed” PODs are located within health care organizations, fire departments, businesses, or other community organizations. Closed PODs may be developed for response partners and vulnerable populations that can provide the MCM directly to their employees or residents.

MCMs can include vaccines, antiviral drugs, antitoxins, antibiotics, medical equipment, personal protective equipment, and materials designed to prevent or mitigate effects of illness or injury. ASPR's Division of the Strategic National Stockpile (SNS) maintains a stockpile that includes medical countermeasures.

Planning considerations and response efforts for MCMs can be quite complex due to the need to address varied incident types and scale; potential tight time constraints and significant volumes of MCMs that need to be dispensed; public trust and compliance issues; coincident major medical surge responses; and the need for coordination across all levels of government and among health care coalition partners.

Related information can be found in the following Topic Collections (listed alphabetically): Bioterrorism and High Consequence Biological Threats; Burns; Chemical Hazards; Disasters and Healthcare Disparity; Influenza Epidemic/ Pandemic; Healthcare-Related Disaster Legal/ Regulatory/ Federal Policy, Hospital Patient Decontamination; Pharmacy; Pre-Hospital Patient Decontamination; Radiological and Nuclear; Coronaviruses (e.g., SARS, MERS and COVID-19); Ebola/VHF; Volunteer Management; and Zika.

Collaboratively with the HHS Coordination Operations and Response Element (H-CORE), ASPR TRACIE has also developed a Medical Countermeasures Commercialization page with information on the COVID-19 countermeasures transition from U.S. government leadership to commercial distribution.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Johnson County Government, Department of Health and Environment. (2021). Dispense Assist.
This online tool may be used to pre-screen individuals that will receive medical countermeasures at Point of Dispensing (PODs) sites to support rapid dispensing at the PODs. After answering a few targeted questions, users can print out a completed screening form that indicates the countermeasure they should receive at the POD. It also contains information on pathogen-specific responses, such as for COVID-19, influenza, and tularemia.
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Melton, M., Puerini, R., and Daoust, E. (2018). Factors that Will Most Significantly Impact the Effectiveness of MCM Distribution (Warehouse and MCM Delivery Operations). Los Angeles County Department of Public Health.
This document consists of a one-page table that summarizes the different factors involved in attaining preparedness for medical countermeasure (MCM) distribution. The authors include considerations for the pre-activation phase; preparing for incoming deliveries; warehouse operations at the Receipt, Store, and Stage (RSS) site; inventory tracking; outgoing deliveries from the RSS site; and readiness of the receiving sites to effectively manage the MCMs when they are delivered.
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Rubin, G.J., Chowdhury, A., and Amlôt, R. (2012). How to Communicate with the Public About Chemical, Biological, Radiological, or Nuclear Terrorism: A Systematic Review of the Literature. Biosecurity and Bioterrorism. 10(4):383-95.
The authors reviewed 33 peer-reviewed studies that assessed communication strategies or information needs using hypothetical CBRN scenarios or in actual CBRN incidents to identify in advance what people would want to know, where they would get information from, and how messages should be presented. These strategies are critical for ensuring that affected individuals get to the right place at the right time to receive assessment and interventions.
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U.S. Department of Health and Human Services. (n.d.). Radiation and Emergency Medical Management (REMM). (Accessed 3/8/2024).
This webpage provides guidance on diagnosis and treatment for healthcare providers. It includes downloadable tools, templates, references, and contact lists.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (n.d.). Chemical Hazards Emergency Medical Management (CHEMM). (Accessed 3/6/2024.)
This website provides a wide range of information on chemical hazards for first responders, healthcare providers, and incident command staff.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (n.d.). Strategic National Stockpile. (Accessed 3/10/2024.)
In the event of a public health emergency so severe that local supplies are taxed, the Strategic National Stockpile (SNS) can be activated to ensure medicine and supplies get to those who need it most. This website includes information on the history of the SNS; sustaining the SNS; partnerships; managed inventory; training and exercises; and examples of the SNS in action.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2023). Public Readiness and Emergency Preparedness (PREP) Act.
The Public Readiness and Emergency Preparedness Act provides liability immunity related to the development process and administration of medical countermeasures against agents that cause public health emergencies. This webpage contains information on an amendment to include COVID-19 medical countermeasures.
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U.S. Food and Drug Administration. (n.d.). MCM Legal, Regulatory and Policy Framework. (Accessed 3/8/2024.)
The FDA works within this framework to ensure that the U.S. legal system effectively supports public health emergency preparedness and response. This webpage includes links to related legislation on topics such as emergency use authorizations, cooperative arrangements, and the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013.
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Distribution of MCM: Warehouse and MCM Delivery

* Centers for Disease Control and Prevention. (2018). Public Health Emergency Preparedness and Response Capabilities.
This website includes information on the capabilities for national public health preparedness planning at the state, local, tribal, and territorial levels developed with the input of subject matter experts and stakeholder organizations. This document describes the functions, tasks, performance measures, and resource elements required to achieve the Public Health Preparedness Capabilities. For information on the capabilities relevant to medical countermeasures, go to the “Explore the 2018 Preparedness and Response Capabilities” section and select Capability 8 and 9.
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Centers for Disease Control and Prevention. (2021). Vaccine Administration Management System (VAMS). (Free registration required.)
The Vaccine Administration Management System (VAMS) is a free web-based platform that was created to help jurisdictions, federal agencies, and organizations (including public health-approved clinics) manage COVID-19 vaccine clinics.
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* Frederick County Health Department. (2018). Medical Countermeasure Dispensing and Distribution Annex.
This plan for requesting and dispensing medical countermeasures contains detailed information on Frederick County’s MD authorities, state vs. local roles, and information about POD operation and distribution decision-making. While the information may be slightly outdated, contents may be helpful for other counties interested in creating similar plans.
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* Government Accountability Office. (2022). Public Health Preparedness: HHS Should Address Strategic National Stockpile Requirements and Inventory Risks.
This document describes the U.S. Department of Health and Human Services’ management of the Strategic National Stockpile before and after the COVID-19 pandemic.
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Koonin, L., Pillai, S., Kahn, E., et al. (2020). Strategies to Inform Allocation of Stockpiled Ventilators to Healthcare Facilities During a Pandemic. Health Security. 18(2):69-74.
The authors discuss how to optimize the use of ventilators during a severe pandemic resulting in a surge of respiratory illnesses, both in planning for the pre-pandemic and intra-pandemic phases. They emphasize the importance of staff, space, equipment, and supplies for effective use of ventilators in health care facilities.
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Mass.gov. (2023). Learn About Medical Countermeasures Programs.
This webpage contains an overview of the Strategic National Stockpile, Emergency Dispensing Sites (EDS), the CHEMPACK Program for chemical incidents, and a web-based course designed by the Massachusetts Department of Public Health. For checklists and information on EDS, access https://www.mass.gov/lists/eds-planning-guide-and-resources
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Melton, M., Puerini, R., and Daoust, E. (2018). Factors that Will Most Significantly Impact the Effectiveness of MCM Distribution (Warehouse and MCM Delivery Operations). Los Angeles County Department of Public Health.
This document consists of a one-page table that summarizes the different factors involved in attaining preparedness for medical countermeasure (MCM) distribution. The authors include considerations for the pre-activation phase; preparing for incoming deliveries; warehouse operations at the Receipt, Store, and Stage (RSS) site; inventory tracking; outgoing deliveries from the RSS site; and readiness of the receiving sites to effectively manage the MCMs when they are delivered.
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* Oregon Health Authority. (n.d.). Medical Countermeasure Mass Dispensing Guidance. (Accessed 3/6/2024.)
This webpage contains links to resources on COVID-19 points of dispensing (PODs), POD planning and operations, and medical countermeasure resources such as bioterrorism FAQs, the CHEMPACK program to mitigate chemical attacks, and post-exposure prophylaxis standing orders.
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Education, Training, and Exercises

