defined roles for all auxiliary agencies and workers, such as law enforcement, firefighters, and emergency personnel. Communities, in partnership with state and federal public health agencies, will need to define smallpox preparedness, assess how close they are to attaining it, and decide what additional actions are needed to ensure they are prepared.

At its February 2003 meeting, the committee heard from CDC and its partners that the success of program activities should not be judged solely by number of vaccinees reached, but by what has been a principal goal since the beginning—preparedness, in terms of safely building capacity to respond effectively to a potential smallpox bioterrorism event (Anderson, 2003; Henderson, 2003). It is important to note that the president’s statement on December 13, 2002, gave no numerical goal, but later statements by the administration and DHHS offered between 400,000 and 500,000 vaccinees as a possible total (CDC, 2002). Although based on assumptions and very rough calculations,2 these figures quickly became the symbolic target for phase I of the program, but as was noted in the February 6, 2003 CDC telebriefing, the program “goal is achievement of a preparedness capacity” (CDC, 2003a).

The committee strongly agrees with the emphasis on preparedness. Although original estimates were useful in planning and initiating the program, the practical experience acquired by states and localities in the first several weeks of the program suggests that other benchmarks are equally if not more important. CDC will now be able to consider both the realities of operationalizing the vaccination program and a more careful view of how many vaccinated individuals, and in what roles, it would take to achieve preparedness to respond to a smallpox attack.

Defining Preparedness

In general, state and local jurisdictions will be able to determine when they are prepared to respond to a case of smallpox in their region, but due to the movement of populations across state boundaries and to geographic,

2  

The June 2002 Advisory Committee on Immunization Practices (ACIP) recommendation was for the creation of at least one public health response team per state or territory and for health care teams in designated hospitals to serve as referral centers for initial smallpox cases. Rough estimates made at that time indicated that approximately 15,000 vaccinees would be required. That recommendation was revised in October 2003 due in part to concerns that no one hospital would volunteer for what could be viewed as the stigma of “the smallpox hospital” in that state. Thus, the recommendation was amended to offer all acute-care hospitals the opportunity to create smallpox health care teams. Rough estimates made at that time indicated that this approach would result in approximately 500,000 vaccinees (AMA-CSA, 2003). In practice, it appears that the reality of the program will result in a number of vaccinees somewhere between these two estimates.



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