The fourth meeting of the Institute of Medicine Committee on Smallpox Vaccination Program Implementation was held on Thursday, November 6, 2003 at the Wyndham Hotel in Washington, DC. The all-day meeting featured representatives from state and local public health organizations, health care professionals, health care institutions, and first responders who discussed their views on the draft metrics and indicators of smallpox preparedness prepared by CDC for use by the grantees of the Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism.