National Health 

Security Strategy and 

Implementation Plan

2015-2018
 

 

 

 

 

 

 

 

 

 

 

 

 

Contents
 

Contents............................................................................................................................................ii
 

Foreword...........................................................................................................................................v
 

Introduction ......................................................................................................................................1
 

Strategic Landscape .......................................................................................................................2
 

Past Progress .................................................................................................................................5
 

Vision, Goal, and Guiding Principles................................................................................................6
 

Guiding Principles ................................................................................................................................ 8
 

Strategic Objectives ...........................................................................................................................9
 

Strategic Objective 1: Build and Sustain Healthy, Resilient Communities .......................................10
 

Scope ..................................................................................................................................................10
 

Vision for Building and Sustaining Healthy, Resilient Communities ..................................................10
 

Operational Context...........................................................................................................................10
 

Priorities .............................................................................................................................................11
 

Strategic Objective 2: Enhance the National Capability to Produce and Effectively Use Both Medical
 

Countermeasures and Non-Pharmaceutical Interventions.............................................................13
 

Scope ..................................................................................................................................................13
 

Vision for Enhancing the National Countermeasure Capability.........................................................13
 

Operational Context...........................................................................................................................14
 

Priorities .............................................................................................................................................16
 

Strategic Objective 3: Ensure Comprehensive Health Situational Awareness to Support DecisionMaking Before Incidents and During Response and Recovery Operations ......................................18
 

Scope ..................................................................................................................................................18
 

Vision for Ensuring Health Situational Awareness to Support Decision-Making...............................19
 

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Operational Context...........................................................................................................................20
 

Priorities .............................................................................................................................................21
 

Strategic Objective 4: Enhance the Integration and Effectiveness of the Public Health, Healthcare, 

and Emergency Management Systems..........................................................................................23
 

Scope ..................................................................................................................................................23
 

Vision for Enhancing the Integration and Effectiveness of the Public Health, Healthcare, and
 

Emergency Management Systems.....................................................................................................23
 

Operational Context...........................................................................................................................25
 

Priorities .............................................................................................................................................27
 

Strategic Objective 5: Strengthen Global Health Security...............................................................28
 

Scope ..................................................................................................................................................29
 

Vision for Strengthening Global Health Security................................................................................29
 

Operational Context...........................................................................................................................29
 

Priorities .............................................................................................................................................31
 

Conclusion .......................................................................................................................................33
 

Appendix A: National Health Security Strategy Implementation Plan 2015–2018 ...............................35
 

Implementation...........................................................................................................................35
 

National Health Security Stakeholders..........................................................................................35
 

Aligning Implementation with Strategy ........................................................................................37
 

Implementation Activities ............................................................................................................37
 

Organization of the Document .....................................................................................................38
 

Strategic Objective 1: Build and Sustain Healthy, Resilient Communities .......................................39
 

Overview ............................................................................................................................................39
 

Activities by Priority ...........................................................................................................................39
 

Strategic Objective 2: Enhance the National Capability to Produce and Effectively Use Both Medical
 

Countermeasures and Non-Pharmaceutical Interventions.............................................................42
 

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Overview ............................................................................................................................................42
 

Activities by Priority ...........................................................................................................................43
 

Strategic Objective 3: Ensure Comprehensive Health Situational Awareness to Support DecisionMaking Before Incidents and During Response and Recovery Operations ......................................47
 

Overview ............................................................................................................................................47
 

Activities by Priority ...........................................................................................................................48
 

Strategic Objective 4: Enhance the Integration and Effectiveness of the Public Health, Healthcare, 

and Emergency Management Systems..........................................................................................54
 

Overview ............................................................................................................................................54
 

Activities by Priority ...........................................................................................................................55
 

Strategic Objective 5: Strengthen Global Health Security...............................................................59
 

Overview ............................................................................................................................................59
 

Activities by Priority ...........................................................................................................................59
 

Implementation Management......................................................................................................63
 

Oversight ............................................................................................................................................63
 

Supporting Stakeholder Execution of the Implementation Plan .......................................................65
 

Evaluating Progress Toward National Health Security.......................................................................66
 

Appendix B: Glossary .......................................................................................................................67
 

Appendix C: Abbreviations ...............................................................................................................72
 

Appendix D: Crosswalk Between Public Health Service Act Goals and Subgoals and the National Health
 

Security Strategy and Implementation Plan 2015–2018.....................................................................76
 

Appendix E: References....................................................................................................................93
 

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Foreword
 

In 2009, the U.S. Department of Health and Human Services (HHS) released the first National Health 

Security Strategy (NHSS), which sought to galvanize efforts to minimize the health consequences of 

large-scale emergencies. The strategy was meant to fill a need born out of the tragic events of the 

previous decade—from the 9/11 terrorist attacks to Hurricane Katrina. Since then, communities have 

taken many steps to become more resilient—by developing their capabilities to withstand and 

overcome disasters, by engaging and training community members, and by securing community 

infrastructure, to cite just a few examples. Important progress has been made, but the nation must 

remain vigilant in its efforts to detect and address new threats in the shifting health security landscape. 

To unify effort and ensure future progress, the National Health Security Strategy and Implementation 

Plan (NHSS/IP) 2015–2018 presents a vision for the nation’s health security over the next four years. 

This document represents the latest milestone in the congressionally mandated requirement to achieve 

a health-secure and resilient nation. In 2009, the first NHSS presented a coherent vision of national 

health security and identified priorities to guide the nation’s efforts. More recently, the National Health 

Security Review (NHSR) 2010–2014 described progress and challenges in improving and sustaining 

national health security over the past four years, and results from this analysis strongly informed the 

current strategy. The NHSS/IP 2015–2018 builds on past progress while providing strategic direction 

and an updated, streamlined approach toward increasing our national health security. 

Like its predecessor, the NHSS/IP 2015–2018 is a national—not just federal—strategy. This means that 

the NHSS was developed through the sustained involvement of a broad array of stakeholders, including 

agencies and organizations from across the federal government, as well as representatives from the 

private sector, state and local governments, the nonprofit sector, community-based organizations, and 

the scientific and academic community. All these stakeholders provided substantial input, time, data, 

ideas, and feedback. Their contributions have helped shape a common vision of health security that this 

nation can stand behind and support. We at HHS are confident that the nation will continue to progress 

toward achieving national health security. We see a nation that is prepared to counter both intentional 

and unintentional threats; in which individuals and communities are alert and ready to support the 

response during an emergency; and in which the public health, healthcare, and emergency management 

systems work seamlessly together. We see communities that seek to strengthen relationships among 

their members and with other communities. 

This strategy is not just HHͼ’ή strategy, but is a strategy for all Americans. The NHSS/IP 2015–2018 aims 

to make this nation a safer place to live in a world of diverse threats and high-consequence incidents. 

We hope that all Americans will take ownership of this strategy and champion its implementation for 

the betterment of the nation. 

Nicole Lurie, MD, MSPH 

Assistant Secretary for Preparedness and Response 

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Introduction
 

National health security is a state in which the nation and its people are prepared for, protected from, 

and resilient in the face of incidents with health consequences. The threats and risks that communities 

face are diverse—they can be intentional or naturally occurring and can result from both persistent and 

emerging threats, including severe weather, infectious diseases, hazardous material exposures, and 

terrorist attacks. The impact of these incidents can be exacerbated by vulnerabilities that vary from 

community to community, such as a large number of at-risk individuals, * 1 weak social networks, 

unprotected critical infrastructure, a lack of training and exercising for health security, and a lack of 

available countermeasures for emerging infectious diseases. The health security of our nation depends 

on the efforts of all Americans and begins at the community level. 

National health security also depends firmly on the ingenuity of individuals and connected, healthy 

communities. Communities contribute to the nation’s health security by building and leveraging local 

assets and skills, enhancing and protecting their ̮ΛΓΓΎΔͻθϥ’ή infrastructure, facilitating citizen 

engagement, fostering interpersonal connections among community members, and cultivating 

relationships among local organizations. In addition, many communities have contributed to health 

security by developing and strengthening relationships with faith-based organizations, academic 

institutions, and private industry. The federal government maintains a proactive posture, works to build 

and support a culture of resilience, develops key skills and core capabilities in the federal and nonfederal 

workforce, partners with private industry to ensure a manufacturing infrastructure to produce medical 

countermeasures, and acts as a safety net in response to large-scale emergencies, particularly those that 

outstrip the response capacity of local or state governments. 

* At-risk individuals: ͵̼ΪήΛΔή ϟ͸Λͳ “[̭\̼͆ΛΪ̼ͳ ̸ΎΪͻΔͮͳ ̠Δ̸ ̠͆θ̼Ϊ ̠Δ ͻΔ̮ͻ̸̼Δθͳ͙may have additional needs in one or 

more of the following functional areas: communication, medical care, maintaining independence, supervision, and 

θΪ̠ΔήΧΛΪθ̠θͻΛΔͶ IΔ̮΍Ύ̸̼ή ͻΔ̸ͻϞͻ̸Ύ̠΍ή ήΧ̼̮ͻ͆ͻ̮̠΍΍ϥ Ϊ̼̮ΛͮΔͻϪ̸̼ ̠ή “̠θ-ΪͻήΊ” ͻΔ θ͸̼ ͵̠Δ̸̼Γͻ̮ ̠Δ̸ !΍΍-Hazards 

Preparedness Act section 2802 of the PHS Act (i.e., children, senior citizens, and pregnant women), individuals who 

may need additional response assistance [including] persons who have disabilities, live in institutionalized settings, 

are from diverse cultures, have limited English proficiency or are non-English speaking, are transportation 

disadvantaged, have chronic medical disorders, and have pharmacological dependency.”
 

 

 

 

 

 

 

 

 

 

 

Recognizing the significant health component of national security, in 2006, Congress passed landmark 

legislation, the Pandemic and All-Hazards Preparedness Act, which required that a National Health 

Security Strategy (NHSS), implementation plan (IP), and an evaluation of progress be developed every 

four years.2 Released in 2009, the original NHSS introduced a unified vision and approach to national 

health security.3 In 2013, Congress passed the Pandemic and All-Hazards Preparedness Reauthorization 

Act, and called for the second iteration of the NHSS to be submitted in 2014 and every four years 

thereafter. This iteration of the NHSS provides strategic direction to ensure that efforts to improve 

health security nationwide are guided by a common vision, based on sound evidence, and carried out in 

an efficient, collaborative manner. It builds on knowledge of the progress made since 2009, as well as 

awareness of current gaps in national health security and the ever-shifting strategic landscape. 

Strategic Landscape 

The strategic landscape is made up of contextual factors that influence decision-making for the NHSS. 

The current national health security landscape differs in some important ways from the landscape that 

existed when the first NHSS was released five years ago. 

First, national strategies, policies, and doctrine now define the strategic landscape in which we operate. 

The National Security Strategy (NSS), θ͸̼ Δ̠θͻΛΔ’ή ΛϞ̼Ϊ̠Ϊ̮͸ͻΔͮ ή̼̮ΎΪͻθϥ ̸Λ̮ΎΓ̼Δθ, recognizes healthrelated issues, specifically pandemic disease threats, as potential threats to national security.4 In 

addition, the NSS incorporates concepts central to health security, including resilience, engaged 

communities and citizens, intergovernmental coordination, global public health cooperation, and 

strategic partnerships with nongovernmental organizations (NGOs). The National Preparedness Goal, 

developed in response to Presidential Policy Directive (PPD)-8 to strengthen our nation’s security and 

resilience, outlines core capabilities organized into the five mission areas (prevention, protection, 

mitigation, response, and recovery).5, 6 The NHSS drives actions that communities must to take to 

address five key mission areas before, during, and after an incident (Figure 1). These mission areas 

align with those found in the National Preparedness Goal.7 Moreover, the NHSS follows these 

strategies, policies, and doctrine and supports their overarching objectives. 

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Figure 1. Mission Areas Relevant to National Health Security 

The health policy landscape is also changing rapidly with the implementation of the Affordable Care 

Act.8 The Patient Protection and Affordable Care Act, hereafter referred to as the Affordable Care Act, 

affects national health security in a variety of important ways. For example, expanded insurance 

coverage, including coverage for preventive services, is expected to increase the overall health and 

resilience of the population. A healthier population will be better able to respond to and recover from 

incidents. Through increased access, increased insurance coverage is also expected to improve patient 

care in the aftermath of an event that displaces people from their local communities. Healthcare 

delivery system reforms, such as accountable care organizations, are a key element of the Affordable 

Care Act intended to improve the quality and efficiency of care. Such reforms are also expected to 

improve health situational awareness (HSA) and the use of electronic health records (EHRs) to ensure 

continuity across the patient continuum of care, from first encounter with the medical system in the 

field, until the time he or she is discharged from a definitive care facility. The implementation of the 

Affordable Care Act will facilitate the collection of better data to understand the population needs of a 

community before an incident occurs (e.g., identifying populations that require assistance during power 

outages because they use medical equipment that make them electricity-dependent).9 Although many 

of the provisions of the Affordable Care Act will improve health security, implementation of the law 

varies by state and affects communities differently; as a result, it is important for stakeholders to 

continue to prioritize planning for emergencies throughout ongoing implementation. 

Second, a period of economic austerity has resulted in the need for health security stakeholders to take 

a closer look at how resources are allocated and to examine whether these resources are being used 

efficiently. Although resource-constrained environments can have negative effects on health security, 

they can also facilitate strategic and thoughtful prioritization of health security activities and innovative 

practices to improve efficiency. Many communities face financial hardships that negatively affect 

governmental and nongovernmental service provision, individuals’ ability to prepare their households 

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for incidents, and professionals’ availability for training and coordination. State and federal 

governments also face financial challenges, while needing to continue to perform their current 

functions. Therefore, health security activities that are efficient, effective, and synergistic—using 

existing resources and routine practices—are desired. 

Third, we live in a world that is characterized by the rapid proliferation of technological advances that 

provide great opportunities for improving society but also introduce new vulnerabilities. For example, 

new technologies in the life sciences provide opportunities to treat or cure diseases while at the same 

time those technologies could be applied with a harmful intent. Air travel and information technologies 

make our world increasingly interconnected, allowing people, ideas, and information to flow globally. 

However, through these same means, localized disease outbreaks can quickly become global pandemics. 

The growth of social media not only increases opportunities for individuals and organizations to connect 

with each other and to access and use information, but also facilitates the spread of potentially 

dangerous rumors and misinformation—with significant consequences for public health. To address 

these communication challenges, health security leaders and other stakeholders must ensure proper 

cybersecurity, understand how to frame communications effectively, and know how to optimally 

manage and use social media as sources of “big data,”

10 especially with respect to differentiating useful 

and erroneous information. The nation also requires sustained research and development to support 

continued technological innovations for health security including the infrastructure to develop, 

manufacture, and test medical countermeasures for man-made and natural threats. 

Incidents, such as the Ebola epidemic in West Africa, Deepwater Horizon oil spill, Hurricane Katrina, 

Superstorm Sandy, and the 2009 H1N1 influenza pandemic have demonstrated the need for “science 

preparedness.” Science preparedness emphasizes the need for disaster research and its supporting 

infrastructure to answer critical questions about public health emergencies, which can help emergency 

planners, responders, and communities recover more rapidly, and learn how to better respond to a 

similar incident. After an incident, there is a finite window of opportunity to identify, collect, and 

analyze the critical and time-sensitive data and information needed to protect the health and safety of 

responders, communities, and the nation as a whole.11 Science preparedness is a collaborative effort to 

establish and sustain an evidence-based research framework that supports all the health security 

mission areas. 

Fourth, climate change is expected to have ongoing effects on the health of Americans in every region of 

the country. As emphasized in the National Climate Assessment,

12 some extreme weather and climate 

events, including hurricanes, heat waves, floods, and droughts, have increased in recent decades, and 

these trends are projected to continue, and could accelerate. Extreme weather events present 

immediate health hazards as well as longer-term risks related to mold, waterborne diseases, and 

behavioral health– and stress-related disorders. Changes in temperature, precipitation, and in the 

timing and duration of seasons affect food security; the distribution of disease vectors, such as ticks and 

mosquitos; and the length and intensity of allergy seasons. Increased levels of ground-level ozone, as 

well as particulate matter from more frequent forest fires and droughts, affect outdoor air quality. 

Many of these health threats disproportionately affect at-risk individuals. It is important to have a 

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coordinated and thoughtful approach to addressing such a diverse and far-reaching set of threats to 

health security. 

Over the past five years, the strategic landscape has changed, affecting national health security in many 

ways. Given these changes, we must continually reassess our course to respond to strategic changes, 

look toward the future to anticipate what we may encounter, and take action now. The NHSS/IP 2015–

2018 attempts to anticipate what our nation will face over the next four years and to drive action in 

areas that will best enhance the nation’s health security. 

Past Progress 

The nation’s future health security builds on the progress made by diverse stakeholders over the past 

five years, as described in the NHSR 2010–2014. Community resilience has been the focus of increased 

awareness and has been incorporated into programs and policies. Furthermore, although the 

importance of individual preparedness continues to be recognized, there is now a greater understanding 

and appreciation for the role of community health resilience in supporting health security. The Public 

Health Emergency Medical Countermeasures Enterprise (PHEMCE) is operational and coordinates 

federal efforts to prepare for enhanced chemical, biological, radiological, and nuclear (CBRN) threats 

including pandemic influenza and emerging infectious diseases from a medical countermeasure (MCM) 

perspective.13 HSA is now commonly understood to be broader than biosurveillance, encompassing 

health system and human services resources and health-related response assets, leading to a more 

comprehensive picture of the range of potential health threats, their potential adverse impacts to 

human health, and the assets available for response and recovery operations to mitigate the adverse 

impact on human health. A growing number of healthcare personnel understand how they can 

positively affect health security, and a greater number of paid staff and volunteers have received 

training in how they can support health security. Hospitals are better prepared to identify and respond 

to mass-casualty events and disease outbreaks and public health emergency managers are now working 

in collaboration with state, local, tribal, and territorial (SLTT) emergency managers. Finally, the U.S. 

government has established stronger relationships with other countries in a collaborative effort to 

improve global health security. 

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Vision 

A nation that is secure and resilient in the face of diverse incidents with health 

consequences, with people in all communities enjoying a high level of security against 

threats to their health and well-being. 

