Experts have been warning of the threat of a biological attack on the United States for m any years. In the aftermath of the 2001 anthrax release, various agencies within the Federal government initiated a series of program s intended to prevent incident s and ameliorate the perceived threat. State and local first responders have also invested heavily in systems and mechanisms for responding to an unanticipated disease outbreak. Private sector actors (hospitals, doctors, vaccine providers, and others) have mobilized to enhance their readiness, resilience, and capacity to respond. After nearly 10 years of political, legal a nd practical ferment, many have recognized the need to take stock of our efforts thus far and to assess how effective they have been.