The goal of this research was to identify opinion leaders' perceptions regarding the roles and activities of state health departments during the 2003 National Smallpox Vaccination Initiative (NSVP). The NSVP was the first vaccination program sanctioned to protect homeland security rather than the interest of public health. The research targeted the state epidemiologists in 50 states and the District of Columbia. Respondents were contacted by telephone and electronically to solicit participation in the study. The purpose of the study was to determine how opinion leaders viewed the role(s) of the state health department during the pre-event vaccination program. The Diffusion of Innovation theory was incorporated into the research to assess how the attributes of innovation contributed to participation during the vaccination initiative.

An electronic survey was sent to 51 potential respondents; two follow-up reminders/surveys were sent to non-respondents. Forty individuals responded to the survey and 31 successfully completed the survey. Statistical analyses included frequency data, ANOVA, correlation and regression.

Respondents identified activities undertaken during the initiative, including external partner collaboration and vaccinee recruitment. Perceived readiness to respond to a smallpox outbreak as a result of the NSVP was also reported. While more than half of respondents who completed the survey felt that their states were either very prepared or moderately prepared to respond to an outbreak of smallpox, as a result of the smallpox vaccination efforts during the NSVP, some aspects of the campaign might have hindered the total number of individuals vaccinated. Opinion leaders assumed various roles during the vaccination program, but those who reported lower relative advantage and compatibility were more likely to have lower rates of healthcare workers vaccinated in their state. Overall, the NSVP provided the opportunity to learn about the virus and provided hands-on experience to plan and implement mass prophylaxis clinics. However, the campaign did not exceed expected vaccine rates. Implications of the data collected provide insight into differences between the perceived roles of state health departments and perceived attributes of innovation. These findings are significant for the planning and implementation of future public health preparedness immunization efforts.