Goal 

To strengthen ̠Δ̸ ήΎήθ̠ͻΔ ̮ΛΓΓΎΔͻθͻ̼ή’ ̠̭ͻ΍ͻθͻ̼ή θΛ ΧΪ̼Ϟ̼Δθͳ ΧΪΛθ̼̮θ ̠̠ͮͻΔήθͳ Γͻθͻ̠ͮθ̼ θ͸̼

effects of, respond to, and recover from incidents with negative health consequences. 

Vision, Goal, and Guiding Principles 

The NHSS 2015–2018 provides a foundation on which the whole community can contribute to the 

common goal of national health security. The NHSS seeks to inform governmental and 

nongovernmental policies and programs; encourage coordinated planning and activities; and guide 

prioritization of investments of time, talents, funds, and other resources. It provides direction by 

establishing a vision that is shared among stakeholders, a goal for the nation, principles to guide 

decision-making, and strategic objectives to focus and coordinate stakeholders’ efforts to achieve highpriority results. 

The vision can be achieved only through strong leadership across all levels of government and the 

commitment of communities around the nation. Leadership and coordinated planning at the 

community level can be achieved as dedicated individuals work together with the organizations that 

are common to most communities (see Figure 2). These organizations include emergency management 

(EM) agencies that protect and serve, schools that protect and educate youth, faith communities that 

inspire and support, county-based cooperative extensions that provide connections to education and 

research institutions, civic organizations that channel the dedication and goodwill of community 

members, and small businesses that are the heart and economic center of our communities. The 

strength of a community derives from both the engagement of individual citizens and the relationships 

among its many organizations. States, working in concert with communities and augmented by the 

federal government, have unique authorities and can play important coordination and support roles in 

health security. 

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Figure 2. An Inclusive, Proactive Approach to Partnerships and Collaboration Within and Among 

† 14 Communities to Enhance National Health Security

† Cooperative extensions provide resources for land-grant institutions to solve public needs with college or 

university resources through nonformal, noncredit programs. The extensions address six major areas, including 4-H 

youth development, agriculture, leadership development, natural resources, family and consumer sciences, and 

community and economic development. 

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Guiding Principles 

A set of principles guides national health security decision-making. These guiding principles describe the 

characteristics that lead to high performance and productive relationships, both of which facilitate 

collaborative achievement of national health security. 

Strategic Alignment 

The NHSS will contribute to the achievement of the goals of the National Security Strategy and PPDs and 

should guide initiatives that contribute to the health security of communities across the nation. 

Evidence-Based Practice 

Scientifically based evidence will be the foundation for health security policies, programs, practices, and 

informed decisions and should be improved through research, analysis, and experience. 

Continuous Quality Improvement 

Policies, programs, and practices to improve national health security will be monitored, evaluated, and 

improved using systematic and rigorous quality management processes. 

Community Engagement 

An inclusive, proactive approach will be used to foster effective partnerships and collaboration within 

and among communities, and the needs and contributions of individuals will be integrated into national 

health security efforts. 

Maximum Benefit 

National health security will be strengthened and sustained by leveraging opportunities in one area to 

make advances in others and by prioritizing improvements that benefit multiple sectors, populations, or 

levels of government. 

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Strategic Objectives
 

The goal of the NHSS is supported by five strategic objectives (see box below). The priorities identified 

for each strategic objective are those deemed to require dedicated and focused attention for the next 

four years. The NHSS Implementation Plan (Appendix A) lists activities that could be performed over 

the next four years in support of the priorities. Stakeholders will need to collaborate on many of these 

activities. The next sections explain the objectives and priorities in greater detail, while the IP provides 

greater detail on the activities. 

Strategic Objectives 

1. Build and sustain healthy, resilient communities.

2. Enhance the national capability to produce and effectively use both medical

countermeasures and non-pharmaceutical interventions. 

3. Ensure comprehensive health situational awareness to support decision-making before

incidents and during response and recovery operations. 

4. Enhance the integration and effectiveness of the public health, healthcare, and

emergency management systems. 

5. Strengthen global health security.

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Strategic Objective 1: Build and Sustain Healthy, Resilient 

Communities 

Scope 

Community resilience is a communiθϥ’ή sustained ability to withstand, 

adapt to, and recover from adversity.15 Promoting community 

resilience is a multisector endeavor that leverages community and 

individual assets, such as infrastructure, talents, skills, relationships, 

technology, and natural resources. Because health is a key aspect of 

overall community resilience, the scope of this objective is community 

health resilience—a community’s ability to use its assets to strengthen 

public health and healthcare systems and to improve the community’s 

physical, behavioral, and social health to withstand, adapt to, and 

recover from adversity. 

Vision for Building and Sustaining Healthy, Resilient 

Community health 

resilience is the ability of a 

community to use its assets 

to strengthen public health 

and healthcare systems and 

θΛ ͻΓΧΪΛϞ̼ θ͸̼ ̮ΛΓΓΎΔͻθϥ’ή 

physical, behavioral, and 

social health to withstand, 

adapt to, and recover from 

adversity. 

Communities 

The nation will create a robust culture of health resilience, promoting physical and behavioral health 

and well-being, connecting communities, and championing volunteers. Across the nation, communities, 

organizations, and individuals will all contribute through their unique resources and capabilities. A 

culture of resilience will equip them not only to address daily challenges, but also to prevent, prepare 

for, mitigate, respond to, and recover from large-scale emergencies. Individuals and households will 

know how to improve health and will act on that knowledge. They will be engaged with the healthcare 

system and understand how to support their neighbors and community. Households and communities 

will work together, with the support of local organizations, and will engage in training and planning that 

prepare them to fulfill their roles in health security. Communities will promote health in part by 

supporting community infrastructure, including secure housing, economically viable neighborhoods, 

quality healthcare facilities, and spaces for gathering and exercise.16 Public health, healthcare, 

behavioral health, and social service organizations will understand the needs of the people they serve 

and be ready to meet those needs before, during, and after an incident. As individuals and 

organizations become more health-resilient and build robust social networks, whole-community 

resilience will thrive. 

Operational Context 

The NHSS 2010–2014 heightened awareness of and refined the concept of community resilience. 

Increasingly, national and federal policies have prioritized community resilience and community health 

resilience through operational guidance (e.g., the National Disaster Recovery Framework17), national 

guidance, and grant funding guidelines (e.g., Healthcare Preparedness Capabilities: National Guidance 

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for Healthcare System Preparedness).18 The Patient Protection and Affordable Care Act has benefited 

communities by increasing interorganizational collaboration among NGOs (particularly healthcare 

facilities) and governmental organizations. The nation has made progress in understanding how to build 

and sustain resilient communities, including the roles that people and infrastructure play. However, 

opportunities remain for many parts of the public health and healthcare systems to improve their 

contributions to health security. For example, expanded health insurance coverage might contribute to 

the ̮ΛΓΓΎΔͻθͻ̼ή’ health resilience by improving access to care. The potential for such a contribution 

will vary by community, as communities often have distinct characteristics, strengths, and risks. The 

unique makeup of communities influences the types of operational support that may be needed from 

state or federal governments following a disaster and the kinds of partners that need to be engaged in 

preparedness activities to build resilience prior to an event. 

Communities are facing an increasingly complex array of challenges. Human-caused and naturally 

occurring incidents are more frequent and costly and are influenced by global factors, such as climate 

change, interconnected economies, and population shifts toward large, dense urban centers and 

megacities. A wider range of partners and capabilities must be brought together to address these 

heightened risks and to complement and expand available community, state, and federal support. A 

community resilience approach does this by encouraging actions that improve the community’s ability 

to withstand, adapt to, and recover from adversity while also promoting strong day-to-day systems and 

addressing the underlying social determinants of health. In particular, incidents with negative health 

consequences, particularly those that are catastrophic, underscore the importance of social 

connectedness, educated and effective bystander response (e.g., spontaneous action by a member of 

the public to help another person), and strong partnerships among people and organizations that can be 

leveraged to improve response and sustain recovery. 

Priorities 

Several areas are prioritized to continue to build and sustain healthy, resilient communities. Improving 

social connectedness will enhance individual and community health resilience. Communities that plan 

together will be better able to identify risks, take action to withstand the effects of an incident, and 

recover more swiftly than communities that do not. Governmental organizations and NGOs can 

improve the physical, behavioral, and social health of a community. These organizations need to forge 

and maintain strong relationships prior to an incident to understand each community’s unique strengths 

and vulnerabilities; quickly provide resources to those in need; and mobilize a whole-community effort 

for prevention, protection, mitigation, response, and recovery. Relationships among stakeholders in 

government and private industry, NGOs, and academia expand the reach of resources and extend the 

reach of the public workforce while also helping NGOs meet people’s needs. All organizations—

including those that do not have health security as their primary mission—need to develop, train, and 

exercise response and recovery plans in coordination with community partners. 

Communities need to continue to build and foster a culture of health resilience, one in which individuals 

are mindful of and habitually take actions that improve their own health and resilience and those of 

Page 11 
 

their families, neighborhoods, and communities. Building a culture of health resilience includes 

investing in comprehensive health education and promotion activities to teach residents about actions 

that they can take to be healthier, as well as ways in which they can protect themselves and their 

families before, during, and after an incident. These activities should integrate the access and functional 

needs of at-risk individuals. 

Strategic Objective 1 Priorities 

1.1. Encourage social connectedness through multiple mechanisms to promote 

community health resilience, emergency response, and recovery. 

1.2. Enhance coordination of health and human services through partnerships and other 

sustained relationships. 

1.3. Build a culture of resilience by promoting physical, behavioral health, and social 

health; leveraging health and community systems to support health resilience; and 

increasing access to information and training to empower individuals to assist their 

communities following incidents. 

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Strategic Objective 2: Enhance the National Capability to Produce and 

Effectively Use Both Medical Countermeasures and NonPharmaceutical Interventions 

Scope 

Countermeasures are used to protect communities from and limit the adverse health impacts of CBRN 

attacks, outbreaks of infectious diseases, and other incidents. There are two main types of 

countermeasures: MCMs and non-pharmaceutical interventions (NPIs). MCMs include medications and 

other pharmaceutical remedies which mitigate and prevent the spread of disease - such as vaccines, 

small molecule, antibody, and cellular therapeutics, antimicrobials, antidotes, antitoxins, and 

decorporation agents to reduce radioactive contamination - as well as non-pharmaceutical medical 

devices and approaches - such as ventilators, diagnostics, personal protective equipment (PPE), and 

patient decontamination.‡19 NPIs refer to community mitigation strategies that are used to prevent the 

spread of disease, contamination, or other adverse effects related to an incident. NPIs include both 

actions taken by individuals, such as hand hygiene and covering one’s mouth when coughing, and 

actions taken by communities to reduce contact with contagious persons, such as social distancing (e.g., 

closing schools and asking people to work at home).§ 20 This objective encompasses the enhancement 

of the successful PHEMCE, and the range of actions related to enhancing the nation’s capacity to 

develop, manufacture, evaluate, and use MCMs and NPIs both for routine public health purposes as well 

as during emergencies; from research to development and acquisition, to effective use or 

implementation of countermeasures, to assessing the intended and unintended consequences of the 

countermeasures. 

Vision for Enhancing the National Countermeasure Capability 

The nation will rapidly and nimbly develop, manufacture, evaluate, and deploy countermeasures 

through public-private partnerships that protect communities from and alleviate the effects of: 

 CBRN agents 

‡ Although the 2012 PHEMCE strategy identifies ventilators, diagnostics, and similar equipment and services as 

“non-pharmaceutical interventions,” the PHEMCE implementation plan has updated the terminology to “nonpharmaceutical MCM interventions.” For purposes of consistency, the NHSS uses the PHEMCE implementation 

Χ΍̠Δ’ή ΍̠ΔͮΎ̠̼ͮͳ ϟ͸ͻ̮͸ ͻή ̠΍ήΛ ̮ΛΔήͻήθ̼Δθ ϟͻθ͸ ̼Δθ̼Ϊή ͆ΛΪ Dͻή̼̠ή̼ ΛΔθΪΛ΍ ̠Δ̸ ͵Ϊ̼Ϟ̼ΔθͻΛΔ (D) ΍̠ΔͮΎ̠̼ͮ ͆ΛΪ ͣ͵IήͶ

§ These lists are not exhaustive. 

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 infectious diseases, including pandemic influenza, emerging and re-emerging pathogens, and

antimicrobial-resistant pathogens.

The nation will be poised to address a wide range of threats. It will create a comprehensive suite of 

countermeasures for everyday public health and in public health emergencies, as well as coordinated 

process for using them effectively. To ensure the best response, stakeholders will make use of both 

MCMs and NPIs. For example, the response to an influenza pandemic would employ social distancing 

(e.g., canceling large gatherings, asking people to stay home when sick) or usage of antiviral drugs until a 

vaccine is available. The nation will invest in developing and manufacturing cost-effective MCMs and in 

plans to implement NPIs and ensure their efficacy. Countermeasure experts will collaborate with 

healthcare practitioners and the public to integrate their efforts in planning for and using 

countermeasures. 

Operational Context 

The nation has made progress in developing and preparing countermeasures through the active 

involvement of many agencies and organizations. PHEMCE has facilitated and strengthened interaction 

among federal stakeholders and between federal- and nonfederal stakeholders. It provides an 

integrated vision of the entire MCM enterprise, which is necessary to ensure the maximum health 

benefit and most-efficient use of public and private resources. Figure 3 shows the PHEMCE mission 

components, as well as lead agencies within and outside of HHS and essential nonfederal stakeholders. 

Central to this strategic objective are the 2012 PHEMCE Strategy and Implementation Plan and annual ** 21 updates. 

HHS and the U.S. Department of Defense (DoD) maximize the nation’s ability to respond to CBRN threats 

by aligning available MCM research and development and related infrastructure resources with PHEMCE 

public health emergency and DoD requirements and priorities.22 DoD partners have also supported 

development of MCMs of mutual interest to DoD and HHS and coordinated closely with HHS down to 

the level of funding individual projects. These investments have supported progress in early- and latestage MCM research and in identifying new applications and uses of existing products. The Biomedical 

Advanced Research and Development Authority’s (BARDA’s) Centers for Innovation in Advanced 

Development and Manufacturing, !͸D!’ή Fͻ΍΍ FͻΔͻή͸ ̠͢ΔΎ̠̮͆θΎΪͻΔͮ ̼ͣθϟΛΪΊ, ̠Δ̸ DΛD’ή !̸Ϟ̠Δ̸̮̼ 

Development and Manufacturing Capability were established to assist companies in the advanced 

** The updated 2014 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and 

Implementation Plan (SIP) is anticipated for release in late calendar year (CY) 2014. Developers of the 2014 

PHEMCE SIP have been actively engaged in the NHSS process to ensure alignment. 

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development and manufacture of MCMs and respond rapidly in the development and manufacturing of 

MCMs during public health emergencies. Additionally, the National Institute of Allergy and Infectious 

Diseases (NIAID), the lead component of the National Institutes of Health (NIH) for research and 

development of MCMs for CBRN threats, supports early and preclinical development of MCMs and 

transitions those that show promise to BARDA for advanced development. The length of time to 

develop an MCM is an ongoing challenge; however, successes have been realized. These successes 

include a reduction in the time needed for product sterility testing, more rapid access to both clinical 

and nonclinical testing, and a reduction in time to move bulk MCM product into its final form needed for 

use. As a result, seven MCMs received FDA approval in the last two years and 12 new products have 

become available under Project BioShield since 2004. Additionally, NIAID and BARDA are actively 

providing developers many core pharmaceutical services that small companies lack to develop, 

manufacture, and test their MCM candidates. 

CDC has invested significantly in procuring and maintaining materiel for the Strategic National Stockpile 

(SNS), the nation’s repository of antibiotics, vaccines, antidotes, antitoxins, and other critical medical 

equipment and supplies. State and local capacity to receive, distribute, and dispense MCMs has 

improved since 2009. Such programs as the CDC Division of State and Local Readiness provide 

distribution and dispensing technical assistance, while the Cities Readiness Initiative (CRI) provided 

funding and technical assistance to state and local health departments. In the past four years, research 

has been conducted to model the impact that many NPIs have on influenza transmission, and new 

evidence-based guidance for communities on the use of NPIs is being developed and will be available 

soon. 

Currently, some gaps remain in the nation’s countermeasure capability. Despite the availability of 

portable diagnostic assays for some high-priority threat pathogens, point-of-care diagnostics for other 

high-priority threats are unavailable and remain PHEMCE priorities for advanced development. Research 

on NPIs is lacking, and the ability to develop, manufacture and test novel MCMs rapidly for unknown 

emerging infectious disease threats (e.g., MERS-CoV) remains a challenge for the PHEMCE. 

Harmonization and streamlining for rapid biosafety and biosecurity permitting is needed among CDC, 

FDA, and USDA for transport of MCMs, reagents, and allied supplies during domestic and global public 

health emergencies. Moving forward, progress must be sustained—and innovation fostered—for both 

MCMs and NPIs in the face of changes to funding mechanisms and the fiscal environment. Doing so 

requires additional efforts to facilitate engagement of the full range of essential stakeholders. 

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Figure 3. Lead Agencies in the Public Health Emergency Medical Countermeasures Enterprise23 

Priorities 

This NHSS objective aims to enhance and expand the national countermeasure capability in several 

ways. First, innovation and application of both MCMs and NPIs to address both routine public health 

needs as well as those that arise during emergencies is fundamental. 

Public health and emergency management professionals at all levels must learn and consider the full 

range of countermeasure options available in order to determine which combination to deploy in 

response to an incident. The nation must ensure that countermeasures are developed and tested 

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appropriately to address the needs and priorities of all segments of the population, including firstresponse personnel and at-risk individuals. 

Second, this objective will help to implement the vision described in the PHEMCE strategy by improving 

collaboration with nonfederal stakeholders to better ensure that PHEMCE’s priorities are achieved. 

Third, this objective will encourage the effective use of NPIs through planning and preparation to 

identify effective interventions, the situations in which they should be deployed, methods for 

monitoring their effects, and indicators to modify or discontinue NPIs. Identification will require an 

understanding of the intersection between biology and all countermeasures that are required to contain 

the threat. Specifically, research is needed to inform decisions regarding which NPIs are most effective 

under specific circumstances; to identify and understand the effects of interventions (including 

unintended effects); and to determine their feasibility (e.g., in terms of public acceptability and ease of 

use). 

