25 Years After the Anthrax Attacks, Reauthorize and Modernize PAHPA to Better Protect Americans

Reports last week of suspicious letters containing white powder mailed to congressional offices serve as an unsettling reminder of the anthrax attacks that rattled Americans shortly after al Qaeda’s 9/11 attacks. In the wake of those 2001 attacks, roughly 32,000 people across multiple states were offered antibiotics. Overall, 31 people tested positive for exposure to anthrax, 22 more people developed symptoms of anthrax infections, and 5 Americans were killed. Multiple buildings were contaminated, requiring hundreds of millions of dollars to remediate over two years. The FBI’s investigation became one of the “largest and most complex in the history of law enforcement,” but the perpetrator was never identified. Subsequent reviews confirmed the urgent need to improve the United States’ ability to detect and attribute the source of biological attacks.

On October 7, 2026, the CSIS Bipartisan Alliance for Global Health Security hosted a discussion to mark the 25th anniversary of the anthrax attacks. Senior U.S. health security leaders recounted their personal experiences in managing the harrowing crisis in the fall of 2001 and described how these attacks triggered action by the George W. Bush administration and Congress to enhance the U.S. biodefense infrastructure.

Now, 25 years later, the biological threat landscape is becoming even riskier. U.S. biological defenses are weakened, and the time has arrived, again, for Congress to refresh its thinking and lead in upgrading concrete U.S. capabilities.

The Anthrax Attacks Inspired Congress to Act, but Gaps Remain

In the aftermath of the anthrax attacks, Congress recognized that further measures were needed to protect the United States against biological threats. In 2004, Congress authorized Project BioShield to hasten work on medical countermeasures to protect against infectious diseases that could impact national security. In 2006, Congress enacted the Pandemic and All-Hazards Preparedness Act (PAHPA), which addressed vital gaps in U.S. emergency preparedness and response capabilities for multiple health security threats. During the 2001 anthrax response, the United States had sufficient antibiotics stockpiled to protect everyone who had been exposed, but such readiness was not in place across the range of possible threats. Recognizing that more was needed to create new defenses, PAHPA created the Biomedical Advanced Research and Development Authority (BARDA). BARDA’s support has resulted in 53 therapeutics and vaccines that have received licenses, approvals, or clearances from the Food and Drug Administration.

Today, more action is needed to meet the rising threat level. Pathogens that cause infections such as anthrax can mutate in ways that make them resistant to current therapeutics, and recent advances in synthetic biology make it easier to modify these pathogens in ways that make current countermeasures ineffective. Congress should act to ensure that the United States develops and funds a clear industrial policy that reduces risks of misuse and incentivizes researchers and manufacturers to ensure the country is prepared to protect the American public from both traditional and novel biological threats.

The 2001 anthrax attacks also revealed that the United States lacked a clear national authority to coordinate a response to bioterrorist emergencies. PAHPA established the Administration for Strategic Preparedness and Response (ASPR), which would both coordinate internal Department of Health and Human Services (HHS) efforts and bridge federal and state responders to close this gap. While ASPR has fostered internal HHS coordination and integration, subsequent outbreaks have shown that this structure falls short in coordinating interagency planning and response. In 2023, Congress authorized, but did not fund, the White House Office of Pandemic Preparedness and Response Policy to integrate these activities across departments and agencies. The current status of that office is unclear. Today, Congress once again has an opportunity to act to clarify federal roles and responsibilities in a biological emergency.

In 2001, there was no surveillance system that monitored for deliberate biological attacks. Since then, some progress has been made to integrate intelligence, public health, and other data streams, but more action is needed by Congress to improve the United States’ ability to detect indications of a threat before an attack and to prevent an attack altogether.

Deliberate Biological Threats Are Rising as Capabilities Decline

In 2025, the U.S. State Department confirmed that North Korea and Russia maintain offensive bioweapons programs and raised concern about similar programs in China and Iran. The intelligence community’s 2026 Annual Threat Assessment notes that these threats continue to grow.

While bioweapons have historically been challenging to create and deploy, it is now becoming cheaper, faster, and easier for both state and nonstate actors to develop bioweapons. Without safeguards, AI and other advanced biotechnology tools lower the knowledge barrier to create harmful biological agents. China has implemented an AI governance framework to protect its public from such risks, while the United States has not. Other potential avenues to prevent the creation of bioweapons, such as advancing lab biosafety and biosecurity protections and screening biological materials purchases, have advanced slowly and inconsistently. The United States has not imposed regulations on the companies that produce equipment and biological materials that could be used for nefarious purposes, nor has it updated oversight of the companies and researchers who are using these tools.

Since 2001, the U.S. healthcare system has become much more expensive, while delivering worse outcomes than other high-income countries. Shortages of doctors, nurses, and other key personnel are growing. The number of Americans with chronic diseases, which can make them more vulnerable to biological threats, has grown, while recent federal actions—including efforts to create mistrust of vaccines and researchers and historically deep cuts to budgets, staff, and programming—have only compounded persistent vulnerabilities and weakened core U.S. national security and public health capabilities. “Make America Healthy Again” is a laudable goal, but it has resulted in little tangible action to improve the U.S. healthcare system or U.S. national security.

The Imperative for Congress to Act Again

Although 25 years have passed since the last biological attack on U.S. soil, the United States cannot afford to become complacent and unprepared for the real and rising risk of future deliberate biological events. Congress updated and reauthorized PAHPA with bipartisan support in both 2013 and 2019, but it allowed these authorities to lapse in 2023. It is time for Congress to reauthorize and modernize PAHPA to more clearly define interagency roles and responsibilities, enhance U.S. biosurveillance capabilities to detect emerging biological threats, strengthen oversight of AI-driven risks, and better protect the American people from evolving biological threats.

Paul Friedrichs is a senior adviser (non-resident) with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Sophia Hirshfield is an associate fellow in the Global Health Policy Center at CSIS.