But external events also affected the pace of change in the Canadian health care system. The attacks of September 11, 2001 and their aftermath raised the spectre of bioterrorism and Canada had to respond to the threat of anthrax and smallpox in 2002. An even more deadly enemy, SARS (severe acute respiratory syndrome), appeared in March 2003. The outbreak was focused in Ontario and demonstrated the impact of budget cuts on both the curative and preventive systems. As a result of the report of the National Advisory Committee on SARS and Public Health led by Dr. David Naylor, the federal government created the Public Health Agency of Canada, which brought together the public health components of Health Canada with disease control and emergency planning experts under the direction of a junior minister of state. When the Public Health Agency began its work in 2004, it focused attention on health promotion and population health until the need for pandemic planning — in light of the threat of avian influenza — came to the forefront in 2005–2006.