The events of September 11, 2001, marked by the airplane attacks on New York City and Washington DC, were followed just days later by the spread of anthrax spores in both greater New York and greater Washington. The latter incidents, which infected 22 persons and which killed five, brought into specific relief a subject that had not been unknown in the health-care community but that also, as it turned out, not been any more adequately conceptualized than had 9/11: bioterrorism. Indeed, despite evidence of a growing body of professional research on bioterrorism before 9/11, as well as evidence of attempts by some policy makers to address issue fronts it raised during the 1990s, what happened with the anthrax scare was that such research had by no means been adequately operationalized by the vast majority of health-care practitioners or public-policy officials. Still less had bioterrorism entered popular discourse, although that would shortly change. Bioterrorism has now passed into the post-9/11 language and culture, but it remains a somewhat arcane subject. In that connection, it is worth noting that while the criminals who murdered the 2,976 people at the World Trade Center, the Pentagon, and the field in Pennsylvania were identified more or less expeditiously, the source of the anthrax murders has as of March 2004 never been found (Chen, 2004).
Discourse of bioterrorism anticipates the targeting of civilian as well as military populations, and bioterrorism as both concept and possibility affects American health care decisively today. Typically, the term is associated with the use of organic (biological) and inorganic (chemical) agents as weapons against the health of the nation's population, although the protocols for responding to chemical and biological attacks differ. For example, whereas a chemical agent, such as a hazardous-waste spill, might involve law enforcement and firefighters, a biological agent is more likely to invol...