The third element of preparedness described in the CDC/DHHS guidance is the protection of the public, through means such as mass vaccination. To ensure the public is protected, the location of vaccine stocks and logistic plans must support the most efficient distribution of vaccine to all local jurisdictions involved in smallpox vaccination. The location and operation of vaccination clinics also must be established before a potential event. To apply this element of smallpox preparedness to comprehensive public health preparedness for all threats, the same sites could be used to distribute other vaccines or countermeasures and provide other services in response to an outbreak or other threat. Furthermore, the circumstances of an attack and available resources may not allow the immediate vaccination of the entire population, so plans for prioritizing categories of vaccinees should be worked out pre-event, perhaps taking as guidelines the definition of essential personnel, the needs of medically at-risk groups, and those of groups at high risk of exposure (Fock et al., 2002). Furthermore, contraindications and screening criteria for smallpox vaccination in a postevent situation may be different, and these potential changes should be explored as soon as possible. Prospective vaccinees in a mass vaccination situation also might have different needs and rights for information and education, and they will require some degree of follow-up (e.g., vaccine take checks). Planning should include these and other considerations.
To facilitate rapid public health response and conduct efficient mass vaccinations, there are special subsets of the population that will require added consideration in the areas of planning, communication, and training of key responders. These include populations that have historically been negatively affected by government policies or programs, populations with special needs, and other hard-to-reach populations, including, but not limited to, immigrants, particularly those with limited English proficiency. To help ensure that these populations are included in preparedness planning and programs, pre-event communication and plans for post-event communication (including vaccination clinic site informational and screening materials and procedures) should emphasize social, cultural, and linguistic competence and, wherever possible, should include the participation of opinion leaders and community leaders, including those representing special populations, in planning, implementation, and testing of response plans.
Good communication and information systems (within and among public health agencies, and at the interface with the health care sector) form the core of smallpox and overall public health preparedness (IOM, 2002;