The Smallpox Vaccination Program: Public Health in an Age of Terrorism

November 6, 2003, meeting and offers this report based on the information gathered at that meeting and during its ongoing assessment of the smallpox vaccination program.

INTRODUCTION

The committee commends CDC for communicating more clearly that the focus of the smallpox preparedness effort is on all components of smallpox readiness (e.g., preparedness, detection, response,² containment, and recovery). Development of the smallpox readiness indicators—and the overall public health preparedness indicators—has helped to put preparedness for one hazard (e.g., smallpox) into the context of all-hazards public health preparedness. By planning to use the public health preparedness indicators to assess readiness and establish a baseline during the first year of their use, CDC has helped cast preparedness within the broader work of public health.

The committee also applauds CDC for responding to the needs of state and local public health agencies by beginning the development of smallpox—and overall public health emergency—preparedness indicators. CDC’s state and local partners have stated that they need assistance in determining what constitutes a minimum level of preparedness (Selecky, 2003) and the most likely scenarios for which they should be preparing. The IOM committee echoed these concerns in its second report by encouraging CDC to define smallpox preparedness and to work with states to decide what more is needed to achieve smallpox preparedness (IOM, 2003a), and again in its fourth report by recommending that CDC assist states in establishing a baseline level or minimum standard of smallpox preparedness (IOM, 2003b). CDC has begun important work in this area by launching the Public Health Preparedness Project to ensure national preparedness for bioterrorism. The committee commends CDC for aiming toward indicators that will help state and local public health agencies document their progress on preparedness.

Description of the Public Health Preparedness Project

CDC has long recognized the importance of preparedness for bioterrorism and other public health threats. Prior to September 11, 2001,

In this report, the committee uses the terms “response” and “respond” to mean all the activities that are necessary following identification of an infectious disease outbreak or bioterrorism event (e.g., epidemiologic investigation, activation of communication plans, implementing mass vaccination plans, enhanced surveillance, etc.).

Table of Contents

Front Matter R1-R22

Executive Summary 1-8

1 Smallpox and Smallpox Control in the Historical Context 9-21

2 Policy Context of Smallpox Preparedness 22-38

3 The Implementation of the Smallpox Vaccination Program 39-80

4 Lessons Learned from the Smallpox Vaccination Program 81-108

Appendix A: Recomendations from Letter Reports 1-6 109-122

Appendix B: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #1 123-161

Appendix C: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #2 162-194

Appendix D: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #3 195-202

Appendix E: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #4 203-251

Appendix F: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #5 252-284

Appendix G: Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation Letter Report #6 285-328

Appendix H: Agendas for Committee Information-Gathering Meetings 329-341

Appendix I: Committee Biosketches 342-348

Index 349-370

INTRODUCTION

Description of the Public Health Preparedness Project