Administration for Strategic Preparedness and Response. (n.d.). SNS Training and Exercises. (Accessed 3/6/2024.) U.S. Department of Health and Human Services.
This website provides links to courses, trainings, and exercises on the Strategic National Stockpile, and federal medical stations.
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Administration for Strategic Preparedness and Response. (n.d.). Strategic National Stockpile Course Listing. (Accessed 3/6/2024.) U.S. Department of Health and Human Services.
This webpage contains information and links to training on the Strategic National Stockpile, managed by the Administration for Strategic Preparedness and Response. It includes resources on risk communications, federal medical stations, planning for, receiving, staging, and storing countermeasures.
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CDC TRAIN. (2023). CDC TRAIN. (Free registration required.)
The Centers for Disease Control and Prevention offer numerous on-line courses on volunteer management, medical countermeasures, the Strategic National Stockpile, dispensing and vaccination clinics. Users should search by keyword to locate courses specific to their needs.
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Centers for Disease Control and Prevention. (2018). MCM Coordinator Common Responsibilities and Associated Skills. National Association of County & City Health Officials
The CDC’s Division of State and Local Readiness (DSLR) Training Team identified a set of six common responsibilities and associated skills of Medical Countermeasure (MCM) Coordinators to aid in supporting the training needs of MCM Coordinators across the country. These responsibilities and skills were developed with input from CDC MCM subject matter experts, the National Association of County & City Health Officials (NACCHO), and the Association of State and Territorial Health Officers (ASTHO).
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Centers for Disease Control and Prevention. (2023). This is a TEST (Tabletop Exercise Simulation Tool).
The Centers for Disease Control and Prevention created this tool to help emergency preparedness and response partners who may be involved in post-radiation incident population monitoring. "This is a T.E.S.T." is a game that uses operational exercises and narrative-based problems to improve teamwork, understand resource management, and aid in understanding specific roles and responsibilities during a radiation emergency.
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Johns Hopkins Center for Health Security. (2019). Event 201 Pandemic Exercise: Segment 1, Intro and Medical Countermeasures (MCM) Discussion.
This video recording of a large-scale exercise in October 2019 brought together stakeholders to understand pandemic preparedness and readiness. Segment 1 focused on medical countermeasure stockpiles and distribution to mitigate health impacts.
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Los Angeles County Department of Public Health. (2015). MCM Exercise Resource Page.
This webpage includes links to HSEEP-compliant exercise documents that were developed by the Los Angeles County Department of Public Health. This series of exercises concluded with full-scale exercises of Medical Countermeasure Distribution and Dispensing in November 2015.
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National Academies of Sciences, Engineering, and Medicine. (2023). Medical Countermeasures- Expanding Delivery and Increasing Uptake Through Public-Private Partnerships: A Workshop Series.
Each of these five 2-hour workshops explores a different facet of medical countermeasures and public-private partnerships. Topics include data-informed decision making, acceptance and uptake, dispensing and distribution, and administration of countermeasures.
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Northwest Center for Public Health Practice. (n.d.). Capability 8: Medical Countermeasure Dispensing. (Accessed 3/8/2024.)
This webpage links to several trainings (available on TRAIN, for which users need a free account) that can assist planners with preparing for medical countermeasure dispensing.
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* Pagaoa, M., Leblanc, T., Renard, P., et al. (2018). Performance of Point of Dispensing Setup Drills for Distribution of Medical Countermeasures: United States and Territories, 2012–2016. American Journal of Public Health. 108(53):5221-5223.
The authors reviewed drills by local jurisdictions between 2012 and 2016 as they practiced dispensing of medical countermeasures. They aggregated point of dispensing (POD) setup data from around the U.S. to understand the time required to set up a POD. They conclude that there have been national improvements in POD preparedness, though some jurisdictions may benefit from technical assistance when setting up these dispensing sites.
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University of Minnesota. (2020). PUBH X322 - Online: PODs (Points of Dispensing): Public Health Training for Staff and Volunteers.
This course (online and self-paced) was designed to supplement just-in-time training and provides a general overview of points of dispensing (PODs) and the roles that staff and volunteers can play to ensure PODs run smoothly. It also includes information on the Strategic National Stockpile in emergency response, dispensing site design and flow, and positions which should be filled for POD operations.
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Equity in Countermeasure Distribution

* Blair, H., Javit, L., Fox, S., et al. (2014). Improved Planning for Vulnerable Populations Through Use of Closed PODs.
Speakers share challenges associated with vulnerable populations and open points of dispensing (PODs) and strategies for using closed PODs to help protect the health of members of vulnerable populations.
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Disaster Preparedness Advisory Council. (2016). Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism. Pediatrics. 137(2).
The Council shares that many medical countermeasures (MCM) are more likely to be approved for adult use and may not take the unique needs of children into account. They drafted this policy statement to suggest recommendations that address the gaps for the development and use of MCMs in children during public health emergencies or disasters and discuss available options and regulatory issues.
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Hatchett, R. (2023). Re-Engineering for Equity: CEPI’s Vision for Achieving Equitable Access to Countermeasures for Epidemic and Pandemic Threats. Coalition for Epidemic Preparedness Innovations (CEPI).
This article discusses how global equity in medical countermeasure access can be achieved, in part through CEPI’s 100 Days Mission, which aims to deliver effective vaccines within 100 days of an emergent pathogen’s first impact. The author outlines how global equity in countermeasure access is essential to health security.
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Hotez, P., Batista, C., Amor, Y., et al. (2021). Global Public Health Security and Justice for Vaccines and Therapeutics in the COVID-19 Pandemic. eClinicalMedicine. 39:101053.
The authors from this task force discuss how to develop, manufacture, test and distribute COVID-19 countermeasures to low- and middle-income countries without letting global intellectual property rules prevent access. They discuss processes at the global level to get countermeasures distributed, to establish a collaborative research network, and to combat anti-science disinformation.
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Kasstan, B., Mounier-Jack, S., Letley, L., et al. (2022). Localising Vaccination Services: Qualitative Insights on Public Health and Minority Group Collaborations to Co-Deliver Coronavirus Vaccines. Vaccine. 40(14):2226-2232.
The authors discuss the coronavirus vaccine rollout in Orthodox Jewish neighborhoods in England, as these communities have experienced measles outbreaks in the past due to suboptimal vaccine coverage. By conducting 28 semi-structured interviews with relevant stakeholders such as religious representatives and household members, the authors conclude that local vaccine programs should involve trusted community organizations in related communication and implementation strategies.
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Meaney-Delman, D., Zotti, M., Creanga, A., et al. (2014). Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women. Emerging Infectious Diseases. 20(2).
The authors present information regarding vaccine, antimicrobial drug prophylaxis and treatment, clinical considerations, and other factors healthcare practitioners must take into consideration when treating pregnant and postpartum women after an anthrax exposure.
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* Persad, G., Leland, R., Ottersen, T., et al. (2023). Fair Domestic Allocation of Monkeypox Virus Countermeasures. Viewpoint. 8(5):E378-E382.
The authors describe how to equitably distribute mpox vaccine given the limited supply during outbreaks. They stress the importance of “understanding three groups: people at greatest risk of infection, of infecting others, and of suffering the most harm if infected” and categorizing them by priority tiers (displayed in Table 1). Strategies for implementing these tiers are also discussed.
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The National Academies of Sciences, Engineering, and Medicine. (2020). Framework for Equitable Allocation of COVID-19 Vaccine. The National Academies Press.
This consensus study report offers a phased framework based on ethical and procedural principles for equitable allocation of COVID-19 vaccine that reduces severe morbidity and mortality and negative societal effects of the pandemic. In addition to the framework, the authors addressed implementation challenges related to program administration, risk communication and community engagement, vaccine acceptance, and global equity in allocation.
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U.S. Food and Drug Administration. (2018). Pediatric Medical Countermeasures.
Pediatric patients may react differently to certain medications, making the development of safe and effective medical countermeasures (MCM) for young patients critical to public health emergency preparedness. This webpage includes links to resources specific to bioterrorism emergencies and radiation emergencies.
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World Health Organization. (2023). Deliver, Together: Partnerships to Deliver Vaccines in a Pandemic—Learning from COVID-19 Vaccine Delivery.
This report provides information on how to distribute medical countermeasures based on the experience of UNICEF, WHO, and Gavi during the COVID-19 vaccine delivery process. It includes lessons learned on organizational structure, governance, internal coordination, and effective tools such as political advocacy, technical training, country engagement, delivery funding, data monitoring, among other aspects of countermeasure delivery.
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Guidance

