If there ever is another anthrax attack, the mailman may deliver your antibiotics. Federal health officials are beginning a project in Minneapolis-St. Paul to let letter carriers stockpile a personal supply of emergency antibiotics so they are protected and ready to go deliver aid to the rest of the city at a moment's notice.
"These letter carriers are being asked to put their lives on the line to help their communities," Health and Human Services Secretary Michael Leavitt said Wednesday. By ensuring they are protected first, "the carriers can be ready on short notice to take to the streets."
The project aims to overcome a big hurdle of emergency planning. The government has lots of drugs stockpiled in case of future bioterrorism, but little way to get them quickly to panicked citizens. Leavitt noted that if someone possibly has inhaled anthrax, the chances of survival are best if antibiotic treatment begins within 48 hours.
The U.S. Postal Service came forward, he said, and said "they have people who every day walk to every house." Those carriers could provide "a front-end quick strike," added the Health and Human Services Department's emergency planning chief, William Raub.
But could letter carriers successfully deliver medications to a great number of homes during an emergency, when the carriers might be mobbed? Would they be willing?
To address the first issue, test projects in Seattle, Philadelphia and Boston over the past two years paired letter carriers with police officers on holidays. Carriers volunteered to do double routes, delivering empty pill bottles along with a "This is a Test" flier explaining what was happening. In Philadelphia, 50 carriers reached about 53,000 households in eight hours, Raub said.
As for getting volunteers, the post office and its unions told the government that carriers who stepped up during this kind of emergency would need assurances that they and their families were fully protected.
That led to the idea of letting carriers store enough of the antibiotic doxycycline in their own homes for them and their families. In an emergency, they could start taking the medication while the government raced in more supplies for the rest of the city that the carriers then would distribute.
Some 700 letter carriers who deliver to 20 ZIP codes are eligible for the Minneapolis pilot project. Medical teams will screen volunteers to be sure they are appropriate candidates for a prescription of doxycycline. The carriers would have to be physically fit enough to wear a special anthrax-protective mask while walking their mail routes.
Volunteers receive extensive education, including a prohibition on dipping into their stored doxycycline for any other reason. Raub does not think that is a big threat. In a different test, medication kits went out in advance to emergency responders in St. Louis to see if they would store them probably without using; more than 98 percent of the kits were returned intact.
Leavitt on Wednesday authorized the Postal Service's role in the event of another anthrax attack. Next, the Food and Drug Administration must approve the unusual advanced drug prescribing before the Minneapolis project begins. The FDA's deputy commissioner, Randall Lutter, said the agency would act quickly.
Minneapolis was chosen because of its extensive bioterrorism preparations, Raub said. If the $500,000 pilot project works well, it could be offered to other cities starting next year.
In the fall of 2001, anthrax-laced letters killed five and sickened 17 others.