Finally, this objective will give special attention to building national capacity to distribute and dispense 

MCMs. Encouraging communities and governments to collaborate will help ensure stakeholder support 

for an effective countermeasure response when an incident occurs. 

Strategic Objective 2 Priorities 

2.1. Create and/or refine decision-making frameworks and coordinated processes that 

consider both MCMs and NPIs when making research, advanced development, and 

acquisition decisions related to countermeasures and determining the best 

approaches to reducing adverse health effects of particular incidents of concern. 

2.2. Increase nonfederal stakeholder engagement within PHEMCE processes. 

2.3. Focus research and translation on NPIs to ensure that evidence is accurate and 

actionable. 

2.4. Expand and improve national capacity to research, develop, manufacture, obtain, 

distribute, and dispense medical countermeasures. 

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Strategic Objective 3: Ensure Comprehensive Health Situational 

Awareness to Support Decision-Making Before Incidents and During 

Response and Recovery Operations 

Scope 

Detection is an important aspect of national health security that should not be understated.24 Detection 

refers to the timely identification of a threat or incident with negative health consequences. National 

situational awareness (SA) includes all sectors and relevant actors nationally and globally across the 

prevention, protection, mitigation, response, and recovery mission areas (see Figure 1) and uses a 

process that involves an active, continual, and timely information-gathering loop that relies on existing 

assets, networks, and systems. Active and timely SA provides the foundation for decisions and actions 

that, in turn, can result in better resource utilization, successful prevention and mitigation of emerging 

threats, and improved security for the nation. HSA contributes to overall SA by providing information 

that includes data regarding health threats, population health, health system and human services 

†† 25 resources, health-related response assets, and other considerations to inform decision-making. HSA 

is also both domestic and international in reach and contributes to health security, homeland security, 

and national security. HSA processes actively gather information about resource allocation, risk analysis, 

forecasting, response, and other actions that might affect health security to support decision-making 

before incidents and during response and recovery operations. 

HSA is a knowledge state that results from the process of actively gathering, analyzing, integrating, 

interpreting, validating, and disseminating information. HSA includes routine and emergency 

‡‡ biosurveillance information and other health-related information, and nonhealth inputs, as shown in 

Figure 4. 

†† HSA is a knowledge state that results from the process of active information-gathering (both domestic and 

international) with appropriate analysis, integration, interpretation, validation, and sharing of information related 

to health threats and the health of the human population, as well as health system and human services resources, 

health-related response assets, and other information that could affect the public’s health to inform decisionmaking, resource allocation, and other actions. 

‡‡ Biosurveillance is defined in the National Strategy for Biosurveillance ̠ή “θ͸̼ process of gathering, integrating, 

interpreting, and communicating essential information related to all-hazards threats or disease activity affecting 

human, animal, or plant health to achieve early detection and warning, contribute to overall situational awareness 

Λ͆ θ͸̼ ͸̼̠΍θ͸ ̠ήΧ̼̮θή Λ͆ ̠Δ ͻΔ̮ͻ̸̼Δθͳ ̠Δ̸ θΛ ̼Δ̠̭΍̼ ̭̼θθ̼Ϊ ̸̼̮ͻήͻΛΔ Γ̠ΊͻΔͮ ̠θ ̠΍΍ ΍̼Ϟ̼΍ήͶ”

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Figure 4. Inputs to Health Situational Awareness26 

HSA and biosurveillance are integrally related, though not synonymous. Biosurveillance is a key 

information-gathering activity that encompasses human disease surveillance, animal disease 

surveillance, environmental monitoring, and gathering of intelligence and other information for early 

warning and SA. HSA encompasses both biosurveillance information-gathering activities and data as 

well as data related to the assets available for response and recovery operations to mitigate the adverse 

impact on human health including human services and public health and healthcare system assets, 

resources, and infrastructure. 

Vision for Ensuring Health Situational Awareness to Support Decision-Making 

HSA is an operational capability that is flexible to provide timely and relevant information based on the 

unique nature of the incident to decision-makers to support health-related decision-making. A robust 

capability for HSA would allow users at all levels of the prevention, protection, response, recovery and 

mitigation mission areas and across sectors to define and access the information most relevant to them. 

A capability for HSA will provide decision-makers with the following: 

 Insight on threats and risks that could adversely affect health and the assessment of potential 

consequences. 

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 Near-real-time information on the status of the human population health that is adversely 

affected or at-risk. 

 Near-real-time information on the response and recovery capabilities and resources available to 

protect human health and mitigate adverse impacts. 

 Forecasting and analysis of future needs to ensure proactive decision-making and efficient and 

effective allocation and use of resources. 

 Near-real-time information from other sectors on critical infrastructure functionality that could 

affect health and triggers for corrective action. 

 Information to consistently provide risk communication to the public. 

 Coordinate a management structure to ensure information is retrieved from and provided to all 

relevant stakeholders in a timely fashion. 

 Insight on severity, counterability, and urgency. 

A capability for HSA will leverage state-of-the-art technology and information management systems 

while always ensuring privacy and security in accordance with the National Strategy for Information 

Sharing and Safeguarding.27 These systems will be continuously improved and made interoperable or 

functionally compatible.§§ In addition, a capability for HSA will be underpinned by a robust workforce 

and human networks of subject-matter experts and will include human, animal, and environmental 

health. 

Operational Context 

SA has been operationalized in the past few years by automating and integrating the collection, analysis, 

and visualization of data into meaningful knowledge and usable information. Timely (near-real-time) 

delivery of appropriately analyzed, relevant data to the key decision-makers involved in all phases of a 

health incident is vital to achieving successful outcomes. Interoperability or functional compatibility 

among systems is also important to allow for information flow across all sectors of a community and 

among all levels of government. The breadth of the collected information needs to include not only 

health-related data but also non–health-related data that may be required to make sound operational 

decisions (e.g., transportation data, power-grid status, active intelligence from law enforcement, realtime weather and climate information). SA products and services have been integrated into the 

National Incident Management System (NIMS) to inform and improve the allocation of critical resources 

§§ Functional compatibility is defined as a combination of means and ways to perform a set of tasks under specified 

standards and conditions that collectively provide the ability to achieve a desired effect. 

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during all stages of incident management. SA processes, systems, and products provide decision-makers 

with the knowledge, contextual insight, and forecasting needed to make informed and effective 

management decisions during response and recovery operations and to inform public affairs and risk 

communication during incidents. 

The HHS Secretary’s Operations Center (SOC) serves as the central HSA hub through which HHS 

monitors public health and medical indicators and warnings, both domestically and internationally, and 

coordinates integrated response and recovery operations related to ongoing events of public health 

significance. The SOC maintains HSA on a 24-hour-a-day, 365-day-a-year basis and oversees all phases 

of the information management process, including collection, analysis, integration, and dissemination. 

Dissemination of information is conducted under a phased reporting structure that mirrors the structure 

used by the Department of Homeland Secruity (DHS) National Operation Center and the Federal 

Emergency Management Agency (FEMA) National Watch Center, and allows for the sharing of 

information with both internal and external partners. Additionally, the SOC works with other federal and 

SLTT operations centers to share information and coordinate appropriate responses for public health 

and medical consequences. The SOC works internally to coordinate all department and agency activities 

across the HHS spectrum. 

Specific examples of success in improving operational HSA have been demonstrated. HHS monitors 

social media during incident responses to identify potential emerging public health concerns. Following 

Superstorm Sandy, HHS used social media tools to discover an outbreak of norovirus and alerted HHS 

personnel working in shelters to prevent further spread. The increased use of EHR technology, 

promoted through the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs, is 

providing opportunities for near-real-time exchange of disease surveillance data.28 HHS has employed 

MedMap, a secure geographic information system (GIS)-based electronic, interactive mapping 

application that combines data from multiple federal and public agencies into a single visual 

environment for enhanced SA to support planning for and response to natural and human-caused 

incidents. Effective decision support requires coordinated information-sharing and analysis to provide 

appropriate context and transform the information into actionable tasks to support desired outcomes. 

Priorities 

The development of several national strategies relevant to HSA has increased attention in this area and 

promoted a shared vision. The next step is to implement that vision by continuing to build and improve 

the data systems needed to support effective HSA. An area of focus for this objective will be improving 

the ability to share information—human health, environmental, and zoonotic—across all relevant 

stakeholders and to use that information to identify threats and mitigate their effects. More generally, 

data collection and information creation activities need to be flexible and responsive to adapt to 

evolving decision support requirements. The ability to refine data sources throughout the life cycle of 

an incident and to include contextual information is vitally important and should be strengthened and 

promoted. In the next four years, it will also be critical to achieve a better understanding of the full 

range of HSA needs among stakeholders, including the access and functional needs of at-risk individuals 

Page 21 
 

 

and the extent to which existing operational capabilities address them. Coordination among public and 

private stakeholders can be facilitated by creating a voluntary oversight authority with representatives 

from key stakeholder groups and sectors. In addition, data collection and sharing among stakeholders 

can be informed by a better understanding of the barriers (e.g., barriers to surveillance, interoperability 

and data sharing), whether technology- or policy-related, and ways to address them. 

Strategic Objective 3 Priorities 

3.1. Improve HSA and data-sharing with respect to integrating human health, 

environmental, zoonotic, and other relevant information to mitigate immediate, 

short-, and long-term health effects. 

3.2. Promote continuous improvement through use of state-of-the-art innovative systems, 

tools, and partnerships to ensure improvement of HSA. 

3.3. Determine and expand operational capabilities to meet the HSA needs for all relevant 

stakeholders so that data sourcing is both situationally and user-defined. 

3.4. Develop a voluntary, collaborative coordinating authority (CCA) and management 

structure for HSA to promote and coordinate consistent approaches to HSA. 

3.5. Address technology and policy challenges to ensure the functional compatibility of 

systems to collect, integrate, analyze, visualize, and share information. 

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Strategic Objective 4: Enhance the Integration and Effectiveness of 

the Public Health, Healthcare, and Emergency Management Systems 

Scope 

The public health, healthcare, and emergency management systems are related, overlapping systems 

contributing to national health security. The public health system includes public agencies (e.g., schools, 

Medicaid, environmental protection agencies, land-use agencies), state and local public health 

departments, and private organizations whose actions have significant consequences for the health of 

the public.29 The healthcare system is the organization of people, institutions, and resources that deliver 

healthcare services, including behavioral health services, to meet the healthcare needs of the 

population. Emergency management30 involves the efforts of communities or businesses to plan for and 

coordinate the people and emergency services required to reduce vulnerability to hazards and to cope 

with disasters while addressing all mission areas of health security (See Figure 1). Emergency services 

involve ̠ ̮ΛΓΓΎΔͻθϥ’ή first-responder organizations that have the specialized training and equipment to 

support a national level health incident through response, treatment or stabilization, transportation 

through fire services and emergency medical services (EMS), and decontamination of personnel and 

equipment through hazardous material services.31 Components of the emergency management system 

are also essential to establishing and maintaining incident command and incident management 

operations. A skilled workforce is the foundation of these systems. The workforce is made up of paid 

and volunteer staff employed by governments and other organizations, as well as interim employees, 

volunteers, and bystanders who just happen to be at the scene of an incident and seek to contribute. 

The integration of public health, healthcare, and emergency management systems means that they can 

work together day to day, mutually supporting one another so that they can seamlessly scale up to 

handle increased requirements or demands during the mitigation, response, and recovery phases of the 

incident life cycle. Furthermore, integrating the expertise and specialized equipment found in the public 

health, healthcare, and emergency management systems will enhance a community’s resilience without 

duplicating services under different organizations or strategies. 

Vision for Enhancing the Integration and Effectiveness of the Public Health, Healthcare, 

and Emergency Management Systems 

Integrated, scalable public health, healthcare, and emergency management systems will be dynamic, 

risk-informed, and flexible. These systems will be able to adjust, on immediate notice, from baseline 

operations to crisis response mode using established, trained, and tested processes and practices, as 

well as information-sharing tools and technologies. Systems will address the needs of all communities 

and populations, including at-risk individuals. The federal government will maintain robust national 

capabilities (e.g., ability to deploy skilled personnel through the National Disaster Medical System) that 

can augment state and local efforts as needed. Communication and coordination across levels of 

government will facilitate an integrated response when local capabilities are overwhelmed. 

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The workforce supporting these systems will be highly skilled and will exhibit both the ability and the 

willingness to respond to complex incidents. The workforce will be large enough to meet both routine 

and surge demands. Given the interdependencies across workforces, efforts to develop the health labor 

force will be coordinated across key workforce domains to enhance the national security workforce 

(Figure 5). Workers will be well-educated in their respective disciplines, established incident 

management practices, and safety protocols. Paid staff and volunteers (e.g., civilian Medical Reserve 

Corps members) will be trained in key evidence-based competencies. Interim volunteers will be 

registered, trained on emergency response plans, exercised, and emergency managers will use them 

effectively. An active bystander culture will be nurtured, in which members of the general public have 

the support and confidence to take life-saving actions, especially in the early moments following an 

incident and before traditional first responders can arrive. During an incident, when bystanders and 

other spontaneous volunteers appear on the scene, emergency managers will establish an orientation 

session to identify volunteers’ specific skills and abilities, arrange just-in-time training, and attempt to 

direct their contributions according to their specific skills and abilities, to augment first-responder 

resources. 

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Figure 5. Integrated Emergency Management System, Public Health System, and Healthcare
 

System Supported by Paid Staff and Volunteers
 

Communities will enhance the national health security workforce by engaging youth, offering them 

service projects and leveraging their enthusiasm and creativity to solve problems. These experiences will 

call to action the next generation of emergency management leaders and prepare them to face existing 

and future threats. 

Operational Context 

Since 2009, the nation has made progress toward establishing the foundation for integrated public 

health, healthcare, and emergency management systems. Regional planning alliances and healthcare 

coalitions have increased in number, strengthening organizational ties, and introducing new sectors into 

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planning and response activities. In a 2011 survey, 94.5 percent of acute care hospitals that responded, 

reported participation in a coalition for emergency planning and response purposes.32 Most responding 

coalitions indicated wide participation of both hospital and other stakeholders, such as public health 

agencies, EMS providers, and emergency management agencies. Although the number of coalitions is 

increasing, evidence is needed to determine whether coalitions or other organizational relationships or 

approaches are associated with improved intrasystem and intersystem integration. If the evidence is 

found, understanding which characteristics are associated with improved outcomes could inform 

guidance and improve healthcare system performance and resilience. The implementation of the 

Health Information Technology for Economic and Clinical Health (HITECH) Act33 and Affordable Care Act 

has furthered the adoption of EHRs, which has facilitated the integration of healthcare and other 

organizations. However, EHR interoperability issues among governments, including federal agencies, 

and between governmental and nongovernmental sectors, remain as a challenge. 

Healthcare delivery organizations have improved their workers’ ability to respond to rapid, temporary 

increases in patients through better integration with public health, emergency management, and other 

partners. Many organizations have developed guidance, tools, and templates to improve the scalability 

of the national health security system, including resources for crisis standards of care for communities. 

Legal and policy challenges, however, remain barriers to implementation of crisis standards of care. The 

Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) cooperative 

agreements34 and Emergency Medical Services for Children (EMSC) program all have defined capabilities 

and associated guidance to help states, territories, and select large municipalities improve integration 

across the public health, healthcare, and emergency management systems, including resources 

addressing the access and functional needs of at-risk individuals. However, decreasing funds threaten 

the sustainability of achievements made by communities nationwide. 

The public health, healthcare, and emergency management workforces are all currently operating under 

significant constraints, with gaps in coverage in many communities.35 In recent years, activities have 

been undertaken to build a highly competent workforce for health security. In particular, there has 

been a focus on identifying core competencies for the disaster medicine and public health workforces. 

Many educational courses have been delivered, including training in points of dispensing (PODs), safety, 

and environmental health. Progress has been made toward both quantifying the number of staff and 

volunteers available for incident response and assessing ̮ΛΓΓΎΔͻθͻ̼ή’ ability to quickly notify and 

assemble staff and volunteers. However, performance measurement, logistical, and other challenges 

remain. Although creative actions have been taken in communities and states to cope with the 

insufficient workforce, collaborative and swift national corrective action is needed to address these 

problems. In this regard there are several notable needs: 1) evaluate the effectiveness of workforce 

training; 2) adapt existing training materials for regional use; 3) place more epidemiologists, public 

health informaticians, other skilled public health professionals at the state and local levels; 4) develop 

new training materials in communities and regions where none exists, and 5) expand the reach and 

use of e-learning for training. 

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Priorities 

The priorities for this objective seek to sustain and build on recent progress. Increased integration will 

improve ήϥήθ̼Γή’ resilience, meaning that they will become more scalable, robust, efficient, 

interoperable, sustainable, and adaptive to change. These qualities might be strengthened through 

coalition-building, as well as cooperative planning, training and exercising in all mission areas. Perhaps 

the greatest gains can be made by focusing on those organizations that do not view health security as 

their primary responsibility. To reduce the burden on responders, it is important to ensure that home 

health agencies, behavioral health facilities, long-term-care facilities, provider groups, Medicaid 

providers, and others remain operational and serve the populations that rely on them. A focus on rural 

communities will also be helpful because many planning assumptions based on urban models do not 

apply in rural areas. System integration can be improved both by building on routine services so that 

relationships and processes are understood, and by ensuring that infrastructure is in place to support 

information-sharing and exchange. Efforts are also essential to ensure that the integrated systems can 

address the needs of all individuals, including at-risk individuals. 

Additional competency and capability-based training is needed to help paid staff, volunteers, and the 

organizations they serve to understand and perform their specific roles and responsibilities in health 

security. A broad education framework that articulates professional roles and competencies for 

national health security and offers training and career development paths will help ensure proficient 

and effective workers. Ongoing recruitment and retention strategies are critical to ensure that there is a 

sufficient supply of qualified workers to meet routine and surge demands for services, particularly at the 

state and local levels. Additional efforts to improve the management and use of volunteers to 

supplement the paid workforce will enhance national health security because volunteers are critical to 

any response or recovery effort. 

