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Date: March 3, 2005
Contacts: Christine Stencel, Media Relations Officer
Megan Petty, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail <>


Future Bioterrorism Preparation Can Be Improved
Through Lessons Learned From the National Smallpox Vaccination Effort

WASHINGTON -- In future efforts to prepare for bioterrorism, U.S. public health officials and policy-makers should develop strategies to balance national security imperatives -- such as protecting classified information -- with the need to give appropriate information to the individuals involved, and also define clear criteria for preparedness at the outset of any initiative. The national smallpox vaccination program offers these and other useful lessons, says the final report in a series from the Institute of Medicine of the National Academies that provided guidance to the U.S. Centers for Disease Control and Prevention during the implementation of the smallpox campaign.

Concluding that the nation's readiness to handle a smallpox attack is indeterminate, the committee that wrote the report called for regular, comprehensive assessments of preparedness for bioterrorism at the national and state levels to help jurisdictions continuously learn from and improve the process of preparing for public health emergencies and to inform Americans about the public health system's ability to protect their health. Such systematic assessments are necessary to determine the nation's readiness to handle an outbreak of smallpox or any other biological threat, the report says.

"It's an unfortunate reality that similar efforts to prepare for bioterrorist threats may be needed in the future," said committee chair Brian Strom, professor of biostatistics and epidemiology and of medicine and pharmacology, University of Pennsylvania School of Medicine, Philadelphia. "The lessons learned from the smallpox vaccination program can help officials overcome the challenges of conducting public health campaigns within a national security context. One of the principal lessons is the importance of clear and authoritative scientific information communicated by a credible source, such as CDC, to instill confidence and buy-in from state public health officials, medical staff, and other key public health constituencies as well as the general public."

Open communication, which is crucial to the success of health campaigns that require participation by the public, may be difficult when classified information and other national security considerations come into play, the committee acknowledged. Uncertainty arose during the smallpox vaccination campaign in large part because the rationale for the initiative and its rapid implementation were not clearly explained to key constituencies, the committee said. Moreover, it appeared that CDC was constrained in its customary role as a credible, authoritative voice to communicate about the initiative to those involved and to the broader public.

In future efforts, the U.S. Department of Health and Human Services and other decision-makers should find ways to balance the reality that national security considerations may limit full disclosure of information with the need to provide the scientific evidence and public health analysis necessary to help secure the trust and acceptance of key constituents and the broader public, the report says. Steps also should be taken to ensure that CDC or any other responsible public health agency is able to provide appropriate explanations and guidance. These should always be transparent, consistent, and based on the best available scientific and public health reasoning. Dialogue among the relevant agencies and government officials will be needed to identify ways to ensure that necessary information is made available within the context of heightened national security measures.

To avoid confusion about whether a campaign is achieving its objectives, CDC should collaborate with state and local partners to set clear goals and determine at the outset what accomplishments or markers will be used to determine when preparedness has been achieved, the report urged. The smallpox campaign at first focused solely on how many people needed to be vaccinated rather than more broadly on all the essential elements of preparation, including training health professionals to recognize and respond appropriately to an outbreak, and developing emergency response and communication plans. This led to the widespread and incorrect impression that the number of vaccine recipients is the sole measure of preparedness.

In addition, opportunities to assess and revise programs as needed should be built into future initiatives. And to maintain credibility and public support, CDC and its partners should share information with the public about the status of preparation efforts.

This study was sponsored by CDC. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.
A pre-publication version of The Smallpox Vaccination Program: Public Health in an Age of Terrorism is available from the National Academies Press; tel. (202) 334-3313 or 1-800-624-6242 or on the Internet at Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).

[ This news release and report are available at ]

Board on Health Promotion and Disease Prevention

Committee on Smallpox Vaccination Program Implementation

Brian L. Strom, M.D., M.P.H. (chair)
Chair and Professor
Department of Biostatistics and Epidemiology;
Director, Center for Clinical Epidemiology and Biostatistics; and
Associate Vice Dean, School of Medicine
University of Pennsylvania

Kristine M. Gebbie, M.S.N., Dr.P.H. (vice chair)
Elizabeth Standish Gill Associate Professor of Nursing;
Director, Center for Health Policy; and
Director, Doctor of Nursing Science Program
Columbia University
New York City

Robert B. Wallace, M.D. (vice chair)
Professor of Epidemiology and Internal Medicine
Colleges of Public Health and Medicine
University of Iowa
Iowa City

E. Russell Alexander, M.D.
Professor Emeritus of Epidemiology
School of Public Health
University of Washington

Ronald Bayer, Ph.D.
Professor of Sociomedical Sciences
Joseph L. Mailman School of Public Health
Columbia University
New York City

R. Alta Charo, J.D.
Associate Dean
Research and Faculty Development
University of Wisconsin Law School, and
Elizabeth S. Wilson Professor of Law and Bioethics
Law School and Medical School
University of Wisconsin

Thomas J. Coates, Ph.D.
Division of Infectious Diseases
David Geffen School of Medicine
University of California
Los Angeles

Penelope Dennehy, M.D.
Division of Pediatric Infectious Diseases
Brown Medical School
Providence, R.I.

Vincent Fulginiti, M.D.
Professor Emeritus of Pediatrics and Chancellor Emeritus
School of Medicine
University of Colorado, and
Professor Emeritus of Pediatrics
University of Arizona

Jay Harper, M.D.
Medical Director of Employee Health Services
University of Pittsburgh Medical Center

Colleen H. Kivlahan, M.D.
Medical Director
Ambulatory Primary Care
Fantus Health Center
Cook County Bureau of Health Services

Jeffrey Levine, M.S.J.
Health Communications Director
American Institutes for Research
Silver Spring, Md.

Kenneth McIntosh, M.D.
Professor of Pediatrics
Harvard Medical School, and
Professor of Immunology and Infectious Diseases
Harvard School of Public Health

Elizabeth Murane, R.N.
Director of Public Health Nursing
Shasta County Public Health Department (retired)
Redding, Calif.

Peter Rosen, M.D.
Attending Emergency Medical Physician
Beth Israel Deaconness Hospital
Boston, and
Professor Emeritus of Clinical Medicine and Surgery
University of California
San Diego

William Weston, M.D.
Professor of Dermatology and Pediatrics
School of Medicine
University of Colorado, and
Chief of Dermatology
Children's Hospital

Robert F. Woolson, M.D.
Professor of Biometry and Epidemiology
Medical University of South Carolina


Kathleen Stratton, Ph.D.
Study Director

Andrea Pernack Anason, M.P.H.
Program Officer

Alina Baciu, M.P.H.
Program Officer