The challenges are to assess how great a threat particular agents pose, and improving the Nation’s surveillance and response capabilities. Successful preparation will depend upon the development of a well-orchestrated plan to be used by the civilian personnel first responding to an event. For biological terrorism, first responders will be epidemiologists, infections disease experts, emergency room personnel, and critical care unit personnel. The traditional first responder community for chemical or explosive events would be complementary but not central to the management of an epidemic caused by bioweapons. The Institute of Medicine (IOM), in conjunction with the National Academy of Sciences’ Commission on Life Sciences, produced a report called Chemical and Biological Terrorism: Research and Development to Improve Civilian Medical Response. This report identifies more than 60 research and development projects potentially useful in minimizing damage caused by a terrorist attack, and discusses steps that could be taken to improve capabilities of public health departments, poison control centers, and metropolitan police departments. Biological agents that are considered to be priority threats are bacteria, viruses, and toxins. Detecting and isolating these agents requires the ability to identify and diagnose uncommon diseases and a surveillance system for collecting reports of such cases. Experts all agree that States are not prepared to respond to a bioterrorist event. Preparing to meet the needs of civilian victims will require the coordination of the health care community as a whole, as well as of many other organizations, experts, and agencies at all levels of government. Congress has appropriated funds for bioterrorism and related public health infrastructure activities, such as development of an overall preparedness plan, and developing national response capabilities.1 table, 6 endnotes