On Public Health Security: Planning for the Next Pandemic Flu

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February 2018

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This month’s issue of On Public Health Security features a guest writer: Alisha Powell of the National Governor’s Association (NGA).

Any views or opinions expressed by the author do not necessarily represent the views of CDC, HHS, or any other entity of the United States government.

Dear CDC Preparedness Partners,

This year marks the 100th anniversary of the 1918 flu pandemic—which caused about 50 million deaths worldwide—reminding us of the deadly and disruptive potential of pandemic flu. While many may think flu pandemics are relics from the past, experts know it is not a question of if we will experience another deadly flu pandemic, but when.

Despite more awareness of the consequences of public health emergencies, the United States can do more to prepare for an influenza pandemic. In the United States, the federal government sets national planning priorities for an influenza pandemic, and states and local health departments have the primary responsibility for preparing for and managing initial disease outbreaks. However, with constrained budgets,[1] states often have the expertise but lack the resources to fully prepare and exercise for a major public health event or outbreak. To avoid the kind of catastrophe that occurred 100 years ago, states must have updated and tested plans in place that can prepare them for pandemic flu.

Governors have a unique and critical role in public health preparedness. As commanders-in-chief, governors can declare an emergency in their states, relax or suspend regulations, and control resource deployments. Their actions can make or break a community’s ability to respond to and recover from an outbreak. Additionally, governors have a significant role in the healthcare sector’s day-to-day operations in their capacity as purchasers and regulators.

Despite their influence on the healthcare system, most governors have relatively little expertise or training in public health emergency response and recovery. During the 2009 H1N1 pandemic, governors played a critical role in leading responses in their states. Today, there are only two sitting governors who were in office during that outbreak. Recent outbreaks, such as Ebola and Zika, have tested our sitting governors and illustrate why we need to take targeted action now to mitigate the consequences of pandemic flu.

Our governors need tools and services that support preparedness in the following ways:

  • Ensure they understand their legal authority to respond in the event of a public health disaster.
  • Establish and institutionalize coordination among key players.
  • Strengthen internal and external communications.
  • Identify gaps in baseline capabilities and available resources needed to address these gaps.[2]

More than a decade ago, the National Governors Association, with support from the U.S. Department of Health and Human Services, worked with every state and four U.S. territories to conduct a nationwide assessment and update of state pandemic preparedness plans. Many of the issues uncovered in the past such as complex legal authorities, public-private sector coordination, and workforce capacity remain a challenge today. To resolve these issues, we need collaboration among both states, territories and the federal government.

Now is the time to bring together a whole community of effort at the state, federal, local, private, and nonprofit levels to ensure that jurisdictions have the appropriate policies, plans, and resources in place to respond to a pandemic. The federal government is a critical partner in the process and provides subject-matter expertise. It is important that states find ways to maximize federal support as well as ensure that the legal, financial, and policy mechanisms at the state and federal levels are flexible to meet individual state needs. 

Proactively ensuring that government officials understand their administrative and legal responsibilities before a pandemic occurs will help states and the federal government protect their citizens and minimize the adverse impacts from a future pandemic. Planning ahead is not only responsible, but it also keeps Americans safe, healthy, and productive.

Thank you,

Alisha Powell
Program Director, Homeland Security & Public Safety Division
National Governor’s Association (NGA) Center for Best Practices

The National Governors Association (NGA) is the collective voice of the nation’s governors and one of Washington, D.C.'s most respected public policy organizations. Its members are the governors of the 55 states, territories and commonwealths. NGA provides governors and their senior staff members with services that range from representing states on Capitol Hill and before the Administration on key federal issues to developing and implementing innovative solutions to public policy challenges through the NGA Center for Best Practices. NGA also provides management and technical assistance to both new and incumbent governors.

[1] National Association of State Budget Officers, Fiscal Survey of States, Fall 2017: https://www.nasbo.org/reports-data/fiscal-survey-of-states

[2] These are recommendations NGA made in a September 2016 issue brief titled, Improving State Efforts to Prepare and Respond to Public Health Emergencies


Upcoming Events


Attend the 2018 Association of Schools & Programs of Public Health (ASPPH) Annual Meeting, taking place March 7th-9th in Arlington, Virginia.


Attend the 8th Annual International Crisis & Risk Communication Conference, hosted by the University of Central Florida, taking place March 12th-14th in Orlando, Florida.


Attend the National Association of Community Health Centers (NACHC) 2018 Policy & Issues Forum, taking place March 14th-18th in Washington, D.C. 


Attend the National Emergency Management Association (NEMA) 2018 Mid-Year Emergency Management Policy and Leadership Forum taking place March 19th-23rd in Alexandria, Virginia.


Additional Resources


We have recently updated our Stories from the Field page with Public Health Emergency Preparedness (PHEP) program success stories related to a measles outbreak in Minnesota and the Hurricane Matthew response in North Carolina.


CDC has recently announced a new Notice of Funding Opportunity (NOFO) to strengthen the nation’s public health infrastructure; ensure a competent, current, and connected public health system; and improve the delivery of essential public health services through capacity-building assistance activities. Organizations funded under this NOFO will implement activities to strengthen governmental and nongovernmental components of the public health system. Applications are due no later than 11:59 pm (ET) on March 29th, 2018.


A recent Morbidity and Mortality Weekly Report (MMWR) entitled Population-Based Surveillance of Birth Defects Potentially Related to Zika Virus Infection – 15 States and U.S. Territories, 2016,” provides the first comprehensive data on the number of babies born with birth defects potentially related to Zika virus infection – three per 1000 live births.

centers for disease control and prevention - office of public health preparedness and response

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