Administration for Strategic Preparedness and Response. (2024). Strategy for Improving Access to Federal Resources During a Public Health Emergency Response for Federally Recognized Tribal Governments, Indian Health Service Health Care Providers, Tribal Health Authorities, and Urban Indian Organizations. U.S. Department of Health and Human Services.
Theis document: outlines current request processes for federally recognized tribes and Urban Indian Organizations (UIOs) to access Strategic National Stockpile (SNS) and other federal public health response supplies under a variety of legal instruments and emergency response authorities; describes the factors driving both the request processes themselves and medical countermeasure deployment methods used by SNS; and recommends strategies for accessing supplies that can support native communities, prevent supply shortages, and reduce health disparities.
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American Society of Health-System Pharmacists. (2020). ASHP COVID-19 Vaccine Planning Tool for Pharmacists and Pharmacies.
This tool can assist with the involvement of pharmacists and pharmacy staff in institutional and community COVID-19 vaccine planning efforts. It addresses integration with facility planning, vaccine supply and distribution, infrastructure, personnel, patient care, vaccine safety monitoring and surveillance, and legislative and regulatory controls.
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Bower, W., Schiffer, J., Atmar, R., et al. (2019). Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices. U.S. Centers for Disease Control and Prevention.
This Morbidity and Mortality Weekly Report includes information from the CDC Advisory Committee on Immunization Practices on use of anthrax vaccine. Updates in this report include timing for boosters for people at high risk of exposure, intramuscular administration during an emergency response, vaccine preservation strategies if demand for vaccine outstrips supply, and clarification on use of antibiotic therapy in conjunction with use of the vaccine.
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Bower, W., Yu, Y., Person, M., et al. (2023). CDC Guidelines for the Prevention and Treatment of Anthrax. U.S. Centers for Disease Control and Prevention.
This Morbidity and Mortality Weekly Report includes information on prevention and treatment of naturally occurring anthrax. It includes alternative treatment regimens in case of patient contraindications to first line therapy or if the anthrax strain is multidrug resistant.
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Centers for Disease Control and Prevention. (2020). Considerations for Planning Curbside/Drive-Through Vaccination Clinics. U.S. Department of Health and Human Services.
This resource page provides information for those planning curbside or drive-through vaccination clinics. It offers steps for planning the clinic and what to do before, during, and after the vaccination encounter. It also includes links to additional resources.
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Federal Emergency Management Agency. (2023). 3.2 Medical Countermeasures.
This webpage contains information on the response and recovery for biological emergencies, including medical countermeasure (MCM) distribution. It covers types of countermeasures such as antibiotics, antivirals, and personal protective equipment, how hospital supplies can be used before MCMs arrive from state or federal stockpiles, dispensing and tracking of supplies, and MCM challenges.
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Healthcare Distribution Alliance. (2023). Pandemic and All-Hazards Preparedness Act Reauthorization: Background and Opportunities to Enhance Resilience.
This document provides an overview of the Pandemic and All-Hazards Preparedness Act (PAHPA), the Pandemic and All-Hazards Preparedness Reauthorization Act, and the Pandemic and All-Hazards Preparedness and Advancing Innovation Act, along with the expected reauthorization. Additionally, the document explains how each of these Acts intends to enhance the availability of medical countermeasures and a proposal to include healthcare distributors as partners.
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National Academies of Sciences, Engineering, and Medicine. (2021). Ensuring an Effective Public Health Emergency Medical Countermeasures Enterprise.
This report includes information on how the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) was formalized by Congress to coordinate medical countermeasure distribution and dispensation across the U.S. It covers delivering on PHEMCE’s mission, ensuring its decisions are defensible, and engaging stakeholders.
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U.S. Department of Health and Human Services. (2023). Fact Sheet: HHS Announces ‘HHS Bridge Access Program For COVID-19 Vaccines and Treatments’ to Maintain Access to COVID-19 Care for the Uninsured.
This fact sheet describes the "Bridge Access Program For COVID-19 Vaccines and Treatments Program," designed to maintain broad access to COVID-19 vaccines for millions of uninsured Americans. The program will create a unique $1.1 billion public-private partnership to help maintain uninsured individuals’ access to COVID-19 care at their local pharmacies, through existing public health infrastructure, and at their local health centers.
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U.S. Food and Drug Administration. (2023). What are Medical Countermeasures?
This webpage contains an overview of medical countermeasures (MCMs) and the U.S. Food and Drug Administration’s (FDA) role in their development, approval, and dispensation. It covers how MCMs are used in emergencies and provides information on FDA’s “Animal Rule” and links to additional information on MCMs.
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Bueker, J., Weinman, B., and McCarthy, J. (2022). Federal Funding of Medical Countermeasures: Opportunities, Risks, and Enforcement Trends. Food and Drug Law Institute (FDLI).
This webpage contains information on federal funding of medical countermeasures, including opportunities and risks of new wave funding and strategies to reduce risks. The authors conclude that federal funding for medical countermeasures has created opportunities for the life sciences industry, but that those risks also need to be mitigated with compliance infrastructure and steady supply contracts.
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Centers for Medicare & Medicaid Services. (2023). Coronavirus Waivers and Flexibilities.
This fact sheet can help health care providers better understand the coronavirus waivers and flexibilities.
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Congressional Research Service. (2023). PREVENT Pandemics Act (P.L. 117-328, Division FF, Title II).
The Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act) consists of reforms to address pandemic preparedness and response after the COVID-19 pandemic. It also provides policy updates related to public health, medical supply chains, innovation, and research security.
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Kels, C.G. (2015). Dispensing Medical Countermeasures: Emergency Use Authorities and Liability Protections. (Free registration required.) Health Security. 13(2): 139-151.
The evolution of authorities and public health liability protection for emergency use of medical countermeasures, associated with the Pandemic and All-Hazards Preparedness Reauthorization Act, is analyzed to advance emergency preparedness and response activities and protection of personnel.
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Medicalcountermeasures.gov. (n.d.). Division of Regulatory and Quality Affairs. (Accessed 3/6/2024) Biomedical Advanced Research and Development Authority.
This website describes the Division on Regulatory and Quality Affairs’ efforts to minimize risks associated with medical countermeasures, from development to distribution. Links to reports and references on the animal rule, expiration dating extensions, and the related legal, regulatory, and policy framework are provided.
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Tran, A. and Witek, T. (2021). The Emergency Use Authorization of Pharmaceuticals: History and Utility During the COVID-19 Pandemic. Pharmaceutical Medicine. 35(4): 203-213.
The authors examined the history of emergency use authorizations (EUAs) since their inception in 2004, with a particular focus on their use during the COVID-19 pandemic. EUAs facilitated the rollout of COVID-19 vaccines and allowed a pause for safety review of one vaccine. The authors also discussed new drug/vaccine application approvals.
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U.S. Department of Health and Human Services. (2022). Notice of Amendment (Anthrax).
This amendment includes an updated “description of covered countermeasures and the disease threat; extend[s] the effective time period of the declaration;” and clarifies the terms of the declaration.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2018). Legal Authority of the Secretary of Health and Human Services.
This page describes the legal authority possessed by the Secretary of Health and Human Services with and without a formal declaration of a public health emergency.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2023). Public Readiness and Emergency Preparedness (PREP) Act.
The Public Readiness and Emergency Preparedness Act provides liability immunity related to the development process and administration of medical countermeasures against agents that cause public health emergencies. This webpage contains information on an amendment to include COVID-19 medical countermeasures.
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U.S. Department of Health and Human Services, Food and Drug Administration, Office of the Commissioner, Office of the Chief Scientist, and Office of Counterterrorism and Emerging Threats. (2018). Material Threat Medical Countermeasure Priority Review Vouchers Guidance for Industry.
This draft guidance document includes information regarding the implementation of section 3086 of the 21st Century Cures Act (Cures Act) (Public Law 114-255), which added section 565A of the Federal Food, Drug, and Cosmetic Act (FD&C Act) (21 U.S.C. 360bbb-4a). Section 565A requires the Food and Drug Administration “to award a priority review voucher (PRV) to sponsors of certain medical countermeasure (MCM) applications that meet the criteria specified in that section.”
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U.S. Food and Drug Administration. (n.d.). MCM Legal, Regulatory and Policy Framework. (Accessed 3/8/2024.)
The FDA works within this framework to ensure that the U.S. legal system effectively supports public health emergency preparedness and response. This webpage includes links to related legislation on topics such as emergency use authorizations, cooperative arrangements, and the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013.
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U.S. Food and Drug Administration. (2016). Order Permitting Emergency Dispensing of Oral Formulations of Doxycycline and Waiver of CGMP Requirements during an Anthrax Emergency.
This order allows public health emergency stakeholders to permit emergency dispensing of FDA-approved oral dosage forms of doxycycline products without prescription for the post-exposure treatment of “inhalational anthrax during an emergency involving Bacillus anthracis (B. anthracis), the biological agent that causes anthrax disease.”
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U.S. Food and Drug Administration. (2018). 21st Century Cures Act: MCM (Medical Countermeasures)-Related Cures Provisions.
This webpage includes information and links to resources specific to facilitating the development of medical products (including MCMs) and MCM-specific Cures provisions (e.g., Emergency Use Authority and the MCM priority review voucher program).
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U.S. Food and Drug Administration. (2018). Emergency Use Authorization.
This authorization allows the Food and Drug Administration to facilitate the availability and use of medical countermeasures to assist during public health emergencies. Links to information on current authorizations (e.g., anthrax, Ebola, and nerve agent) are provided on this page.
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U.S. Food and Drug Administration. (2023). Extramural Research.
This webpage contains information on research funded by the U.S. Food and Drug Administration (FDA) to assess medical countermeasure (MCM) effectiveness and quality. It includes information on Broad Agency Announcement funding, areas of interest to FDA, lists of current and completed projects, and information on how the funding fits into U.S. MCM priorities.
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Lessons Learned: COVID-19

