the term “scenario,” though recognizing that the descriptions below are mere sketches and at most can be called general parameters of smallpox scenarios.

Due to time limitations and their limited purpose, these particular scenarios are simply four possible situations, and the activities that would need to receive particular attention in each scenario. These scenarios were chosen because they represent a range of possible situations, without focusing on the extremes (i.e., assuming that there is zero risk of a smallpox attack or assuming that smallpox will infect every single person in the United States). Should CDC and its partners deem these four scenarios a useful starting point, providing an illustrative range of smallpox contingencies, more work would be needed to fill in the details to lead to more elaborate scenarios that are useful for conceptualizing the federal, state, and local response to a smallpox outbreak. As described in previous reports (IOM, 2003b), the committee believes that detailed smallpox planning scenarios are necessary to assist states in planning their response activities and evaluating their level of preparedness. If CDC intends to use scenarios as a planning tool, the committee recommends that the scenarios represent a range of possible situations, be used to help guide state and local planning activities, and facilitate state and local assessment of their level of preparedness.

Description of Smallpox “Scenarios” Used to Assess Readiness Indicators
Scenario #1: No smallpox case(s)/known presence of virus

This scenario assumes that preparedness activities continue, with no new data on degree of risk (most recent statement from the President about risk: “no information that a smallpox attack is imminent” [White House, 2002]). This scenario can be thought of as the “maintenance state,” and would also include any false alarms (i.e., pseudo-case). For this “no case” scenario, state and local public health agencies would need to focus, in particular, on training, vaccinating new members of response teams due to turnover, surveillance, planning, exercises, public information for false alarms, and clear lines of authority for decision-making.


By “known presence of virus,” the committee means the existence of the smallpox virus (i.e., in a vial or in the environment) outside of the two laboratories in the U.S. and Russia with known secured stocks of the smallpox virus.

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