This chapter provides a summary of key milestones in the course of the program and other major events that occurred during implementation and may have affected or been affected by the program. The program experienced considerable implementation challenges. However, it also provided opportunities to gain experience with a broad multisector and interdisciplinary effort of biopreparedness and led to novel findings about potential complications from smallpox vaccine.

The committee hopes that CDC and its partners at the state and local levels will ensure that what has been accomplished and learned through the great investment of effort and resources is sustained and is integrated into the full spectrum of public health preparedness.

TABLE 3-2 Smallpox Vaccination Program Timeline


Events (policy, program, and other developments)

IOM Committee Meeting or Report

September 2000

DHHS contracts with OraVax (now a part of Acambis, Inc.) for new smallpox vaccine to be delivered in 2004 (CIDRAP and IDSA, 2004).


June 2001

ACIP recommendation on smallpox (vaccinia) vaccine: because of low risk of deliberate release and indeterminate risk to population, limit vaccination to laboratory or medical personnel working with non-highly-attenuated orthopox viruses (CDC, 2001).

“Dark Winter,” a war game for senior-level officials, is conducted by Center for Strategic and International Studies in partnership with Johns Hopkins Center for Civilian Biodefense Studies and ANSER Institute for Homeland Security. Exercise included a smallpox outbreak spreading to 25 states and 15 countries (ANSER Institute for Homeland Security, 2003).

September 2001

Terrorist attacks in New York, Arlington (Virginia), and Pennsylvania.

DHHS placed an order for 40 million doses of smallpox vaccine with Acambis (20-year contract for cell-culture vaccine) (IOM, 2002b).

October 2001

Letters containing anthrax spores delivered through U.S. mail.

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