The US Postal Service could dispense antibiotics to the homes of civilians in the event of a bioterrorist attack.
The U.S. Postal Service (USPS) is working to develop dispensing plans in which postal carriers who volunteer to participate in the program will deliver antibiotics to residences in certain zip codes. Bio-threats such as Anthrax, widely believed to be the most likely bioterrorist threat in the U.S. today, can be treated with certain antibiotics, generally referred to as medical countermeasures (MCMs). To be effective, these countermeasures generally must be delivered in very large quantities in a short period of time. For example, in the event of an outdoor release of aerosolized anthrax over a wide geographic area, hundreds of people would need prophylactic antibiotics within 48 hours of exposure to prevent deadly inhalational anthrax. Given the number of potential biological threats, an extensive array of different medical countermeasures are needed to protect the public against these agents. This in itself is a huge challenge, but the delivery of MCMs to those who need them during a public health emergency has been identified as a major challenge facing the medical and public health community. The U.S. Postal Service is ideally placed to facilitate the dispersal of the MCMs. According to the Dept. of Health and Human Services, “The U.S. Postal Service has the capacity for rapid residential delivery of medical countermeasures for self-administration across all communities in the United States”. They have the vehicles, manpower and logistical knowhow to get the antibiotics to households swiftly. Having a door-to-door delivery system would also greatly reduce the traffic and potential chaos that might occur if people had to go to central locations to get them.
Funding to explore the feasibility of the postal model came out the Cities Readiness Initiative, a federally funded program established in 2004 to enhance the ability of American cities to effectively respond to a bioterrorist attack. In 2009, President Obama signed an executive order to create a national postal model for distributing medical countermeasures in response to a bioterrorist attack. Earlier this month, public health officials in Minnesota conducted Operation Medicine Delivery, a full-scale exercise using 300 mail carriers to delivery empty pill bottles to 37,000 households. Officials said the exercise went well.As for the mail carriers themselves, participation in the postal model would be completely voluntary and those who opt to participate would make their rounds with a police escort. According to Jonathan Purtle of the Philadelphia Inquirer, the results from Minnesota suggest that a sizable portion of the postal workforce are ready and willing to be public health heroes; 385 carriers volunteered for the recent exercise- 80% more than would be needed for the region.To ensure postal employees deliver in a real emergency, volunteers and their families would need to be provided with MedKits containing antibiotics to keep in their homes. This is consistent with research carried out in 2007, which reported that responders are more likely to stay on duty if they are sure their own families are protected.
The National Postal Model is a promising and innovative method of quickly and cheaply dispensing MCMs during a public-health crisis, and a unique response asset. There are still many issues both logistically and ethically that must be ironed out, deliberately sending civilian personnel (voluntarily or otherwise) into a potential anthrax zone is certainly one of them, but perhaps the biggest challenge for this model is the survival of the U.S. postal service itself. Close to bankruptcy, the USPS is currently going through major restructuring and has made 28,000 staff redundant, largely due to intense competition from the private sector. The implications of this restructure for public health matters are as yet unclear. It is likely that the proposed streamlining of the USPS, which is deemed necessary for its survival, will undermine its ability to assist in a public health crisis. This may be a secondary concern, however, for a publicly funded organisation that is losing $36 million a day.
Sources: Philadelphia Inquirer, DHHS, NCBI