Unknown to many Americans is the emergency preparedness initiative of the Departments of Homeland Security and Health and Human Services for a potential outdoor anthrax attack in key cities.
The program, the
Cities Readiness Initiative (CRI) uses United States Postal Service (USPS) carriers in the event of an anthrax attack. The program is a federally funded initiative that was launched in 2004. It originally targeted twenty one, and subsequently fifteen more, vulnerable cities and metropolitan regions that were considered to be likely targets for a bioterrorist attack. The goal of CRI is to rapidly dispense medication to entire populations. Among the initial set of cities were Atlanta, Baltimore, Chicago, Detroit, Cleveland, Washington, D.C., New York, Philadelphia, and St. Louis. An additional 36 cities were identified in 2006, including sites such as Birmingham, New Orleans and Richmond.
Under the
program the cities identified are to develop plans for the mass dispensing of drugs to 100% of the area within 48 hours when a decision is made to do so. Under normal circumstances people would be encouraged to get to a point-of-delivery (POD) facility to receive medications. POD’s are considered a “pull” modality since people are pulled or encouraged to go to a facility. The other method of getting medications to the affected public is through a “push” modality that involves delivering the drugs to the party in need. The Department of Health and Human Services has identified several alternative methods of delivery that could help states and localities achieve the 48 hour dissemination target. They include:
1. Home delivery of antibiotics by the United States Postal Service (USPS)
2. Pre-deployment of community-based caches of medications
3. Pre-event dispensing to first responders
4. A home MedKit
The Postal plan, MedKit and pre-dispensing are all “push” modalities because it entails delivering the medications out. Under the USPS contingency mail carriers will deliver antibiotics to all homes in selected zip codes. Recently Secretary of Homeland Security Michael Chertoff and HHS Secretary Mike Leavitt invoked their authority under section 564 of the
Food, Drug and Cosmetic Act to trigger the Food and Drug Administration (FDA) to consider authorizing eligible postal carriers to receive kits containing small quantities of antibiotics for future use. The idea is that postal carriers would medicate themselves and then deliver medications to residences in their communities. It is a voluntary program for mail carriers. HHS Secretary stated:
“In an anthrax attack, time is of the essence in preventing illness and death by getting antibiotics to those who may have been exposed. By providing advance protection to letter carriers who volunteer to deliver antibiotics in an affected community, we can gain the benefits of the unique capabilities of the Postal Service to get much needed medicines to those who need it quickly. This is one part of our strategy to encourage preparedness at all levels of government to enable our nation to respond effectively in the event of an anthrax emergency.”
HHS and the USPS have developed and tested the capacity to have mail carriers quickly deliver quantities of antibiotics from the Strategic National Stockpile door-to-door in residences in targeted communities in Seattle, Philadelphia and Boston. The idea is to buy time for state and local public health officials to set up points of dispensing for further distribution of antibiotics across communities.
Postmaster General John E. Potter said:
“The letter carrier has long been a reliable presence in America's neighborhoods. This important and potentially lifesaving undertaking is a natural extension of what the carriers see as a service to their community.”
The pre-deployment plan would involve the delivery of antibiotics to churches, schools, large employers or fraternal organizations. Pre-event dispensing would involve issuing antibiotics to critical personnel and/or volunteers in advance. The home MedKit project involves testing participants to determine if they can follow instructions on proper storage, maintenance and use of a MedKit containing antibiotics.
HHS Secretary Leavitt also recently issued a declaration under the
Public Readiness and Emergency Preparedness Act (PREP Act) that provides liability protection for activities related to developing, manufacturing, distributing, prescribing, dispensing, administering and using anthrax countermeasures in preparation for, and in response to a potential anthrax attack. The action is meant to protect retail stores, pharmacies and other businesses that help deliver and distribute medicines.
