CDC’s overall goal seems to be the successful implementation of an immunization program that is truly voluntary and as safe as possible, but that establishes the response capacity necessary to protect the public’s health in the event of a smallpox attack. Success would mean securing an adequate set of vaccinated teams of health care workers willing to participate in responding to such an attack. The committee is unable to assess CDC’s progress at this time, but will do so as program implementation experience allows.

There are a number of important matters the committee recognized, but was unable to address in this report, and some additional areas on which CDC may wish to request guidance as the implementation of the vaccination program begins and progresses. These matters and areas include, but are not limited to:

• Discussion of the optimal response to an immediate change in the determination of smallpox threat, with a focus on state and local preparedness;

• A review of local readiness for implementation and an assessment of opportunity costs and resource allocation issues;

• Assessment of the adequacy of the screening materials, based on experiences during the first phase;

• Assessment of the adequacy of the informed consent materials (particularly the information provided to vaccinees on the relation of risks to benefits and the range of possibilities for adverse reactions), based on experiences during the first phase;

• Assessment of secondary transmission to contacts, including an assessment of site care guidance and vaccinee’s adherence to that guidance;

• Occupational safety issues, particularly related to bifurcated needles;

• A review of the organization and function of the DSMB; and

• Prioritization of recommendations, recognizing that multiple demands may be necessary and some of the committee’s recommendations require resources.