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| Copyright © 2012. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
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Review of the Centers for Disease Control
and Prevention's Smallpox Vaccination
Program Implementation
Letter Report # 5
Committee on Smallpox Vaccination Program Implementation
Board on Health Promotion and Disease Prevention
INSTITUTE OF MEDICINE
OF THE NABONAl ACADEMIES
OCR for page R2
INSTITUTE OF MEDICINE · 500 Fifth Street,NW · Washington,DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the
committee responsible for the report were chosen for their special competences and with regard for
appropriate balance.
Support for this project was provided by Centers for Disease Control and Prevention. The views
presented in this report are those of the Institute of Medicine Committee on Smallpox Vaccination
Program Implementation and are not necessarily those of the funding agencies.
Additional copies of this report are available in limited quantities from the Committee on Smallpox
Vaccination Program Implementation; Board on Health Promotion and Disease Prevention; Institute of
Medicine; 500 Fifth Street, NW; Washington, DC 20001. The full text ofthis report is available online at
http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2003 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and
religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of
Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
OCR for page R3
'-'Kim is chat c7~ot`,91~; 17'c' Bust Hopi?'
Allis is '~t c'`~r~1~; ,~e Bust do. "
Cl<~ctl3e
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Shaping the Future for Health
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THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in
scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general
welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to
advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of
Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a
parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing
with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of
Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and
recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent
members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts
under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal
government and, upon its own initiative, to identity issues of medical care, research, and education. Dr. Harvey V. Fineberg is
president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community
of science and technology with the Academy's purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating
agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies
and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National
Research Council.
www.national-academies.org
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COMMITTEE ON SMALLPOX VACCINATION PROGRAM IMPLEMENTATION
BRIAN STROM, M.D., M.P.H., (Chair), George S. Pepper Professor of Public Health and Preventive
Medicine, Professor of Biostatistics and Epidemiology, Professor of Medicine and Professor of
Pharmacology, University of Pennsylvania School of Medicine
KRISTINE GEBBIE, Dr.P.H., R.N., (Vice Chairg, Elizabeth Standish Gill Associate Professor and
Director of Center for Health Policy, Columbia University School of Nursing
ROBERT WALLACE, M.D., M.Sc., (Vice Chairs, Professor of Epidemiology and Irene Ensminger
Professorship in Cancer Research, University of Iowa
E. RUSSELL ALEXANDER, M.D., Professor Emeritus of Epidemiology, School of Public Health and
Community Medicine, University of Washington
RONALD BAYER, Ph.D., Professor of Sociomedical Sciences, Mailman School of Public Health,
Columbia University
R. ALTA CHARD, J.D., Associate Dean for Research and Faculty Development, University of
Wisconsin Law School and Professor of Law and Bioethics, University of Wisconsin Law School and
Medical School
THOMAS COATES, Ph.D., Professor, Division of Infectious Diseases, David Geffen School of
Medicine, University of California, Los Angeles
PENELOPE DENNEHY, M.D., Associate Director of Pediatric Infectious Diseases, Hasbro Children's
Hospital and Professor of Pediatrics, Brown Medical School
VINCENT FULGINITI, M.D., M.S., Professor Emeritus of Pediatrics,
Sciences Center
Jniversity of Arizona Health
JAY HARPER, M.B.A., M.D., M.P.H., Clinical Assistant Professor of Environmental and Occupational
Health, University of Pittsburgh Graduate School Public Health
COLEEN KIVLAHAN, M.D., M.S.P.H., Medical Director, Ambulatory Primary Care, Fanuts Health
Center, Bureau of Health Services, Cook County, IL
JEFFREY LEVINE, M.A., Vice President/Group Manager, Ketchum Washington
KENNETH MCINTOSH, M.D., Professor of Pediatrics, Harvard Medical School and Professor of
Immunology and Infectious Diseases, Harvard School of Public Health
ELIZABETH MURANE, R.N., M.S., Public Health Nurse and Retired Director of Public Health
Nursing for Shasta County, CA
PETER ROSEN, M.D., Attending Emergency Medical Physician, Beth Israel Deaconess Hospital
(Boston, MA)
WILLIAM WESTON, M.D., Professor of Dermatology and Pediatrics, University of Colorado School
of Medicine
ROBERT WOOLSON, Ph.D., Professor of Biometry and Epidemiology, Medical University of South
Carolina
Health Promotion and Disease Prevention Board Liaison
GEORGE ISHAM, M.D., Medical Director and Chief Health Officer, HealthPartners, Inc. (Minneapolis,
MN)
Consultant
WILLIAM H. FOEGE, M.D., M.P.H., Presidential Distinguished Professor, Department of International
Health, Emory University and Health Advisor, Bill and Melinda Gates Foundation
v
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Study Staff
KATHLEEN STRATTON, Ph.D., Study Director
ALINA BACIU, M.P.H., Program Officer
ANDREA PERNACK, M.P.H., Program Officer
NICOLE AMADO, M.P.H., Research Associate
AMBER CLOSE, Senior Project Assistant
ROSE MARIE MARTINEZ, Sc.l)., Director, Board on Health Promotion and Disease Prevention
V1
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REVIEWERS
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and
technical expertise, in accordance with procedures approved by the NRC's Report Review Committee.
