The 20th anniversary of the terrorist attacks on September 11, 2001, resulted in deep national reflection. Less remembered are the events that began to unfold 7 days later as anonymous letters laced with deadly anthrax (Bacillus anthracis) spores began arriving at postal facilities, media companies, and congressional offices. The first death from inhaled anthrax exposure occurred on October 5, with an additional 4 deaths and 17 infections over the ensuing months.1 The anthrax attacks exposed a health system ill-equipped to respond to acute emergencies. Modernizing the Health System Before 2001, state and local health departments operated mostly during weekday business hours, with limited capacity for coordination.2 State laboratories were largely unable to test for anthrax or other bioterrorism agents. The health care sector was also unprepared, unable to effectively diagnose and treat patients infected with novel pathogens. Hospitals lacked operational plans for a surge response or to initiate crisis standards of care. Before the events of 2001, there was little formal coordination among hospitals and no dedicated strategy for responding to biological and other threats. But after the anthrax attacks, hospitals developed emergency operations plans for a range of scenarios, including bioterrorism and pandemic influenza.3 Key hospital reforms included patient surge plans, interoperable communication systems, and planning for hospital evacuations. Hospitals also organized into health care coalitions to jointly plan for health emergencies and share resources. Enhanced Federal Capacities Federal programs established after 2001 changed the public health landscape. In 2002, the Department of Health and Human Services created the Office of Public Health Emergency Preparedness (OPHEP) to coordinate federal agencies. The OPHEP provided funding for health departments and hospitals for bioterrorism planning. The Pandemic and All-Hazards Preparedness Act of 2006 replaced the OPHEP with the Office of the Assistant Secretary for Preparedness and Response and expanded 2 key grant programs. The Public Health Emergency Preparedness cooperative agreement and the Hospital Preparedness Program provided dedicated funding to health departments and hospitals for human resources and emergency response ...
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", language="en", issn="0098-7484", doi="10.1001/jama.2021.19292", url="http://dx.doi.org/10.1001/jama.2021.19292" }