On Mar. 26, 2024, the National Academies of Sciences, Engineering, and Medicine released a report that said action is needed to enhance U.S. readiness for smallpox and related diseases, as well as to improve diagnostics, vaccines, and therapeutics that could be used in case of an outbreak.

The report stated that plans for responding to a smallpox outbreak or attack need to be flexible and continually updated to meet the challenges of multiple potential scenarios. The small number of manufacturers capable of producing smallpox medical countermeasures is a specific vulnerability, and there is currently insufficient capacity to scale production in the event of a large outbreak or attack.