• the informed consent process;

  • contraindications screening;

  • the system in place to assess the safety profile of the smallpox vaccine;

  • guidance for the treatment of vaccine complications;

  • professional training programs CDC is developing;

  • the communications efforts;

  • guidance CDC offers to states in developing their implementation plans; and

  • overall progress at achieving the goals of the program.

Given the rapid pace of planning for the smallpox vaccination program, the committee realizes that while it has been working on this report, CDC has been moving ahead, and at the time of the report’s release, it is possible that CDC has already accomplished some of the components the committee is recommending.

In addition to CDC’s partners, many in the general public will be interested in this communication. Moreover, all reports of IOM committees are released to the public. We thus provide some background information directed at readers less familiar with the issue. This letter is divided into general statements about implementing the recently announced pre-event smallpox vaccination program, followed by targeted recommendations on the specific components of the committee’s charge.

Our intent is to help CDC and its partners across the country implement President Bush’s pre-event smallpox vaccination policy as safely as possible. We begin by offering our professional admiration for the hard work of CDC staff and their public health partners in our states and territories, major metropolitan areas, counties, and local communities who have been working under conditions of many uncertainties to prepare for this program. We hope we can help make these efforts even more successful.


On September 30, 2002, the Centers for Disease Control and Prevention (CDC) entered into a contract with the Institute of Medicine (IOM) of the National Academies to provide targeted advice on the implementation of a “pre-event” or precautionary smallpox vaccination program. An independent, nongovernmental, nonprofit organization operating under the 1863 congressional charter to the National Academy of Sciences, the IOM has provided advice on matters of health and medicine for over 30 years. The IOM often tackles issues of importance to CDC’s public health mission, including matters of vaccine financing, supply, development, and—

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