Planning the bioterrorism response supply chain: Learn and live

Margaret L. Brandeau, PhD, David W. Hutton, MS, Douglas K. Owens, MD, MS, Dena M. Bravata, MD, MS


Responses to bioterrorism require rapid procurement and distribution of medical and pharmaceutical supplies, trained personnel, and information. Thus, they present significant logistical challenges. On the basis of a review of the manufacturing and service supply chain literature, the authors identified five supply hain strategies that can potentially increase the speed of response to a bioterrorism attack, reduce inventories, and save money: effective supply chain network design; effective inventory management; postponement of product customization and modularization of component parts; coordination of supply chain stakeholders and appropriate use of incentives; and effective information management. The authors describe how concepts learned from published evaluations of manufacturing and service supply chains, as well as lessons learned from responses to natural disasters, naturally occurring outbreaks, and the 2001 US anthrax attacks, can be applied to design, evaluate, and improve the bioterrorism response supply chain. Such lessons could also be applied to the response supply chains for disease outbreaks and natural and manmade disasters.


bioterrorism, logistics, supply chain, inventory management

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Bravata DM, McDonald KM, Owens DK, et al.: Regionalization of Bioterrorism Preparedness and Response. Rockville, MD: Agency for Healthcare Research and Quality; April 2004. Evidence Report/Technology Assessment Report No. 04-E016-2. Prepared by Stanford- University of California San Francisco Evidence-based Practice Center under Contract No. 290-02-0017.

Hupert N, Bearman GM, Mushlin AI, et al.: Accuracy of screening for inhalational anthrax after a bioterrorist attack. Ann Intern Med. 2003; 139 (5 Part 1): 337-345.

Inglesby TV: Observations from the TOPOFF exercise. Public Health Rep. 2001; 116 (Suppl 2): 64-68.

Inglesby TV, Grossman R, O’Toole T: A plague on your city: Observations from TOPOFF. Clin Infect Dis. 2001; 32(3): 436-445.

Hupert N, Mushlin AI, Callahan MA: Modeling the public health response to bioterrorism: Using discrete event simulation to design antibiotic distribution centers. Med Decis Making. 2002; 22 (5 Suppl): S17-S25.

Lee EK, Maheshwary S, Mason J, et al.: Decision support system for mass dispensing of medications for infectious disease outbreaks and bioterrorist attacks. Ann Oper Res. 2006; 148: 25-54.

Bravata DM, Zaric GS, Holty J-EC, et al.: Reducing mortality from anthrax bioterrorism: Strategies for stockpiling and dispensing medical and pharmaceutical supplies. Biosecur Bioterror. 2006; 4(3): 244-262.

Zaric GS, Brandeau ML, Bravata DM, et al.: Modeling the logistics of response to anthrax bioterrorism. Med Decis Making. In press.

Ernst R, Kamrad B: Evaluation of supply chain structures through modularization and postponement. Eur J Oper Res. 2000; 124: 495-510.

Lee HL, Billington C: The evolution of supply-chain-management models and practice at Hewlett-Packard. Interfaces. 1995; 25(5): 42-63.

Cheng F, Ettl M, Yao DD: Inventory-service optimization in configure-to-order systems. Manuf Service Opera Manag. Spring 2002; 4(2): 114-132.

Lin G, Ettl M, Buckley S, et al.: Extended-enterprise supplychain management at IBM Personal Systems Group and other divisions. Interfaces. 2000; 30(1): 7-25.

Nahmias S: Supply Chain Management. Production and Operations Analysis. 4th ed. Boston: McGraw-Hill, 2001.

Arntzen BC, Brown GC, Harrison TP, et al.: Global supply chain management at Digital Equipment Corporation. Interfaces. 1995; 25(1): 69-93.

Brown AO, Lee HL, Petrakian R: Xilinx improves its semiconductor supply chain using product and process postponement. Interfaces. 2000; 30(4): 65-80.

Mohammed A: Polaroid Corporation: European Distribution System. Boston, MA: Case Study, Harvard Business School, June 26, 1995.

Graves SC,Willems SP: Optimizing strategic safety stock placement in supply chains. Manuf Service Oper Manag. Winter 2000; 2(1): 68-83.

Sery S, Presti V, Shobrys DE: Optimization models for restructuring BASF North America’s distribution system. Interfaces. 2001; 31(3): 55-65.

