Since September 11, 2001, the importance of the public health and safety infrastructure has become clearer than ever before. Bioterrorism is the intentional release, or threat of release, of biological agents (viruses, bacteria, or toxins) in order to terrorize a civilian population or manipulate a government. A chemical attack would be instantly obvious, whereas a biologic attack would take days, if not weeks, to become apparent. This distinction is important because in the differences between biological and chemical attacks lie unique requirements for preparedness. A more coordinated approach to bioterrorism is needed that improves and augments current programs. These programs include the national laboratory system, laboratory response network, health alert network, national pharmaceutical stockpile, and national disaster medical system. Some of the most serious preparedness gaps exist within the public health infrastructure, considered to be the backbone of bioterrorism preparedness. The seven priority areas for capacity building at State and local areas are a well-trained public health workforce, timely and accurate laboratory capacity, rapid detection epidemiology and surveillance, accessible and rapid information systems, rapid and secure communications systems, routine assessment of policy and evaluation, and preparedness and response mechanisms to develop and test plans. Vaccine development and use in bioterror-related events have called into question several legal and regulatory issues. Most drug makers have not heavily invested in research and development of vaccines. Options for improving vaccine and medicine availability include public-private partnerships, partnerships with other countries, and partnerships with Defense Department research facilities.