The purpose of this independent review is to provide candid and critical comments that will assist the
institution in making its published report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to the study charge. The review
comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We wish to thank the following individuals for their review of this report:
Mary Gilchrist, Ph.D., D(ABMM), University of Iowa
Peter Jensen, M.D., VA Medical Center (San Francisco, CA)
John Lumpkin, M.D., M.P.H., Robert Wood Johnson Foundation
Nicole Lurie, M.D., M.S.P.H., The RAND Corporation
Scott Ratzan, M.D., M.P.A., Johnson & Johnson
Helen Smits, M.D., Eduardo Mondlane University
Tener Goodwin Veenema, Ph.D., M.P.H., M.S., University of Rochester
Robert Weinstein, M.D., John Stroger Hospital of Cook County (IL)
Although the reviewers listed above have provided many constructive comments and suggestions,
they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the
report before its release. The review of this report was overseen by Ronald Estabrook, Ph.D.,
University of Texas Southwestern. Appointed by the National Research Council and Institute of
Medicine, he was responsible for making certain that an independent examination of this report was
carried out in accordance with institutional procedures and that all review comments were carefully
considered. Responsibility for the final content of this report rests entirely with the authoring committee
and the institution
vat
. .
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PREFACE
l
1
The Institute of Medicine (IOM) Committee on Smallpox Vaccination Program Implementation was
convened in October 2002 to provide timely advice to the Centers for Disease Control and Prevention
(CDC) in its implementation of the national smallpox vaccination program.
The committee's work differs in two respects from that of typical IOM committees. First, the evidence
base used is somewhat different, because the committee is commenting on an ongoing government
program as it evolves. The evidence reviewed by the committee is sometimes qualitative. The bulk of
the evidence for the series of reports includes CDC presentations to the committee and reports on program
status, articles about the program in Morbidity and Mortality Weekly Report, CDC media telebriefing
transcripts, national and local media coverage of the smallpox vaccination program, the policy statements
and issue briefs of public health and health care organizations, and to a lesser extent the experiences,
opinions, and perspectives of public health and health care leaders and workers expressed in presentations
to or informal discussions with the committee. Second, most of the committee's products are brief,
frequent "letter reports" addressed to CDC Director Dr. Julie Gerberding. Letter reports offer an
abbreviated version of the extensive background and documentation provided in more sizable IOM
reports, and often focus on one or a few topics of immediate importance to a program's unfolding or to
next steps in the program Although they differ from typical IOM reports in size and nature, letter reports
undergo the standard process of external peer review, conducted by reviewers anonymous to the
committee until report is released, and monitored by the National Research Council.
The present letter report is fifth in a series. For the purpose of brevity, some background information
about the program is generally not repeated in every report; only a reading of the entire report series
would provide a complete overview of the committee's work to date. For ease of reference, every report
includes a table of contents, a listing of key messages, and a summary of all recommendations made in
the report. All the committee's reports to CDC are available for download at: www.iom.edu/smallpox.
. · .
V111
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TABLE OF CONTENTS
INTRODUCTION 1
Description of the Public Health Preparedness Project
Committee Tasks 3
GENERAL PARAMETERS OF FOUR SCENARIOS TO ASSESS SMALLPOX READINESS
INDICATORS ...................
Utility of Smallpox Scenarios
Learning from Real-Life Experiences and Hypothetical Scenarios
Purpose, Development, and Use of Four Smallpox "Scenarios "
Description of Smallpox "Scenarios" Used to Assess Readiness Indicators
Scenario I
Scenario 2
Scenario 3
Scenario 4
Caveats to Consider in Proposed "Scenarios" 6
Applicability of Scenarios to Specific Local Circumstances 7
Little Variability in Types of Planning Activities across Scenarios
Applicability of Scenarios to Decision-Making and Management Structure of a Smallpox
Response
COMMENTS ABOUT THE DRAFT READINESS INDICATORS
Continuous Quality Improvement ...........................................................................
Purpose of the Indicators .............................
A Dual Purpose in Developing Indicators
Distinct Indicators Neededfor Federal, State, and Local Jurisdictions .......................
A Framework for Readiness Indicators
Elements Not Reflected in the Readiness Indicators ......................................................
Collaboration and Communication 1-
Collaboration and Communication among Federal Agencies with Health
Responsibilities ...............................
Training and Education ............................
Issues Related to Surge Capacity ...............................................................................
Selected Gaps and Needs of Public Health Preparedness Identified by Stakeholders ....
Panelist Comments about Training and Education ...............................................
15
16
16
.......... 18
18
1X
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Panelist Comments about Resources (e.g., human, equipment and supplies,
communication) ...........................................................................
Panelist Comments about Surge Capacity .....................
Panelist Comments about Mental Health .......................
Panelist Comments about Populations with Special Needs
CONCLUDING REMARKS
REFERENCES ................
APPENDIX A: Draft Smallpox Indicators and Suggested Criteria
APPENDIX B: Summary of Recommendations ~
APPENDIX C: Essential Capabilities Needed for Preparedness...
18
19
............... 19
.20
........ 20
...22
...25
x
