there was nearly complete silence on the part of the federal government about the status and future of this biopreparedness program; no official update of program progress or impact had been provided (see additional discussion in Chapter 4).

Members of Congress contributed to the smallpox vaccination program at various points in its evolution, from policy development to evaluation. Some policy-makers contributed to the early discussion of policy options. In the weeks and months before the smallpox vaccination program was announced, Senators Bill Frist and Judd Gregg and others publicly urged the government to consider making smallpox vaccine available to all Americans to facilitate individual choice (Frist, 2002; Gregg, 2002; McKenna, 2003). Several congressional committees and subcommittees held hearings on the subjects of smallpox vaccination and bioterrorism preparedness beginning soon after the September 11, 2001, attacks. Testimony before Congress as early as October 2001 (ASTHO, 2001) informed legislators about the need for a smallpox response plan, the need for additional resources, the need for a compensation mechanism for injuries associated with smallpox vaccination, and problems in the implementation of the program (NGA, 2003; U.S. House of Representatives, 2004). For example, at a July 2003 hearing of the Senate Committee on Health, Education, Labor and Pensions, members of the Senate expressed concerns about the slow progress of smallpox vaccination and questioned federal officials about possible causes, including delays in finalizing the table of vaccine-related injuries that could be compensated under the new federal compensation provisions (Heil, 2003). Congress also played an important role in moving the legislation to provide a comprehensive plan for compensation of people injured by smallpox vaccine (Rath and Turcotte, 2003).

Finally, members of Congress asked GAO to evaluate progress in the smallpox vaccination program; this led to the April 2003 report described above (GAO, 2003). In January 2004, a year after the beginning of smallpox vaccination, some members of Congress issued a report that critiqued the smallpox vaccination program and called for changes to ensure and strengthen smallpox preparedness (U.S. House of Representatives Select Committee, 2004).