A qualitative analysis of iodine prophylaxis predistribution as a viable strategy in nuclear emergency preparedness

Off-site nuclear emergency preparedness and response plans have conventionally focused on sheltering, stable iodine prophylaxis, and evacuation of residents as the primary short-term protective actions. Among these, the effectiveness of administering stable iodine prophylaxis has been affirmed over the years, by its ability to reduce intake of radioiodine and minimize the incidence of thyroid cancer in the administered population. The hypothesis of this study was that an advance distribution of prophylaxis, also called predistribution, to households during the preparedness stage is justified. To validate this hypothesis, we carried out a systematic literature review of existing studies on this topic. We also used multi-attribute utility theory to select relevant literature as per the criteria specific to this study. A detailed qualitative analysis was carried out to find the evidence that either substantiated or disproved our hypothesis. We found that over the years, there has been a steady increase in the number of articles advocating a predistribution strategy, especially following nuclear accidents. The most commonly held views against predistribution were as follows: (i) it would lead to accidental ingestion or possible overdose, (ii) it would be misplaced and not serve its purpose at the time of emergency, and (iii) it would not be cost-effective to implement such a distribution. The most common arguments supporting the hypothesis were as follows: (i) it offered maximum effectiveness as it could be immediately administered upon declaration of emergency, (ii) it reduces risk to the first responders who may otherwise be involved in distribution, and (iii) it serves as a last mode of radiation protection when consumed immediately and all other protective actions fail. This study found overwhelming evidence in support of the hypothesis, and hence, we suggest that a predistribution strategy for prophylactics is justified on the grounds of effective and timely radiation protection.