Although the anthrax hoaxes peaked in 1998-1999, they never entirely disappeared, as the abortion clinic incidents illustrate. The government emphasis on the extreme threat of anthrax terrorism coupled with the intense media coverage of events like the Larry Wayne Harris arrests and the anthrax hoaxes themselves created an intense national anxiety about biological warfare that culminated with the October 2001 national anthrax crisis.

The crisis began in Boca Raton, Florida, where Robert Stevens, a 63-year old photo editor for a tabloid newspaper, was admitted to the hospital in early October and later diagnosed with inhalation anthrax. He died on October 5. Three days later officials announced that Ernesto Blanco, a 73-year old mailroom employee in the building, had anthrax spores in his nasal passages. Moreover, spores had been found on Stevens’ computer keyboard. On October 10, a third person was hospitalized and the case became a federal criminal investigation.

With startling rapidity, anthrax contaminated letters then showed up in Washington, D.C., and New York City, with political leaders and media figures being the primary targets. Postal workers in facilities that had handled anthrax-contaminated letters began testing positive for—and dying of—the disease.

Almost as soon as the anthrax incidents began occurring, a second wave of anthrax hoaxes commenced. The victims in this second wave were much the same as in the first: government buildings, abortion clinics, schools, and a variety of miscellaneous targets. Some of the hoaxes, such as the abortion clinic hoaxes, gave every indication of being as planned and as purposeful as those in the first wave. Others have been opportunistic or impulsive. One example is the disturbing case of a Los Angeles fire captain arrested for sending a threatening letter with a suspicious powder to a law firm that had represented his ex-wife during their divorce (the letter did not use the word ‘anthrax’). Only weeks before, the captain had served with a crisis intervention team at the World Trade Center following the September 11 terrorist attacks.

The perpetrator or perpetrators at this point of the actual anthrax incidents are completely unknown (as is the identity of most of the hoaxers). The main lines of speculation point fingers at international terrorists on the one hand and domestic extremists on the other. At first, "expert" speculation concentrated on possible international connections, not surprising in light of the September 11 terrorist attacks and the trauma they are still causing, as well as the puzzling coincidence involving the wife of an employee at the Boca Raton building attacked by anthrax who brokered rental apartments for two of the September 11 hijackers.

More recently, perhaps simply because of a lack of additional clues or evidence, speculation is leaning toward a domestic source. However, the possibility of a non-ideological criminal perpetrator cannot be ignored, either.

Though the identity of the perpetrator remains unknown, the intent seems to be much clearer. America’s first anthrax terrorist event was designed to cause terror, not mass casualties. An anonymous figure mailed anthrax-laden letters to several strategically selected destinations. This is a poor way to cause mass casualties: the number of people likely to be exposed to the agent is limited; the recipient has every chance of becoming suspicious of the letter and not opening it in the first place; and an envelope containing anthrax is probably most likely to cause cutaneous anthrax, the most diagnosable and treatable form of the disease. The perpetrator may or may not have thought about the possibility that spores might leak through the envelopes and contaminate the postal system.