• Theoretically, biological agents can be genetically altered to escape detection.

• Dangerous biological agents require no precursors for development, unlike chemical and nuclear agents, and a covert program is much more difficult to detect.

Before 1990 little thought was given to the possibility of a biological terrorist attack on U.S. cities. Even as recently as 1997, the U.S. Department of Defense spent only $137 million on biodefense to protect the deployed force, while academia, industry, local governments, and the rest of the federal government were in some cases doubtful about the threat of biological terrorism.

Since fiscal year 2000, the United States has committed billions of dollars to military biodefense and to domestic preparedness for biological attack. The federal government has formed the U.S. Department of Homeland Security, a number of university medical centers have received funding for developing research programs in biodefense, and state and local governments have become proactive in developing and implementing emergency preparedness and disaster response plans to counter terrorism.

At the request of the Illinois Department of Public Health, a proposal was developed primarily by the University of Illinois for a statewide bioterrorism plan. In 2002 a number of leading universities were designated as Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases by the National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health,² and charged to develop emergency preparedness and disaster response plans. The first year focused on needs assessments and planning activities. The centers of excellence coordinated the needs assessments for nongovernmental health care entities. Upon completion of assessments, the health care entities and the Illinois Department of Public Health received reports on their emergency and terrorism preparedness.

With the assistance of centers of excellence and the Illinois Department of Public Health, all health care entities developed uniform clinical protocols for clinical interventions for biological, chemical, radiological, nuclear, and explosive acts of terrorism. They developed a syndromic round-the-clock surveillance system in Illinois for uniform reporting of diseases from hospital emergency departments to the Illinois Department of Public Health. Finally they integrated