but it will be the role of state and local health departments, local boards of health, and communities to assess the possible scenarios and decide how they want to allocate public health and bioterrorism preparedness funds. No matter where an attack initially occurs, it can spread to other areas, so communities will need to consider how they would respond to such an event.

Little Variability in Types of Planning Activities Across Scenarios

The general parameters of four scenarios that the committee used to assess the smallpox readiness indicators highlight key differences in the scope of response activities—the pace of the response, the overall timeline for accomplishing response activities, supplies and personnel that are readily available—but in terms of the planning activities that are required before the event, most of the same activities are needed.

By examining the 10 proposed smallpox indicators, the committee determined that most of the indicators deal with planning activities that would be required of any community should smallpox appear anywhere in the world (e.g., enhanced surveillance, preparations for increased laboratory capacity, more frequent and widespread communications, expanded education and training). Even the indicator addressing the activation of mass vaccination clinics shows little variability in terms of planning activities across the four scenarios (except for the “no cases” scenario) since CDC has stated that a case of smallpox anywhere in the world would lead to a decision to offer mass vaccination to the public (Henderson, 2003b). The main variability in planning that emerges across scenarios is for those indicators that are related to the response to a case in one’s own jurisdiction (e.g., activation of quarantine and isolation procedures, designation of medical surge capacity sites).

Since it would not be prudent to only plan for the “no case” scenario, most communities will find that most of the readiness indicators are applicable to a majority of their planning activities. However, variability does exist in the response activities that would be required for different scenarios. If any of these scenarios occurs, the actions needed for that particular situation, the time frame in which those actions will need to be accomplished, and the resources that will be required for the response will be very different from what is required for another scenario.

Applicability of Scenarios to Decision-Making and Management Structure of a Smallpox Response

Although the four smallpox scenarios described above (or any range of scenarios) may be of limited utility for differentiating planning efforts that

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