pilot-testing the indicators, some additional areas should be considered to ensure that even a limited set of indicators provides a comprehensive assessment of readiness. Such additional measures include, but are not limited to:

  • Sentinel indicators of diversion of effort, such as childhood immunization rates.

  • The implementation of exercises and drills (which are both a way to test some of the criteria for various indicators, and an indicator on their own—does public health agency conduct drills/exercises and how does it do?).


  1. 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.

  2. The committee recommends that a flexible, incremental, science-based decision-making and management structure for smallpox response that includes all levels of government be developed and communicated to state and local agencies so that the consequences of a smallpox outbreak can be managed effectively.

  3. The committee recommends that CDC consider conducting the preparedness assessments on a multiyear basis.

  4. The committee recommends that CDC address its immediate need of measuring cooperative agreement compliance with a concise and simple set of indicators, and then use this set of indicators as the foundation of a longer, deliberative, national process to develop measures that address the full range and appropriate balance of preparedness activities.

  5. The committee recommends that federal agencies and CDC, specifically, be held accountable for their unique federal responsibilities in an emergency response and assessed on their progress in facilitating national public health emergency preparedness.

  6. The committee recommends that CDC consider utilizing the Ten Essential Public Health Services as a framework for the readiness indicators.

  7. The committee recommends that CDC collaborate with HRSA to integrate the preparedness indicators into one document, in order to help the health care and public health communities work hand-in-hand to plan, implement plans, and evaluate their readiness to respond to threats (includ-

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