A report [1] published Friday examined U.S. government programs in place to respond to a bioterror attack and the threat of anthrax as a weapon. The report, based on findings from a study conducted by the Institute of Medicine, said that an effective response to a large-scale anthrax attack would require planned coordination on a local level and the ability to get antibiotics to those affected.

With similar ideas in mind, the President signed an executive order [2] in 2009 directing Health and Human Services (HHS), the Department of Homeland Security, and the U.S. Postal Service (USPS) to come up with a system for U.S. cities to respond to a bioterror attack by dispensing antibiotics and implementing other countermeasures.

The Centers for Disease Control and Prevention’s (CDC) Cities Ready Initiative (CRI [3]) has been exploring the potential for using this type of system to deliver oral antibiotics in the aftermath of a bioterrror attack. The CRI is a federally funded effort to prepare major U.S. cities and their surrounding metropolitan areas to effectively respond to a large scale bioterrorist event by dispensing antibiotics to their entire identified population within 48 hours of the decision to do so, according to the CDC Web site. Within that initiative, the plan is to use the USPS because it already has the resources and is an organization that already delivers routinely directly to households.

The USPS has the capability to deliver mail to every residential address in the country, allowing it to rapidly distribute initial doses of antibiotics to a large area in a short amount of time. The program would rely on existing postal workers who volunteer for the duty.

A pilot for the program in the Minneapolis-St. Paul area estimated that 179 volunteer carriers, each covering two routes, could distribute required medicines to 575,000 people in 205,000 households in a regular working day. These volunteer carriers would already have a supply of medicines for themselves and their families so they could administer them and immediately head out should they be called upon in an emergency. This type of distribution of antibiotics by postal workers would be a supplement to help reduce strain on preset distribution sites.

One problem with relying on the postal service going forward is that the USPS has its own financial woes, which have led it over the past four years to reduce its workforce by 110,000 employees. The postal service is also discussing closing thousands of local offices and reducing delivery days, all of which could limit its ability to fulfill any agreement to deliver antibiotics in an emergency.

Officials say there won’t be any impact, however. Jude Plessas, countermeasures distribution and delivery manager at the USPS, explains:

“When it comes to delivery, we’re required to provide universal service and delivery to every address. If there’s a consolidation in a particular city, that doesn’t affect the way deliveries are taken care of,” he said.

“Typically with post office closure, you’re dealing with retail and the interface with the public at the counter. That’s not what the postal model relies on. Our reliance is actually on the residential delivery of these medications. As long as universal service remains our mandate, we won’t see that affect our reach as far as delivery is concerned.”

In fact, despite bleak postal service headlines, the program seems to be progressing at a steady pace under federally supplied grants. Minneapolis-St. Paul has a plan in place that would allow it to respond in 20 zip codes and in Louisville, Kentucky, the USPS is in the process of putting together a volunteer corps that would cover 23 zip codes in Kentucky.

Within a year’s time, USPS hopes to be operational (having people screened, trained, and ready to respond) in San Diego, Philadelphia, and Boston.

“The model can be applied anywhere, but right now we’re going where we have the grant money to go. It’s a bottom up approach. We want to integrate our response with local and state public health response so it supplements what they already have in the can,” Plessas said.

“This program’s continued existence depends on continued funding….So as long as we continue to see funding we’ll be able to maintain our presence in cities where it’s been deployed and hopefully expand out,” he said.

For more information, see the National Postal Model for the Delivery Of Medical Countermeasures [4].

photo by Noize Photography/flickr [5]

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