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Strategic Objective 4 Priorities 

4.1. Define and strengthen healthcare coalitions and regional planning alliances across all 

incident phases. 

4.2. Build upon and improve routine systems and services as a foundation for incident 

response and risk reduction, focusing on common elements that leverage the 

alignment of routine capabilities with those needed during an incident. 

4.3. Ensure that the integrated, scalable system can meet the access and functional needs 

of at-risk individuals. 

4.4. Strengthen competency and capability-based health-security-related workforce 

education. 

4.5. Expand outreach to increase the numbers of trained workers and volunteers with 

appropriate qualifications and competencies. 

4.6. Effectively manage and use nonmedical volunteers and affiliated, credentialed, and 

licensed (when applicable) healthcare workers. 

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Strategic Objective 5: Strengthen Global Health Security 

Scope 

Global health security refers to mitigation of, preparedness for, response to, and recovery from 

incidents that adversely affect health and that also could pose a risk to national and international 

security, destabilize economies, disrupt social cohesion, and affect the critical business of government.36 

΂Λ̸̠ϥ’ή global health security threats arise from many sources, both natural and human-created. These 

include emerging infectious diseases, antimicrobial-resistant pathogens, natural disasters, the risk that 

accelerating scientific research capabilities may cause the inadvertent release of CBRN agents, 

vulnerabilities across a globalized food supply, and continued concerns about intentional use of CBRN 

agents. Furthermore, storms are getting more frequent and much stronger, droughts, fires, 

earthquakes, floods, and other natural and man-made phenomena that will have a direct impact on 

communities are ever-present. 

The health of the American people and that of the people around the world are more closely linked than 

ever before. Greater movement of people, animals, and goods across international borders increases 

the risk of exposure to health threats originating outside one’s own country. In such an interconnected 

environment, the best way for a country to protect its population is to prevent a health threat from 

emerging and spreading in the first place. This means addressing threats early and at their source, 

before they spread more widely within and across borders; it also means that other countries, including 

the United States, should prepare for the arrival of such trans-national threats within their own borders. 

The 2014 Ebola outbreaks are a good illustration of this. Thus, all nations benefit from attention to their 

own health security and to global health security. 

Vision for Strengthening Global Health Security 

The nation will strengthen global health security and, as a result, its own health security. In partnership 

with other nations, intergovernmental organizations, and public and private stakeholders, the United 

States will help accelerate progress toward a world safe from public health threats and will promote 

efforts to strengthen global health security as a national health security priority. By working together 

with international partners to develop global capacities and operational capabilities to prevent 

epidemics, detect threats early, rapidly respond to incidents, and support integrated recovery efforts, 

the United States will also protect the health of the American people from global health security threats. 

Operational Context 

The U.S. government has responded effectively to many national and global health security threats. 

These include the 2009 influenza pandemic (H1N1), the ongoing occurrences of Avian Influenza A (H7N9 

and H5N1), the emergence of Middle East Respiratory Syndrome (MERS), and the unprecedented Ebola 

epidemic in West Africa—all of which underscore how infectious diseases can emerge (or reemerge) and 

spread or have the potential to spread rapidly across countries and even around the globe. The U.S. 

government has also sought to mitigate health security threats emanating from international incidents 

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that overwhelmed local response capacity, such as the 2010 earthquake in Haiti, the 2011 tsunami and 

nuclear power plant incident in Japan, and the 2013 typhoon in the Philippines. 

The U.S. government uses a variety of mechanisms to strengthen national and global health security. 

Domestically, several national strategies highlight U.S. health security, including the National Strategy 

37 38 for Countering Biological Threats, the National Strategy for Pandemic Influenza, the National Strategy 

39 40 for Combating Antibiotic-Resistant Bacteria, and the National Strategy for Biosurveillance. 

On an international level, the United States works within multiple bilateral and multilateral agreements 

and frameworks to protect the American people from global health security threats. For example, the 

United States is a signatory to the 2005 International Health Regulations (IHR), a legally binding 

agreement among 196 state parties, which obligates member states to develop and maintain the 

capability to detect, assess, notify, and respond to public health threats, especially those of international 

concern. 41 Under the IHR, the U.S. government works both domestically and internationally to ensure 

that health security capabilities are in place. The United States is also a party to the Global Health 

Security Initiative,

42 an international partnership that arose in the immediate aftermath of the 2001 

terrorist attacks among like-minded countries to strengthen health preparedness and response globally, 

encompassing CBRN threats and pandemic influenza. The North American Plan for Animal and 

Pandemic Influenza43 and the health security work under the U.S.-Canada Beyond the Border initiative44 

are other examples of regional efforts in which the United States plays a part to promote global health 

security. 

Although substantial progress has been made toward building global capacity to respond to health 

threats, much work remains. To accelerate progress toward a world safe from health security threats 

and to promote global health security as an international security priority, the United States, working 

with at least 30 partner countries, recently launched the Global Health Security Agenda (GHSA).45 

Through the GHSA, the United States has committed to prioritize coordinated action and specific, 

measurable steps focused on preventing epidemics, detecting biological threats early, and rapidly 

responding to biological threats of international concern.46 As part of the GHSA, CDC, Department of 

State (DOS) and DoD are collaborating with other agencies and partner countries to establish emergency 

operations centers, build information systems, and strengthen laboratory capacity and capability to 

mitigate biological threats.47 U.S. Department of Agiriculture (USDA) is partnering with the World 

Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations 

(FAO), and other nations to rapidly detect, diagnose, and manage dangerous animal diseases in affected 

and high-risk countries. In 2014, the U.S. Agency for International Development (USAID) launched its 

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new Emerging Pandemic Threats Program48 in 20 countries, which provides technical and operational 

support for preventing, detecting, and responding to new emerging zoonotic disease threats. 

The efforts just described are a sampling of the many ways in which the United States is working to help 

mitigate global health security threats. The priorities outlined here are consistent with and will 

complement and strengthen the current objectives within the global health security agenda.*** 

Priorities 

Global health security is a priority for the United States. Developing and strengthening partnerships 

with other countries and intergovernmental organizations is a key component to developing global 

health security capabilities. Additionally, promoting the development of multisectoral biosafety and 

biosecurity systems, frameworks for food and drug safety, and mechanisms to address weaknesses in 

the medical supply chain all contribute to preventing the global spread of diseases and other public 

health threats. Strengthening laboratory systems, linking regional and global networks for 

biosurveillance, improving sample-sharing, and improving global efforts to develop and widely deploy 

novel diagnostics can improve the timely detection of public health threats and diseases. Finally, 

developing multisectoral response capabilities, as well as frameworks and policies for the international 

sharing of MCMs and medical and public health personnel, plays a vital role in the international 

response efforts during a public health emergency. Thus, the United States will continue to partner with 

*** The Objectives of the Global Health Security Agenda are as follows: 

1.	 Prevent the emergence and spread of antimicrobial drug resistant organisms and emerging zoonotic 

diseases, and strengthen international regulatory frameworks governing food safety. 

2.	 Promote national biosafety and biosecurity systems. 

3.	 Reduce the number and magnitude of infectious disease outbreaks. 

4.	 Launch, strengthen, and link global networks for real-time biosurveillance. 

5.	 Strengthen the global norm of rapid, transparent reporting and sample sharing. 

6.	 Develop and deploy novel diagnostics and strengthen laboratory systems. 

7.	 Train and deploy an effective biosurveillance workforce. 

8.	 Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response 

to biological incidents. 

9.	 Improve global access to medical and non-medical countermeasures during health emergencies. 

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other countries and intergovernmental organizations to achieve concrete, measurable, and meaningful 

gains in the world’s ability to prevent, detect, and respond to global health security threats. 

Strategic Objective 5 Priorities 

5.1. Support implementation of the WHO International Health Regulations (IHR 2005) 

and partner with the WHO, the World Organisation for Animal Health (OIE), the 

Food and Agriculture Organization (FAO), and other intergovernmental 

organizations and countries towards development of global public health 

capacities and capabilities. 

5.2. Strengthen national capacities and capabilities globally to detect diseases in a 

timely manner. 

5.3. Strengthen national capacities and capabilities globally to prevent the global 

spread of public health threats and diseases. 

5.4. Strengthen national capacities and capabilities globally to respond to public health 

emergencies of international concern. 

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Conclusion
 

Threats to our nation’s security are both persistent and evolving. Decision-making for the NHSS 2015–

2018 builds on the foundation established by the NHSS 2010–2014 while taking into account important 

changes that have occurred in the strategic landscape for national health security during the past five 

years. First, the concept of national health security is now widely understood and has been 

incorporated into laws and policies at all levels of government. Second, the nation continues to 

experience economic challenges, which slows progress in health security but facilitates strategic and 

thoughtful prioritization of innovative activities and practices that improve efficiency. Last, the use of 

social media has flourished, increasing opportunities for both individuals and organizations to connect 

with each other and to access and use information while emphasizing the need for a better 

understanding of how such tools can be used to disseminate health security information. 

The five strategic objectives within the NHSS organize and steer improvement efforts within substantive 

areas critical to achieving health security. These objectives take into account key features of the 

operational context in which health security is strengthened and sustained: 

	 Promoting community resilience is a multisectoral endeavor that leverages community and 

individual assets, such as infrastructure, talents, skills, relationships, technology, and natural 

resources. Because health is a key aspect of overall community resilience, strategic 

objective 1 focuses on building and sustaining community health resilience—a 

community’s ability to use its assets to strengthen public health and healthcare systems and 

to improve the community’s physical, behavioral, and social health to withstand, adapt to, 

and recover from adversity. 

	 The nation has made progress in developing and implementing countermeasures, including 

progress in conducting early- and late-stage MCM research; developing, manufacturing, and 

testing vaccines, therapeutics, diagnostics, and other products; improving state and local 

capacity to receive, distribute, and dispense MCMs; and understanding the impact that 

different NPIs can have on influenza and other infectious disease transmission. Strategic 

objective 2 focuses on enhancing and expanding the nation’s overall countermeasure 

capabilities for everyday healthcare and addressing public health emergencies while 

improving elements within these capabilities. 

	 The national SA enterprise is made up of organizations nationwide that collectively 

contribute to SA. Since 2009, the government has developed several national strategies 

that improve HSA (including the National Strategy for Biosurveillance,

49 the Federal Health 

Information Technology Strategic Plan,

50 and the National Biosurveillance Strategy for 

Human Health, version 2.0).51 Strategic objective 3 focuses on improving current HSA 

capabilities while improving elements of data collection to inform decision-making and 

information-sharing. 

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	 The public health, healthcare, and emergency management systems are related, 

overlapping systems contributing to national health security. The integration of these 

systems means they are able to work together day to day, mutually supporting one another 

so that they can seamlessly scale up to handle increased requirements or demands during 

mitigation, response, and recovery phases. A skilled workforce, made up of both paid and 

volunteer staff, is the foundation of these systems. Strategic objective 4 focuses on 

enhancing the integration and effectiveness of the public health, healthcare, and 

emergency management systems. 

 Global health security remains a priority for the United States. The health of the American 

people and that of the people around the world are more closely linked than ever before. 

Greater movement of people, animals, and goods across international borders increases the 

risk of exposure to health threats originating outside one’s own country. In such an 

interconnected environment, the best way for a country to protect its population is to 

prevent a health threat from emerging and spreading in the first place. Strategic objective 5 

focuses on using partnerships, relationship-building, and technical assistance to strengthen 

global health security. 

Ensuring a health-secure future is a collective responsibility requiring coordinated action among all 

stakeholders—individuals, households, governments, private industry, community-based organizations 

(CBOs), and academic and research organizations. Within the current strategic landscape, effective, 

efficient actions and sustainable processes and systems will be prioritized. Evaluations will be promoted 

to support decision-making and quality improvement efforts, particularly at the community level. With 

this strategy, the nation takes its next step towards protecting the health and safety of all Americans. 

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Appendix A: National Health Security Strategy 

Implementation Plan 2015–2018 

Implementation 

The NHSS Implementation Plan (IP) serves as a framework to help guide the nation and facilitate 

collaboration and coordination among stakeholders in their pursuit of advancing the current state of 

national health security. The IP elaborates on the priorities introduced in the NHSS by describing 

specific implementation activities on which stakeholders might collaborate to address those priorities 

over the next four years (2015 to 2018). It is important to recognize that each IP activity described is 

subject to the availability of funds and resources. 

National Health Security Stakeholders 

Implementation of the NHSS will require contributions from a wide variety of stakeholders. Key 

stakeholder groups are shown in Figure A.1, which describes the complex relationships and 

dependencies of national health security stakeholders. Core stakeholders include (1) individuals and 

families, (2) communities, (3) the emergency management workforce, (4) the public health workforce, 

and (5) the healthcare workforce. Coordination of efforts among this core group of stakeholders is 

needed to ensure progress toward the priorities in the NHSS. The periphery of the figure shows the 

sectors of society that support the core group in achieving national health security: (1) the scientific and 

academic community; (2) CBOs; (3) the nonprofit sector; (4) the private sector; and (5) federal, state, 

local, tribal, and territorial governments. In order to achieve and sustain national health security, 

contributions are needed from all sectors of society at all levels. 

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Figure A.1. National Health Security Stakeholders 

The diversity of national health security stakeholders reflects the fact that national health security is the 

responsibility of the entire nation. Governments can contribute resources, provide leadership, and 

coordinate actions, but they cannot adequately address health security priorities without the 

cooperation, innovation, and investment of nongovernmental partners. Individuals, for example, might 

be called on to respond to an incident or help their neighbors; and new technologies provide 

opportunities for individuals to contribute to HSA. CBOs can provide assets for all health security 

mission areas, mobilize and train volunteers, and promote health resilience. Although the government 

can offer guidance to nongovernmental partners within the community, it is the responsibility of these 

nongovernmental partners to convey their needs and implement solutions. Activities through which 

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stakeholders, at all levels of government and in all sectors of society, can contribute to progress toward 

advancing national health security are described in the sections below. 

Aligning Implementation with Strategy 

Although the strategy is essential to defining a vision for national health security and illuminating a path 

forward, true progress will be achieved only through the coordinated engagement and sustained action 

of a diverse array of stakeholders. The activities within the IP are intended to operationalize the 

objectives and priorities laid out in the NHSS. They also are the means to achieve progress that can be 

tracked and measured for the next four years. Because many of the activities require partnerships 

among stakeholders, these activities will not only advance the individual strategic objectives but also 

strengthen the cooperation, coordination, and integration of systems in communities nationwide, which 

is critical for fostering community health resilience. To reinforce the motivation of stakeholders, achieve 

national health security goals, and cultivate and sustain lasting partnerships in this endeavor, HHS will 

work with nonfederal partners to spotlight and acknowledge ήθ̠Ί̼͸Λ΍̸̼Ϊή’ contributions following the 

completion of an activity or the achievement of a goal. 

Implementation Activities 

The implementation activities were developed and selected through an intensive stakeholder 

engagement process managed by HHS/ASPR. At the start of the process, candidate priorities and 

activities for each priority area in the NHSS were created using input from multiple sources, including 

subject-matter experts, national strategies and policies, formal evaluations of progress for the 2009 

††† 52 NHSS, and academic and gray literature. Focus groups, surveys, and in-depth interviews with 

hundreds of governmental and nongovernmental subject-matter experts were used to evaluate and 

prioritize activities and identify issues of strategic importance for the next four years. 

Broadly, the activities fall into four categories. For some stakeholders, key contributions will take the 

form of direct provision of services (e.g., crafting and testing plans, stockpiling medications for acute and 

chronic conditions). For others, activities may involve creating policy guidance, standards, or metrics 

appropriate for their communities. Other activities might involve developing incentives (e.g., tax credits, 

identified cost savings) that increase the number of nongovernmental entities engaged in actions that 

enhance their communitͻ̼ή’ health security. Stakeholders may also be involved in capacity-building 

††† Gray literature ͻή “written material (as a report) that is not published commercially or is not generally 

accessibleͶ”

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activities. Activities typically require the participation and coordinated action of multiple stakeholders. 

The execution of activities will be facilitated by the production of guidance and tools produced under 

the direction of HHS. 

Organization of the Document 

The remainder of the IP is organized in six sections: There is one section outlining activities for each of 

five strategic objectives and a final section describing the approach that will be used to manage and 

coordinate implementation and evaluate progress toward advancing national health security. 

The formatting convention for activities followed a model that states what federal agencies or partners 

“ϟͻ΍΍” ̸Λʹ ̠Δ̸ ϟ͸̠θ nonfederal ήθ̠Ί̼͸Λ΍̸̼Ϊή ΛΪ Χ̠ΪθΔ̼Ϊή “Γ̠ϥ ΛΪ ̮̠Δ” ̸ΛͶ ΂͸ͻή ̠ΧΧΪΛ̠̮͸ ϟ̠ή θ̠Ί̼Δ ͻΔ ̠Δ

effort to amplify federal agencies’ commitments to the IP activities and out of recognition that the 

majority of health security work can be realized only through active engagement and nonfederalstakeholder action. It is important to recognize that nonfederal activities are not expressed as 

directives. It is equally important to recognize that, although federal activities are characterized with 

the term will, federal departments and agencies will, to the extent possible, execute the NHSS activities 

and support other federal departments and agencies in these activities contingent on the availability of 

resources and as departmental missions permit. The following federal departments and agencies are 

currently listed as leads, co-leads, or potential partners to champion activities included in the IP: 

 Department of Commerce (DOC) 

 Department of Defense (DoD) 

 Department of Education (DoED) 

 Department of Homeland Security (DHS) 

 Department of Interior (DOI) 

 Department of Justice (DOJ) 

 Department of Labor (DOL) 

 Department of State (DOS) 

 Department of Transportation (DOT) 

 Environmental Protection Agency (EPA) 

 Federal Bureau of Investigation (FBI) 

 Health and Human Services (HHS) 

 Housing and Urban Development (HUD) 

 National Center for Disaster Medicine and Public Health (NCDMPH) 

 Peace Corps 

 United States Agency for International Development (USAID) 

 United States Department of Agriculture (USDA) 

 United States Geological Survey (USGS) 

 United States Department of Veterans Affairs (VA) 

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In instances in which a federal department or agency has a clear role in leading an activity, the 

organization with primary responsibility has been included in the brackets after the descriptive text. 

