Large catastrophic events, or rare acute events, may cause situations in which a local jurisdiction's medicines and medical supplies are not sufficient to provide care to the population it serves. In these cases of natural or engineered disasters, such as a terrorist attack, influenza pandemic, or earthquake, state or local authorities can request that the federal government provide assets from the Strategic National Stockpile to augment the state and local jurisdictions' resources. The Centers for Disease Control and Prevention's (CDC's) Strategic National Stockpile (SNS) is the nation's repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel designed to supplement and resupply state and local public health agencies in the event of an emergency. The materiel is intended to support national health security and is managed by the Office of Public Health Preparedness and Response's (OPHPR's) Division of Strategic National Stockpile (DSNS). The stated mission of the SNS is to prepare and support partners and provide the right resources at the right time to secure the nation's health. The National Academies of Sciences, Engineering, and Medicine organized a two-day public workshop to explore opportunities to improve the efficiency, effectiveness, and sustainable methods used by the CDC's SNS to distribute medical countermeasures and other supplies during disasters and other public health emergencies, especially those which result in disruption of physical infrastructure such as the electrical grid, central roadways, bridges, and tunnels within the impacted community. Participants explored relevant distribution lessons learned from other federal agency stockpiles and the private sector as well as opportunities to develop public-private collaborations in the purchase, warehousing, management, and distribution of medical countermeasures. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction, Background, and Context 2 The Strategic National Stockpile: Origin, Policy Foundations, and Federal Context 3 Studies and Reports Related to the Strategic National Stockpile 4 Potential Opportunities for Restructuring Strategic National Stockpile Scope, Governance, and Decision Making 5 Reaching the Last Mile: Potential Opportunities to Improve Coordination and Communication Among Local, State, and Federal Agencies 6 Potential Supply-Chain Opportunities and Lessons from the Commercial Sector and Government Partners 7 Wrap-Up References Appendix A: Workshop Agenda Appendix B: Workshop Speaker Biographies

Emerging infectious disease threats that may not have available treatments or vaccines can directly affect the security of the world's health since these diseases also know no boundaries and will easily cross borders. Sustaining public and private investment in the development of medical countermeasures (MCMs) before an emerging infectious disease becomes a public health emergency in the United States has been extremely challenging. Interest and momentum peak during a crisis and wane between events, and there is little interest in disease threats outside the United States until they impact people stateside. On March 26 and 27, 2015, the Institute of Medicine convened a workshop in Washington, DC to discuss how to achieve rapid and nimble MCM capability for new and emerging threats. Public- and private-sector stakeholders examined recent efforts to prepare for and respond to outbreaks of Ebola Virus Disease, pandemic influenza, and coronaviruses from policy, budget, and operational standpoints. Participants discussed the need for rapid access to MCM to ensure national security and considered strategies and business models that could enhance stakeholder interest and investment in sustainable response capabilities. This report summarizes the presentations and discussions from this workshop. Table of Contents Front Matter 1 Introduction 2 A Wake-Up Call: The 2014 Ebola Outbreak Response 3 Preparedness as an Issue of National Security 4 Rapid Development of Ebola Vaccines 5 Influenza Risk Assessment and Pandemic Preparedness 6 Developing MCMs for Coronaviruses 7 Sustainable Business Models to Ensure Rapid and Nimble Responses 8 Supporting MCM Development Across Threats and Funding Cycles A References B Acronyms and Abbreviations C Statement of Task D Agenda E Biosketches of Invited Speakers and Facilitators