Public Health
Emergency
Preparedness
and Response
Capabilities
National Standards for
State, Local, Tribal, and
Te
itorial Public Health
October 2018
Updated January 2019
Centers for Disease
Control and Prevention
Center for Preparedness
and Response
1
Public Health Emergency Preparedness and Response Capabilities:
National Standards for State, Local, Tribal, and Te
itorial Public Health
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Introduction
Public health systems play an integral role in preparing communities to respond to and
ecover from threats and emergencies. The public
health consequences of disasters and emergencies
initially affect local jurisdictions. During the initial
esponse, the people and communities that are
impacted must rely on local community resources.
As a result, all state, local, tribal, and te
itorial
emergency response stakeholders must be
prepared to coordinate, cooperate, and collaborate
with cross-sector partners and organizations at
all governmental levels when emergencies occur,
egardless of the type, scale, or severity.
While public health agencies are expected to
take the lead when infectious disease out
eaks
occur, jurisdictional public health agencies also
must be prepared to coordinate with a diverse
a
ay of partners and stakeholders, including other
government agencies to refine public health lead
and support roles, responsibilities, and assignments
when other technological, human-caused, or
natural disasters occur.
In 2011, the Centers for Disease Control and
Prevention (CDC) established the Public Health
Preparedness Capabilities: National Standards
for State and Local Planning, a set of 15 distinct,
yet inte
elated, capability standards designed
to advance the emergency preparedness and
esponse capacity of state and local public
health systems. These standards pioneered a
national capability-based framework that helped
jurisdictional public health agencies structure
emergency preparedness planning and further
formalize their public health agency Emergency
Support Function (ESF) #8 role(s) in partnership
with emergency management agencies.
Each capability standard identifies priority resource
elements that are relevant to both routine public
health activities and essential public health
services. This helps support an “everyday use”
model in which applying the capability standards
to improve day-to-day effectiveness builds a
stronger foundation from which a jurisdictional
public health agency can surge when an
emergency incident occurs. Although jurisdictional
public health agencies can demonstrate capability
through exercises, planned events, and real
incident responses, they also are encouraged to
incorporate routine public health agency activities
strategically into demonstration projects to test
and evaluate their emergency preparedness and
esponse capacity.
2
Public Health Emergency Preparedness and Response Capabilities:
National Standards for State, Local, Tribal, and Te
itorial Public Health
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Introduction
Public Health Emergency Preparedness Cooperative Agreement Program
In 1999, CDC competitively awarded approximately $40 million to 50 states and four major metropolitan
health departments to support biote
orism preparedness and response. The program, now administered
y CDC’s Center for Preparedness and Response, Division of State and Local Readiness (DSLR), evolved into
the cu
ent Public Health Emergency Preparedness (PHEP) cooperative agreement.
Today, the PHEP program funds 62 cooperative agreement recipients: 50 states, four localities, and eight
te
itories and freely associated states. Depending upon the organizational structure of the funded
jurisdictional public health agency, directly funded PHEP recipients may share PHEP funding with local
public health agencies, tribes, and native-serving organizations. This approach provides financial resources
to help build public health emergency response capability both nationally and at state, local, tribal, and
te
itorial government levels.
Since the initial publication of the preparedness capability standards in 2011, CDC has required that the
62 PHEP recipients develop and implement capability-based work plans and use their PHEP funding to
uild and sustain their public health preparedness and response capacity. However, use of the capability
standards now extends well beyond informing jurisdictional public health agency cooperative agreement
work plans. Today, the capability standards are a vital framework for jurisdictional public health agencies
to organize and evaluate emergency responses and exercises, ensure the public health consequences of
jurisdictional emergencies are a response priority, and promote collaboration by establishing a common
language among preparedness professionals. Perhaps most importantly, the capability standards allow
state, local, tribal, and te
itorial public health agencies to advance response strategies aligned with
community needs, preferences, and resources without dictating or overprescribing “how” to specifically
manage every jurisdictional response.
Operational Support for the National Preparedness System and the National
Preparedness Goal
CDC’s capability standards and PHEP cooperative agreement program provide operational support for the
Federal Emergency Management’s (FEMA) National Preparedness System to strengthen the security and
esilience of the United States through systematic preparation for threats that pose the greatest risk to the
nation’s security. The National Preparedness System has six parts that include identifying and assessing risk,
estimating capability requirements, building and sustaining capabilities, planning to deliver capabilities,
validating capabilities, and reviewing and updating.