* Government Accountability Office. (2022). Public Health Preparedness: HHS Should Address Strategic National Stockpile Requirements and Inventory Risks.
This document describes the U.S. Department of Health and Human Services’ management of the Strategic National Stockpile before and after the COVID-19 pandemic.
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Government Accountability Office. (2023). Public Health Preparedness: HHS Should Plan for Medical Countermeasure Development and Manufacturing Risks.
This document provides information on how the U.S. Department of Health and Human Services (HHS) can improve development and manufacturing of medical countermeasures. The report examines how HHS used Centers for Innovation in Advanced Development and Manufacturing funds before and during the COVID-19 pandemic, challenges for the program, and how a new program model can address those challenges.
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Healthcare Distribution Alliance. (2022). The Path Forward: Transitioning From the COVID-19 Public Health Emergency.
This brief offers potential ways to manage the distribution of vaccines and ancillary kits. These options include continuing to distribute vaccines and kits through a closed system overseen by the federal government, a combination of government and market distribution, or full market distribution.
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King County. (2022). King County Recovery Plan.
This plan contains information on how Washington’s King County is recovering from the COVID-19 pandemic. It covers the local impact and response to COVID-19, the funding strategy and different funding streams, theory of change, and county performance during the pandemic.
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National Academies of Sciences, Engineering, and Medicine. (2022). Public Health Interventions and Countermeasures for Advancing Pandemic and Seasonal Influenza Preparedness and Response.
This report highlights how lessons learned from the COVID-19 response can improve preparedness and response for seasonal and pandemic influenza or other respiratory viruses, with a focus on non-vaccine countermeasures.
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Wollek, S., Singaravelu, S., and Snair, M. (2022). Coordinating Surveillance and Medical Countermeasure Response. National Academies of Sciences, Engineering, and Medicine.
This book chapter discussed the present and future of U.S. and global disease surveillance systems as well as potential improvements to stockpiles and supply chains for medical countermeasures.
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Lessons Learned: Ebola

Crozier, I., Britson, K., Wolfe, D., et al. (2022). The Evolution of Medical Countermeasures for Ebola Virus Disease: Lessons Learned and Next Steps. Vaccines. 10(8):1213.
The authors discuss medical countermeasures (MCM) which can be used to protect against Ebola virus disease (EVD), including vaccines, diagnostics, and therapeutics developed after recent EVD outbreaks. The authors describe the U.S. government efforts to develop these countermeasures and lessons learned which can inform future MCM development.
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Lessons Learned: Influenza

Jester, B., Uyeki, T., Patel, A., et al. (2018). 100 Years of Medical Countermeasures and Pandemic Influenza Preparedness. American Journal of Public Health. 108(11):1469-1472.
The authors provide an overview of the improvements made to medical countermeasures since the 1918 influenza pandemic including developments in medical care, vaccines, antivirals, diagnostics, and communications. The article also highlights remaining gaps in the speed of vaccine manufacturing, more effective antivirals, and better respiratory protection.
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National Academies of Sciences, Engineering, and Medicine. (2017). Building a National Capability to Monitor and Assess Medical Countermeasure Use During a Public Health Emergency: Going Beyond the Last Mile: Proceedings of a Workshop. The National Academies Press.
Workshop participants discussed the need for shared terminologies; data needs, sources, and collection methodologies; considerations for conducting rapid clinical research on medical countermeasures (MCM) during a public health emergency; and the federal perspective on MCM. Lessons from a 2012 fungal infection outbreak, anthrax, and H1N1 are shared in sidebars throughout the proceedings.
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Puerini, R., Caum, J., Francis, N., and Alles, S. (2015). The 49th Hour: Analysis of a Follow-up Medication and Vaccine Dispensing Field Test. Health Security. 13(1): 54-63.
The authors used a real seasonal influenza vaccination clinic to assess throughput and accuracy, and to evaluate the resources needed to operationalize a Point of Dispensing (POD) model to distribute the additional 50-day course of antibiotics and administer the 3-dose vaccine series required after the initial response to an aerosolized anthrax release is completed.
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Saha, S., Dean, B., Teutsch, S. et al. (2014). Efficiency of Points of Dispensing for Influenza A(H1N1)pdm09 Vaccination, Los Angeles County, California, USA, 2009. Emerging Infectious Diseases. 20(4).
The Los Angeles County Department of Public Health used points of dispensing (PODs) to vaccinate residents during the H1N1 outbreak. This article highlights vaccination rates by demographic, average distance traveled to PODs, and other factors that should be considered by emergency planners.
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Lessons Learned: Mpox

Messerly, M., and Mahr, K. (2022). As Demand for the Monkeypox Vaccine Stalls, Outreach Goes Hyperlocal. Politico.
The authors discuss outreach to LGBTQI+ communities during the mpox outbreak. They describe strategies for reaching this population across the United States and the U.S. Department of Health and Human Services’ efforts to reach those at highest risk.
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* Persad, G., Leland, R., Ottersen, T., et al. (2023). Fair Domestic Allocation of Monkeypox Virus Countermeasures. Viewpoint. 8(5):E378-E382.
The authors describe how to equitably distribute mpox vaccine given the limited supply during outbreaks. They stress the importance of “understanding three groups: people at greatest risk of infection, of infecting others, and of suffering the most harm if infected” and categorizing them by priority tiers (displayed in Table 1). Strategies for implementing these tiers are also discussed.
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Mass Prophylaxis Planning: General

