clearly defined objectives; a needed emphasis on defining preparedness against smallpox attack; CDC’s communications plans; CDC’s training and education efforts; the systems for monitoring the safety of the vaccine; the need for a compensation program; and matters of resource allocation.

CDC completed an enormous amount of work between the committee’s first and second meetings. The committee extends its congratulations and expresses its admiration to CDC and the thousands of state and local partners in health departments, hospitals, and elsewhere involved in this program. The vaccination program has thus far progressed cautiously and with great deliberation, with states, local jurisdictions, and hospitals taking locally appropriate steps (Henderson, 2003). It is fitting that the beginning, scale, and pace of each local program have been dictated by considerations of the safety of participants and their families and close contacts (who may be vulnerable to spread of vaccinia from an improperly cared for vaccination site) and by local decisions and analyses about what smallpox preparedness requires.


The committee urges CDC to:

  1. Carry out all aspects of ongoing discussion, planning, and analysis of the smallpox vaccination program with the intent to advance the goal of smallpox preparedness.

  2. Conduct comprehensive evaluation of the program and its outcomes in order to improve its implementation and to protect the vaccinees and the public.


Plans for implementation of the vaccination program have evolved in a way that precludes the firm demarcation between what were initially intended as two distinct phases or stages of the program. The committee hopes that this turn of events will not impair efforts to ensure the safest vaccination program possible, but steps must be taken to (1) define and progress toward smallpox preparedness, and (2) evaluate the effectiveness of implementation and the safe use of the vaccine as extensively as the mandates and realities of the vaccination program will allow. Thus, evaluation at the national level might not take place before the program progresses (although some state and local jurisdictions may be able to pause for evaluation before expanding their program activities) but at least should occur simultaneously, to ensure that lessons are learned from phase I even in the face of a rapid expansion.

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