Lockamy A: Supply-chain excellence for accelerated improvement. Interfaces. 2000; 30(4): 22-31.

Davis EW: General Electric TSBO (A): Purchasing and Just-in- Time. Charlottesville, VA: Case Study, Darden Graduate School of Business Administration, University of Virginia, 1983.

Karabakal N, Gunal A, Ritchie W: Supply-chain analysis at Volkswagen of America. Interfaces. 2000; 30(4): 46-55.

Hahn CK, Duplaga EA, Hartley JL: Supply-chain synchronization: Lessons from Hyundai Motor Company. Interfaces. 2000; 30(4): 32-45.

Thonemann UW, Brandeau ML: Optimal commonality in component design. Oper Res. 2000; 48(1): 1-19.

Rao U, Scheller-Wolf A,Tayur S: Development of a rapid-response supply chain at Caterpillar. Oper Res. 2000; 48(2): 189-204.

Lee HL, Hoyt DB: Lucent Technologies: Global Supply Chain Management. Stanford,CA: Case Study, Graduate School of Business, Stanford University, January 2001.

Chen E, Enna A, Jordan S, et al.: Instill Corporation: Improving the Foodservice Industry Supply Chain. Stanford, CA: Case Study, Graduate School of Business, Stanford University, February 2000.

Takeda Y, Matsuo H: ECR: A “fresh” look from Japan. ECR J. Winter 2002; 2(2): 17-27.

Kunitomo R: Seven-eleven is revolutionising grocery distribution in Japan. Long Range Plann. 1997; 30(6): 877-889.

Ghemawat P, Neueno JL: ZARA: Fast Fashion. Boston, MA: Case Study, Harvard Business School, Cambridge, MA,April 1, 2003.

Burns LR (ed.): The Health Care Value Chain: Producers, Purchasers, and Providers. San Francisco: Jossey-Bass, 2002.

de Kok T: Philips Electronics synchronizes its supply chain to end the bullwhip effect. Interfaces. 2005; 35(1): 37.

Yadav P: McGriff Treading Company implements service contracts with shared savings. Interfaces. 2003; 33(6): 18.

Barratt M: Unveiling enablers and inhibitors of collaborative planning. Int J Logist Manag. 2004; 15(1): 73.

Koplan J: CDC’s strategic plan for bioterrorism preparedness and response. Public Health Rep. 2001; 116 (Suppl 2): 9-16.

Centers for Disease Control and Prevention: Strategic National Stockpile. August 11; Available at index.asp. Accessed April 6, 2004.

Centers for Disease Control and Prevention: National Pharmaceutical Stockpile. Available at NationalStockpile/national_pharmaceutical_stockpile.pdf. Accessed August 27, 2003.

Agency for Health Care Quality and Research: Bioterrorism and health system preparedness, Issue Brief No. 9: Addressing Surge Capacity in a Mass Casualty Event.Available at news/ulp/btbriefs/btbrief9.htm. Accessed September 26, 2006.

United States Food and Drug Administration: Procedures for Implementation of Enforced Compliance and Penalties for the Bioterrorism Act. Available at linkhandler/cgov/import/commercial_enforcement/bioterrorism/ external_bt_procedures.ctt/external_bta_procedures.doc. Accessed April 6, 2004.

Jernigan DB, Raghunathan PL, Bell BP, et al.: Investigation of bioterrorism-related anthrax, United States, 2001: Epidemiologic findings. Emerg Infect Dis. 2002; 8(10): 1019-1028.

Stohr K: A multicentre collaboration to investigate the cause of severe acute respiratory syndrome. Lancet. 2003; 361(9370): 1730-1733.

Emergency Management Assistance Compact. 57th Legislature, 2001 Regular Session ed, 2001.

National Emergency Management Association: Emergency management assistance compact.Available at About_EMAC/Model_Legislation.cfm. Accessed April 6, 2004.

Santa Clara County (California) Fire Department: Santa Clara County local fire service and rescue mutual aid plan. Accessed August 7, 2002.

State of California: California Disaster and Civil Defense Master Mutual Aid Agreement: State of California. November 15, 1950.

State of California Office of Emergency Services: Emergency Managers Mutual Aid Plan: Office of Emergency Services; November 1997.

Haynes BE, Freeman C, Rubin JL, et al.: Medical response to catastrophic events: California’s planning and the Loma Prieta earthquake. Ann Emerg Med. 1992; 21(4): 368-374.