Also of note, because the IP will cover a span of four years, a time frame for likely execution of activities 

has also been included in the brackets at the end of the descriptive text for each activity. 

Strategic Objective 1: Build and Sustain Healthy, Resilient 

Communities 

Overview 

ΛΓΓΎΔͻθϥ Ϊ̼ήͻ΍ͻ̼Δ̮̼ ͻή ̠ ̮ΛΓΓΎΔͻθϥ’ή ήΎήθ̠ͻΔ̸̼ ability to withstand, adapt to, and recover from 

adversity.53 Promoting community resilience is a multisector endeavor that leverages community and 

individual assets, such as infrastructure, talents, skills, relationships, technology, and natural resources. 

Because health is a key aspect of overall community resilience, the scope of this objective is community 

health resilience—̠ ̮ΛΓΓΎΔͻθϥ’ή ̠̭ͻ΍ͻθϥ θΛ Ύή̼ ͻθή ̠ήή̼θή θΛ ήθΪ̼Δͮθ͸̼Δ ΧΎ̭΍ͻ̮ ͸̼̠΍θ͸ ̠Δ̸ ͸̼̠΍θ͸̮̠Ϊ̼ 

ήϥήθ̼Γή ̠Δ̸ θΛ ͻΓΧΪΛϞ̼ θ͸̼ ̮ΛΓΓΎΔͻθϥ’ή Χ͸ϥήͻ̮̠΍, behavioral, and social health to withstand, adapt to, 

and recover from adversity. 

The NHSS identifies three priorities to build and sustain healthy, resilient communities. The remainder 

of this section outlines activities for the next four years to address each of the high-priority focus areas 

for implementation. 

Activities by Priority 

Priority 1.1: Encourage social connectedness through multiple mechanisms to promote community 

health resilience, emergency response, and recovery. 

1.1.1.	 State governments and professional societies can create templates and toolkits for communities 

to tailor with audience-specific messages on community connectedness, social capital, and 

health resilience. [2015] 

1.1.2. Federal partners will work with academia to evaluate and report on the best uses of traditional 

media (e.g., print and visual media) and new media (e.g., social media and mobile health 

technologies) to promote social connections among community members. [HHS, DHS, USDA] 

[2015] 

1.1.3. Local governments can encourage community members to use social networking sites and other 

methods designed to strengthen neighbor-to-neighbor ties and explore potential uses of such 

sites for emergency response. [2015] 

1.1.4.	 Local governments, CBOs, and the private sector can empower constituents to engage in their 

communities’ resilience, response, and recovery activities by creating culturally sensitive 

guidance based on sociocultural research. [2016–2018] 

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1.1.5. CBOs and the faith community can identify at-risk individuals and connect them with personal 

and logistical support. [2016-–2018] 

1.1.6.	 Federal partners; state, local, tribal, and territorial (SLTT) governments; CBOs; academia; and 

research organizations can coordinate research efforts to implement and translate health 

resilience research needs articulated in the national health security applied research agenda. 

[DHS, HHS, DOT, USGS, DoED, USDA, DoD] [2016–2018] 

Priority 1.2: Enhance coordination of health and human services through partnerships and other 

sustained relationships. 

1.2.1. Federal partners will identify and disseminate culturally and linguistically appropriate promising 

practices in developing cross-sector partnerships to promote community health resilience, 

response, and recovery. [DHS, HHS] [2016–2018] 

1.2.2. State and local governments can map current local assets for provision of health and human 

services during and after incidents. [2015] 

1.2.3. SLTT governments, CBOs, the research sector, and federal partners can identify options for 

incentivizing human services providers to participate in HPP coalitions. [2016–2018] 

1.2.4. SLTT governments and CBOs can cross-train public health, healthcare and human services 

professionals to improve recovery service provision. [2016–2018] 

1.2.5. SLTT governments can work with CBOs to ensure that community leaders, on whom 

constituents rely for support, have access to behavioral health services. [2016–2018] 

1.2.6. Federal partners will work in conjunction with academia and SLTT governments to incorporate a 

framework to guide the integration of culturally and linguistically appropriate community 

education efforts for professionals on recovery planning. [DHS, EPA, HHS, HUD, USDA] [2016–

2018] 

Priority 1.3: Build a culture of resilience by promoting physical, behavioral, and social health; 

leveraging health and community systems to support health resilience; and increasing access to 

information and training to empower individuals to assist their communities following incidents. 

1.3.1. State and local governments, CBOs, and the private sector can promote general population 

training in health-related areas, such as first aid, cardiopulmonary resuscitation, psychological 

first aid, and self- and family care. [2015] 

1.3.2.	 CBOs can use routine community meetings and events to disseminate culturally and 

linguistically appropriate information on the topic of health resilience and sponsor events to 

encourage planning for incident response and recovery. [2015] 

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1.3.3. Federal partners, state and local governments, CBOs, and academia can improve the 

dissemination and implementation of existing community health resilience learning 

opportunities for volunteers. [DHS, HHS, USDA] [2016–2018] 

1.3.4. State and local governments can encourage the identification of safe places for children postdisaster, including emergency care and effective supports for reconstitution of routine child care 

services within the community. [2016–2018] 

1.3.5. State and local government and NGOs can implement trainings and exercises for volunteers on 

effective and educated bystander response. [2016–2018] 

1.3.6. Nonfederal stakeholders, such as the private sector, can promote volunteerism and 

participation in employer-sponsored wellness activities through programs that recognize or 

compensate employees for their efforts in these areas. [2016–2018] 

1.3.7. State and local governments, academia, CBOs, and the private sector can integrate messaging 

on health resilience into national educational initiatives, such as America’s PrepareAthon and 

annual influenza messaging. [2016–2018] 

1.3.8. CBOs can partner with local governments to develop a messaging campaign to encourage 

financial donations through existing mechanisms, such as the National Donations Management 

Network. [2016–2018] 

1.3.9. SLTT governments and CBOs (e.g., Voluntary Organizations Active in Disasters, National 

Voluntary Organizations Active in Disasters, American Red Cross) can partner with the state 

coordinator for volunteers before a disaster by developing a volunteer and donation 

management plan or developing memoranda of understanding. [2016–2018] 

1.3.10. Federal partners will work with the private sector to develop a culturally and linguistically 

appropriate community health resilience guide for businesses on promoting employee health 

and preparing for disasters. [HHS] [2017–2018] 

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Strategic Objective 2: Enhance the National Capability to Produce and 

Effectively Use Both Medical Countermeasures and NonPharmaceutical Interventions 

Overview 

Countermeasures are used to protect communities from and limit the adverse health impacts of CBRN 

attacks, outbreaks of infectious diseases, and other incidents. There are two main types of 

countermeasures: MCMs and non-pharmaceutical interventions (NPIs). MCMs include medications and 

other pharmaceutical remedies which mitigate and prevent the spread of disease - such as vaccines, 

small molecule, antibody, and cellular therapeutics, antimicrobials, antidotes, antitoxins, and 

decorporation agents to reduce radioactive contamination- as well as non-pharmaceutical medical 

devices and approaches - such as ventilators, diagnostics, personal protective equipment (PPE), and 

‡‡‡ 54 patient decontamination. NPIs refer to community mitigation strategies that are used to prevent 

the spread of disease, contamination, or other adverse effects related to an incident. NPIs include both 

actions taken by individuals, such as hand hygiene and covering one’s mouth when coughing, and 

actions taken by communities to reduce contact with contagious persons, such as social distancing (e.g., 

§§§ 55 closing schools and asking people to work at home). This objective encompasses the enhancement 

of the successful PHEMCE, and the range of actions related to enhancing the nation’s capacity to 

develop, manufacture, evaluate, and use MCMs and NPIs both for routine public health purposes as well 

as during emergencies; from research to development and acquisition, to effective use or 

implementation of countermeasures, to assessing the intended and unintended consequences of the 

countermeasures. . 

The NHSS identifies four priorities to enhance the national capability to produce and effectively use both 

MCMs and NPIs. The remainder of this section outlines activities for the next four years to address each 

of the high-priority focus areas for implementation. 

‡‡‡ Although the 2012 PHEMCE strategy identifies ventilators, diagnostics, and similar equipment and services as 

“non-pharmaceutical interventions,” the PHEMCE implementation plan has updated the terminology to “nonpharmaceutical MCM interventions.” For purposes of consistency, the NHSS uses the PHEMCE implementation 

Χ΍̠Δ’ή ΍̠ΔͮΎ̠̼ͮͳ ϟ͸ͻ̮͸ ͻή ̠΍ήΛ ̮ΛΔήͻήθ̼Δθ ϟͻθ͸ ̼Δθ̼Ϊή ͆ΛΪ Dͻή̼̠ή̼ ΛΔθΪΛ΍ ̠Δ̸ ͵Ϊ̼Ϟ̼ΔθͻΛΔ (D) ΍̠ΔͮΎ̠̼ͮ ͆ΛΪ ͣ͵IήͶ

§§§ These lists are not exhaustive. 

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Activities by Priority 

Priority 2.1: Create and/or refine decision-making frameworks and coordinated processes that 

consider both MCMs and NPIs when making research, advanced development, and acquisition 

decisions related to countermeasures and determining the best approaches to reducing adverse 

health effects of particular incidents of concern. 

2.1.1. Federal partners will continue to work with state and local stakeholders on efforts to improve 

state and local readiness to make and implement decisions about use of MCMs and NPIs in 

responses through the identification, design, and implementation of response plans, 

countermeasure guidance, exercises/drills, algorithms, and checklists/flowcharts that involve 

integrated MCM–NPI approaches to diverse incidents. [DHS, HHS] [2016–2018] 

2.1.2. State governments can lead, with academia and local governments in support of, the 

development of a coordinated approach to regional and federal planning processes that 

contribute information on implementation constraints, opportunities, and the social and 

economic benefits and costs of MCMs and NPIs. [2016–2018] 

2.1.3. Federal partners will develop communication plans to better communicate to nonfederal 

stakeholders the risks and benefits of implementing different types of MCMs and NPIs during 

CBRN incidents. [HHS, DHS] [2016–2018] 

2.1.4. Federal partners will create a strategy or approach (including budgeting and risk assessments) to 

prioritize investments in MCM and NPI development and implementation to best affect health 

security. [HHS, DoD, DHS] [2016–2018] 

2.1.5. Federal partners will collaborate with academia and state and local public health departments 

on developing personnel guidance that addresses remaining gaps in healthcare worker and 

healthcare first responder MCM and NPI preparedness. [DOL, HHS] [2016–2018] 

2.1.6. Federal partners will establish a mechanism to develop an overarching framework and capability 

to rapidly identify best medical countermeasure strategies and other options to control newly 

emerging pandemic infectious diseases. [HHS, DHS] [2018] 

Priority 2.2: Increase nonfederal stakeholder engagement within PHEMCE processes. 

2.2.1. Federal partners will identify the scope of, and mechanisms to maximize, nonfederal 

engagement in the PHEMCE process to, for example, encourage basic research, promote public 

private partnerships with industry; and ensure state, local, and private sector capabilities to 

distribute MCMs. [DHS, HHS] [2015] 

2.2.2. Federal partners will identify ways for nonfederal partners to engage in the PHEMCE process for 

requirement-setting for MCM research and development. [HHS, DoD, USDA, VA] [2016–2018]] 

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2.2.3. Federal partners associated with the PHEMCE will work with nonfederal PHEMCE stakeholders, 

such as SLTT governments and the medical community and providers, to identify the highestpriority needs for appropriate nonfederal-stakeholder input into the PHEMCE process. [DHS, 

HHS] [2016–2018] 

2.2.4. Federal partners will and other PHEMCE stakeholders can improve and expand federal and 

nonfederal communication on security-sensitive PHEMCE-related issues by building on and 

leveraging existing protocols for communicating classified information to SLTT governments. 

[DHS] [2016–2018] 

2.2.5. Federal partners will work with academies of clinical practice to develop and disseminate, as 

appropriate, the PHEMCE response planning portfolio for those MCMs that are already in the 

stockpile. [HHS] [2016–2018] 

2.2.6. Federal partners will and SLTT governments can improve the active engagement of end users, 

such as patient providers and public health officials, in MCM-oriented trainings and exercises. 

[DHS, HHS] [2016–2018] 

2.2.7. Federal PHEMCE stakeholders will engage nonfederal stakeholders in a discussion of the 

prioritization of antimicrobial resistance measures and solutions. [DHS, HHS, DoD] [2016–2018] 

Priority 2.3: Focus research and translation on NPIs to ensure that evidence is accurate and 

actionable. 

2.3.1. Federal partners will expand work with public health and medical sectors to test and evaluate 

the utility of federal guidance on NPI use for targeted audiences. [HHS] [2015] 

2.3.2. Federal partners will work with SLTT governments and professional societies to assess, develop, 

and improve strategies for implementing research findings related to NPIs—including PPE, social 

distancing, and other community mitigation strategies—to enhance translation of research into 

practice. [DOJ, DOL, HHS, VA, DoD] [2016–2018] 

2.3.3. Federal partners will collaborate with state and local health departments, CBOs, and academia 

to research and translate risks, costs, benefits, and expectations of use, in addition to personal, 

social, and legal barriers, for NPIs. [DHS, DOJ, HHS, DoD] [2016–2018] 

2.3.4. Federal partners will and academia can identify situations through research and evaluation in 

which NPIs can be prioritized because of delay in MCM production or when MCMs are 

determined to be infeasible. [HHS] [2016–2018] 

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Priority 2.4: Expand and improve national capacity to research, develop, manufacture, obtain, 

distribute, and dispense medical countermeasures. 

2.4.1.	 Federal partners will develop a coordinated communication approach that shares timely and 

accurate information on supply, challenges associated with the production and dissemination of 

emerging and existing MCMs, specifically if the product is in limited supply and high demand. 

[HHS] [2015] 

2.4.2. Federal partners will draft guidance outlining the process for dissemination and prioritization of 

MCMs for first response personnel and their families during specific types of events. [DHS, HHS] 

[2015] 

2.4.3.	 Federal partners, SLTT governments, and CBOs can work cooperatively to develop user-friendly 

tools for communicating scientific guidance on use of MCMs and NPIs to policy-makers and the 

public. [HHS] [2016–2018] 

2.4.4. Federal partners will collaborate with academia and the commercial industry on a report for 

multipurpose use of the manufacturing infrastructure to allow scalable delivery of 

countermeasures. [HHS, DHS] [2016–2018] 

2.4.5.	 Federal partners will explore funding opportunities that can help SLTT governments address 

gaps in MCM and NPI education, training, and guidance. [HHS, DHS] [2016–2018] 

2.4.6.	 Federal partners will work with academia and the private sector to identify and assess novel 

strategies for sustaining the SNS. [HHS, DoD] [2016–2018] 

2.4.7. SLTT governments can promote field tests of readiness for distribution and dispensing of 

countermeasures in every state, taking into consideration the resources of both private supplychain contractors and government stockpiles. [2016–2018] 

2.4.8. Federal partners will draft guidance for nonfederal stakeholders on how the private sector, SLTT 

governments, CBOs, academia, and healthcare systems can contribute to distribution and 

dispensing strategies and operational requirements, increase the number of closed PODs, and 

participate in training, exercises and drills. [HHS, DHS, VA, DoD] [2016–2018] 

2.4.9. Federal partners will develop strategies for prioritizing basic research, applied research, 

advanced development, and procurement of medical countermeasures that address the public 

health and medical consequence of CBRN accidents, incidents, and attacks as well as pandemic 

influenza and emerging infectious diseases. [HHS, DoD] [2018] 

2.4.10. Federal partners will develop strategies to maintain, and where appropriate expand, advanced 

development pipelines replete with medical countermeasures and platforms to address unmet 

public health needs, emphasizing innovation, flexibility, multi-purpose and broad spectrum 

application, and long-term sustainability. [HHS] [2018] 

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2.4.11. Federal partners will create or sustain overarching capabilities to rapidly mature promising 

candidate drugs, vaccines, therapeutics,and diagnostics using public-private ventures and other 

collaborative opportunities. [HHS, DoD] [2018] 

2.4.12. Federal partners will develop a capability base to provide enabling core services to medical 

countermeasure innovators that includes establishing Centers for Innovation and Advance 

Development and Manufacturing and identifying ways to accelerate regulatory processes for 

these public health emergency medical countermeasures whenever possible to help provide 

safe and effective products quickly to the end users. [HHS] [2018] 

2.4.13. 	 Federal partners will develop agile, robust and sustainable U.S. manufacturing infrastructure 

capable of rapidly producing vaccines and other biologics against pandemic influenza and other 

emerging threats. [HHS] [2018] 

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Strategic Objective 3: Ensure Comprehensive Health Situational 

Awareness to Support Decision-Making Before Incidents and During 

Response and Recovery Operations 

Overview 

The national situational awareness (SA) enterprise includes all sectors and relevant actors nationally 

and globally across the prevention, protection, mitigation, response, and recovery mission areas (see 

Figure 1 in the NHSS) and uses a process that involves an active, continual, and timely informationgathering loop that relies on existing assets, networks, and systems. Active and timely SA provides the 

foundation for decisions and actions that, in turn, can result in better resource utilization, successful 

prevention and mitigation of emerging threats, and improved security for the nation. HSA contributes 

to overall SA by providing information that includes data regarding health threats, population health, 

health system and human services resources, health-related response assets, and other considerations   56 to inform decision-making. HSA is also both domestic and international in reach and contributes 

to health security, homeland security, and national security. HSA processes actively gather information 

about resource allocation, risk analysis, forecasting, response, and other actions that might affect health 

security to support decision-making before incidents and during response and recovery operations. 

HSA is a knowledge state that results from the process of actively gathering, analyzing, integrating, 

interpreting, validating, and disseminating information. HSA includes routine and emergency 

†††† biosurveillance information and other health-related information, and nonhealth inputs, as shown in 

Figure 4 in the NHSS. 

** ** HSA is a knowledge state that results from the process of active information-gathering (both domestic and 

international) with appropriate analysis, integration, interpretation, validation, and sharing of information related 

to health threats and the health of the human population, as well as health system and human services resources, 

health-related response assets, and other information that could affect the public’s health to inform decisionmaking, resource allocation, and other actions. 

