Federal, state, local, and other public health agency roles in preparedness

ABSTRACT

Even prior to the September 11, 2001, terrorist attacks and the subsequent mailing of letters and packages contaminated with anthrax spores, public health agencies were focused on the topic of public health emergency preparedness. However, in the last 20 years, based on lessons learned from the public health responses to a number of emergencies, the public health emergency preparedness field has adapted and evolved to changing circumstances. The greatest of these has been changes to funding and funding mechanisms. These include grants and cooperative agreements from the Centers for Disease Control and Prevention that support state, tribal, local, and territorial health departments' ability to detect and respond to public health threats. During public health emergencies, including COVID-19, a mix of supplemental funds, relief packages, and emergency funds are used to support temporary surge capacity, often supporting additional Epidemiology and Laboratory Capacity and an expanded contract-based workforce. In addition to public health emergency preparedness, public health agencies also provide many essential services that are invisible to most when working well, and the need for these essential services continues during an emergency response. In an increasingly connected world, collaborative cross-jurisdictional and global relationships with groups such as the World Health Organization tribal public health agencies, and others are also essential for protecting the public's health. The response to the COVID-19 pandemic has drawn attention to the many gaps in our decentralized public health system in the U.S., including inadequate investment in the public health workforce.