across the jurisdiction in multiple facilities. Whether vaccinated before an event or not, effective mobilization of key responders requires prior preparation to ensure, at a minimum:

  • adequate size and composition of health care and public health response teams;

  • regularly tested and updated plans known to all participants and relevant agencies;

  • initial and periodic training, including training about response plan(s) (as well as training of vaccinators, case investigators, etc.);

  • job assignments and descriptions for all responders (e.g., vaccinators, public health investigators, crowd control, and security), and consideration of relevant licensure or practice privileges should teams need to cross jurisdictional, state, or even national borders; and

  • reliable and efficient channels of communication among all relevant parties, including methods for contacting team members (e.g., pagers), and for the movement of information between health care organizations and public health agencies and between the health sector and traditional first responder agencies such as law enforcement and emergency management (English et al., 1999).

Furthermore, having adequate workforce to respond to a smallpox (or other) event requires managing staff turnover (workers who leave or retire), and the ability to mobilize as many vaccinated personnel as possible. One recipient activity described in Annex A of the DHHS/CDC guidance is the development and maintenance by states and territories of a registry of all public health, health care, security, and other personnel who may be occupationally at risk and should receive vaccination immediately in the event of a smallpox release.

In addition to having identified such priority occupational groups to be vaccinated post-event, programs should take necessary steps to maximize the use of any available vaccinated personnel. For example, the Department of Defense (DoD) has vaccinated over 400,000 military personnel, some of whom are reservists, and others who will complete military service. The committee hopes that CDC and DoD could collaborate to maintain contact with vaccinees, particularly those who enter civilian life, and to link them to any mechanism developed to include as many as possible in planning for preparedness. Contact also should be maintained with health care or public health workers who received a smallpox vaccine because of exposure to a case of monkeypox, so they could be utilized for response to a smallpox event. The committee recommends that CDC support the establishment of state and/or local and, if appropriate, national



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