The smallpox vaccination program and associated activities implemented by CDC and its state and local partners have provided information and training about smallpox disease and vaccine to public health and health care workers, have probably improved clinician knowledge and rash illness diagnostic skills, and have led to vastly improved communication and collaboration among public health agencies, between the public health and clinician communities, and among public health, law enforcement, and emergency response agencies (Committee on Smallpox Vaccination Program Implementation Study Staff, 2003; Elliott, 2003; NACCHO, 2003b). However, much more is necessary to strengthen and test smallpox preparedness and to ensure that smallpox-related efforts are part of overall public health preparedness activities. The committee hopes that this report will provide some useful direction toward that end.

The national smallpox vaccination program may well be the first disease-specific test of implementing public health preparedness in a systematic and comprehensive manner and with some public visibility. The smallpox vaccination program has taken the notion of preparedness beyond the realm of public health professionals and academics and has brought it to the attention of a broader audience of health care workers, emergency responders, and even the general public.

Implementing the smallpox vaccination program, however, has also highlighted the need to integrate smallpox preparedness into readiness to respond to a vast range of public health challenges, including bioterror agents and other weapons of mass destruction, emerging or reemerging infectious diseases, natural disasters, and the insidious and growing threat of chronic diseases and their predisposing conditions (e.g., obesity). Smallpox is just one of a multitude of actual and potential threats to the public’s health.

The Continuation Guidance for Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism (CDC, 2003b), describes the capacities needed for smallpox response in the context of all other bioterrorism threats, even calling for coordination with the National Public Health Performance Standards, which guide public health activities in general. In practice, such integration has been lacking and has been difficult to accomplish, in part due to the intense emphasis on smallpox vaccination, which has been advanced perhaps at the expense of other aspects of smallpox preparedness, as well as overall public health preparedness to respond to any threat.