Charge to the Committee

One way to measure public health agencies’ performance in achieving preparedness is by performing and evaluating exercises.2 Whereas exercises have been conducted and evaluated in the emergency management field for many years, public health has had less experience with exercises and is currently beginning to assess their value for relationship-building, training, and performance measurement. To place the role of exercises appropriately into the broader definition of what it means to be prepared and to identify specific aspects for which measures can be developed, CDC asked the Committee on Smallpox Vaccination Program Implementation to:

  1. Describe the state of the science in exercises and related preparedness strategies;

  2. Identify leadership and experience to build upon, from other fields and other federal agencies; and

  3. Identify issues or concerns about this approach to performance measurement (Sosin, 2004).

To meet the charge presented by CDC, the committee has endeavored to: (1) examine conceptual issues and challenges related to integrating public health into disaster preparedness and response; (2) review some of the evidence base from disaster research and practice that is germane to public health preparedness; (3) learn from the public health response to proxy events; (4) discuss the usefulness of modeling; and (5) discuss the usefulness of exercises, including a description of some of the exercise activities occurring in the federal government.

Summary of Recommendations

The report’s recommendations revolve around the issues of interagency and intersectoral coordination, learning from experience and research, and continuously improving performance.

Recommendation 1:

The committee recommends that all federal entities concerned with bioterrorism preparedness (e.g., CDC, the Health Resources and Services Administration, the Office of Domestic Preparedness) should more actively coordinate guidance and funding activities. Federal agencies should also work together to develop mechanisms that facilitate coordination and


Initially, the committee’s discussion was concerned with both exercises and drills, as they are related categories along a spectrum of possible activities used for training, performance measurement, etc. However, since drills tend to be very narrowly focused and they typically take place within a single agency, their usefulness is more easily verified. Therefore, they are less relevant to the present broad discussion of preparedness exercises and evidence of their usefulness.


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