Administration for Strategic Preparedness and Response. (2024). SNS Planning Resources. (Free registration required.) U.S. Department of Health and Human Services.
This ASPR state, tribal, local, and territorial (SLTT) SharePoint Site serves as a communication resource and information repository for the Strategic National Stockpile (SNS) to provide SNS medical countermeasure planning guidance and resources intended for target audiences in SLTT public health and hospital preparedness programs. Free registration is required for access.
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* Centers for Disease Control and Prevention. (2018). Public Health Emergency Preparedness and Response Capabilities.
This website includes information on the capabilities for national public health preparedness planning at the state, local, tribal, and territorial levels developed with the input of subject matter experts and stakeholder organizations. This document describes the functions, tasks, performance measures, and resource elements required to achieve the Public Health Preparedness Capabilities. For information on the capabilities relevant to medical countermeasures, go to the “Explore the 2018 Preparedness and Response Capabilities” section and select Capability 8 and 9.
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* Centers for Disease Control and Prevention. (2022). Community-Wide (Mass) Vaccination.
The goal of community-wide mass vaccination is to inoculate all willing and eligible people in an area. This smallpox-specific webpage defines points of dispensing and provides links to Maxi-Vac Version 1.0 and Maxi-Vac Alternative, a modeling program that can help planners allocate human resources to vaccinate the greatest number of people as quickly as possible.
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SteelFisher, G., Blendon, R., Ross, L.J., et al. (2011). Public Response to an Anthrax Attack: Reactions to Mass Prophylaxis in a Scenario Involving Inhalation Anthrax From an Unidentified Source. Biosecurity and Bioterrorism. 9(3):239-50.
This article discusses findings from a poll conducted to examine the public's response to a mass prophylaxis program conducted under a “worst-case scenario” in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings provide indicators of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (n.d.). Strategic National Stockpile. (Accessed 3/10/2024.)
In the event of a public health emergency so severe that local supplies are taxed, the Strategic National Stockpile (SNS) can be activated to ensure medicine and supplies get to those who need it most. This website includes information on the history of the SNS; sustaining the SNS; partnerships; managed inventory; training and exercises; and examples of the SNS in action.
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Mass Prophylaxis Planning: Point of Dispensing Alternatives (e.g., Closed PODs)

* Blair, H., Javit, L., Fox, S., et al. (2014). Improved Planning for Vulnerable Populations Through Use of Closed PODs.
Speakers share challenges associated with vulnerable populations and open points of dispensing (PODs) and strategies for using closed PODs to help protect the health of members of vulnerable populations.
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Fletcher, M., Puerini, R., Caum, J., and Alles, S.J. (2014). Efficiency and Effectiveness of Using Nonmedical Staff During an Urgent Mass Prophylaxis Response. Biosecurity and Bioterrorism. 12(3): 151-159.
The Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. Mean throughput and accuracy rates were compared to a previous public POD exercise staffed by health department personnel and medical volunteers. Overall accuracy, and pediatric dosing accuracy, were found to be significantly lower during the closed POD vs. the public POD.
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Florida Health. (2023). Closed POD Program Resources.
This closed point of dispensing (POD) toolkit includes documents to use during POD planning, a variety of exercises and drills, and files which are of use when operating a closed POD.
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Florida Health Lake County. (2022). Closed Point of Dispensing (POD) Program.
This county department of health webpage provides background on closed points of dispensing (PODs) that can be used to prepare for public health emergencies such as a biological attack or disease outbreak requiring medical countermeasure dispensation. It includes a link to a registration form for setting up a POD in Florida that can be tailored and used by other jurisdictions.
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Mecklenburg County (NC) Public Health Department. (n.d.). Closed Point of Dispensing (POD) Toolkit. (Accessed 3/8/2024.)
This toolkit provides information on how to become a closed POD. It includes materials such as a closed POD dispensing plan template, sample POD checklists, sample Incident Command System structure and job action sheets, and a supply list for closed PODs.
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National Association of County & City Health Officials. (2014). Using Closed PODs to Protect Critical Infrastructure.
This webpage includes links to an infographic and report on a survey which found 86 percent of surveyed healthcare-related entities have closed POD agreements.
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* Oregon Health Authority. (n.d.). Medical Countermeasure Mass Dispensing Guidance. (Accessed 3/6/2024.)
This webpage contains links to resources on COVID-19 points of dispensing (PODs), POD planning and operations, and medical countermeasure resources such as bioterrorism FAQs, the CHEMPACK program to mitigate chemical attacks, and post-exposure prophylaxis standing orders.
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Rebmann, T., Foerst, K., Charney, R., et al. (2021). Approaches, Successes, and Challenges in Recruiting Closed Points of Dispensing Sites: A Qualitative Study. (Abstract only.) Health Security. 19(3):327-337.
The authors conducted qualitative interviews with disaster planners to understand how they recruit sites to be closed points of dispensing (PODs). They found that site size, ability to serve populations who lacked access to public PODs, and critical infrastructure organizations were important selection criteria. Lack of understanding of the importance of closed PODs and fear of legal repercussions due to medical countermeasure administration were challenges to closed POD site recruitment. The findings can be useful for other disaster planners expanding their closed POD networks.
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Rebmann, T., Foerst, K., Charney, R., et al. (2022). Challenges in Managing, Sustaining, and Assessing Closed Point of Dispensing Sites: Findings from a Qualitative Study. PLoS One. 17(7):e0271037.
The authors interviewed 16 disaster planners about closed point of dispensing (POD) management practices, such as communication with POD sites, training for staff, and helping with exercises. Most closed PODs were in hospitals, long-term care facilities, and first responder sites. Respondents reported communication with health department officials once a site was determined a closed POD, but regularity differed. The importance of regular exercises was emphasized, as was understanding challenges associated with assessing readiness to deploy and managing a variety of sites. The practices explored in the article can improve jurisdictions’ ability to deploy medical countermeasures in the future.
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Mass Prophylaxis Planning: Public Points of Dispensing (PODs)

Asgary, A., Najafabadi, M., Karsseboom, R., et al. (2020). A Drive-through Simulation Tool for Mass Vaccination during COVID-19 Pandemic. Healthcare. 8(4):469.
The authors developed a drive-through vaccination simulation tool for COVID-19, building on drive-through testing for SARS-CoV-2 early in the pandemic. The tool can be used to aid in planning and operation of drive-up points of dispensing. While it was developed before COVID-19 vaccine implementation, it may be useful during planning for future iterations of drive-through sites.
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ASPR TRACIE. (2024). Drive-through Point of Dispensing (POD) Resources.
This ASPR TRACIE TA response includes resources related to drive-through PODs. Related Topic Collection: Mass Distribution and Dispensing of Medical Countermeasures.
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* Centers for Disease Control and Prevention. (2022). Community-Wide (Mass) Vaccination.
The goal of community-wide mass vaccination is to inoculate all willing and eligible people in an area. This smallpox-specific webpage defines points of dispensing and provides links to Maxi-Vac Version 1.0 and Maxi-Vac Alternative, a modeling program that can help planners allocate human resources to vaccinate the greatest number of people as quickly as possible.
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Gupta, A., Evans, G., and Heragu, S. (2013). Simulation and Optimization Modeling for Drive-Through Mass Vaccination – A Generalized Approach. Simulation Modelling Practice and Theory. 37.
The authors describe the simulation modeling work completed for a mass vaccination drive-through clinic in 2009, where more than 19,000 patients were served (more than two-thirds via 10 drive-through lanes). Using this model can help public health emergency planners determine “the required number of Points of Dispense (POD) lanes, number and length of the lanes for consent hand outs and fill in, staff needed at the consent handout stations and PODs, and average user waiting time in the system.”
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Holt Buck, B., Cowan, L., Smith, L., et al. (2021). Effective Practices and Recommendations for Drive-Through Clinic Points of Dispensing: A Systematic Review. (Abstract only.) Disaster Medicine and Public Health Preparedness. 15(3):374-388.
The authors reviewed the literature on drive-through clinics (DTCs) as a novel type of point of dispensing and highlight the following themes that emerged: “1) optimal DTC design and planning via decision support systems and decision support tools; (2) clinic layouts, locations, and design aspects; (3) staffing, training, and DTC communication; (4) throughput time; (5) community outreach methods; (6) DTC equipment; (7) infection prevention and personal protective equipment; and (8) adverse events prevention and traffic management.”
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* Johnson County Government, Department of Health and Environment. (2021). Dispense Assist.
This online tool may be used to pre-screen individuals that will receive medical countermeasures at Point of Dispensing (PODs) sites to support rapid dispensing at the PODs. After answering a few targeted questions, users can print out a completed screening form that indicates the countermeasure they should receive at the POD. It also contains information on pathogen-specific responses, such as for COVID-19, influenza, and tularemia.
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* Minnesota Department of Health. (2022). Medical Countermeasures.
This webpage contains background on a state’s role in medical countermeasure (MCM) dispensing during public health emergencies, and guidance for those in charge of distribution, including requesting resources from the Administration for Strategic Preparedness and Response and the Strategic National Stockpile. Strategies and tools for distributing the supplies through local health departments through open points of dispensing (PODs) include an online screening form, a POD locator (when they are open), and links to related courses.
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Mohawk Area Public Health Coalition. (n.d.). Drive Through Dispensing Planning Considerations. (Accessed 3/6/2024.)
This document describes many facets of setting up and coordinating a drive-through point of dispensing (POD). It includes sections on the drive-through POD concept of operations, site selection, traffic and safety, communications, equipment required, staffing, infection control, and signs for the site. Descriptions of roles and checklists throughout the document can be tailored and used by health care coalitions planning for drive-through PODs.
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* Napa County Health and Human Services Agency. (2012). Countermeasure Distribution Plan.
This plan document covers Point of Dispensing (POD) operations, logistics, and staffing. It also reviews POD alternatives. It may be referenced and/or adapted by other jurisdictions and includes tables showing throughput vs. population / time, forms, and layouts. Though dated, components of the plan may be useful to other county planners developing related plans.
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Oregon Public Health Division. (2019). Standardized Mass Prophylaxis Point of Dispensing (POD) Field Operations Guide (FOG).
This downloadable Point of Dispensing (POD) Field Operations Guide (FOG) was created for the state of Oregon but may be used as a model for other jurisdictions to develop detailed operational plans for both mass dispensing of prophylactic antibiotics (medical and non-medical models) and mass vaccination of a given population.
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* Pagaoa, M., Leblanc, T., Renard, P., et al. (2018). Performance of Point of Dispensing Setup Drills for Distribution of Medical Countermeasures: United States and Territories, 2012–2016. American Journal of Public Health. 108(53):5221-5223.
The authors reviewed drills by local jurisdictions between 2012 and 2016 as they practiced dispensing of medical countermeasures. They aggregated point of dispensing (POD) setup data from around the U.S. to understand the time required to set up a POD. They conclude that there have been national improvements in POD preparedness, though some jurisdictions may benefit from technical assistance when setting up these dispensing sites.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (n.d.). Behavioral Health Tips for Responders: Maintaining Calm at a POD. (Accessed 3/8/2024.)
This fact sheet provides recommendations for responders working at points of dispensing (PODs) during an emergency or disaster. It is broken up into three sections: Assumptions; What to do; What to say.
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University of Rochester Medical Center. (2023). NYSDOH Point of Dispensing (POD) Resources.
This webpage provides a link to training for New York state point of dispensing (POD) staff and a list of staff roles which are important to dispensing from a POD. It also links to job action sheets for staff that can be tailored and used by other states.
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Wakefield, M. (2015). Local Health Department Engages in Pharmacy Preparedness Exercise. National Association of County & City Health Officials.
The author describes the pilot testing of a program designed to dispense medical countermeasures via a Costco warehouse in Virginia.
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Plans, Tools, and Templates

