program, and resource variations among states, there is an undeniable need for leadership and coordination at a national level. Also, agreement on local, state, and national definitions of smallpox preparedness would be helpful in evaluating the program’s success. (An outbreak in one state has implications for that state’s neighbors, and all states need the assurance that neighboring jurisdictions are sufficiently prepared and have the capacity to assist in an emergency if needed.) The Public Health Competencies for Bioterrorism and Emergency Preparedness and the state and local Emergency Preparedness and Response Inventories may be useful resources in developing smallpox-specific inventories and checklists of competencies to guide action and enable evaluation (Columbia University, 2002).

CDC and its state and local partners face the need to determine how to best and most rapidly integrate a new set of potential vaccinees into efforts toward smallpox preparedness. CDC’s goals for the entire vaccination program (i.e., preparedness/capacity to respond, protection of those who will investigate and treat suspected cases, and gaining experience with vaccination, [Anderson, 2003]), suggest that states may determine that once each local jurisdiction: (1) has ready access to both a public health and a health care response team;3 (2) is capable of investigating an outbreak and caring for cases;4 and (3) is ready to rapidly and safely vaccinate anyone else necessary—from additional health care workers to the general public—it can conclude that it has completed precautionary smallpox vaccination of critical personnel, thus accomplishing one component of overall preparedness. Clearly, the contribution of additional vaccinees to this profile of preparedness can best be assessed by each jurisdiction in partnership with CDC.

As the committee noted in its first letter report (IOM, 2003), state and local officials working to approach smallpox preparedness goals would benefit from taking into account program sustainability, particularly in terms of staff turnover. At the state level, program management and leadership could be affected by turnover in state health commissioners, and at the local level, the ability of a jurisdiction to rapidly vaccinate great numbers of people could be affected by changes in the employment status of members of public health and health care response teams. The prospect of such changes requires planning, recruitment, training, and education for volunteers needed to replenish the smallpox response teams, and training and education of new state public health officials, to help ensure program continuity.


Note: this does not require that each jurisdiction should contain a public health or health care smallpox response team.


October 2003 ACIP recommendation states that a health care team should be sufficient to provide “continuity of care” for 2 days.

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