†††† Biosurveillance is defined in the National Strategy for Biosurveillance ̠ή “θ͸̼ process of gathering, integrating, 

interpreting, and communicating essential information related to all-hazards threats or disease activity affecting 

human, animal, or plant health to achieve early detection and warning, contribute to overall situational awareness 

Λ͆ θ͸̼ ͸̼̠΍θ͸ ̠ήΧ̼̮θή Λ͆ ̠Δ ͻΔ̮ͻ̸̼Δθͳ ̠Δ̸ θΛ ̼Δ̠̭΍̼ ̭̼θθ̼Ϊ ̸̼̮ͻήͻΛΔ Γ̠ΊͻΔͮ ̠θ ̠΍΍ ΍̼Ϟ̼΍ήͶ”

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The NHSS identifies five priorities for ensuring HSA to support decision-making. The remainder of this 

section outlines activities for the next four years to address each of the high-priority focus areas for 

implementation. 

Activities by Priority 

Priority 3.1: Improve HSA and data-sharing with respect to integrating human health, environmental, 

zoonotic, and other relevant information to mitigate immediate-, short-, and long-term health effects. 

3.1.1. SLTT health, agriculture, and environment agencies can expand the integration and sharing of 

human and animal surveillance and outbreak information across states, counties, and other 

sectors, especially for zoonotic, environmental, and food- and water-borne illnesses. [2016–

2018] 

3.1.2. Scientific institutions can convene a body of experts to develop a list of leading indicators of 

environmental health warning signs for human, animal, and plant health. [2015] 

3.1.3. Federal partners will develop a prioritized list of top environmental and zoonotic threats to 

focus strategic planning activities and resource allocation for One Health (e.g., food safety, 

specific zoonotic diseases). [HHS, DoD, USDA, EPA, FBI, USGS] [2015] 

3.1.4. Higher education centers can develop partnerships, curricula, and cross-degree programs (e.g., 

joint public health and veterinary medicine degrees) to aid in developing a workforce that 

understands the language of human, animal, and environmental health. [2016–2018] 

3.1.5. Federal partners will and state agricultural agencies can work with industry to increase public 

reporting and alerts on the incidence and prevalence of disease in animals intended for human 

consumption. [USDA, HHS, DOI] [2016–2018] 

Priority 3.2: Promote continuous improvement through use of state-of-the-art innovative systems, 

tools, and partnerships to ensure improvement of HSA. 

3.2.1. Federal partners will and nonfederal stakeholders can recruit local institutions, such as schools, 

clinics, hospitals, long-term-care facilities, and pharmacies, to actively and passively participate 

in the collecting of HSA information and timely reporting to local health departments. [HHS, 

DoED] [2016–2018] 

3.2.2. Federal partners will work with nonfederal stakeholders, including private industry, to develop a 

framework and research agenda to guide efforts to build capacity to harness electronic health 

information for HSA while maintaining patient confidentiality and ensuring adequate security. 

[HHS, DHS, DoD, VA, DOC] [2016–2018] 

3.2.3. Federal partners will and state health departments can identify opportunities for improvement 

in HSA through reviews of after-action reports of recent national events and evaluation of HSA 

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efforts across the spectrum from preparedness to recovery. [HHS, DHS, DoD, USDA, DOT, FBI] 

[2016–2018] 

3.2.4. Federal partners will work with SLTT stakeholders to innovate and improve functional 

compatibility of their systems across all sectors and among all levels of government. [HHS, DHS, 

DoD, VA] [2016–2018] 

3.2.5. Federal partners will conduct a comprehensive multi-agency review and evaluation of existing 

and planned data systems and sources to build and maintain a shared inventory that could be 

used for HSA purposes. [HHS, DHS, DoD, VA, USDA, EPA, USGS] [2016–2018] 

3.2.6. Federal partners will encourage and facilitate engagement with skilled experts across 

government, academia, and private industry who can analyze and interpret data vital to 

comprehensive HSA. [HHS, DHS, DoD, VA, USDA, EPA] [2016–2018] 

3.2.7. Nonfederal stakeholders can identify innovative approaches to address research priorities under 

relevant areas identified by the 2013 National Biosurveillance Science and Technology 

Roadmap.57 [HHS] [2016–2018] 

3.2.8. Federal partners will work with nonfederal stakeholders to help improve the resiliency of their 

cybersecurity systems by supporting and promoting the use of the National Institute of 

Standards and Technology Framework for Improving Critical Infrastructure Cybersecurity where 

relevant to HSA.58 [DHS, DOC] [2016–2018] 

3.2.9.	 Federal partners will conduct a cooperative multi-agency and multi-sector review and 

evaluation of existing modeling systems to identify gaps and improve coordination as it relates 

to HSA. [DHS, DoD, HHS, VA, EPA, USDA, FBI] [2016–2018] 

3.2.10. State health departments can work with professional associations to conduct an inventory of 

regional health information organizations (RHIOs) and electronic health information exchanges 

(HIEs) and determine the potential for inclusion in a national HSA capability. [2016–2018] 

3.2.11.	 SLTT health and emergency management departments can develop strategies for integrating 

new technologies and SA products, tools, and standards into routine practice. [2016–2018] 

3.2.12. Federal partners will develop alternative protocols for patient triage that seek to identify higher 

levels of efficiency for electronic medical records and EHRs during casualty surges. [HHS, VA, 

DoD] [2016–2018] 

3.2.13.	 Federal partners will invest in research to improve the methodology of and measures included in 

the National Health Security Preparedness Index (NHSPI). [HHS] [2016–2018] 

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Priority 3.3: Determine and expand operational capabilities to meet the HSA needs for all relevant 

stakeholders so that data sourcing is both situationally and user-defined. 

3.3.1. State and local health, environment, law enforcement, and agriculture agencies can strengthen 

joint health, intelligence, agricultural, and law enforcement capabilities for prevention and 

mitigation of animal- or human disease incidents. [2015] 

3.3.2. State departments of health, environment, and agriculture can implement mechanisms for 

routine interdisciplinary and interagency health information-sharing, along with other entities, 

‡‡‡‡ such as hospitals, while leveraging existing RHIOs and HIEs. [2016–2018] 

3.3.3. Federal partners will and nonfederal stakeholders can implement mechanisms to strengthen 

health-security communications related to disease events across all sectors and at all levels of 

government and, where appropriate, broaden key audiences to include large-animal 

associations at national and SLTT levels. [DHS, HHS, USDA, FBI] [2016–2018] 

3.3.4. Federal partners will work with SLTT health departments to determine information-sharing 

needs across all levels of government and among all sectors, including but not limited to RHIOs 

and HIEs, schools, healthcare providers, businesses, and other healthcare organizations to 

enhance multidirectional SA. [HHS] [2016–2014] 

3.3.5. Federal partners will work with nonfederal stakeholders to improve HIEs to support patient 

healthcare needs, as well as population-oriented uses, in near-real time.§§§§ [HHS] [2016–2018] 

3.3.6.	 Federal partners will develop secure, seamless pathways by which appropriate classified 

information, intelligence products, open-source information, and relevant health information ***** can be shared across agencies. [HHS, DoD, DHS, VA, USDA, EPA, FBI] [2016–2018] 

3.3.7. Federal partners will work with academic institutions to incorporate disaster decision support, 

bio-informatics, modeling and simulation, information-sharing, GIS, and data visualization into 

††††† undergraduate- and graduate-level emergency management curricula. [DoED] [2016–2018] 

‡‡‡‡ As appropriate, according to privacy and security laws and regulations. 

§§§§ As appropriate, according to privacy and security laws and regulations. 

***** As appropriate, according to privacy and security laws and regulations. 

††††† As appropriate, according to privacy and security laws and regulations. 

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3.3.8. Federal partners will work with state health departments to encourage the establishment and 

participation of RHIOs in providing public health departments access to relevant data. [HHS] 

[2016–2018] 

3.3.9. Federal partners will work with SLTT health departments to harmonize SA-preparedness 

performance metrics across programs. [DHS, DoD, HHS, USDA, DOT] [2016–2018] 

3.3.10. Federal partners will work with SLTT governments and the private sector to develop the 

capability to house, share, and appropriately use information related to SA that protects 

proprietary interest and patient confidentiality. [HHS, DOC] [2016–2018] 

3.3.11. Federal partners will work with SLTT partners to develop multi-sectoral policy frameworks and 

advance regulatory oversight for managing material to support diagnostic research and 

biosurveillance activities. [HHS, DHS, DoD, DOT] [2016–2018] 

3.3.12. SLTT health departments will work together with individuals and their caregivers to share health 

information and empower them to become more active participants in health as related to HSA. 

[2016–2018] 

Priority 3.4: Develop a voluntary, collaborative coordinating authority (CCA) and management 

structure for HSA to promote and coordinate consistent approaches to HSA. 

3.4.1. Federal partners will work with academia to survey and evaluate successful and unsuccessful 

national, local, and regional models of governance, including those employed by the PHEMCE 

and the Senior Leaders Council on Patient Movement,59 to inform the development of a (CCA). 

[HHS, DHS, VA, DoD] [2015] 

3.4.2. Federal partners will solicit federal agencies and recruit qualified subject-matter experts to serve 

as members of an HSA collaborative coordinating authority that will leverage existing entities 

and processes, through engagement with SLTT partners. [HHS, DHS, VA, DoD, USDA, DOI, EPA] 

[2015] 

3.4.3. The CCA will develop a charter with an actionable plan to align with and support the NHSS 

oversight structure. [HHS, DHS] [2015] 

3.4.4. The CCA will work with state health departments to establish forums for the sharing of best 

practices, protocols, and lessons learned in SA. [HHS, DHS] [2015] 

3.4.5. The CCA will work with state health departments to establish systematic and ongoing methods 

and mechanisms for multi-stakeholder priority-setting and decision-making. [HHS, DHS] [2016–

2018] 

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Priority 3.5: Address technology and policy challenges to ensure the functional compatibility of 

systems to collect, integrate, analyze, visualize, and share information. 

3.5.1. Federal partners will work with nonfederal stakeholders to develop and disseminate data-use 

and data-sharing agreement templates that address the proprietary, privacy, security, ethical 

constraints, data ownership, stewardship, and liability protection issues that may arise with 

‡‡‡‡‡ sharing various types of data. [HHS] [2016–2018] 

3.5.2. Federal partners will work with nonfederal stakeholders, including private industry, to identify 

existing standards for maintaining the security and privacy of HSA data and information, 

determine whether gaps exist, and develop additional standards if needed. [HHS, DOC] [2015] 

3.5.3. Federal partners engaged in HSA will review and update information management plans to align 

with current strategies and policies while coordinating with other stakeholders to determine 

critical information exchange requirements and best practices. [HHS, DHS, DoD] [2015] 

3.5.4. The CCA will identify the types of information that could be shared and develop an action plan 

to encourage engagement among federal, nonfederal, and international partners with regard to 

information-sharing strategies. [DHS, HHS] [2016–2018] 

3.5.5. Federal partners will and SLTT health departments can examine and document the existing 

multi-directional information-sharing and reporting relationships between SLTT health 

departments and local institutions, such as schools, clinics, hospitals, long-term-care facilities, 

and community organizations and businesses, and identify where additional information-sharing 

may be beneficial. [HHS] [2015] 

3.5.6. State health departments can coordinate with local health department public information 

officers (PIOs) to develop guidelines for effective use of social media for public communications. 

[2015] 

3.5.7. Federal partners will identify existing policies and best practices to expand HIE usage by 

nontraditional providers to include EMS and public health and human services. [HHS, DOT] 

[2015] 

‡‡‡‡‡ As appropriate, according to privacy and security laws and regulations. 

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3.5.8. Federal partners will evaluate models for best practices and lessons learned on ensuring 

communications redundancy and coverage. [DHS, DoD] [2015] 

3.5.9. Federal partners will conduct cybersecurity risk assessments of healthcare systems, with the 

goal of developing contingency plans for continuity of operations in the event of a cyberincident that leverage existing cybersecurity risk assessment resources. [DHS, DOJ] [2016–2018] 

3.5.10. Federal partners will enforce policies that harmonize the implementation of Health Insurance 

Portability and Accountability Act of 1996 (HIPAA) privacy and security provisions and 

regulations.60 [HHS] [2016–2018] 

3.5.11. Federal partners will work to implement and leverage standardization of data elements to 

promote interoperability among disparate healthcare information among public health, and 

emergency management. [HHS] [2016–2018] 

3.5.12. Federal partners will implement information-sharing interoperability solutions across healthcare 

coalitions. [HHS, DHS, DoD, VA, USDA, EPA] [2016–2018] 

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Strategic Objective 4: Enhance the Integration and Effectiveness of 

the Public Health, Healthcare, and Emergency Management Systems 

Overview 

The public health, healthcare, and emergency management systems are related, overlapping systems 

contributing to national health security. The public health system includes public agencies (e.g., schools, 

Medicaid, environmental protection agencies, land-use agencies), state and local public health 

departments, and private organizations whose actions have significant consequences for the health of 

the public.61 The healthcare system is the organization of people, institutions, and resources that deliver 

healthcare services, including behavioral health services, to meet the healthcare needs of the population. 

Emergency management62 involves the efforts of communities or businesses to plan for and coordinate 

the people and emergency services required to reduce vulnerability to hazards and to cope with disasters 

while addressing all mission areas of health security (See Figure 1 in the NHSS). Emergency services 

involve a ̮ΛΓΓΎΔͻθϥ’ή first-responder organizations that have the specialized training and equipment to 

support a national level health incident through response, treatment or stabilization, transportation 

through fire and emergency medical services (EMS), and decontamination of personnel and equipment 

through hazardous-material services.63 Components of the emergency management system are also 

essential to establishing and maintaining incident command and incident management 

operations. A skilled workforce is the foundation of these systems. The workforce is made up of paid 

and volunteer staff employed by governments and other organizations, as well as interim employees, 

volunteers, and bystanders who just happen to be at the scene of an incident and seek to contribute. 

The integration of public health, healthcare, and emergency management systems means that they can 

work together day to day, mutually supporting one another so that they can seamlessly scale up to 

handle increased requirements or demands during the mitigation, response, and recovery phases of the 

incident life cycle. Furthermore, integrating the expertise and specialized equipment found in the public 

health, healthcare, and emergency management systems ϟͻ΍΍ ̼Δ͸̠Δ̮̼ ̠ ̮ΛΓΓΎΔͻθϥ’ή resilience without 

duplicating services under different organizations or strategies. 

The NHSS identifies six priorities to enhance the integration and effectiveness of the public health, 

healthcare, and emergency management systems. The remainder of this section outlines activities for 

the next four years to address each of the high-priority focus areas for implementation. 

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Activities by Priority 

Priority 4.1: Define and strengthen healthcare coalitions and regional planning alliances across all 

incident phases. 

4.1.1. Federal partners will develop tools and guidance for the inclusion of nontraditional 

organizations (e.g., utility agencies, pharmacies, human service organizations) in the regional 

preparedness planning process, including information on how to incentivize nontraditional 

organizations to join and remain active participants. [HHS] [2016] 

4.1.2. Federal partners working in collaboration with academia and the community will build the 

evidence base around coalition effectiveness, including developing and testing metrics of 

coalition performance. [HHS] [2016–2018] 

4.1.3. Local health departments can work with nonprofit hospitals to identify ways in which the 

hospitals can contribute to community health resilience by addressing issues identified in a 

community’s health needs assessment, as described in the Affordable Care Act. [2016–2018] 

4.1.4. Healthcare coalitions can work with their members and state emergency operations centers 

(EOCs) to define active response roles for the coalition beyond pre-incident planning. [2016–

2018] 

4.1.5. Healthcare coalitions can encourage member organizations to voluntarily share information 

about their mobile medical assets and training on those mobile medical asset platforms that 

could potentially be used through the Emergency Management Assistance Compact (EMAC). 

[2016–2018] 

4.1.6.	 Federal partners, in collaboration with healthcare coalitions, will establish guidance for the 

development, implementation, evaluation, and improvement of health system emergency 

management programs (e.g., doctrine). [HHS] [2016–2018] 

Priority 4.2: Build upon and improve routine systems and services as a foundation for incident 

response and risk reduction, focusing on common elements that leverage the alignment of routine 

capabilities with those needed during an incident. 

4.2.1. Federal partners will incentivize the implementation of existing tools that promote the 

coordination of care in an event (e.g., patient-tracking tools, EHR compatibility features). [HHS] 

[2016–2018] 

4.2.2. Federal partners will provide guidance for how to modify existing information systems (e.g., EHR 

systems, immunization information systems) to better support national health security goals. 

[HHS] [2016–2018] 

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4.2.3. Federal partners will work with nonfederal stakeholders (e.g., Joint Commission) to support the 

widespread application of principles of disaster risk reduction and mitigation. [HHS] [2016–

2018] 

4.2.4. Hospitals, providers, and academia can explore how existing telemedicine programs and 

technologies can be redirected in an event to address surge and increase access in areas 

affected by disaster, including rural communities. [2016–2018] 

4.2.5. Nonfederal stakeholders can promote community support of hospitals during a disaster by 

developing continuity-of-operations plans that address the relocation of personnel, the 

performance of essential functions, and the devolution of services (when the transfer of 

essential functions is required) using the guidance provided in Continuity Guidance Circular 1 

and 2, published by FEMA. [2016–2018] 

4.2.6. SLTT government planners can evaluate their continuity plans and capabilities using the 

Continuity Assistance Tool (CAT), published by FEMA. [2016–2018] 

4.2.7. Federal partners will enhance existing fatality management capabilities by developing policy and 

procedural recommendations for a mass fatality response in a resource-scarce environment in 

which operations may need to be modified to account for limited personnel, infrastructure, or 

equipment and supplies. [HHS, DoD, DHS, VA, FBI] [2016–2018] 

Priority 4.3: Ensure that the integrated, scalable system can meet the access and functional needs of 

at-risk individuals. 

