Global Alert and Response (GAR)

Preparedness in the event of a smallpox outbreak

The use of Bacillus anthracis in the United States in the autumn of 2001 with the intent to harm a civilian population has raised public health concerns among countries about potential exposure to intentionally released Variola virus and other biological agents. Efforts by WHO to support Member States in the event of intentional use of Variola virus as a biological weapon include activities to strengthen preparedness:

Smallpox Vaccine Emergency Stockpile

An emergency smallpox vaccine stockpile was created to ensure smallpox vaccine is immediately available if needed. This emergency stockpile consists of a physical stock in Switzerland and a pledged component by different countries. The management of this stockpile includes ensuring * SOPs for vaccine requests and deployment * agreements with donating countries * availability of new vaccines * a protocol for monitoring adverse events

WHO statement on the acceptance of MVA based vaccine for the WHO smallpox vaccine stockpile

In November 2013, the Strategic Advisory Group of Experts on Immunization (SAGE) was asked to advise on which vaccines should be included in the global WHO’s Smallpox Emergency Vaccine Stockpile for use in case of a re-emergence of smallpox. In considering the specific context of the SAGE recommendations, and the fact that non-replicating vaccines might be needed in groups at high risk of adverse reaction (e.g. immunocompromised), the Director-General accepted a donation of non-replicating MVA vaccine, from the US Government, into the WHO Smallpox Emergency Vaccine Stockpile. Future donations of MVA vaccine will also be accepted as circumstances warrant.

A G7+ - Global Health Security Initiative Workshop held in September 2002 reviewed the production and handling of vaccines for smallpox and other potentially dangerous pathogens.
"Best Practices in Vaccine Production for Smallpox and Other Potential Pathgens" (.pdf - 90k)


WHO monitors and verifies all rumours of smallpox through its epidemic intelligence activities within its global alert and response operations.

Laboratory diagnosis: Ensuring the availability of diagnostic capacities

WHO is assisting countries by directing them to the most appropriate and convenient laboratory for diagnosis of suspected smallpox infections, using the network of WHO Collaborating Centres as well as other laboratories. WHO is promoting the development of diagnostic tests for suspected cases of smallpox. Confirmation will be performed by either of the two WHO Collaborating Centres, Centers for Disease Control and Prevention, Atlanta, Georgia, United States and the Russian State Centre for Research on Virology and Biotechnology, Koltsovo, Novosibirsk Region, Russian Federation.

Responding to a possible outbreak

WHO is preparing guidance for response in the post-eradication era, including protocols for surveillance and epidemiological investigation; case management; media inquiries; coordination and logistics; and immunization strategies for outbreak containment. (WHO fact sheet)

Information and training materials

WHO has provided training materials for clinicians and health care workers to assist in the diagnosis of smallpox.

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