will probably also require recruiting more expertise, which requires both money and time. Local medical care surge capacity—including personnel, training, space, supplies, and equipment—must be strengthened. Hospitals are nowhere near being prepared to take on the tens to hundreds of thousands of mass casualties expected in the event of a large bioterrorist event. Equally important is the frontline health care responder who will likely be the one to sound the alarm. To this end, first responders must be adequately trained to recognize the symptoms of the various bioterrorist infectious agents. Real-time response role-playing exercises based on probable biological attack scenarios would be helpful in such planning.
Coordinating bioterrorism operational planning among jurisdictions, including with every hospital, will be a significant challenge since state level health departments have limited leverage to make this happen. One suggestion is to apply a model plan to be disseminated to local jurisdictions where it can then be adopted and exercised. It was recommended that jurisdictions share best practice information and new systems be integrated with systems that are already in place.
Julie L. Gerberding,* M.D., M.P.H.
Acting Deputy Director, National Center for Infectious Diseases, Centers for Disease Control and Prevention
We are learning many lessons from the recent anthrax events. By reviewing the behind-the-scenes processes as the investigation unfolded, we can identify conspicuous gaps and evaluate what needs to be done to strengthen our biodefense response capabilities.
The response to the recent events can be divided into overlapping stages. The first stage was initial detection of the threat and the immediate response to what was happening. This included case detection by astute clinicians, presumptive laboratory diagnoses, and evaluation of suspicious powders. Laboratory confirmation rapidly ensued, both in laboratories within the LRN and at CDC. One of the strengths of our response was the rapid deployment of personnel, antimicrobials, and other assets in response to requests from state and local health departments, which occurred within hours of detection or confirmation of events.
In the next stage, full-scale investigation and prevention interventions were priorities. This included post-exposure prophylaxis, building closure, environmental sampling and criminal investigation in addition to traditional epidemi-