The committee urges that CDC and the Department of Health and Human Services (DHHS) proceed in their public discussions and program guidance with attention to clarity, focusing on issues such as timelines and terminology.

First, there has been confusion on the part of the committee, and likely others as indicated by media reports on the subject (Altman and O’Connor, 2003; Young, 2003), about the characteristics of program phases, the numbers of people estimated to be vaccinated, when vaccinations will begin, and the estimated duration of each phase. Specific wording should be chosen (e.g., waves, phases, stages), clearly defined, and then used consistently in all communications from CDC and DHHS. In addition, all communications should be clear about whether particular guidance refers to pre-event (precautionary) smallpox vaccination or to post-event (response and control) vaccination. This is particularly important for any discussion of contraindications, which are very different under the situation of postexposure vaccination. In this regard, the pre-event program must be explained as part of a general program of public health preparedness for bioterrorism and other threats to the public’s health.

It is clear to the committee and other interested parties that the stated policy of the president is an absolutely voluntary vaccination program for hospitals that may choose whether to have a smallpox response team and for public health and health care workers who may volunteer to be members of a response team, but this matter bears continual emphasis in communications and planning.

Finally, some administration and other policy statements about the early part of vaccination implementation have described the group to be vaccinated as “first responders” or “response teams.” The committee believes there is a need to more clearly explain in policy and planning materials that in the event of a smallpox release, the first responders (i.e., those who are likely to first encounter or identify smallpox) will be public health and health care teams. Fire, police, and emergency personnel commonly described as first responders may have a role to play in mass vaccination, in addition to law enforcement’s role in investigating the criminal aspects of a smallpox virus release.

Although not a specific “line-item” within its contractual charge, the committee interprets general issues of compensation for adverse reactions as integral to its stated charge to assess the overall progress at achieving the goals of the program. [The committee will use the term “adverse reactions”