backgrounds among potential vaccinees and the general public, the committee hopes that CDC will seek other types of expert advice and resources.

The committee advises CDC to communicate frequently with the public focusing on consistency, transparency, and a balanced representation of what is known and not known. CDC should be very clear about its jurisdiction—questions about the likelihood of attack are national security issues that CDC is not able/qualified to answer. If asked about the risk of the smallpox vaccine, however, the agency should answer with the facts—that the risk of serious adverse reactions is relatively low, but still higher than any other vaccine in routine and mass use.

With the exception of guidance on safety system issues, the committee is unable to comment on CDC’s guidance to states due to lack of access to certain materials. The committee hopes to provide comments on other components of guidance to states in a future report, when it has received further information.

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;