FIGURE ES-1 Key findings, conclusion, and recommendation.

health component of a national security program, so the principles outlined above apply. It was important to ensure that the people who would implement the program understood and supported the rationale for the program. However, the committee found that the key constituencies expected to play vital roles in the implementation of the vaccination program did not receive sufficient information about the reasoning that led to the program and remained skeptical of the need for pre-event vaccination.

The vaccination policy set expectations for numbers of vaccinees to be reached in three phases beginning with rapid implementation of the first phase, but no explanation for that overall strategy was offered to those who would implement it. For example, when the smallpox vaccination policy ultimately developed by top officials of the executive branch (of which CDC is a part) diverged from the recommendations of ACIP, the panel that advises the government on immunization policy, only vague explanation was given. Although it is understandable that the policy for the public health component of a national security program would be shaped by information from both fields, the national security assessment informing it was not available (except for the caveat that there was no information to suggest that an attack was imminent), and the public health reasoning

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