White cardboard boxes small enough to fit in a medicine cabinet will be delivered Sept. 23 to the mailboxes and doorsteps of more than 23,000 Boston households.
The packages will be empty, but the purpose of their delivery will be deadly serious.
The parcels will be tangible evidence of how effectively and swiftly antibiotics can be delivered if terrorists attack with anthrax. Boston will be the third US city to participate in such an exercise, pairing mail carriers, police officers, and public-health specialists.
The fake pill boxes will be delivered to every residence in two ZIP codes: 02132, in West Roxbury, and 02118, which covers most of the South End and a sliver of Roxbury.
The exercise will yield clues about how medication could be dispensed during other health emergencies.
"We feel that it is a way to get an initial push of life-saving medications out to residents on a very fast basis and allaying, hopefully, any sense of panic among the public," said John Jacob, acting director of the city's Public Health Preparedness Office.
Since the Sept. 11, 2001, terrorist attacks and the arrival of rogue letters containing anthrax a month later, big cities such as Boston have been engaged in campaigns to prepare for assaults involving biological agents such as anthrax, plague, and tularemia. Antibiotics work stunningly well against those bacteria, but they have to be administered within 48 hours of exposure.
Typically, doctors would be loathe to even consider blanketing a city with drugs without first assessing patients individually. That would change, though, in the midst of a bioterror attack.
"Normally, we prefer to have a health professional do it, but when we're dealing with the prospect that there could be thousands or tens of thousands of deaths and speed could mitigate that, for me and many of my colleagues, the ethical calculus is pretty clear," said Dr. William Raub, science adviser to Mike Leavitt, US secretary of Health and Human Services.
In the event of a biological attack, cities would establish drug-dispensing centers in schools and community centers. In Boston, the city's Public Health Commission would open 30. But because it would take time to get those centers running, health authorities became intrigued by the possibility of using mail carriers to deliver an initial supply of antibiotics. The drug of choice against anthrax would be Doxycycline.
The federal government is underwriting the cost of the exercises, which cost "well under $100,000" each, Raub said.
"The idea is you can hit a lot of households fast," said James Apa, communications manager for Public Health - Seattle & King County, where the first drill was held in Washington state in November. "It actually went quicker than expected; it ran ahead of schedule."
In Boston, more than 30 pairs of US Postal Service carriers and Boston police officers will venture onto the streets of the two ZIP codes at 7 a.m., Sept. 23.
Those two areas were selected because of their diversity and differences. In West Roxbury, the residents tend to be older, and mail is often ferried by vehicles. In the other ZIP code, carriers travel on foot, and, Jacob said, "the Sound End is just a really great, widely varied demographic."
Authorities decided to conduct the experiment on a Sunday, in part because they did not want to disrupt mail delivery on regular service days. They also figured that if terrorists struck, regular mail delivery would stop and people would stay indoors.
Health agencies quickly identified mail carriers as their best option for emergency deliveries, and the Postal Service agreed.
"Getting these medications out to people as fast as possible will be of utmost importance," said Bob Cannon, spokesman for the Postal Service in Boston. "The letter carriers know the streets, they know where the mailboxes are, they know how to walk these routes."
The mail service did have one major concern: the safety of their carriers if they're dropping off medication that could be widely coveted during an emergency. That's why a police officer is being paired with each letter carrier.
The boxes are meant to simulate containers that would carry 20 pills of Doxycycline. Once the drill is completed, recipients of the boxes can recycle them or, Jacob said, save them as a keepsake.
Stephen Smith can be reached at firstname.lastname@example.org.