Administration for Strategic Preparedness and Response. (n.d.). Inventory Management and Tracking System (IMATS). (Accessed 3/8/2024.)
The Inventory Management Tracking System (IMATS) is used during a public health crisis to distribute large quantities of medical countermeasures. This page describes IMATS training, inventory data exchange, and user support for the IMATS program.
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Administration for Strategic Preparedness and Response. (2021). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the strategy, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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* Centers for Disease Control and Prevention. (2018). Public Health Emergency Preparedness and Response Capabilities.
This website includes information on the capabilities for national public health preparedness planning at the state, local, tribal, and territorial levels developed with the input of subject matter experts and stakeholder organizations. This document describes the functions, tasks, performance measures, and resource elements required to achieve the Public Health Preparedness Capabilities. For information on the capabilities relevant to medical countermeasures, go to the “Explore the 2018 Preparedness and Response Capabilities” section and select Capability 8 and 9.
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Centers for Disease Control and Prevention. (2022). National Pandemic Strategy.
This plan includes updates to the seven domains. Domain 3 is “Medical Countermeasures: Diagnostic Devices, Vaccines, Therapeutics, and Respiratory Devices” and includes seven objectives that can “improve effectiveness, timeliness, availability and accessibility to medical countermeasures.”
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Cities Readiness Initiative (CRI) Northwest. (2017). Inclusive Just-in-Time Training for Mass Prophylaxis/Point of Dispensing (POD) Operations Field Training Guide. (Free registration required.)
This guide is designed for team leaders who will be delivering Just-in-Time training to personnel involved in mass prophylaxis/POD operations.
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Department of Health Services, County of Los Angeles. (2023). Mobilization of Local Pharmaceutical Caches.
This policy posted by Los Angeles County includes steps related to the release of local pharmaceutical caches in the event of a major incident.
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Franklin County Public Health. (n.d.). Memorandum of Understanding. (Accessed 3/8/2024.)
This template memorandum of understanding is for organizations who may work with Franklin County Public Health to provide emergency public health services to affected populations. The document outlines liability, provider responsibilities, Franklin County Public Health responsibilities, terms and implementation.
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* Frederick County Health Department. (2018). Medical Countermeasure Dispensing and Distribution Annex.
This plan for requesting and dispensing medical countermeasures contains detailed information on Frederick County’s MD authorities, state vs. local roles, and information about POD operation and distribution decision-making. While the information may be slightly outdated, contents may be helpful for other counties interested in creating similar plans.
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Indiana Department of Health. (2023). Medical Countermeasures Distribution and Dispensing Plan Guide.
This document provides guidance for developing a medical countermeasure distribution and dispensing plan. It includes steps for planning, regulatory, electrical outage, and tracking considerations, among others. It also links to further POD distribution and dispensation resources.
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* Johnson County Government, Department of Health and Environment. (2021). Dispense Assist.
This online tool may be used to pre-screen individuals that will receive medical countermeasures at Point of Dispensing (PODs) sites to support rapid dispensing at the PODs. After answering a few targeted questions, users can print out a completed screening form that indicates the countermeasure they should receive at the POD. It also contains information on pathogen-specific responses, such as for COVID-19, influenza, and tularemia.
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* Minnesota Department of Health. (2022). Medical Countermeasures.
This webpage contains background on a state’s role in medical countermeasure (MCM) dispensing during public health emergencies, and guidance for those in charge of distribution, including requesting resources from the Administration for Strategic Preparedness and Response and the Strategic National Stockpile. Strategies and tools for distributing the supplies through local health departments through open points of dispensing (PODs) include an online screening form, a POD locator (when they are open), and links to related courses.
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* Napa County Health and Human Services Agency. (2012). Countermeasure Distribution Plan.
This plan document covers Point of Dispensing (POD) operations, logistics, and staffing. It also reviews POD alternatives. It may be referenced and/or adapted by other jurisdictions and includes tables showing throughput vs. population / time, forms, and layouts. Though dated, components of the plan may be useful to other county planners developing related plans.
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National Association of County & City Health Officials. (2018). Medical Countermeasures and Non-Pharmaceutical Interventions.
This webpage includes links to initiatives and helpful information related to medical countermeasures, the Strategic National Stockpile, chemical response, radiation preparedness, pandemic influenza preparedness, and antiviral distribution and dispensing.
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New Mexico Department of Health. (2017). Point of Dispensing (POD) Operations Guide.
This plan includes operational considerations related to Points of Dispensing, and may be referenced and/or adapted by other jurisdictions in the development of their respective countermeasure dispensing plans.
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Noble County Health Department. (2017). Annex H1: Medical Countermeasure Dispensing.
This plan outlines emergency countermeasure deployment for Noble County, Ohio. The plan is designed to scale from a small portion to all the county’s 14,645 residents. It incorporates dispensing sites, individual site plans, and staffing for dispensing points.
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Ohio Department of Health. (2016). Ohio Medical Countermeasures (MCM) Site Survey for Points of Dispensing (POD) and Drop Site Facilities.
This survey template can help health departments choose a site for medical countermeasure dispensing points. It contains questions on the suitability of candidate sites and building features.
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* Oregon Health Authority. (n.d.). Medical Countermeasure Mass Dispensing Guidance. (Accessed 3/6/2024.)
This webpage contains links to resources on COVID-19 points of dispensing (PODs), POD planning and operations, and medical countermeasure resources such as bioterrorism FAQs, the CHEMPACK program to mitigate chemical attacks, and post-exposure prophylaxis standing orders.
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Trumbull County. (2019). Trumbull County Combined Health District (TCCHD) Medical Countermeasure (MCM) Dispensing Annex.
This plan outlines operational management of pharmaceutical supplies for Trumbull County, Ohio. In the event of a disaster or large-scale emergency, the plan is activated to supply lifesaving pharmaceuticals.
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Tuolumne County Public Health. (2018). Medical Countermeasures (MCM) Plan.
This county document contains a response checklist, background on the authority needed to activate medical countermeasures dispensation, the scope and purpose of the plan, and county demographics, which can aid in planning and carrying out distribution. It also includes a concept of operations with information on requesting additional resources, dispensing, vaccinating, and demobilization. Appendices include information on dispensing modalities and point of distribution checklist. While the information may be slightly outdated, contents may be helpful for other counties interested in creating similar plans.
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Strategic Planning/Research and Development

