• Fourth, on page 4, the guidance states that the public should be assured that public health has the capacity to “fully vaccinate the entire population within a short period of time once smallpox has been identified” and on page 6 of 7, that large-scale vaccination is to be “rapidly” executed. State programs might benefit from more specific guidance about the time frame for which they should aim.

The committee also noticed that the final enhanced capacity described in Focus Area B corresponds to one of the ingredients of smallpox preparedness identified in our phone discussions with local and state programs (“working links between health department staff and key individuals and organizations engaged in healthcare, public health, and law enforcement”) (personal communications to staff, April 21–29, 2003). It is not clear why this important issue has not been identified as a critical capacity; preparedness appears to require working relationships with hospital administrators, fire, emergency and law enforcement officials, and many others.

In closing, the committee expresses its thanks for the opportunity to be of assistance to CDC and its partners. It would like to reiterate its call for a pause to facilitate evaluation and planning before moving on to more widespread voluntary vaccination of other types of personnel. Furthermore, the committee hopes its comments on the recently released guidance are helpful as states prepare their responses, and as CDC evaluates those responses.

Brian L. Strom,

Committee Chair

Kristine M. Gebbie,

Committee Vice Chair

Robert B. Wallace,

Committee Vice Chair

Committee on Smallpox Vaccination Program Implementation

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