The Problem with PODs

Points of Distribution, or PODs, are the hub of pandemic planning in some communities. PODs are set up at certain locations and used to distribute oral or injected medication. Despite urging from the emergency response community, many jurisdictions have hung onto the POD plan as the only distribution method for pharmaceuticals in the setting of pandemic. Although not entirely a bad idea, the POD system has a number of faults that should be addressed and considered in the planning and contingency process.
What is a POD? As mentioned, a POD is a site designated for the distribution of medications or supplies in the event of a crisis or emergency. The pubic gathers at a give location or locations and materials are handed out.

Why was the POD system developed? In short, the current points of distribution model is based on an earlier process used to receive, break down, repackage, and distribute materials/supplies from the National Pharmaceutical Stockpile (NPS). The idea was further refined for the use in the setting of SARS and later, H5N1 Highly Pathological Avian Flu.

So, whats the problem? The first problem is in the planning assumptions made with POD Establishment. The assumption has been made that "we'll know" when a given pathogen is threatening and have time to medicate/vaccinate our public. That assumption was based on experience with SARS and predictions of H5N1 and is totally dysfunctional. To assume there will be a "lead-time" when we know a pathogen is coming is a terrible mistake. As we have seen with H1N1 in 2009, the disease was present in various states with little or no lead-in. In that situation, we have to plan for the disease spreading beyond any given boundary...simply by virtue of our modes of modern travel. So, to bring otherwise healthy people together into a central location(s) may actually increase exposure.

The next assumption we have to deal with is that a vaccine or medication may not be available in the amount we need...we could run out of medication. Running out of medication leaves us with people standing in line and not getting protected, perhaps being exposed. And speaking of standing in line...managing the que and providing sanitation services, shelter from the environment, food, and medical care at POD locations can be an event in itself. These continence's are not often included in POD plans. As one pubic health emergency managed told me; "the people in line are not our problem..."
That brings me to the problem of civil unrest and disobedience. Dealing with uncooperative persons, people with special needs, and those intent on causing problems is often beyond the scope of those working in a POD. Understand that the unrest can turn into a riot and become violent quickly...especially if you run out of medication.

In recent experiences, some PODs were overwhelmed with people and had delays of several hours while other locations remained nearly silent. Why? Because people did not know where to go, under what conditions to go, or did not understand direction. We cannot plan on people following direction. We can expect that once the media announces that site "A" is running with a ten-hour delay, many people will flood site "B".

Want another snapshot view...see Mitigation Journal Of Chicken and Expectations from May, 2009 to see what I'm talking about. Points of Distribution sites are difficult to manage and plan for...they are a part of pandemic planning, but only a part. Putting all our eggs in the POD basket puts us at risk of failure to meet the expectations of the public. Not meeting expectations will be disastrous.