appendixes that contain the committee’s body of prior work. The first appendix contains a summary of the recommendations in the committee’s six previous reports. The remaining appendixes contain the complete text of the committee’s first six reports, released from January 2003 to July 2004 in response to CDC’s requests for specific and timely advice, and they reflect in part information gathered at the committee’s public meetings held from December 2002 to March 2004.

The report’s first chapter, “Smallpox and Smallpox Control in the Historical Context,” provides a brief summary of the history of smallpox and its eradication. The historical narrative explains the near-mythic status of smallpox among other dangerous diseases, but it also tells the hopeful story of a disease that was vanquished thanks to an effective vaccine and the coordinated and capable efforts of public health and health care workers around the world.

The second chapter, “Policy Context of Smallpox Preparedness,” outlines policies that predated the 2002 smallpox vaccination policy and describes key events and people that contributed to the decision to vaccinate selected groups in advance of a potential smallpox virus release. The chapter is intended to provide some background information about the complex circumstances (such as the high level of public, congressional, and media interest) surrounding the federal government’s decision to revive smallpox vaccination. The committee believes that its summary of the program’s policy context is consistent with its charge because it highlights early factors that the committee asserts influenced the implementation and outcomes of the vaccination program. Specifically, CDC’s difficulties in communicating about the smallpox vaccination policy and program and in securing the participation of public health and medical professionals (the third item in the committee’s charge) may be traced to the way the policy and its rationale were communicated to key constituencies.

In the report’s third chapter, “The Implementation of the Smallpox Vaccination Program,” the committee provides a loosely chronological account of the program’s implementation structured around major events, from the president’s program announcement in December 2002 to the enactment of a compensation plan for injuries resulting from smallpox vaccination in April 2003 and the June 2003 Advisory Committee on Immunization Practices (ACIP) recommendation to bring pre-event smallpox vaccination to a close. The committee also explores congressional interest in the program and the relationship between the civilian and military smallpox vaccination programs. The chapter includes a discussion of vaccination program challenges. The committee found that the implementation of the program was compromised by operational factors related to broader, strategic issues (examined in Chapter 4). For example, some of the program’s challenges were due to its extraordinarily rapid implementation; there was



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