Public health emergency preparedness and response have been defining goals in the United States since the terrorist and anthrax attacks in the fall of 2001. The objective of emergency preparedness is to improve the nation's ability to detect and respond to an array of public health emergencies including bioterrorism, emerging infectious diseases, and natural disasters. Despite progress toward this goal, the public is skeptical about the government's capabilities, fueled by the perceived lack of leadership and accountability following Hurricane Katrina.1 On December 19, 2006, President George W. Bush signed the Pandemic and All-Hazards Preparedness Act (PAHPA), which is intended to improve the organization, direction, and utility of preparedness efforts.2 PAHPA centralizes federal responsibilities, requires state-based accountability, proposes new national surveillance methods, addresses surge capacity, and facilitates the development of vaccines and other scarce resources.2 This act, however, raises important issues regarding federalism, evidence-based practice, privacy, volunteerism, and technological innovation.