4.3.1. Federal partners will develop quality measures for pediatric disaster preparedness in order to 

provide guidance to state and local governments regarding incidents affecting children. [HHS] 

[2016] 

4.3.2. Nonfederal stakeholders can explore options to incentivize providers to counsel at-risk 

populations about preparedness (e.g., obtain a Current Procedural Terminology [CPT] code for 

preparedness counseling). [2016] 

4.3.3.	 Federal partners will work with academia, private industry, and SLTTs to conduct research on 

how to use social media and other data sources (e.g., records of durable medical goods 

providers and health plans) to locate at-risk individuals. [HHS] [2016] 

4.3.4.	 Federal partners will work with nonfederal stakeholders to create guidance on how to plan for 

and engage populations with enhanced privacy needs (e.g., domestic violence victims) for 

evacuation and sheltering. [HHS, DHS] [2016–2018] 

4.3.5. State and local governments can work with schools and day care centers to increase awareness 

of the need to develop and exercise family reunification plans. [2016–2018] 

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Priority 4.4: Strengthen competency and capability-based health-security-related workforce 

education. 

4.4.1. Academia and professional associations can create short, tailored trainings for specialty 

providers (e.g., obstetrician/gynecologists) and government employees to assist with emergency 

response without a prescribed role in National Preparedness Goal mission areas. [2016–2018] 

4.4.2. State governments can coordinate training at the regional rather than local level to ensure 

consistency across potential responder groups. [2016–2018] 

4.4.3.	 Federal partners will work with nonfederal stakeholders to identify cybersecurity-awareness and 

training opportunities through both public and private agencies and organizations. [DHS, HHS, 

DoED] [2016–2018] 

4.4.4. Federal partners will work with all relevant stakeholders to develop a national plan for disaster 

health education and training, including core content, a scope-of-practice model, educational 

standards, educational program accreditation, and individual provider certification. [HHS, 

NCDMPH] [2016–2018] 

4.4.5. Federal partners will work with all relevant stakeholders to establish disaster health education 

credentials in fields that currently lack them. [HHS, NCDMPH] [2018] 

4.4.6. Federal partners will review, adapt, and disseminate existing Incident Command System (ICS) 

and other training materials originally produced for use by first responders to healthcare and 

public health personnel. [HHS, DHS, NCDMPH] [2017–2018] 

4.4.7.	 Federal partners, with academia and other nonfederal stakeholders, will develop new 

consensus-based national health security competencies and create metrics to assess the 

validity, relevance, and status of new, as well as currently defined, workforce competencies. 

[HHS, DHS] [2017–2018] 

4.4.8.	 State and local governments can assess the return on investment of workforce training to 

understand effects of trainings, training gaps, and retention of workers over time. [2018] 

Priority 4.5: Expand outreach to increase the numbers of trained workers and volunteers with 

appropriate qualifications and competencies. 

4.5.1. Federal partners will explore options to incentivize states to adopt the model interstate EMS 

licensure compact language for events that do not meet the threshold for a gubernatorial 

disaster declaration. [DHS, DOT, NHTSA] [2015] 

4.5.2. Stakeholders can participate in public–private initiatives to facilitate workforce expansion during 

a response. [2015] 

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4.5.3. Before incidents, federal partners will and state and local governments and private sector 

businesses can identify requirements and the minimal effective number of surge staff needed, 

as well as local, state, regional, and federal sources of surge staff (e.g., 

temporary/intermittent agency staff, volunteers, and local government staff) outside of health 

departments, assign them to likely response tasks suited to their reassignments, and ensure that 

available skills and competencies match defined response requirements. [HHS] [2016] 

4.5.4. Nonfederal stakeholders can engage national temporary staffing agencies before incidents and 

conduct advanced credentialing to facilitate rapid deployment. [2015] 

4.5.5.	 Federal partners will and nonfederal stakeholders can incentivize the retention of volunteers 

and professional staff (e.g., provide free community college, college credit). [HHS, DoED] [2018] 

Priority 4.6: Effectively manage and use nonmedical volunteers and affiliated, credentialed, and 

licensed (when applicable) healthcare workers. 

4.6.1. Nonfederal stakeholders can adopt common (pathogen-specific) standards for personal 

protective equipment for responders and volunteers based on federal guidance. [2016-–2018] 

4.6.2. State and local governments can identify and consider opportunities to leverage credentialing 

efforts that may be under way for routine healthcare needs for use in incident response. [2016–

2018] 

4.6.3. State and local governments can work with institutions of higher education to ensure that 

individuals who volunteered as students continue to be engaged and informed of opportunities 

after graduation. [2016–2018] 

4.6.4. Federal partners will work with voluntary organizations not traditionally involved in national 

health security to assist them in defining roles in incident response and identifying ways they 

can contribute to community resilience in incident prevention, protection, mitigation, response, 

and recovery phases. [HHS] [2016–2018] 

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Strategic Objective 5: Strengthen Global Health Security 

Overview 

Global health security refers to preparedness for, response to, and recovery from incidents that 

adversely affect health and that also could pose a risk to security, destabilize economies, disrupt social 

cohesion, and affect the critical business of government.64 Today’s global health security threats arise 

from many sources, both natural and human-created. These include emerging infectious diseases, 

antimicrobial-resistant pathogens, natural disasters, the risk that accelerating scientific research 

capabilities may cause the inadvertent release of CBRN agents, vulnerabilities across a globalized food 

supply, and continued concerns about intentional use of CBRN agents. Furthermore, storms are getting 

more frequent and much stronger, droughts, fires, earthquakes, floods, and other natural and manmade phenomena that will have a direct impact on communities are ever-present. 

The health of the American people and that of the people around the world are more closely linked than 

ever before. Greater movement of people, animals, and goods across international borders increases 

the risk of exposure to health threats originating outside one’s own country. In such an interconnected 

environment, the best way for a country to protect its population is to prevent a health threat from 

emerging and spreading in the first place. This means addressing threats early and at their source, 

before they spread more widely within and across borders; it also means that other countries, including 

the United States, should prepare for the arrival of such trans-national threats within their own borders. 

The 2014 Ebola outbreaks are a good illustration of this. Thus, all nations benefit from attention to their 

own health security and to global health security. 

The NHSS identifies four priorities to further strengthen global health security. The remainder of this 

section outlines activities for the next four years to address each of the high-priority focus areas for 

implementation. 

Activities by Priority 

Priority 5.1: Support implementation of the WHO International Health Regulations (IHR 2005) and 

partner with the WHO, the Organization OIE, and the FAO and other intergovernmental organizations 

and countries towards development of global public health capacities and capabilities. 

5.1.1. Federal partners will work in collaboration with international organizations, partner countries, 

NGOs, and the private sector to provide technical assistance toward strengthening core public 

health capacities and capabilities globally in line with the IHR. [HHS, DoD, DOS, USAID] [2016–

2018] 

5.1.2. Federal partners will work with partner countries to strengthen capacities and capabilities for 

accurate and transparent international reporting of potential public health threats to the OIE 

Page 59 
 

 

 

 

 

 

 

 

and FAO. [USDA, HHS, DoD, DOS, USAID, USGS] [2016–2018] 

5.1.3. Federal partners, working in collaboration with international organizations and with the support 

of academia and NGOs, could develop and conduct interdisciplinary cross-training in health 

diplomacy. [DOS, USAID, HHS, DoD, USDA] [2016–2018] 

5.1.4. Federal partners, academia, and NGOs can train frontline health workers to strengthen their 

ability to better recognize infectious disease threats. [HHS, DoD, Peace Corps, USAID] [2016–

2018] 

5.1.5. Federal partners will work in collaboration with the public, private, academic, and 

nongovernmental sectors, as well as with intergovernmental organizations, to develop 

mechanisms to identify, document, disseminate, and learn from international health security 

experiences. [HHS, USAID, DoD, DOS, DHS] [2016–2018] 

Priority 5.2: Strengthen national capacities and capabilities globally to detect diseases in a timely 

manner. 

5.2.1.	 Federal partners will work with intergovernmental organizations and partner countries to 

support increased access by local to national health authorities to the worldwide laboratories 

participating in WHO’s Global Outbreak Alert and Response Network (GOARN). [DoD, HHS] 

[2015] 

5.2.2. Federal partners will work with intergovernmental organizations, partner countries, SLTT 

governments, NGOs, and nonfederal stakeholders to enhance early detection and alert systems 

that aim to identify public health threats through both established and innovative sources of 

information, such as social media. [HHS, DHS, DoD, USAID] [2016–2018] 

5.2.3. Federal partners will work with partner countries, intergovernmental organizations, and private 

industry to strengthen model development and wide deployment of novel diagnostics. [HHS, 

DoD, DOS, USDA] [2016–2018] 

5.2.4.	 Federal partners will work with partner countries and intergovernmental organizations to 

develop agreements and implement mechanisms to improve rapid sample-sharing of nonnoninfluenza pathogens with potential for transnational spread, for public health purposes. 

[HHS, DOS, DHS, USDA] [2016–2018] 

5.2.5. Federal partners will work with partner countries and intergovernmental organizations to 

strengthen laboratory systems so that they are capable of detecting pathogens accurately, as 

well as safely, ensuring minimal biosafety and biosecurity risk. [HHS, DoD, DOS, USDA] [2016–

2018] 

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5.2.6. Federal partners will work with partner countries, intergovernmental organizations, NGOs, and 

SLTT governments to enhance detection and reporting of public health threats affecting refugee, 

internally displaced, and migrant populations. [DOS, , DoD, HHS] [2016–2018] 

Priority 5.3: Strengthen national capacities and capabilities globally to prevent the global spread of 

public health threats and diseases. 

5.3.1. Federal partners will work with partner countries and intergovernmental organizations to 

provide information, tools, education, and infrastructure support that contribute to building or 

strengthening food safety systems and regulatory capacity. [USDA, DOC, DOS, HHS, FBI] [2015] 

5.3.2. Federal partners will work with partner countries, intergovernmental organizations, and 

NGOs to promote the appropriate and responsible use of antimicrobial agents in all settings, 

including clinical practice and promoting safe practices in livestock production to prevent the 

spread of antimicrobial resistance. [HHS, DoD, USDA, DOS, EPA] [2016–2018] 

5.3.3. Federal partners will work with partner countries to develop multisectoral policy frameworks 

and advance regulatory oversight for managing materials used in diagnostics research and 

biosurveillance activities. [HHS, DoD, DOT] [2016–2018] 

5.3.4.	 Federal partners will work with academia and the private sector to promote biosafety and 

biosecurity training. [HHS, DoD, DHS, USDA, DOS, FBI, DOL, EPA] [2015–2018] 

5.3.5. Federal partners and private sector stakeholders can engage with foreign counterparts to curb 

spurious, falsely labeled, falsified, or counterfeit (SFFC) medicines that threaten public health, 

trade, innovation, and security, including law enforcement training and technical assistance to 

help detect SFFC medicines and prosecute traffickers. [DHS, HHS, DOJ, DOC] [2016–2018] 

5.3.6. Federal partners and the private sector will help provide or improve training for supply chain 

professionals. [USAID, HHS, DOS] [2016–2018] 

Priority 5.4: Strengthen national capacities and capabilities globally to respond to public health 

emergencies of international concern. 

5.4.1. Federal partners will work with partner countries, the media, academic, and nongovernmental 

stakeholders, as well as the private sector, to foster and refine emergency alert systems and risk 

communication to notify communities in preparation for and during an emergency. [HHS, DOS] 

[2015] 

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5.4.2. Federal partners will work with intergovernmental organizations, partner countries, and NGOs 

to build on existing response networks and promote establishment of and linkage among EOCs 

to enhance real-time communication and coordination during public health emergencies. [HHS, 

DOS, DoD] [2016–2018] 

5.4.3.	 Federal partners will work with intergovernmental organizations, partner countries, and NGOs 

to establish and train multisectoral rapid-response teams, with access to near-real-time 

information systems and the capacity to help identify the likely source of a disease outbreak or 

agent release. [HHS, DOS, USAID] [2016–2018] 

5.4.4. Federal partners will work with partner countries, intergovernmental organizations, and the 

private sector to improve availability of public health emergency MCMs by increasing global 

production capacity, procurement, and stockpiling while taking into account the access and 

functional needs of at-risk individuals. [HHS, DOS] [2016–2018] 

5.4.5. Federal partners will work with domestic and international partners to strengthen the 

infrastructures, policies, and operational frameworks needed to rapidly deploy public health 

MCMs, personnel, and other public health and medical assistance across countries in response 

to emergencies. [HHS, DoD, DOS, USAID] [2016–2018] 

5.4.6. The research community can develop rapidly deployable template protocols to better 

coordinate the effective conduct of scientific investigation and research before, during, and 

after public health emergencies. [2016–2018] 

5.4.7. Federal partners will collaborate with pharmaceutical companies producing MCMs to educate 

partner countries about U.S. regulatory standards, emergency use authorizations (EUAs), 

investigational new drugs (INDs), and stockpiling to facilitate the international deployment of 

MCMs during a public health emergency. [HHS, DOS, DOC] [2016–2018] 

5.4.8. Federal partners will work with partner countries, intergovernmental organizations, and 

academia to focus on the role of scientific research collections to assist with planning or 

mitigation for zoonotic outbreaks. [USDA, HHS, DoD, DOS, DHS, EPA, DOI] [2016–2018] 

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Implementation Management 

The implementation management goal for 2015–2018 is to have relevant stakeholders engaged in 

conducting the activities specified in the IP. Implementation management will focus on fostering and 

coordinating stakeholder participation nationwide. Where possible and appropriate, HHS will seek 

nonfederal representatives from all sectors to take a strong role in implementation activities and help 

promote bottom-up experimentation and consensus-building among nonfederal implementation 

stakeholders. Publication of the NHSS/IP 2015–2018 set the initial conditions for nationwide 

participation in achieving national health security by providing all stakeholders with a shared vision and 

guidance on how to achieve it. 

Oversight 

HHS will fulfill its statutory responsibility for the NHSS using an oversight committee structure that 

comprises: 

(1) a strategic-level guidance committee, 

(2) a core management committee, 

(3) functional subcommittees, and 

(4) nonfederal-stakeholder engagement. 

The oversight committee structure was developed in response to lessons learned from the first NHSS 

quadrennial cycle and demonstrates a commitment to quality improvement. The committee structure 

has several strengths and will facilitate communication and idea-sharing among federal and nonfederal 

stakeholders. HHS will use the oversight committee structure to manage and coordinate 

implementation of the NHSS and execution of the IP. 

The committee structure proposes that the ASPR, on behalf of the HHS Secretary, serve as the authority 

for the NHSS and provides overall national leadership on health security. The oversight committee 

structure provides for strategic direction, management and coordination, functional work, and 

stakeholder engagement during the National Health Security phases of strategy formulation, 

implementation, and evaluation, as well as research that supports the national health security 

endeavor. As Figure A.2 shows, the top tier of the committee structure is made up of the Strategic 

Guidance Committee, which will be led by the HHS Deputy Assistant Secretary for Policy and Planning, 

along with representatives from key national health secruirty federal partners. 

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Figure A.2. Components of National Health Security Oversight Committee Structure 

Participants at this level provide vision and strategic direction to ensure activities are focused and 

contribute to national health security. 

The second tier will be a Management Committee chaired by the HHS Division of Policy and Strategic 

Planning. The management entity leads the intellectual and practical aspects of the quadrennial 

strategic planning and management processes. 

The third tier will be a functional component composed of four subcommittees, devoted to the 

functions of evaluation, strategy formulation, implementation, and research. Within the functional 

component, the Implementation and Strategy Formulation subcommittees will work collaboratively to 

develop course corrections and to shift emphasis to areas in which more progress is needed. The 

Evaluation and Research subcommittees will provide the Implementation and Strategy Formulation 

subcommittees with evidence regarding which activities are meaningful, efficient, cost-effective, and 

promoting health security. 

The fourth tier calls for individuals and community members to have access to the NHSS oversight 

committee structure membership in order to educate and share concerns that may affect progress 

toward advancing national health security efforts. These nonfederal stakeholders may be engaged 

through federal advisory committees, public meetings, solicitations for individual opinions, and other 

mechanisms consistent with the Federal Advisory Committee Act.65 

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Supporting Stakeholder Execution of the Implementation Plan 

Building on the guidance provided in the NHSS and IP, HHS will work continuously over the next four 

years to encourage and help sustain stakeholder participation in implementation activities. The 

Implementation Subcommitee will engage in several activities to support stakeholder progress in 

executing the IP. These include implementation tracking to assess the current status of implementation; 

analysis of information to identify successes, shortfalls, barriers, and enablers; continuous improvement 

to identify and execute or recommend corrective actions; and periodic public communications to sustain 

support for implementation efforts and to encourage additional stakeholders to participate actively. 

Implementation Tracking 

The Implementation Subcommittee will collect and maintain evaluative information on the status of IP 

activities. This will enable the workgroup to create a common operating picture (COP) that will be 

shared with all stakeholders to help coordinate their efforts. The Implementation Subcommittee will 

obtain this information directly from federal partners, leverage existing sources to the extent 

practicable, and request voluntary submission of progress data from nonfederal stakeholders. To fill 

gaps in existing data sources, the Implementation Subcommittee will develop incentives for 

stakeholders to report data voluntarily, remove barriers to data collection, disseminate data-reporting 

standards, and ensure data security and integrity. Information of interest includes not only progress 

toward completion of specific IP activities but also resource availability and allocation, facilitators or 

barriers to initiating or implementing activities, and stakeholder relationships. 

Analysis 

In addition to creating a COP, the Implementation Subcommittee will analyze implementation tracking 

data to identify gaps between planned and actual implementation activities, as well as barriers and 

enablers of participation. The Subcommittee will provide venues in which they can work with 

nonfederal stakeholders to interpret and draw implications from tracking data. These collaborative 

analyses will help to support local tailoring or adaptation of features of the implementation. The 

Subcommittee will also document promising practices and lessons learned. 

Continuous Improvement 

Informed by implementation data, the Implementation Subcommittee will work with stakeholders, 

including representatives from nonfederal organizations, to identify actions that should be taken to 

improve implementation of the NHSS and execution of the IP. These will include targeting resources to 

problem areas and promising opportunities, providing technical assistance, identifying and mobilizing 

new stakeholders and relationships among stakeholders, and working directly and collaboratively with 

implementation stakeholders to create common awareness of implementation barriers and enablers 

and address them through corrective actions. Proposed corrective actions and other initiatives to 

improve implementation will be passed to the management component for review and approval and to 

the strategic component for vetting by federal partners as appropriate. 