Martchenke J, Rusteen J,Pointer JE: Prehospital communications during the Loma Prieta earthquake. Prehospital Disaster Med. 1995; 10(4): 225-231.

Bullock J: The emergency management assistance compact: Creating a network of management in times of emergency. 2000. Available at Accessed April 6, 2004.

Member States: Emergency Management Assistance Compact. Available at cfm. Accessed April 6, 2004.

Samii R, Van Wassenhove L: The United Nations Joint Logistics Centre (UNJLC): The Afghanistan Crisis. Fontainebleau, France: INSEAD, 2003.

Samii R, Van Wassenhove L: The United Nations Joint Logistics Centre (UNJLC):The Genesis of a Humanitarian Relief Coordination Platform. Fontainebleau, France: INSEAD, 2003.

Samii R,Van Wassenhove L, Kumar K, et al.: IFRC: Choreographer of Disaster Management: Preparing for Tomorrow’s Disasters. Fontainebleau, France: INSEAD, 2002.

Samii R,Van Wassenhove L, Kumar K, et al.: IFRC: Choreographer of Disaster Management: The Gujarat Earthquake. Fontainebleau, France: INSEAD, 2002.

Hupert N, Cuomo J:Weill/Cornell Mass Prophylaxis/Vaccination Model. Available at asp. Accessed September 3, 2003.

Ganeshan R, Harrison TP: An Introduction to Supply Chain Management. May 22; Available at misc/supply_chain_intro.html. Accessed December 16, 2002.

Booth M: Aviation disasters: Unique disasters demand unique responses. Available at 030115Airteam.html. Accessed January 16, 2003.

Vanholder R, Sever MS, De Smet M, et al.: Intervention of the renal disaster relief task force in the 1999 Marmara, Turkey earthquake. Kidney Int. 2001; 59(2): 783-791.

Hill O: Medecins Sans Frontieres: Mission impossible? Pract Midwife. 2002; 5(7): 40-44.

Fritz Institute: Hurricane Katrina: Perceptions of the affected. Available at Katrina_Perceptions.pdf. Accessed September 26, 2006.

Davis G, Jones D: Mutual Aid Specialist Committee: Findings and Recommendations: State of California Governor’s Office of Emergency Services, November 30, 1998.

Dieffenbach RJ: Help is just a state away. State Government News, 1998: 28-31. 62. ProMED-mail: Smallpox Vaccination, Adverse Events—USA (09). ProMED-mail. March 29, 2003.

Severe acute respiratory syndrome (SARS): Status of the Outbreak and Lessons for the Immediate Future. Geneva: World Health Organization, May 20, 2003.

Robeson JF, Copacino WC (eds.): The Logistics Handbook. New York: The Free Press, 1994.

Fritz Institute: Humanitarian Logistics Software (HLS):Technical details and architecture.Available at fact_sheets/f_s-hls_tech_platform.html. Accessed January 12, 2004.

Fritz Institute: Humanitarian Logistics: Getting the right relief to the right people at the right time.Available at fact_sheets/f_s-hls.html. Accessed January 12, 2004.

Jones MH: Red Cross in million dollar bid to shake up logistics. Reuters AlertNet. September 4, 2003.

Pan American Health Organization: What is SUMA? Available at Accessed December 16, 2003.

Klitzman S, Freudenberg N: Implications of the World Trade Center attack for the public health and health care infrastructures. Am J Public Health. 2003; 93(3): 400-406.

Lyman F: Messages in the Dust: What are the Lessons of the Environmental Health Response to the Terrorist Attacks of September 11? Denver, CO: National Environmental Health Association, 2003.

Fritz Institute: Lessons from the tsunami: Top line findings. Available at Sept2605.pdf. Accessed April 6, 2004.

Fritz Institute: Rescue, relief, and rehabilitation in tsunami affected Indonesia, India and Sri Lanka. Available at http://www. Accessed April 6, 2004.

Lee HL, Padmanabhan V, Whang S: Information distortion in a supply chain: The bullwhip effect. Manag Sci. 1997; 43(4): 546-558.

Buckeridge DL, Owens DK, Switzer P, et al.: Evaluating detection of an inhalational anthrax outbreak. Emerg Infect Dis. 2006; 12: 1942-1949.

United States Government Accounting Office: Emerging infectious diseases, Asian SARS outbreak challenged international and national response. Report No. GAO-04-564.Washington, DC, 2004.



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