The committee offers five key messages in this report:

1. Smallpox is not the only threat to the public's health, and vaccination is not the only tool for smallpox preparedness. 
2. To improve smallpox preparedness, it is essential to plan, train to the plan, exercise to the plan, and revise the plan.
3. Vaccinating members of the general public beyond the key personnel states deem necessary for preparedness should proceed only under the aegis of smallpox vaccine clinical research trials or other well-structured clinical arrangements that meet the basic requirements of medical and public health ethics.
4. The safety system appears to be working well to date, but CDC and its partners should remain vigilant to ensure the continuing safe implementation of the program. 
5. The development of a research agenda for the smallpox vaccination program is important to ensuring the long-term success of smallpox preparedness efforts, as well as providing useful information for overall public health preparedness.