Preparedness for epidemic disease or bioterrorism: Minimum cost planning for the location and staffing of urban point-of-dispensing centers


  • William M. Bowen, PhD
  • Jen-Yi Chen, PhD
  • Oya I. Tukel, PhD



urban emergency planning, bioterrorism, point-of-dispensing planning, infectious disease, biosecurity, integer programming


Urban health authorities in the United States have been charged with developing plans for providing the infrastructure necessary to dispense prophylactic medications to their populations in the case of epidemic disease outbreak or bioterrorist attack. However, no specific method for such plans has been prescribed. This article formulates and demonstrates the use of an integer programming technique for helping to solve a part of the dispensing problem faced by cities, namely that of providing the federally required infrastructure at minimum cost, using their limited time and resources. Specifically, the technique minimizes the number of point-of-dispensing (POD) centers while covering every resident in all the census tracts within the city's jurisdiction. It also determines the optimal staffing requirement in terms of the number of nurses at each POD. This article includes a demonstration of the model using real data from Cleveland, OH, a mid-sized US city. Examples are provided of data and computational results for a variety of input parameter values such as population throughput rate, POD capacities, and distance limitations. The technique can be readily adapted to a wide range of urban areas.

Author Biographies

William M. Bowen, PhD

Professor of Urban Studies and Public Policy, Maxine Goodman Levin College of Urban Affairs, Cleveland State University, Cleveland, Ohio.

Jen-Yi Chen, PhD

Assistant Professor of Operations and Supply Chain Management, Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio

Oya I. Tukel, PhD

Professor of Operations and Supply Chain Management, Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio


Matthew RA, McDonald B: Cities under siege: Urban planning and the threat of infectious disease. J Am Planning Assoc. 2006; 72(1): 109-117.

Schoch-Spana M: Resilient American communities: Progress in practice and policy. Biosecur Bioterror. 2010; 8(1): 97-98.

Lesperance AM, Olson J, Stein S, et al.: Developing a regional recovery framework. Biosecur Bioterror. 2011; 9(3): 280-287.

SteelFisher G, Blendon R, Ross LJ, et al.: Public response to an anthrax attack: Reactions to mass prophylaxis in a scenario involving inhalation anthrax from and unidentified source. Biosecur Bioterror. 2011; 9(3): 239-250.

Caunhye AM, Nie X, Pokharel S: Optimization models in emergency logistics: A literature review. Socio-Economic Planning Sci. 2012; 46(1): 4-13.

Presidential Policy Directive. Available at Accessed August 2011.

National Research Council: Dispensing Medical Countermeasures for Public Health Emergencies: Workshop Summary. Washington, DC: The National Academies Press, 2008.

Hupert N, Cuomo J, Callahan M, et al.: Community-Based Mass Prophylaxis: A Health Planning Guide for Public Health Preparedness, AHRQ Pub. No 04-0044, Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality, 2004.

Blank S, Moskin LC, Zucker JR: An ounce of prevention is a ton of work: Mass antibiotic prophylaxis for anthrax. Emerg Infect Dis. 2003; 9(6): 615-622.

Zhao B, Coyne D: Walking a tightrope: Are U.S. state and local governments on a fiscally sustainable path? Federal Reserve Bank of Boston Working Paper 13-18, 2013. Available at Accessed September 23, 2013.

Nelson C, Parker AM, Shelton SR, et al.: Analysis of the Cities Readiness Initiative. RAND Health. 2012; 2(1): 17.

Koh HK, Elqura LJ, Judge CM: Implementing the Cities Readiness Initiative: Lessons learned from Boston. Disaster Med Public Health Prep. 2008; 2(1): 40-49.

CDC Guideline: Receiving, Distributing, and Dispensing the National Pharmaceutical Stockpile. A Guide for Planners, Version 9, Atlanta, GA: CDC, April 2011.

Meyer DV, Smith LE, Ahlquist A, et al.: Laboratory response network—Web-based help desk, proficiency testing, and reporting. In Proc AMIA Symp. November 8-12, 2003, Washington, DC. Bethesda, MD: American Medical Informatics Association, 2003: 933.

Mothershead JL, Tonat K, Koenig KL: Bioterrorism preparedness. III: State and federal programs and response. Emerg Med Clin North Am. 2002; 20(2): 477-500.

Mao L, Bian L: Spatial–temporal transmission of influenza and its health risks in an urbanized area. Computers, Environment Urban Systems. 2010; 34(3): 204-215.

Hupert N, Wattson D, Cuomo J, et al.: Predicting hospital surge after a large-scale anthrax attack: A model-based analysis of CDC's Cities Readiness Initiative prophylaxis recommendations. Medical Decision Making. 2009; 29(4): 424-437.

Nelson C, Chan EW, Chandra A, et al.: Recommended infrastructure standards for mass antibiotic dispensing. RAND Corporation Guidelines. RAND, 2008. Available at Accessed May 9, 2014.

Rinchiuso-Hasselmann A, McKay RL, Williams CA, et al.: Protecting the Public from H1N1 through points of dispensing (PODs). Biosecur Bioterror. 2011; 9(1): 13-21.

Baccam P, Willaucr D, Krometis J, et al.: Mass Prophylaxis Dispensing Concerns: Traffic and Public Access to PODs. Biosecur Bioterror. 2011; 9(2): 139-151.

Hupert N, Mushlin AI, Callahan MA: Modeling the public health response to bioterrorism: Using discrete event simulation to design antibiotic distribution centers. Medical Decision Making. 2002; 22(5): 17-25.

Hillier F, Hillier M: Introduction to Management Science. Boston: McGraw-Hill, 2003.

Lindo Systems Inc: Lingo 11. Chicago, IL: Lindo Systems Inc, 2008.

Pavankumar M, Ordóñez F, Dessouky MM: Facility location under demand uncertainty: Response to a large-scale bio-terror attack. Socio-Economic Planning Sci. 2012; 46(1): 78-87.

Ngo VP, Civen RH, Dassey DE, et al.: Using a point-of-dispensing clinic for prophylaxis of meningococcal disease. Biosecur Bioterror. 2010; 8(1): 45-51.

Sox G, Maxymiv K: Exercising the Strategic National Stockpile: Lessons Learned and Tools for Application. Washington, DC: Association of State and Territorial Health Officials (ASTHO), 2004.

Yang J, Lee H: An AHP decision model for facility location selection. Facilities. 1997; 15(9/10): 241-254.

Stein BD, Tanielian TL, Vaiana ME, et al.: The role of schools in meeting community needs during bioterrorism. Biosecur Bioterror. 2003; 1(4): 273-281.

Boscoe FP, Henry KA, Zdeb MS: A nationwide comparison of driving distance versus straight-line distance to hospitals. Professional Geographer. 2012; 64(2): 188-196.

McCullough BD, Vinod HD: The numerical reliability of econometric software. J Economic Literature. 1999; 37: 633-665.

Ablah E, Scanlon E, Konda K, et al.: A large-scale points-of-dispensing exercise for first responders and first receivers in Nassau County, New York. Biosecur Bioterror. 2010; 8(1): 25-35.



How to Cite

Bowen, PhD, W. M., J.-Y. Chen, PhD, and O. I. Tukel, PhD. “Preparedness for Epidemic Disease or Bioterrorism: Minimum Cost Planning for the Location and Staffing of Urban Point-of-Dispensing Centers”. Journal of Emergency Management, vol. 12, no. 5, Sept. 2014, pp. 391-06, doi:10.5055/jem.2014.0204.