In a recently completed study, we looked into various emergency responses to an airborne anthrax attack and concluded that the United States is woefully unprepared. Two pounds of weapons-grade anthrax dropped on a large American city could result in more than 100,000 deaths, even if early cases were successfully diagnosed, antibiotics were distributed broadly and drug adherence was high. The reason for the catastrophic death toll: Not enough people would receive antibiotics quickly enough to prevent symptoms from developing, and those who developed symptoms would overwhelm the medical facilities.
Although the U.S. government promises to get antibiotics to any local airport within 12 hours, cities vary widely in their ability to move these antibiotics from their airports into the mouths of their citizens. There are several options for rapid distribution of antibiotics. We could distribute them within six hours of an attack -- after all, if we can vote in a day, we should be able to hand out pills in a day -- through pre-processing of contraindication data and disclaimer forms, local storage of antibiotics and police-escorted mail workers (or having points of distribution partially manned by nonmedical professionals).
We have already dodged one bullet: Had the 10 grams of weapons-grade anthrax from the 2001 attack been airborne rather than mailborne, 10,000 people could have died, even with rapid antibiotic distribution. It is time for a credible national response to anthrax. The government must close this window of vulnerability in our homeland.