The public health and medical communities have long sought to address the threat of biological, chemical, or other weapons of mass destruction (WMD) and their potential effects on the health and safety of U.S. citizens. The United States has made some key advances in the past five years or so toward increasing the capacity of the public health system to conduct disease surveillance, establishing pharmaceutical stockpiles, and improving the training of medical and public health personnel to detect and treat victims. However, despite these important strides, another key challenge remains: Are local public health agencies and our nation's hospitals (both public and private) prepared to deal with biological or chemical terrorism? Just prior to the September 11 attacks, RAND completed a nationwide survey of state and local response organizations. In this issue paper, the authors discuss some of the results for city and county ("local") public health departments and general acute care hospitals (both public and private). The authors find that, to have an effective public health and medical response to a terrorist attack, more-effective planning is needed at the local level. The focus to date has been primarily on capacity-building and on educational activities. There is a need to go beyond these efforts. Only through integrated planning and exercises and improved communications between health responders and other emergency responders will local communities be able to respond effectively to these emerging threats.