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An intentional release of infectious agents in theUnited States could cause mass casualties, resultingin significant morbidity and mortality, societal disruption, and long-term human and economic hardship. The strain that such events could place on themedical infrastructure would likely be unprecedented. Project BioShield, signed into law by President George W. Bush on July 21, 2004, is the mostprominent of various legislative acts and programsdesigned to address national preparedness for biological terrorism. The authors review the effect ofProject BioShield on preparedness measures in theUnited States. They also examine the shortcomingsof that law and discuss other biological preparednesscountermeasures now under consideration. Finally, they offer recommendations on how primary careand emergency department physicians, as well asother public health providers, can best improve theirown skills at preparing for, recognizing, andresponding to incidents of biological terrorism.

Preparedness for Biological Terrorism in the United States: Project BioShield and Beyond