By Carina Elsenboss, MS, Interim Preparedness Director, Public Health – Seattle & King County

Gone are the days when medication dispensing during an emergency or disaster was staffed and managed solely by local health departments (LHDs). Getting medication quickly to the community is particularly challenging in a large metropolitan area. To meet this challenge, Public Health – Seattle & King County (King County) is joining forces with partners in the community and public and private sectors to lead a whole community response to medication dispensing.

King County is a diverse community requiring diverse solutions. Day-to-day, residents seek medications through their local pharmacies, physicians, and big-box stores. In an emergency, King County expands these options to enable community members to access medications and information through their employers, community clinics, and other trusted locations. Over the past 10 years, King County has successfully incorporated a variety of partners in its emergency medication dispensing strategy including pharmacies, trusted leaders from community and faith organizations, subject matter experts, and Medical Reserve Corps volunteers. The strategy has been continually refined based on lessons learned through emergency responses to pandemics like H1N1 and tested through drills, exercises, and small-scale emergencies.

Early Stages of Outreach and Coordination with Pharmacies

King County learned from multiple exercises and real-world responses that operating points of dispensing (PODs) or medication centers run by the LHD is staff- and resource-intensive, and the LHD has limited ability to open freestanding PODs throughout the 39 municipalities in the county. However, King County has approximately 300 pharmacies that are geographically spread throughout the county’s 2,000 square miles, so the LHD explored how to work with pharmacies to get emergency medication and vaccine to the public. Conversations began with the University of Washington School of Pharmacy, Washington State Board of Pharmacy, and Washington State Pharmacy Association to assess pharmacy capacity, expertise, and interest and potential barriers and challenges to greater collaboration between public health and pharmacies.

King County began collaborating with pharmacies for emergency medication dispensing prior to H1N1 with a focus on antiviral distribution for pandemic flu scenarios. When the 2009 influenza outbreak arrived, it provided the opportunity to leverage the public health and pharmacy collaboration to distribute influenza vaccine. Without the benefit of official memoranda of understanding (MOU), independent and chain store pharmacies supported the regional H1N1 response by providing increased access to vaccine for community members—complementing services offered by doctors’ offices, community clinics, and LHDs. The participating pharmacies were extremely collaborative in the H1N1 response, providing regular updates to King County about supply chain status, customer demand, and doses distributed, and disseminating educational information to their patients. King County later developed and executed MOU between King County and pharmacies that outlined roles and responsibilities and documented liability coverage, in large part based on H1N1 lessons learned.

The success of collaboration to distribute the H1N1 vaccine increased interest in LHD-pharmacy partnerships. While pharmacy partners were enthusiastic about partnering to respond during future events and disease outbreaks, they expressed trepidation about entering into multiple, often different, MOU for each county or local health jurisdiction in Washington. The region identified that LHD-pharmacy partnerships could be simplified and generate greater participation by a statewide MOU geared toward mass vaccination and dispensing.

Local to Statewide Pharmacy Agreements

Building upon the work started in King County, in early 2012 the Washington State Department of Health convened a workgroup to develop the Washington Statewide Pharmacy-Local Health Jurisdiction Memorandum of Understanding and an operational plan. The MOU outlines the process for activating the MOU, how to process resource requests, responsibilities of LHDs and pharmacies, cost and payment, immunity and indemnification, and terms and termination. Efforts to enroll independent, chain, and grocery store pharmacies in the agreement are underway throughout the state. Early feedback from pharmacies indicates that the presence of a statewide legal agreement for mass dispensing partnerships will generate greater participation and create greater efficiency in future emergency responses.

Operationalizing Agreements

Taking the agreements to the next level requires planning and resources. Since the creation of the agreement, King County had an opportunity to partner with pharmacies during seasonal flu campaigns and a pertussis outbreak, testing and refining elements of the agreement such as reporting, outreach and education, and roles and responsibilities. In addition to real-world disease outbreaks, drills and exercises also help strengthen the LHD-pharmacy partnership. In 2014, King County will work with two partners, Costco and Walgreens, to drill and exercise a pharmacy-based mass dispensing strategy. These exercises create exciting opportunities to explore how best to modify the layout and flow of retail pharmacies to maximize patient throughput and how to standardize screening forms and registration.

The upcoming exercise with Costco is part of a Centers for Disease Control and Prevention (CDC) pilot project to develop national agreements with large retailers to distribute medications both to their employees and the community at large as hybrid closed/open dispensing sites. The CDC is supporting several local and state health departments to develop and pilot dispensing plans with large retailers—such as Costco and Home Depot—that can be rolled out through the chains to locations nationally.

Pharmacies and Beyond

In addition to collaborating with pharmacies, King County plans to leverage partnerships with trusted leaders and community members for medication distribution. Such partnership supports a whole community approach by learning from and leveraging existing community expertise and resources and making response planning more sustainable.

One such partnership is with the Somali Health Board, a coalition led by local Somali health professionals dedicated to improving health outcomes in their community through dialogue, advocacy, and partnerships with health systems, social and health service providers, and LHDs. Board members have been strong allies in efforts to ensure equity in preparedness and response efforts, and they have planned and staffed a free flu vaccination clinic at a local mosque to serve the Somali community, with support from King County. In an event requiring medical countermeasures, the capacity developed by this community group will be critical for providing medication dispensing to a community that might otherwise be difficult for King County to reach. Moving forward, King County is developing additional strategies with Somali Health Board members and other community partners to work with ethnic
and community pharmacies to increase the reach into diverse communities.

King County has a strong Medical Reserve Corps (MRC). The MRC provides additional opportunities to engage community members in the medical countermeasures distribution strategy. King County has been able to solicit technical assistance and input from MRC members representing a variety of community interests.

Conclusion

King County’s ultimate goal is to meet the health and medical needs of the community during emergencies and disasters. Community partnerships, pharmacies, subject matter experts, and community leaders are an important part of meeting this goal. Leveraging the everyday systems and expertise that resides within the community enhances King County’s ability to get medications to its residents more effectively and efficiently and reinforces a whole community planning approach. Building relationships with the systems and community before the emergency is vital. Doing so takes time and dedication but is an investment in public health emergency preparedness and will pay dividends in a medical countermeasures response.

For More Information

• Developing Effective and Sustainable Medication Dispensing Strategies: The Collaborative Drug Therapy Agreement (CDTA)
• Northwest Center for Public Health Practice: Partnering for Medical Countermeasure Distribution in Emergencies
• Public Health-Seattle & King County: Emergency Preparedness

This article was originally published in the Summer 2014 edition of NACCHO Exchange. To read the entire issue, download the newsletter from NACCHO’s online bookstore. (Login required).