In case of an anthrax attack, Boston will take city services to a new level: Most residents can expect next-day delivery of antibiotics right at their front doors. But commuters, college students, hotel guests, prisoners, and even those living just outside the city limits will require contingency plans.
On Wednesday, about 130 public health, public safety, and communications officials gathered at the Boston Convention and Exhibition Center for a so-called “tabletop exercise’’ on the “Boston Postal Plan,’’ a little-known strategy that would use local letter carriers to distribute initial doses of oral medications following a bioterrorism attack. The session provided an unusual window into the kind of elaborate planning local governments have to conduct in an age of terrorism.
Yet while it’s reassuring to know that these exercises are going on before a specific threat emerges, it’s also noteworthy that emergency planning suffers from some of the usual pitfalls of government in Massachusetts — for instance, the kind of local control that ensures that even good policies end at municipal limits.
The postal plan would augment, not replace, mass dispensing sites needed in the wake of an attack. Boston is one of just five cities around the country that are piloting the strategy.
Many American cities, including Boston, use sensors to monitor pathogens in the air. In the fictionalized scenario presented at the exercise, state public health officials discover Bacillus anthracis spores in three filters from downtown Boston. A few hours later, according to the scenario, Boston Police discover an abandoned truck containing equipment used for the aerosolized release of anthrax spores.
The exercise raised — but did not fully answer — serious questions about access to life-saving medications. Bostonians may breathe somewhat easier knowing that the Postal Service, with the aid of the Boston Public Health Commission, could deliver medication the next day to any or all sections of the city.
But the plan suffers from an exclusive focus on Boston zip codes. In the summer, winds in Boston generally blow from the southwest. That would put cities and towns to the north and northeast of downtown Boston at greater risk than many neighborhoods within the city limits. The Boston Postal Plan wouldn’t serve them — or suburban commuters who are exposed while downtown, or the students, nursing home residents, and others whose mail is delivered to centralized locations in the city.
“You have to serve everyone fairly,’’ said Ronald Bearse, an observer of the exercise and member of the nonprofit Northeast Disaster Recovery Information X-Change, which provides crisis management for businesses.
Health officials stress that there is an ample national stockpile of medications available in case of a bioterrorism attack and existing plans to supply drugs through dispensing sites across the region. Part of the rationale of the postal plan is to reduce the number of people who would rush to such “pods’’ to secure medication. That makes good sense, logistically and medically.
But participants at the tabletop exercise acknowledged the difficulty of explaining that some people would receive medicine in their homes, while others would be expected to report to dispensaries. Federal officials, meanwhile, aren’t eager to intervene. “Decisions on distribution are all local,’’ explained Edward Gabriel, principal deputy assistant secretary for Preparedness and Response of the US Department of Health and Human Services. “We are supporters and helpers.’’
Public information officers offered various strategies to inform and calm the public. The order of appearance at the initial press conference following an attack already has been worked out: Mayor Menino appears first because he’s the “face of the city.’’ But other communication challenges remain. Postal Service officials worried that some people might be spooked by pill-bearing mail carriers because the mail was the chief vehicle of transmission during the 2001 anthrax attacks that killed five people and sickened more than a dozen others.
The Boston Public Health Commission intends to convene federal, state, and local officials next year for a follow-up exercise. It will focus more on regional responses to bioterrorism and the city’s plan to supply Boston colleges and other institutions with necessary medications in the event of attack. The commission has shown real leadership by stepping up as one of the pilot cities for the postal plan. But by doing so, it bears responsibility for showing that access to life-saving medication isn’t as arbitrary as one’s address.