An attack on the United States using weaponized anthrax — although considered a low-probability event — would have a high impact on the affected communities. If left untreated, the death rate for those who inhale anthrax is more than 99 percent, according to the Military Vaccine Agency.
Anthrax, an acute infectious disease caused by spore-forming bacteria, can be used for biological warfare because the spores can be spread using missiles, artillery, aerial bombs and other methods, making it easily airborne. The good news is that oral medications can be used to treat people who have been exposed; however, the medication must be administered within 48 hours of infection. A bioterrorist attack would likely take place in a large, metropolitan area, and depending on wind speed and direction, the spores could travel hundreds of miles.
In response, state and local health departments are prepared to set up mass dispensing sites to distribute medication from the Centers for Disease Control and Prevention’s (CDC) Strategic National Stockpile to people who may have been infected. But the federal government sought additional methods to dispense the medical countermeasures, and in its planning found a partner in a program that visits nearly all U.S. residences Monday through Saturday — the U.S. Postal Service (USPS). The plan was put on the federal front burner in December 2009 when President Barack Obama signed an executive order stating: “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.” The order gave the USPS and U.S. Department of Health and Human Services (HHS) 180 days to create a national dispensing model for U.S. cities to respond to a large-scale anthrax attack.
The result was a program — the postal plan — that uses the nation’s letter carriers to deliver medical countermeasures. “The postal plan puts letter carriers on the street to deliver medications in the event of such an attack,” said Peter Nowacki, a USPS spokesman in Minneapolis. “Mail delivery would be curtailed, and they would just be going house to house delivering the medication along with information sheets telling people how to take the medication or whether they could take the medication.”
The postal plan was identified as a viable delivery method following an anthrax attack, because postal workers would be doing their everyday job, but with a different material.
“It’s something that enhances the existing capabilities to do the distribution and goes further to helping protect our American people in the event of this kind of crisis,” said John Koerner, chief of the Chemical, Biological, Radiological, Nuclear and Explosives Branch within the HHS’ Division of Preparedness Planning.
The “postal plan,” as people working on the initiative call it, is being tested in the Minneapolis/St. Paul area for locations within the ZIP codes beginning with 551 and 554. The plan is part of the CDC’s Cities Readiness Initiative (CRI), which enhances preparedness in the nation’s largest metropolitan areas and has developed a set of strategies for the rapid delivery of preventive medication to people living in major metropolitan areas following a biological attack. Although the executive order was issued in late 2009, the CRI began in 2004. Cities are selected based on criteria, including population and potential vulnerability to a bioterrorism threat.
Preparing the Nation
The question that comes to many minds is why focus on anthrax when there’s a broad spectrum of potential biological weapons. “The CDC has identified a criteria list of certain agents that we could anticipate being used for such purposes,” Koerner said, “and some of the intelligence and other information we have suggest that if one is going to be used, anthrax is, for a number of reasons, probably the likeliest agent.”
Before the president called for the creation of a national dispensing model in 2009, proof-of-concept exercises had been conducted in Boston, Philadelphia and Seattle. During the exercises, letter carriers delivered mock antimicrobial agents to 20,000, 40,000 and 50,000 separate housing units in each jurisdiction, Koerner said.
“The process went well, and it took only about six to nine hours for them to cover their route and make sure all those folks — the 20, 40 and 50 thousand — received their mock antibiotics in a timely fashion,” he said. “The proof of concept showed that it can work.”
The planning regiment that was used in the drills was applied to the Minneapolis/St. Paul area’s postal plan. USPS representatives visited some post offices within the 551 and 554 ZIP codes and spoke with managers, letter carriers and delegates from the letter carriers’ union to outline the program and its expectations, as well as enlist volunteers to participate in the pilot, Nowacki said.
Before the volunteer postal workers began training, they completed a medical screening to ensure that they could ingest the antibiotics and were fitted for safety equipment. Volunteers were trained on what types of safety equipment to wear; where they’d report if called upon to distribute the medication; what their specific assignments would be; and the procedures for obtaining the medication, loading it into their vehicles and how to deliver it.
About 400 people — including letter carriers, USPS supervisors and public health representatives — in the Minneapolis/St. Paul area are participating in the pilot program, Nowacki said.
Collaboration Is Key
Jude Plessas, executive manager of counter- measures delivery and distribution at USPS Headquarters, stressed that this project requires collaboration and participation from all the
parties involved. “If one party decides that they’re not interested in pursuing this, we basically have to pick up our tents and go home,” he said. “But what we saw in Minneapolis/St. Paul was really an extraordinary collaboration between the Postal Service, Health and Human Services, the public health departments — principally the Minnesota Department of Health, which is the regional planning lead — and also law enforcement agencies, because we require security for our volunteer carriers as they’re performing this mission.”