However, these serious infectious disease threats posed relatively straightforward public health challenges, without the national security issues that complicate the smallpox vaccination program. To maintain its credibility, CDC should demonstrate a sustained commitment to clarity and openness about its smallpox preparedness goals by working toward a concrete description of what preparedness entails (despite the complexities and unknowns involved), communicating regularly with the public, and discussing any specific numbers of vaccinees only within this broader context.

Elements of Smallpox Preparedness

At the committee’s May 2003 meeting, one presenter described the essentials for improving smallpox preparedness as planning, training to the plan, exercising to the plan, and revising the plan (Selecky, 2003). In presentations and conversations with several state and local health departments, the committee heard similar comments about what program administrators believe are the “ingredients” of smallpox preparedness (Committee on Smallpox Vaccination Program Implementation Study Staff, 2003). Most programs remarked on the importance of:

  • developing relationships with all relevant partners (might help enhance surveillance and reporting, as well as planning and implementation of smallpox response);

  • engaging in regular communication with other local and state public health agencies;

  • communicating openly, regularly, and consistently with the media and the public to create a foundation of optimal communication before a potential smallpox event;

  • having a core of set of workers to provide initial response and vaccinate others;

  • having concrete plans, including job descriptions and locations; and

  • educating and training all participants before an event.

These themes are consistent with the three elements of smallpox preparedness identified in Annex A of the DHHS/CDC Continuation Guidance for Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism (CDC, 2003b) and discussed in greater detail below:

  1. Preparing key responders—with a section devoted to health care responders and preparedness in the health care sector (includes the relationship-building, training, and planning described above);

  2. Rapid public health response—rapid detection, identification, in-

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