Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation Letter Report #5 (2003) / Chapter Skim
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Contents of Letter Report
Contents of Letter Report
Pages 1-21
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CDC asked the Institute of Medicine (TOM) committee to review CDC's smallpox readiness indicators, which are part of a larger set of public health emergency preparedness indicators being developed through the Public Health Preparedness Project.
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CDC has begun important work in this area by launching the Public Health Preparedness Project to assure national preparedness for bioterrorism. The committee commends CDC for aiming toward indicators that will help state and local public health agencies document their progress on preparedness Description of the Public Health Preparedness Project CDC has long recognized the importance of preparedness for bioterrorism and other public health threats.
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After an internal CDC workgroup, an external workgroup of national stakeholders, public health partners, and the TOM committee (through this report) provide feedback on the four goals, 22 objectives, and 127 indicators, CDC will pilot test the indicators at five cooperative agreement recipient sites and some local health jurisdictions (Henderson, 2003a)
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Nevertheless, there are at least two ways to develop a useful framework for conceptualizing public health emergency response activities: designing scenarios that illustrate what could happen, and examining responses to reallife public health crises that have occurred aireacly. Scenarios and real life experiences help program planners consider the range of possibilities and complications that must be considered and aciciressec!
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. For this "no case" scenario, state and local public health agencies wouict need to focus on, in particular, training, vaccinating new members of response teams clue to turnover, surveillance, planning, exercises, public information for false alarms, ant!
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number of conf~rmect smallpox cases have been identified somewhere in the United States, but there is no immediate evidence of cases in the particular jurisdiction For this scenario, state and local public health agencies would need to focus on, in particular, enhanced surveillance (particularly focusing on travel hubs) , communication with the public, risk communication, ciecisionmaking about distribution ant!
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Little Variability in Types of Planning Activities across Scenarios The general parameters of four scenarios that the committee used to assess the smallpox readiness indicators highlight key differences in the scope of response activities—the pace of the response, the overall timeline for accomplishing response activities, supplies and personnel that are readily available but in terms of the planning activities that are requires! before the event, most of the same activities are needed.
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. Even the indicator addressing the activation of mass vaccination clinics shows little variability in terms of planning activities across the four scenarios (except for the "no cases" scenario)
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Because it is impossible to foreshadow the exact circumstances of a smallpox outbreak, the committee recommends that a flexible, incremental, science-basect decision-making and management structure for smallpox response that includes all levels of government be developed and communicated to state and local agencies so that the consequences of a smallpox outbreak can be managed effectively. Key message #I: *
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to help document "yes" answers to the ten smallpox indicators and ensure welI-rouncled assessment of jurisdictions' capabilities in areas iclentified by the current inclicators. Continuous Quality Improvement Measuring preparedness should be characterized as a process of continuous quality improvement within the public health system (CDC, 2003c)
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The committee recommends that CDC address its immediate need of measuring cooperative agreement compliance with a concise and simple set of indicators, and then use this set of indicators as the foundation of a longer, deliberative, national process to develop measures that acIdress the full range and appropriate balance of preparedness activities.
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Key message #3: * CDC should address its immediate need of measuring cooperative agreement compliance with a concise and simple set of indicators, and then use this set of indicators as the foundation of a longer, deliberative, national process to develop measures that address the filet range and appropriate balance of preparedness activities.
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which are used by many public health agencies to measure performance and ensure continuous quality improvement (NACCHO, 2002~. Other sets of indicators could be used to help refine CDC's readiness indicators process.
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smallpox preparedness: first responders, health care providers, health care institutions, and the public health community. The panels presented fencings from their review of the CDC readiness indicators, and focused on areas they considered important to preparedness, but were not sufficiently reflected in the indicators: communication, collaboration (in particular, between CDC and the Health Resources and Services Administration)
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~ , ,, ~ ~ , Collaboration and Communication among Federal Agencies with Health Responsibilities The relationship between CDC and HRSA parallels the connections between public health agencies at all levels and health care providers in hospitals, health centers, and communities. Although the CDC and HRSA cooperative agreement guidance documents are somewhat analogous, and make references to each other (and include an appendix about cross-cutting activities and benchmarks)
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In addition to considering indicators that assess such linkages, the committee recommends that CDC collaborate with HRSA to integrate the preparedness indicators into one document, in order to help the health care and public health communities work hand-in-hand to plan, implement plans, and evaluate their readiness to respond to threats (including, but not limited to, a smallpox attack) and to avoid requiring duplicate reporting from states.
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(Austin, 2003; Temte, 2003; GAO, 20034. The surge capacity neecIs of public health laboratories also require careful consideration, as laboratories confirm diagnoses and conduct essential surveillance functions.
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CDC has stated that the assessments that will be conducted through the Public Health Preparedness Project will help identify technical assistance needs and gaps in preparedness of state and local public health agencies (Henderson, 2003a)
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Panelist Comments about Surge Capacity · Changes in the scope of practice of EMS providers for emergencies shouicl be considered, since the health care training that these personnel have received could, where appropriate, contribute to surge capacity in mass vaccination clinics (Fischier, 2003~. · The surge capacity needs of public health laboratories must also be considered.
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By adciressing the three tasks with which CDC asked for advice (reviewing the smallpox readiness indicators, identifying criteria that could be used for the smallpox indicators, and developing smallpox scenarios that could be used to test the smallpox incticators) , the committee has attempted to assist CDC with the important work of assessing the nation's readiness to respond to a smallpox outbreak.
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Wallace, Committee Vice Chair Committee on Smallpox Vaccination Program Implementation 21
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Key Terms
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