At the request of the Administration for Strategic Preparedness and Response, the National Academies convened a committee to examine lessons learned from the COVID-19 pandemic and mpox multi-country outbreak to inform an evaluation of the state of smallpox research, development, and stockpiling of medical countermeasures (MCM). In the resulting report, the committee presents findings and conclusions that may inform U.S. Government investment decisions in smallpox MCM readiness, as well as the official U.S. position on the disposition of live viral collections at future World Health Assembly meetings.Table of ContentsFront MatterSummary1 Introduction2 State of Smallpox Medical Countermeasures Readiness3 Factors Influencing Smallpox Readiness and Response4 Way Forward: Priorities for Research, Development, and StockpilingAppendix A: Study Methods and Public Meeting AgendasAppendix B: Committee and Staff Biographical Sketches