Concurrent Distribution of Anthrax Vaccine & Antibiotics

by Sarah Keally

Public health organizations such as the National Association of County and City Health Officials (NACCHO) have recommended that local health agencies include the anthrax vaccine in their plans for the distribution of medical countermeasures. Many local health department preparedness plans, however, currently do not address the potential difficulties caused by the concurrent dispensing of anthrax vaccine and antibiotics to combat an anthrax attack. Although administering the anthrax vaccine as a post-exposure prophylaxis is considered an effective response to an intentional release of anthrax spores, additional and more detailed federal guidance, as well as technical and financial assistance, is still needed.

According to the Anthrax Vaccine Home Page of the U.S. Centers for Disease Control and Prevention (CDC), a major agency of the U.S. Department of Health and Human Services (HHS), “There is a vaccine to prevent anthrax, but it is not yet available for the general public.” Nonetheless, the Home Page also says, “in the event of an attack using anthrax as a weapon, people exposed would [still] get the vaccine.” Following the passage, in 2008, of the Public Readiness and Emergency Preparedness (PREP) Act, the anthrax vaccine adsorbed (AVA) was added as a medical countermeasure to the CDC’s Strategic National Stockpile (SNS) of medicines and other medical resources. In 2010, the CDC’s Advisory Committee on Immunization Practices (ACIP) further recommended that persons exposed to anthrax by inhalation should receive three doses of the vaccine, and that the first dose be administered no later than 10 days after exposure.

Information & Mounting Concerns

Although this information has been available for several years, some local health departments may not be aware of the specific requirements mandated and, therefore, have not yet updated their own SNS preparation plans. Of course, the concurrent dispensing of AVA and antibiotics poses some significant operational and logistical challenges for local public health agencies. Therefore, preplanning is essential to ensure that an adequate level of qualified staff who are required and have been properly trained for the response effort needed is quickly available.

Another major concern is that, although many local public health agencies may in fact be ready to dispense antibiotics, they may not be sufficiently prepared, or funded, to mount a vaccination campaign simultaneously with the antibiotics distribution also needed in the wake of an aerosolized anthrax attack. One possible reason for this gap is that health agencies at the local level may be unaware of the ACIP and CDC reports on the use of anthrax vaccine for post-exposure prophylaxis.

In addition, there has been little technical and financial support provided to develop this area of preparedness at the level likely to be needed. To begin with, the concurrent dispensing of antibiotics and vaccines necessarily requires that additional staff be available at the dispensing sites, significantly increasing the burden, therefore, on the local public health agencies involved, and their local partners – who also must provide extra support staff. Another consideration that must be taken into account is that access for at-risk populations must be ensured when planning for the concurrent dispensing of both AVA and antibiotics.

As matters now stand, the general guidance provided by federal agencies suggests that the use of AVA, in addition to antibiotics, offers the best response currently available to cope with an intentional release of anthrax spores. However, an official statement from CDC or one of the other agencies directly involved with respect to implementing plans for the concurrent dispensing of anthrax vaccine and antibiotics would help strengthen overall preparedness efforts at the local level.

The bottom line is that local public health agencies should begin now, well prior to an actual event – and with support provided by the federal government – to: (a) address the logistical and operational issues involved in the complementary vaccine dispensing effort required; and (b) provide adequate training for the licensed and professional staff needed to quickly and safely deliver the federally mandated countermeasures to the public during an actual emergency.


For additional information on:

CDC’s Anthrax Vaccine home page, visit

CDC’s “Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP),” 23 July 2010, visit


Sarah Keally, MPH, is a Program Analyst at the National Association of County and City Health Officials (NACCHO) working on the Strategic National Stockpile (SNS) project under the Catastrophic and Pandemic Preparedness Program. Prior to joining NACCHO, she worked as the district’s emergency planner at the Three Rivers Health District in Virginia, where she was the project lead for NACCHO’s Project Public Health Ready and the CDC’s Local Technical Assistance Review. She received a Master of Public Health (MPH) in Health Management from Eastern Virginia Medical School and Old Dominion University.