The Smallpox Vaccination Program Public Health in an Age of Terrorism (2005) / Chapter Skim
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Appendix A: Recomendations from Letter Reports 1-6
Appendix A: Recomendations from Letter Reports 1-6
Pages 109-122
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Appendixes
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to obtain safety data, and to analyze these data before embarking on subsequent phases of the vaccination program. Compensation for Adverse Reactions to the Smallpox Vaccine The committee recommends that CDC and its state and local public health partners immediately work to clarify each state's worker's compen 111
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Opportunity Costs The committee recommends that CDC work with their public health partners to document as well as possible the true costs of the smallpox program. Informed Consent Process The committee recommends that all consent documents include a statement that the risks of the smallpox vaccine, while very low, are predictably higher than the risks associated with most other vaccines, but that the benefit is presently unknown -- possibly very low (absent exposure to smallpox)
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The committee recommends that CDC consider using the blood-donation opt-out and informed consent processes as models for the pre-event smallpox vaccination program. Reasons for Declining Vaccine The committee recommends that CDC collect data on the reasons why potential vaccinees choose not to be vaccinated.
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The committee recommends that the first communication clinicians should receive is basic information about the details of the pre-event smallpox vaccination program. Communication Planning The committee recommends that CDC's communication efforts about smallpox vaccination clearly separate public health issues from national security matters.
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The committee recommends CDC develop and offer journalists training materials and opportunities specifically designed for the media, explaining the program's clinical components, providing the best available scientific evidence, and dedicating staff experts to provide technical support to media representatives. Training and Education The committee recommends that all print materials addressed to a diverse audience (e.g., the public)
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. The committee recommends that CDC work to ensure that a qualified health professional monitors, conducts a "take" reading, and provides a regular vaccination site inspection for each vaccinee in the program and enters the relevant data into the appropriate smallpox vaccination program data system.
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The committee recommends that potential vaccinees be reminded of the current compensation situation before they formally give their consent to be vaccinated. Funding The committee recommends that this inquiry be broad in scope and include not only cost to local and state health departments, but also the financial impact on the provision of other essential public health services, the costs incurred by participating hospitals, and estimates of costs of expanding the vaccination program to additional health care and public health workers and emergency first responders.
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Such registries would include all willing vaccinated personnel not associated with a response team, ranging from retired or relocated health care or public health workers to military reservists and former military personnel. Using Scenarios to Test Preparedness The committee recommends that CDC facilitate the development of a range of scenarios for potential smallpox attack(s)
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Streamlining Data Collection The committee recommends that CDC pursue ways to streamline the data systems that are used in the smallpox vaccination program, improving user-friendliness and integrating the multiple systems to avoid duplicate data entry, especially considering that any future expansion of the vaccination program would require a larger number and greater diversity of data system users, some of whom may be using these systems for the first time. Utility of the Active Surveillance System Because the civilian smallpox vaccination program is a true partnership between CDC, states, and local jurisdictions, the committee recommends that CDC continue and expand their communication with states and local jurisdictions about the imperativeness of their participation in the Active Surveillance System, stressing that the safety of the vaccination program cannot be guaranteed without their full participation and cooperation.
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For system-related questions, in the longer- term, studies of cost and opportunity costs should be a high priority. RECOMMENDATIONS FROM LETTER REPORT #5 If CDC intends to use scenarios as a planning tool, the committee recommends that the scenarios represent a range of possible situations, be used to help guide state and local planning activities, and facilitate state and local assessment of their level of preparedness.
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The committee recommends that CDC collaborate with Health Resources and Services Administration (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)
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122 THE SMALLPOX VACCINATION PROGRAM The committee recommends that CDC should use the Evidence-Based Performance Goals for Public Health Disaster Preparedness to develop standards against which CDC, states, and localities may regularly measure their performance in exercises and in response to proxy events. Public health agency performance in exercises and proxy events should be used to identify gaps in preparedness and to improve planning, communication, and coordination at the agency and interagency levels, as part of a process of continuous quality improvement in preparedness planning and response.
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