Report assesses tools for measuring smallpox readiness.

A draft set of indicators that CDC has developed for measuring state and local readiness for a smallpox attack--part of a larger draft set of tools--provides a useful starting point for assessing the nation's progress toward bioterrorism preparedness, according to a new report from the Institute of Medicine (IOM) of the National Academies. Some gaps and redundancies in these measurement tools should be addressed, however. Moreover, measurement of bioterrorism preparedness should be integrated into an overall process for continuous quality improvement in the public health system.

"Although the national smallpox vaccination program launched one year ago initially focused specifically on an attack using smallpox, CDC has wisely repositioned its smallpox preparedness activities as part of a much broader campaign to shore up readiness for all public health hazards," said committee chair Brian Strom, chair and professor of biostatistics and epidemiology, and of medicine and pharmacology, at the University of Pennsylvania School of Medicine in Philadelphia. "The ability to respond to an attack that uses smallpox or any other agent requires a robust national public health system and an established plan for responding to health threats."

Earlier this year, CDC launched the Public Health Preparedness Project to help define a baseline level of bioterrorism readiness for state and local public health agencies, and to assess how millions in funds allocated for bioterrorism preparations over the past few years are being used. As part of this project, CDC drafted indicators to measure the nation's emergency preparedness and asked the IOM committee that has provided guidance on the agency's smallpox vaccination program to comment on the smallpox indicators.

The committee deemed the draft indicators a useful starting point, particularly for measuring the compliance of states and localities with the terms of the cooperative agreement that funds their preparedness activities. The draft indicators do not, however, reflect the importance of communication and collaboration among the public health system, the health care system, emergency response personnel, and communities. There should be indicators that assess the efforts of a jurisdiction to involve these partners in planning. Including representatives from various community organizations in bioterrorism planning could lead to a better-informed public, which may decrease the potential for fear and panic during an attack or other emergency, the report says.

In addition, there should be better coordination among the federal agencies responsible for overseeing and funding bioterrorism preparation efforts, in particular between CDC and the Health Resources and Services Administration. Moreover, the report notes that state and local agencies are not the only entities that should be evaluated. Federal agencies that have roles in coordinating and supporting preparedness also should be assessed and held accountable for their progress.

Because decisions will need to be made rapidly if evidence of a smallpox outbreak surfaces, a decision-making process and management structure should be established and agreed upon by federal, state, and local agencies and organizations before any event occurs. This arrangement will help reduce the potential for confusion, delays, and public mistrust.

Copies of Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report #5 are available at http://www.nap.edu.