- Since September 2001 Congress has allocated approximately dollars 3 billion to strengthen the public health infrastructure. To achieve this goal, the U.S. Centers for Disease Control and Prevention (CDC) allocates funding to states, which distribute funds to local jurisdictions. Evidence-based measures to assess public health preparedness are lacking. We used an expert-panel process to develop performance measures, based on the ten essential public health services. We developed and conducted tabletop exercises in California to evaluate preparedness to detect and respond to a hypothetical smallpox outbreak based on those measures. There was wide variation of readiness in California. While the sources of variation are often different, common infrastructure gaps need to be addressed.