Biomedical Advanced Research and Development Authority. (2024). Chemical, Biological, Radiological and Nuclear (CBRN) Medical Countermeasures. U.S. Department of Health and Human Services.
This website contains links to the BARDA portfolio of biological, radiological, and nuclear medical countermeasures.
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Biomedical Advanced Research and Development Authority. (2024). COVID-19 Portfolio. U.S. Department of Health and Human Services.
This website contains links to the BARDA portfolio of medical countermeasures for COVID-19, including vaccines, diagnostics, therapeutics, rapidly deployable capabilities, and support services.
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National Academies of Sciences, Engineering, and Medicine. (2016). The Nation’s Medical Countermeasure Stockpile: Opportunities to Improve the Efficiency, Effectiveness, and Sustainability of the CDC Strategic National Stockpile: Workshop Summary.
This document summarized presentations and discussions that focused on the Strategic National Stockpile and: an overview of the plans to distribute medical countermeasures during a disaster or public health emergency; private industry practices geared towards distributing medical products and supplies (daily and during emergencies); gaps in current planning; opportunities for collaboration; and opportunities for economic sustainability as missions and countermeasures evolve.
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National Association of County and City Health Officials. (2022). Medical Countermeasure Best Practice Resource Guide.
The authors of this guide gathered best practices from the COVID-19 pandemic for local health departments to dispense medical countermeasures and share information for disasters, epidemics, or emergencies.
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Renard, P., Vagi, S., Reinold, C. et al. (2017). Improvements in State and Local Planning for Mass Dispensing of Medical Countermeasures: The Technical Assistance Review Program, United States, 2007–2014. American Journal of Public Health. 107(S2): S200-S207.
The authors used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention’s Technical Assistance Review to evaluate and describe outcomes of state and local medical countermeasure preparedness planning. They found that overall preparedness increased during the time period studied, and note that ongoing training, exercising, and incorporation of lessons learned from real events and exercises are all critical to ensuring continued preparedness.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2023). Biomedical Advanced Research and Development Authority (BARDA).
This webpage provides links to the work the Biomedical Advanced Research and Development Authority (BARDA) does to develop and field countermeasures under five categories: core services, CBRN programs, pandemic influenza, innovation, and stockpile building. Links to programs and helpful resources are also included.
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U.S. Food and Drug Administration. (2022). Medical Countermeasure Monitoring and Assessment.
This webpage is focused on the need to build and maintain a national capability to monitor and assess medical countermeasures (MCMs) after they are dispensed or administered in response to a chemical, biological, radiological, or nuclear threat or an emerging infectious disease. Links to “FDA Information about Past and Current MCM Monitoring and Assessment Projects,” including those relevant to COVID-19, are included.
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U.S. Food and Drug Administration. (2023). Medical Countermeasures Initiative (MCMi).
The FDA coordinates medical countermeasure development under this initiative, and links to various initiatives and resources are provided on this webpage.
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Washington State Department of Health. (n.d.). Resources for Specific Emergencies. (Accessed 3/6/2024.)
This webpage links to sample templates, checklists, and factsheets which can be customized for biological threats such as anthrax, botulism, hemorrhagic fever, pandemic influenza, smallpox, or tularemia.
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Threat-Specific Countermeasures

Administration for Strategic Preparedness and Response. (n.d.). Improving Access to Influenza Countermeasures for U.S. Jurisdictions: Strategic National Stockpile. (Accessed 3/6/2024.)
This webpage provides information on Tamiflu, a medical countermeasure for influenza. It includes a current list of expiration dates for Tamiflu stored in the Strategic National Stockpile and links to related resources.
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Biomedical Advanced Research and Development Authority. (2023). Influenza & Emerging Infectious Diseases (EID) Medical Countermeasures.
This website contains information on the Biomedical Advanced Research and Development Authority (BARDA) strategic plan and its alignment with the National Biodefense Strategy, focusing on influenza and emerging infectious diseases. The site includes information on BARDA’s therapeutics, vaccine, adjuvants, and diagnostics programs.
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Borio, L., Bright, R., and Emanuel, E. (2022). A National Strategy for COVID-19 Medical Countermeasures: Vaccines and Therapeutics. JAMA. 327(3):215-216.
The authors highlight the progress in vaccines accelerated by COVID-19. They call for investment in variant-specific vaccines, different methods of vaccine administration, research into optimal vaccine strategies, and expedited COVID therapeutics.
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Çaglayan, Ç., Thornhill, J., Stewart, M., et al. (2021). Staffing and Capacity Planning for SARS-CoV-2 Monoclonal Antibody Infusion Facilities: A Performance Estimation Calculator Based on Discrete-Event Simulations. Frontiers in Public Health. 9:770039.
The authors evaluated 162,000 scenarios to understand the optimal resource allocation at facilities administering monoclonal antibody infusions for COVID-19. They conclude that “physical capacity, check-in staff, and infusion time were as important as nurses for [monoclonal antibody] sites,” and that simulations can be an important tool for planning optimal resource allocation for COVID-19 patients receiving monoclonal antibody infusions and other resource optimization.
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Centers for Disease Control and Prevention. (2023). CDC Guidelines for the Prevention and Treatment of Anthrax, 2023. Morbidity and Mortality Weekly Report (MMWR). 72(6):1-47.
This report provides an update to CDC guidance for prevention and treatment of exposure to anthrax, based on systematic reviews of the literature. This report improves on past CDC recommendations by providing alternative antimicrobial drug recommendations when first line treatments are contraindicated. It also provides information on diagnosis and treatment of anthrax meningitis.
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Centers for Disease Control and Prevention. (2024). Smallpox: Prevention and Treatment.
This webpage explains how the smallpox vaccine can help prevent infection (prior to or within days of exposure) and lists three antiviral drugs that have been shown effective against smallpox: Tecovirimat, Cidofovir, and Brincidofovir.
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European Medicines Agency. (2014). Guidance Document on Use of Medicinal Products for Treatment and Prophylaxis of Biological Agents that Might Be Used as Weapons of Bioterrorism.
This document includes guidance for 10 specific agents and has one chapter on “other infectious diseases” and another on agents for which no treatment can be recommended (e.g., ricin and viral encephalitis).
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Food and Drug Administration. (2023). Cyfendus.
This webpage contains information on Cyfendus, a two-dose anthrax vaccine approved by FDA in 2023 for use after suspected or confirmed exposure to anthrax.
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Health Resources and Services Administration. (2023). Mpox FAQs.
This webpage provides information on HRSA’s distribution of the JYNNEOS vaccine for mpox prevention. It covers questions such as the Ryan White program’s coverage of JYNNEOS, ancillary supplies for the vaccine, eligibility to receive the mpox vaccine, and authorization to administer it. It also provides information for health care providers such as the Health Partner Order Portal and use of health center program funds for treating and preventing mpox.
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Indian Health Service. (2022). IHS Response to Mpox.
This website contains information on the Indian Health Service (IHS) response to mpox, including testing, contact tracing, and access to countermeasures such as vaccines and therapeutics. It links to more information on distribution of countermeasures and clinical guidance for IHS health care providers.
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IOM (Institute of Medicine). (2012). Prepositioning Antibiotics for Anthrax.
The Institute of Medicine convened a committee to study the role of various prepositioning strategies in the overall medical countermeasures dispensing strategy. The committee found that while prepositioning strategies can save time, it also provides less flexibility (e.g., should an attack take place at a different location or uses a strain of anthrax that is resistant to the pre-positioned treatment).
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Lipsitz, R., Garges, S., Aurigemma, R., et al. (2010). Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010. Emerging Infectious Diseases. 18(12).
Workshop attendees were asked to develop consensus recommendations for post exposure treatment against melioidosis and glanders (caused by Burkholderia pseudomallei and B. mallei infections). Recommended prophylaxes includes trimethoprim/sulfamethoxazole or co-amoxiclav. The authors also emphasized the need for standardized animal models and further research and training.
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Nelson, C., Meaney-Delman, D., Fleck-Derderian, S., et al. (2021). Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response. U.S. Centers for Disease Control and Prevention.
This Morbidity and Mortality Weekly Report includes information from a series of systematic literature reviews, nongovernmental workgroup guidelines, and U.S. Food and Drug Administration approvals on the treatment and prevention of plague.
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Rump, A., Ostheim, P., Eder, S., et al. (2021). Preparing for a "Dirty Bomb" Attack: The Optimum Mix of Medical Countermeasure Resources. Military Medical Research. 8:3.
The authors discuss how to optimally use radioactivity screening equipment in triage to reduce the need for antidotes during a radiological emergency. They used data envelopment analysis to examine different combinations of medical countermeasure use, and cost effectiveness was articulated as cost per life year saved. The authors concluded that screening capacity is important to decrease the required number of antidote doses.
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Schwartz, M., Raulli, R., Laney, J., et al. (2022). Systemic Bioavailability of Sublingual Atropine Ophthalmic Solution: a Phase I Study in Healthy Volunteers with Implications for Use as a Contingency Medical Countermeasure. Journal of Medical Toxicology. 18(3):187-197.
The authors conducted a phase I study to understand whether atropine administered under the tongue could be a successful medical countermeasure against organophosphorus nerve agent and organophosphate pesticide toxicity. They found that sublingual atropine may be an effective countermeasure for this nerve agent.
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Singh, V., Romaine, P., and Seed, T. (2015). Medical Countermeasures for Radiation Exposure and Related Injuries: Characterization of Medicines, FDA-Approval Status and Inclusion into the Strategic National Stockpile. Health Physics. 108(6):607-630.
The authors outline the dearth of information on FDA-approved medical countermeasures for acute radiation syndrome (ARS). They review the status of medical countermeasures for ARS that are available and those which could be used in exceptional circumstances. They also highlight experimental countermeasures not yet approved by the FDA for use in humans and the need for additional research on radiation injury and its treatment.
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U.S. Department of Health and Human Services. Chemical Hazards Emergency Medical Management (CHEMM). (2021). CHEMPACK.
CHEMPACKs contain nerve agent antidotes and are stored in secure locations across the country. More than 90 percent of the U.S. population is within one hour of a CHEMPACK location; most locations are in hospitals or fire stations.
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U.S. Food and Drug Administration. (2017). Extending Expiration Dates of Doxycycline Tablets and Capsules in Strategic Stockpiles: Draft Guidance for Government Public Health and Emergency Response Stakeholders.
Doxycycline monohydrate and doxycycline hyclate tablets and capsules (50 mg) and 100 mg of doxycycline are indicated (and stockpiled) for post-exposure prophylaxis or treatment of inhalational anthrax; this guidance document explains how stakeholders can extend the shelf life of these medications.
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U.S. Food and Drug Administration. (2019). Products Approved for Other Bioterrorism Emergencies.
This webpage includes links to information and guidance on products approved for use during bioterrorism emergencies, specifically for botulism, Ebola virus disease, plague, smallpox, tularemia, and Zika virus disease.
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U.S. Food and Drug Administration. (2023). Anthrax.
This webpage provides information on and links to resources specific to vaccines approved to prevent disease.
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U.S. Food and Drug Administration. (2023). FDA Mpox Response.
This website contains information on FDA’s response to the mpox outbreak, from recent updates to the JYNNEOS vaccine, therapeutics, mpox and medical devices, misinformation, and links to additional federal resources for health providers, lab staff, or veterinarians. It also contains links to information for veterinarians and information on JYNNEOS mpox vaccine distribution.
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U.S. Food and Drug Administration. (2023). Radiation Emergencies.
This webpage provides information on and links to resources specific to products approved to treat the effects of radiation exposure. These products are contained in the Strategic National Stockpile (SNS).
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Agencies and Organizations

