Within the framework provided by the Ten Essential Public Health Services, this indicator corresponds to Essential Services 1 and 2.

Suggested Criteria
  • Is there an updated list/registry for each locale with smallpox emergency team members’ names, contact information, and vaccination status?

  • Does the team possess the minimum team competencies as described above? If not, is there a plan for acquiring members with those competencies immediately after notification of an outbreak?

  • Has the notification system for contacting team members been tested and is it effective in mobilizing the team within the desired time frame (with a time parameter if that can be identified)?

Indicator 3.3.2.1: Local and/or state public health will stockpile at least 20 doses of smallpox vaccine per 100,000 population to be available at all times (or a minimum of 1,000 doses [=10 vials] for states with population <3 million) in order to respond initially to a smallpox outbreak using search and containment strategies.

It seems that the terms “search and containment” imply that this stockpile is meant for commencing ring vaccination and intended to be short-term and limited. It is unclear whether states are advised to have one or multiple storage sites. Furthermore, is there a plan (and ways to communicate it) for prioritizing access to the vaccine in the initial 24 hours postevent, including considering vaccinating the families of responders?

This indicator applies to all scenarios.

Within the framework provided by the Ten Essential Public Health Services, this indicator corresponds to Essential Service 7.

Suggested Criteria
  • Is the stockpiled smallpox vaccine in an appropriate storage facility (“appropriate” to be defined by CDC)?

  • Is there a distribution plan for the stockpile, with a timeline for distribution?

Possible Additional Indicators

The set of smallpox indicators, as well as that of overall readiness indicators, seems to lack several important measures. Some, such as measures to assess communication and collaboration, were discussed to a greater extend in the text of the report. As CDC moves forward in refining and



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