Developing National Standards for Public Health Emergency Preparedness with a Limited Evidence Base

Objective: The paucity of evidence and wide variation among communities creates challenges for developing congressionally mandated national performance standards for public health preparedness. Using countermeasure dispensing as an example, we present an approach for developing standards that balances national uniformity and local flexibility, consistent with the quality of evidence available. Methods: We used multiple methods, including a survey of community practices, mathematical modeling, and expert panel discussion. Results: The article presents recommended dispensing standards, along with a general framework that can be used to analyze tradeoffs involved in developing other preparedness standards. Conclusions: Standards can be developed using existing evidence, but would be helped immensely by a stronger evidence base.