Centers for Disease Control and Prevention. On-TRAC (Online Technical Resource and Assistance Center).
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National Association of County & City Health Officials. Medical Countermeasures and Non-Pharmaceutical Interventions.
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U.S. Department of Health and Human Services. Chemical Hazards Emergency Medical Management (CHEMM).
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U.S. Department of Health and Human Services. Radiation Emergency Medical Management (REMM).
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. Medical Countermeasures.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. Strategic National Stockpile.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. Biomedical Advanced Research and Development Authority (BARDA).
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. Project BioShield.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Public Health and Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and Implementation Plan 2022.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. BARDA. Chemical, Biological, Radiological, and Nuclear (CBRN) Threat Programs.
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U.S. Food and Drug Administration. Emergency Dispensing Orders.
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This ASPR TRACIE Topic Collection was refreshed in March 2024 and comprehensively reviewed by the following subject matter experts (listed in alphabetical order):  

 

Stephanie Anspaugh-Naples, MPH, Florida Department of Health; staff from the U.S. Department of Health and Human Services Biomedical Advanced Research and Development Authority (BARDA); Brittan K. Bates-Manni, MS, Rhode Island Department of Health; Brett K. Cass, MS. Emergency Management Coordinator, Navy Medicine Readiness and Training Command Patuxent River; James D. Friday, DMD, MBA, Public Health Advisor, Technical Assistance and Guidance (TAG) Team Capacity Building & Technical Assistance Development Branch (CTAB), Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention; staff from the Healthcare Distribution Alliance (HDA); John L. Hick, MD, Hennepin Healthcare; Jaime Jones-Wormley, Supervisory Public Health Advisor, Technical Assistance and Guidance (TAG) Team B, Capacity Building and Technical Assistance Development Branch (CTAB), Division of State and Local Readiness (DSLR), Office of Readiness and Response (ORR); Mike Melton, MPA, MA, Michael Melton Consulting; Meghan Pennini, PhD, Chief Vaccine and Therapeutics Officer, HHS Coordination Operations and Response Element (H-CORE), ASPR; David Reddick, Chief Strategy Officer and Co-Founder, Bio-Defense Network; and staff from the U.S. Department of Health and Human Services Strategic National Stockpile.  

 

It was originally reviewed in April 2018 by: DeLaine Black, U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR), Medical Countermeasure Operational Advisor; Scott Cormier, Vice President, Emergency Management, EC, & Safety; Kelly James Dickinson, MHA, Division of State and Local Readiness, CDC; Diane DiEuliis, Ph.D., Senior Research Fellow, National Defense University, U.S. Department of Defense; Gary L. Disbrow, Ph.D., Deputy Director (Acting), Biomedical Advanced Research and Development Authority (BARDA); L. Paige Ezernack (Rogers), Senior Policy Analyst, ASPR OPP; Anne Hasselmann, MPH, Principal, ARH Health Consulting; Jack Herrmann, MSEd, NCC, LMHC, Deputy Director, Office of Policy and Planning (OPP), HHS ASPR; John L. Hick, MD, HHS ASPR and Hennepin County Medical Center; Chad M. Hrdina, MS, GC-WMD, EMT, Chief, Medical Countermeasure Utilization and Response Integration, HHS ASPR, Office of Policy and Planning; Sherline Lee, MPH, Epidemiologist, Community and Health Systems Team, Capacity Building Branch, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC); Michael Melton, MPA, MA, Emergency Logistics Coordinator, Los Angeles County Department of Public Health; Jerry Rhodes, Director, Preparedness and Crisis Response, Association of State and Territorial Health Officials; Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition, Palm Beach County, FL; Natalie Sanchez, MPH CHES, MCM Deputy Branch Chief, CDC OPHPR DSLR PSB; Michael Wargo, RN, BSN, MBA, PHRN, Vice President, HCA Healthcare | CSG, Enterprise Preparedness & Emergency Operations; and staff from BARDA and the CDC Office of Public Health Preparedness and Response, Division of the Strategic National Stockpile (SNS).

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