Since the anthrax attacks of 2001, there has been no comprehensive published analysis of the medical and public health response to these events. This article describes aspects of the medical and public health response based on interviews with individuals who were directly involved in the response. The authors interviewed clinicians, public health professionals, government officials, journalists, union representatives, and others who were directly involved in the five geographical areas where the anthrax attacks took place. A total of 37 persons were interviewed. This article does not focus on the actions taken by individual hospitals, the Centers for Disease Control and Prevention (CDC), the Federal Bureau of Investigation (FBI), the Department of Health and Human Services (DHHS), or other Federal agencies, but rather presents the specific challenges and successful strategies that interviewees had observed or identified during the response to the attacks. These issues include: the traditional public health decisionmaking processes were not adequate to cope with the extent, pace, and complexities of events surrounding the attacks; city, county, and State health officials within States, and across State borders, had difficulty acquiring and sharing information; the lack of anthrax experience at the CDC left the CDC and State local public health agencies with an array of scientific uncertainties; public health guidance was not being issued fast enough to guide many necessary clinical decisions; strategies for responding to the media were not in place; and the public health system lacks sufficient personnel, resources, and operational systems necessary to respond to attacks of this magnitude. In conclusion, the interviews revealed several themes that might usefully be considered by those responsible for bioterrorism preparedness and planning. These include: expectations about Federal, State, and local public health responsibilities require clarification; medical preparedness requires better communications among physicians and between medical and public health communities; the public and the media must recognize that response to bioterror attacks will evolve; health officials must prepare to handle the media storm; and public health resources are barely adequate for a small-scale bioterror attack. Footnotes and a chronology of key events following the attacks