Bioterrorism has become a household word. For years experts have warned of the potential of bioterrorist events, and today we have finally experienced the reality of this particular horror. As the nation garners resources to combat current and future bioterrorist activity, questions and debate arise as to the appropriate allocation of resources. Most funding appears targeted toward vaccines and medical supplies with little focus on the underlying public health infrastructure. However, it is the infrastructure-the organizations and people who comprise the nation's public health system-that will ultimately determine the success of any efforts to fight the spread of infectious diseases, including those resulting from bioterrorism. Within the overarching infrastructure, it is the nation's capacity to conduct infectious disease surveillance-detecting unusual disease patterns, investigating sources of outbreaks, and triggering control efforts-that will play the greatest role in our success or failure in combating infectious diseases.

In light of ongoing concerns about the nation's public health infrastructure and infectious disease surveillance capacity, we undertook a study to identify gaps in the system and specific areas in need of improvement. We performed this study on behalf of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services. Given recent events, we believe it is important not only to present the gaps in the system as identified by our study, but also to provide readers with a context and framework for discussing surveillance activities. This Commentary presents a discussion of the goals of infectious disease surveillance, a framework for understanding and discussing the U.S. public health infrastructure in which surveillance occurs, and the results of our analysis on gaps in the infectious disease surveillance system.