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U.S. Department of Health and Human Services

The Last Mile: A Pilot Project

In the event of a large-scale biological attack, the U.S. federal government has a challenging task: dispensing lifesaving antibiotics and other medicines as quickly and efficiently as possible. Partnering with state and local governments as well as industry is critical to accomplish this mission. The Last Mile Project is a collaborative effort within ASPR to examine new initiatives and improve existing processes.

The Last Mile is piloting distribution and delivery efforts in seven major U.S. cities, and promotes collaboration in these jurisdictions with several federal and private partners to ensure all levels of government are prepared to respond if such an attack occurs.

The Last Mile addresses the distribution and dispensing of oral antibiotics, and staffing challenges, which is the most frequently identified gap. Building on the work of the Strategic National Stockpile and the CDC Division of State and Local Readiness, innovative distribution and dispensing strategies are under development for both the state and local levels. The Last Mile is establishing public-private partnerships with hotels in targeted cities to help dispense emergency medications during public health emergencies.
Pills and a syringe


The Last Mile is exploring methods and modalities, and executing plans, in five areas:

  • Enhance response operations by providing medical countermeasures directly to mission-critical federal employees and, where feasible, establishing federal closed points of dispensing (PODs)

  • Leverage the well-established logistics systems of residential delivery for distribution, while diminishing demands on state and local public health authorities; efforts include pursuing mail order pharmacies and other possibilities

  • Engage the private sector, including big box stores, pharmacies, and the hospitality industry, to collaborate with local public health authorities and create a force multiplier for the distribution and dispensing network

  • Assist state and local authorities to pre-position centrally located caches of medical countermeasures for specifically identified groups, such as first responders, critical infrastructure personnel and their families, and isolated or immobile populations

  • Supplement the workforce in affected areas with members of the federal workforce in the likelihood state and local public health officials and support staff are insufficient

7 Jurisdictions:

  • Los Angeles
  • San Francisco
  • Chicago
  • Denver
  • Kansas City, Missouri
  • New York City
  • Washington, D.C.

​​Federal Partners:

  • Department of Defense
  • Department of Justice
  • Department of Interior
  • Department of Homeland Security
  • Department of Veterans Affairs
  • General Services Administration
  • Office of Personnel Management
  • Other agencies of the Department of Health and Human Services

  • This page last reviewed: April 03, 2019