• Sustaining the public health infrastructure to facilitate effective rash surveillance, syndromic surveillance, reporting, laboratory capabilities, and communication; and

  • Re-training and communicating with health care workers and providers on identifying and diagnosing suspicious symptoms, reporting requirements and contact information regularly.

For mass vaccination:

  • Testing the readiness of key responders responsible for mass vaccination (vaccinators, security, etc.) regularly;

  • Maintaining adequate vaccine stocks; and

  • Testing capacity to set up clinic operations and rapidly process large numbers of people regularly.

The first two key messages of the report are:

Smallpox is not the only threat to the public’s health, and vaccination is not the only tool for smallpox preparedness.

To improve smallpox preparedness, it is essential to “plan, train to the plan, exercise to the plan, and revise the plan” (Selecky, 2003).


On December 13, 2002, President Bush announced his policy on pre-event vaccination against smallpox. In those remarks, the president stated, “Our government has no information that a smallpox attack is imminent…. Given the current level of threat and the inherent health risks of the vaccine, we have decided not to initiate a broader vaccination program for all Americans at this time” (White House, 2002). Because of the possible threat, he said that “the military and other personnel who serve America in high-risk parts of the world” would be vaccinated and that “medical professionals and emergency personnel and response teams that would be the first on the scene in a smallpox emergency” could volunteer to receive the vaccine (White House, 2002).

During those remarks, the president also stated, “There may be some citizens, however, who insist on being vaccinated now. The public health agencies will work to accommodate them. But that is not our recommenda-

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