how about them apples all fit in her puss?
The Postal Model
The Cities Readiness Initiative (CRI) is a federally funded effort to help major U.S. cities and metropolitan areas respond effectively to large-scale bioterrorist events such as an anthrax attack (CDC, 2010a). Through the CRI program, state and large metropolitan public health departments develop plans to dispense antibiotics to the entire population of the metropolitan area within 48 hours. This is generally assumed to be the time window following an attack during which people must receive prophylactic antibiotics in order to prevent deadly inhalational anthrax. The CRI project began in 2004, and 72 cities and metropolitan areas are currently funded under the program, with at least one in each state.
The U.S. Postal Service (USPS) is working with select CRI cities to develop dispensing plans in which postal carriers who volunteer to participate in the program will deliver antibiotics to residences in certain zip codes. This model builds on the existing capability of the USPS to service every residential address in the country. The postal model is intended to increase the speed of medical countermeasures dispensing, and to supplement local capacity and as well as reduce the population surge at points of dispensing (PODs) while they are being set up. The current intent of the model is not to replace the need for PODs. Ten million dollars were appropriated to HHS in the 2010 fiscal year to support the delivery of medical countermeasures; of this, up to 8 million dollars could be transferred to USPS. The funding was to remain available over a two-year period.
In 2006 and 2007, operational drills were conducted in Seattle, Philadelphia, and Boston. Results from these drills led to the development of a comprehensive pilot of this model in Minneapolis–St. Paul. Through extensive analysis, the Minnesota Department of Health discovered that they could not meet the 48-hour requirement by relying on more traditional mechanisms of medical countermeasures dispensing such as PODs that require the public to attend the POD to receive the countermeasure. Instead, their analysis showed that a push mechanism was required, that is, a process of actively pushing medication out to the population.
The development of the pilot program in Minneapolis–St. Paul involved collaboration among many stakeholders, including the state department of health, local public health, local and state law enforcement in Minnesota, the National Guard, HHS, the CDC, USPS, and the FDA. This section describes some of the challenges faced in developing the pilot, lessons learned, and solutions developed to address these challenges. It also highlights several areas for future work. First, however, the section briefly highlights recent developments related to the postal model.
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Recent Developments
On December 30, 2009, President Obama signed an Executive Order concerning medical countermeasures following a biological attack (The White House, 2009). The order outlines what needs to be done to establish the federal government’s ability to provide medical countermeasures, in a timely fashion, after a biological attack such as anthrax. To do this, it mandates the establishment of a national USPS medical countermeasures dispensing model within 180 days of the date of the Executive Order. Also included are the directives to establish what needs to be done for a federal rapid response and a corresponding concept of operations, with the development of an accompanying plan to supplement, as necessary, local law enforcement personnel serving as security escorts with local federal law enforcement.
The expansion of the Postal Model for dispensing medical countermeasures has also been included in legislative proposals. In September 2009, Senator Joseph Lieberman introduced Senate bill 1649, the WMD Prevention and Preparedness Act of 2009, “a bill to prevent the proliferation of weapons of mass destruction, to prepare for attacks using weapons of mass destruction, and for other purposes.” If passed, it would direct the HHS Secretary to expand the Postal Model pilot program. This language also appeared in a House bill, H.R. 5057, The WMD Prevention and Preparedness Act of 2010. However, as of the writing of this report, neither of these legislative proposals had been taken up by the Senate or House, respectively, as a whole.