The National Preparedness System outlines an organized process for everyone in the whole community to
advance their preparedness activities and achieve the National Preparedness Goal
“A secure and resilient nation with the capabilities
equired across the whole community to prevent, protect
against, mitigate, respond to, and recover from the threats
and hazards that pose the greatest risk .” (FEMA, 2015)
3
Public Health Emergency Preparedness and Response Capabilities:
National Standards for State, Local, Tribal, and Te
itorial Public Health
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Introduction
The National Preparedness Goal describes a vision for preparedness nationwide and identifies 32 core
capabilities necessary to achieve that vision across five mission areas: Prevention, Protection, Mitigation,
Response, and Recovery. Although only one of the 32 core capabilities within the National Preparedness
Goal specifically focuses on public health and medical support (Public Health, Healthcare, and Emergency
Medical Services), many of the core capabilities relate to and contain public health and medical
considerations that are necessary to successfully achieve a secure and resilient nation.
CDC’s 2018 Public Health Emergency Preparedness and Response Capabilities: National Standards for
State, Local, Tribal, and Te
itorial Public Health include operational considerations that support the public
health and medical components of the 32 core capabilities specified in the National Preparedness Goal.
Jurisdictions should use these operational considerations to develop their public health agency response
strategies in greater alignment with the jurisdictional public health agency ESF #8 role.
Capability Update Initiative
Since the publication of the capability standards in 2011, public health emergency preparedness and
esponse capacity has continued to be tested at national, state, local, tribal, and te
itorial levels. Ongoing
isks related to chemical, biological, radiological, nuclear, and explosive incidents as well as cyberattacks
further underscore the importance of updating and modernizing jurisdictional all-hazards public health
preparedness and response strategies to address emerging technologies and new 21st century threats
through a continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking
co
ective action (in accordance with FEMA’s National Preparedness System).
The PHEP program underwent an internal review in 2015 to identify opportunities to strengthen program
tools, resources, and guidance. The review identified the need for CDC to implement several public health
emergency preparedness improvement initiatives, including the Capabilities Update Initiative, the formal
process CDC used for revising the Public Health Preparedness Capabilities: National Standards for State
and Local Planning.
The purpose of the Capability Update Initiative was to update, clarify, and streamline capability content
and enact changes that would best support state, local, tribal, and te
itorial public health emergency
preparedness work without drastically altering the established 15-capability structure. Thus, the update
process applied a similar approach to that used for the initial development of the 2011 capability
standards. The process included individual work groups for each of the 15 capabilities along with four
additional cross-cutting work groups to address at-risk individuals with access and functional needs, tribal
populations, environmental health, and pandemic influenza.
Lessons learned from public health emergency responses, updates to public health preparedness science,
evised guidance and resources, findings from internal reviews and assessments, subject matter expert
feedback from the practice community, and input from allied agencies all contributed to capability
updates. In addition, representatives from professional associations, including the Association of Public
Health Laboratories (APHL), the Association of State and Te
itorial Health Officials (ASTHO), the Council of
State and Te
itorial Epidemiologists (CSTE), the National Association of County and City Health Officials
(NACCHO), and the National Emergency Management Association (NEMA) were instrumental in helping to
shape the updated capability content.
4
Public Health Emergency Preparedness and Response Capabilities:
National Standards for State, Local, Tribal, and Te
itorial Public Health
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Introduction
Summary of Capability Updates
The 2018 Public Health Emergency Preparedness and Response Capabilities: National Standards for State,
Local, Tribal, and Te
itorial Public Health recognizes the maturity and experience jurisdictional public
health emergency preparedness and response programs have gained since 2011. As with the 2011 version,
technical content is informed by applicable guidance, science, practice, and input from subject matter
experts. Examples of revisions include the addition of public health mission-ready packaging and the
importance of identifying jurisdictional public health agency lead or support roles based on incident
characteristics. Other revisions include updates to public health informatics, vaccine administration,
coordination of infectious disease response, chemical laboratory requirements, environmental health,
disaster epidemiology, and additional considerations for protecting the safety of emergency responders
and volunteers. Unlike the 2011 version, this 2018 update does not include programmatic performance
measures. However, jurisdictional public health agencies are encouraged to use the updated content to
foster their own evaluation strategies.
The original capability structure remains in place, and capability titles are consistent with 2011 except for
Capability 8. Previously recognized as Medical Countermeasure Dispensing, the new title, Capability 8:
Medical Countermeasure Dispensing and Administration, better recognizes that pharmaceutical
countermeasures, such as vaccines, antidotes, and antitoxins, can also be “administered” rather than
“dispensed” like pills.
Overarching changes include
• Revising, resequencing, and merging some capability functions
• Defining capability tasks
• Changing “planning” resource elements to “preparedness” resource elements
• Revising all preparedness, skills and training, and equipment and technology