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Public Communications 

The Implementation Subcommitee will publicize information on implementation status in order to 

socialize and market key concepts in the NHSS and IP, publicize success stories, disseminate best 

practices, create accountability mechanisms, and mobilize new stakeholders. The Subcommittee will 

also collaborate with the public affairs representative on the tier 2 management component (described 

above and shown in Figure A.2). Reporting will include press releases, reports or report cards, social 

media outreach, speeches, and announcements by HHS officials. Venues will include conferences or 

webinars with stakeholders. 

Evaluating Progress Toward National Health Security 

In addition to tracking stakeholder implementation, HHS will evaluate progress toward national health 

security within an evaluation and decision support framework. Evaluation is intended to inform 

strategy, improve implementation, assess outcomes, and inform decisions for national health security. 

Specific requirements are being determined through engagement with both federal and nonfederal 

stakeholders. Experience during the first quadrennial cycle highlighted the importance of evaluation 

activities that are grounded in principles of continuous quality improvement and evidence-based 

practice. 

HHS has institutionalized the evaluation function in its oversight structure and its quadrennial process. 

An Evaluation Subcommittee will be responsible for evaluation activities and products. The 

Subcommittee will evaluate progress toward national health security through an ongoing process that 

involves collecting, analyzing, and integrating both qualitative and quantitative data and information 

from available sources. These sources will include related products, such as the NHSPI, the Trust for 

America’s Health reports, and the National Snapshot of Public Health Preparedness, which will be a 

combined ASPR–CDC report starting in 2016. The NHSPI aggregates 128 existing measures to produce 

national and state scores in five domains of preparedness, mostly focused on public health. The NHSPI is 

developmental, and additional work is needed to test and refine it. Future versions will need to 

incorporate additional sectors and concepts that influence the health security of states and the nation. 

The Subcommittee will produce several evaluation products during the quadrennial cycle, including 

annual updates for stakeholders and concluding with publication of the second NHSR Report. 

Evaluation products will be designed to maximize operational utility for stakeholders, beyond simply a 

retrospective review. Stakeholders will be engaged throughout the process to ensure that evaluation 

activities and products remain relevant to their unique needs in order to encourage meaningful use of 

the results. 

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Appendix B: Glossary
 

All-hazards approach 

“!Δ ̠ΧΧΪΛ̠̮͸ ͆ΛΪ ΧΪ̼Ϟ̼ΔθͻΛΔͳ ΧΪΛθ̼̮θͻΛΔͳ Γͻθͻ̠ͮθͻΛΔͳ Ϊ̼ήΧΛΔή̼ͳ ̠Δ̸ Ϊ̼̮ΛϞ̼Ϊϥ θ͸̠θ ̸̸̠Ϊ̼ήή̼ή ̠ ͆Ύ΍΍ Ϊ̠Δ̼ͮ 

of threats and hazards, including domestic terrorist attacks, natural and [human-caused] disasters, 

accidental disruptions, and other emergencies.”

66 

At-risk individuals 

Persons who, “[b]efore, during, and after an incident, . . . may have additional needs in one or more of 

the following functional areas: communication, medical care, maintaining independence, supervision, 

and transportation. Includes individuals specifically recognized as at-risk in the Pandemic and AllHazards Preparedness Act (i.e., children, senior citizens, and pregnant women), individuals who may 

need additional response assistance [including] persons who have disabilities, live in institutionalized 

settings, are from diverse cultures, have limited English proficiency or are non–English speaking, are 

transportation disadvantaged, have chronic medical disorders, and have pharmacological 

dependency.”

67 

Big data 

Big data refers to datasets whose size is beyond the ability of typical database software tools to capture, 

store, manage, and analyze.68 

Biosafety 

“Development and implementation of administrative policies, work practices, facility design, and safety 

equipment to prevent transmission of biologic agents to workers, other persons, and the 

environment.”

69 

Biosecurity 

“Protection of high-consequence microbial agents and toxins, or critical relevant information, against 

theft or diversion by those who intend to pursue intentional misuse.”

70 

Biosurveillance 

The “process of gathering, integrating, interpreting, and communicating essential information related to 

all-hazards threats or disease activity affecting human, animal, or plant health to achieve early detection 

and warning, contribute to overall situational awareness of the health aspects of an incident, and to 

enable better decision-making at all levels.”

71 

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Capability 

“[P]rovides the means to accomplish a mission or function resulting from the performance of one or 

more critical tasks, under specified conditions, to target levels of performance. A capability may be 

delivered with any combination of properly planned, organized, equipped, trained, and exercised 

personnel that achieves the desired outcomeͶ”72 

Community health resilience 

A ̮ΛΓΓΎΔͻθϥ’ή ability to use its assets to strengthen public health and healthcare systems and to 

ͻΓΧΪΛϞ̼ θ͸̼ ̮ΛΓΓΎΔͻθϥ’ή Χ͸ϥήͻ̮̠΍ͳ ̭̼͸̠ϞͻΛΪ̠΍ͳ ̠Δ̸ ήΛ̮ͻ̠΍ ͸̼̠΍θ͸ θΛ ϟͻθ͸ήθ̠Δ̸ͳ ̸̠̠Χθ θΛͳ ̠Δ̸ Ϊ̼̮ΛϞ̼Ϊ 

from adversity.73 

Community resilience approach 

An approach that encourages actions that improve a ̮ΛΓΓΎΔͻθϥ’ή ̠̭ͻ΍ͻθϥ θΛ ϟͻθ͸ήθ̠Δ̸ͳ ̸̠̠Χθ θΛͳ ̠Δ̸

recover from adversity while promoting strong day-to-day systems and addressing the underlying social 

determinants of health. 

Continuous quality improvement 

An “ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, 

accountability, outcomes, and other indicators of quality services or processesͶ”74 

Cooperative extensions 

Cooperative extensions provide resources for land-grant institutions to solve public needs with college 

or university resources through non-formal, non-credit programs. The extensions address six major 

areas, including 4-H youth development, agriculture, leadership development, natural resources, family 

and consumer sciences, and community and economic development.75

Electronic health record (EHR) 

A " digital version of a patient's paper chart." 76

Emergency management system 

Coordination of systems and multidisciplinary personnel (e.g., police, fire, emergency managers) to 

address all phases of an incident.77 

Emergency medical services (EMS) 

A system of coordinated response involving private and public agencies and organizations that provides 

emergency medical care after an incident that causes serious illness or injury.78 

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Emergency services sector 

! “ήϥήθ̼Γ Λ͆ ΧΪ̼Χ̠Ϊ̸̼Δ̼ήήͳ Ϊ̼ήΧΛΔή̼ͳ ̠Δ̸ Ϊ̼̮ΛϞ̼Ϊϥ ̼΍̼Γ̼Δθή θ͸̠θ ͆ΛΪΓ θ͸̼ Δ̠θͻΛΔ’ή first line of defense 

for preventing and mitigating the risk from physical and cyber attacks, and manmade and natural 

disasters. The sector consists of emergency services facilities and associated systems, trained and tested 

personnel, detailed plans and procedures, redundant systems, and mutual-aid agreements that provide 

life safety and security services across the Nation via a first-responder community comprised of federal, 

stateͳ ΍Λ̮̠΍ͳ θΪͻ̭̠΍ͳ θ̼ΪΪͻθΛΪͻ̠΍ ̠Δ̸ ΧΪͻϞ̠θ̼ ή̼̮θΛΪ Χ̠ΪθΔ̼ΪήͶ”79 

Global health security 

Prevention of, protection from, mitigation of, response to, and recovery from serious incidents that are 

cross-border in nature and that pose a risk to security, destabilize economies, disrupt social cohesion, 

and affect the critical business of government.80 

Healthcare coalition 

A “single functional entity” of healthcare facilities and related organizations that work together to 

prevent, protect, mitigate against, respond to, and recover from an incident.81 

Healthcare system 

΂͸̼ “̭ΪΛ̸̠̼Ϊͳ ̮ΛΓΓΎΔͻθϥ-wide health system that includes hospitals, skilled nursing facilities, nursing 

homes, hospices, health centers, home care, physician and other ambulatory care providers, specialty 

services like dialysis centers, poison control centers, and emergency medical services, and an array of 

other healthcare providers at the State and local level[s].”

82 

Health situational awareness 

A knowledge state that results from the process of active information-gathering (both domestic and 

international) with appropriate analysis, integration, interpretation, validation, and sharing of 

information related to health threats and the health of the human population, as well as health system 

and human services resources, health-related response assets, and other information that could affect 

the public’s health to inform decision-making, resource allocation, and other actions.83 

Incident 

An occurrence, natural or human-caused, that requires a response to protect life or property.84 

Incident command 

“[O]rganizational element responsible for overall management of an incident and consisting of the 

Incident Commander (either single or unified command structure) and any assigned supporting staff.”

85 

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Medical countermeasures 

Medical countermeasures include both pharmaceutical interventions (e.g., vaccines, antimicrobials, 

antidotes, and antitoxins) and non-pharmaceutical medical countermeasure interventions (e.g., 

ventilators, diagnostics, personal protective equipment, and patient decontamination methods) that 

may be used to prevent, mitigate, or treat the adverse health effects of a public health emergencyͶ” 86 

Medical surge 

The capability to rapidly expand the capacity of the existing healthcare system in order to provide 

triage and subsequent medical care with the goal of rapidly and appropriately extending care for the 

injured or ill stemming from the event and the maintenance of continuity of care for non-incidentrelated illness or injury.87 

National health security 

A state in which the nation and its people are prepared for, protected from, and resilient in the face of 

health threats or incidents with potentially negative health consequences.88 

Non-pharmaceutical interventions 

Actions, other than getting vaccinated and taking medicine, that people and communities can take to 

help slow the spread of illnesses, such as influenza; also known as community mitigation strategies.89 

Pandemic and All-Hazards Preparedness Reauthorization Act 

Law signed in March 2013 (Public Law No. 113-5) to reauthorize certain programs under the Public Health 

Service Act (Public Law No. 78-410, July 1, 1944) and the Federal Food, Drug, and Cosmetic Act (Public 

Law No. 75-717, 1938) with respect to public health security and all-hazards and to amend those acts. 

Authorizes funding for certain public health and medical preparedness programs; amends the Public 

Health Service Act to enable the Secretary to authorize state health departments and tribes to 

temporarily reassign personnel funded under Public Health Service Act programs to respond to a 

federally declared public health emergency in their jurisdiction; authorizes funding for buying medical 

countermeasures under Project BioShield; increases the flexibility to support advanced research and 

development of medical countermeasures; increases flexibility to authorize emergency use of 

unapproved products and unapproved uses of approved products.90 

Patient Protection and Affordable Care Act 

Is made up of two pieces of legislation—the Patient Protection and Affordable Care Act (Public Law 111-

148) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152)—that were 

signed into law in March 2010 and that aim to expand access to private and public health insurance while 

improving quality and lowering healthcare costs.91 

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Public health 

“The science and practice of protecting and improving the overall health of the community through 

disease prevention and early diagnosis, control of communicable diseases, health education, injury 

prevention, sanitation, and protection from environmental hazards.”

92 

Public health emergency 

An infectious-disease outbreak; natural disaster; or chemical, biological, radiological, or nuclear event.93 

Public health emergency of international concern 

An “extraordinary event” that is determined, as provided under the International Health Regulations, 

“to constitute a public health risk to other States through the international spread of disease; and to 

potentially require a coordinated international responseͶ”94 

Resilience/community resilience 

A community's ability to withstand and recover—in both the short and long terms—from adversity, such 

as a natural disaster or terrorist attack.95 

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 Page 72 

Abbreviation Definition 

ASPR Assistant Secretary for Preparedness and Response 

BARDA Biomedical Advanced Research and Development Authorit

CBO community-based organization 

CBRN chemical, biological, radiological, and nuclear 

CCA collaborative coordinating authority 

CDC Centers for Disease Control and Prevention 

CMS Centers for Medicare & Medicaid Services 

COP common operating picture 

CPR cardiopulmonary resuscitation 

CPT Current Procedural Terminology 

CRI Cities Readiness Initiative 

CY calendar year 

DHS U.S. Department of Homeland Security 

DOC U.S. Department of Commerce 

DoD U.S. Department of Defense 

DOI U.S. Department of the Interior 

DOJ U.S. Department of Justice 

DOL U.S. Department of Labor 

DOS U.S. Department of State 

DOT U.S. Department of Transportation 

DoED U.S. Department of Education 

Appendix C: Abbreviations
 

y 
 

Abbreviation Definition 

EHR electronic health record 

EM Emergency management 

EMAC Emergency Management Assistance Compact 

EMS emergency medical services 

EMSC Emergency Medical Services for Children 

EOC emergency operations center 

EPA U.S. Environmental Protection Agency 

ESS emergency services sector 

EUA emergency use authorization 

FAO Food and Agriculture Organization of the United Nations 

FBI Federal Bureau of Investigation 

FDA U.S. Food and Drug Administration 

FEMA Federal Emergency Management Agency 

GHSA Global Health Security Agenda 

GIS geographic information system 

GOARN Global Outbreak Alert and Response Network 

HHS U.S. Department of Health and Human Services 

HIE health information exchange 

HIPAA Health Insurance Portability and Accountability Act 

HITECH Health Information Technology for Economic and Clinical Health 

HPP Hospital Preparedness Program 

HSA health situational awareness 

HUD U.S. Department of Housing and Urban Development 

Page 73 
 

Abbreviation Definition 

ICS Incident Command System
 

IHR International Health Regulations
 

IND investigational new drug
 

IP implementation plan
 

MCM medical countermeasure
 

MERS Middle East Respiratory Syndrome
 

NCDMPH National Center for Disaster Medicine and Public Health 

NGO nongovernmental organization
 

NHSPI National Health Security Preparedness Index
 

NHSR National Health Security Review
 

NHSS National Health Security Strategy
 

NHTSA National Highway Traffic Safety Administration
 

NIAID National Institute of Allergy and Infectious Diseases
 

NIH National Institutes of Health
 

NIMS National Incident Management System
 

NIST National Institute of Standards and Technology
 

NPI non-pharmaceutical intervention
 

NSS National Security Strategy
 

OIE World Organisation for Animal Health
 

ONC Office of the National Coordinator for Health Information Technology 

PHEMCE Public Health Emergency Medical Countermeasures Enterprise 

PHEP Public Health Emergency Preparedness 

PIO public information officer 

Page 74 
 Page 75 

Abbreviation Definition 

POD point of dispensing 

PPD presidential policy directive 

PPE personal protective equipment 

RHIO regional health information organization 

SA situational awareness 

SFFC spurious, falsely labeled, falsified, or counterfeit 

SIP strategy and implementation plan 

SLTT state, local, tribal, and territorial 

SNS Strategic National Stockpile 

SOC ͼ̼̮Ϊ̼θ̠Ϊϥ’ή ͩΧ̼Ϊ̠θͻΛΔή ̼Δθ̼Ϊ

USAID U.S. Agency for International Development 

USDA U.S. Department of Agriculture 

USGS U.S. Geological Survey 

VA U.S. Department of Veterans Affairs 

WHO World Health Organization 
Page 76 

 

 

 

Appendix D: Crosswalk Between Public Health Service Act 

Goals and Subgoals and the National Health Security 

Strategy and Implementation Plan 2015–2018 

Public Health 

Service Act 

Preparedness Goals 

and Subgoals 

Sections in NHSS Sections in IP 

(1) Integration. 

Integrating public 

health and public 

and private medical 

capabilities with 

other first responder 

systems, including 

through--

Strategic Objective 3, Priority 

3.2: Promote continuous 

improvement through use of 

state-of-the-art innovative 

systems, tools, and partnerships 

to ensure improvement of HSA 

Strategic Objective 4: Enhance 

the integration and effectiveness 

of the public health, healthcare, 

and emergency management 

systems 

Strategic Objective 5: 

Strengthen global health security 

Activity 1.2.1: Federal partners will identify 

and disseminate culturally and linguistically 

appropriate promising practices in developing 

cross-sector partnerships to promote community 

health resilience, response, and recovery 

Activity 2.1.1. Federal partners will continue 

to work with state and local stakeholders on 

efforts to improve state and local readiness to 

make and implement decisions about use of 

MCMs and NPIs in responses through the 

identification, design, and implementation of 

exercises/drills, algorithms, and 

checklists/flowcharts that involve integrated 

MCM-NPI approaches to diverse incidents 

Activity 2.2.2. Federal partners will identify 

ways for nonfederal partners to engage in the 

PHEMCE process for requirement-setting for 

MCM research and development 

Strategic Objective 5: Strengthen global 

health security: All activities 

(A) the periodic Guiding Principle: Continuous Activity 1.3.5: State and local government 

evaluation of Quality Improvement: Policies, and NGOs can implement trainings and exercises 

federal, state, local, programs, and practices to for volunteers on effective and educated 

and tribal improve national health security bystander response 

preparedness and will be monitored, evaluated, and 
 

Public Health 

Service Act 

Preparedness Goals 

and Subgoals 

Sections in NHSS Sections in IP 

 

response capabilities 

through drills and 

exercises, including 

drills and exercises 

to ensure medical 

surge capacity for 

events without 

notice; and 

improved using systematic and 

rigorous quality management 

processes 

Activity 2.1.1. Federal partners will continue 

to work with state and local stakeholders on 

efforts to improve state and local readiness to 

make and implement decisions about use of 

MCMs and NPIs in responses through the 

identification, design, and implementation of 

exercises/drills, algorithms, and 

checklists/flowcharts that involve integrated 

MCM-NPI approaches to diverse incidents 

Activity 2.2.6: Federal partners will and SLTT 

governments can improve the active 

engagement of end users, such as patient 

providers and public health officials, in MCMoriented trainings and exercises 

Activity 2.4.8: Federal partners will draft 

guidance for nonfederal stakeholders on how the 

private sector, SLTT governments, CBOs, 

academia and healthcare systems can contribute 

to distribution and dispensing strategies and 

operational requirements, increase the number 

of closed PODs, and participate in exercises and 

drills 

Activity 4.3.5: State and local governments 

can work with schools and day care centers to 

increase awareness of the need to develop and 

exercise family reunification plans 

(B) Integrating 

public and private 

sector public health 

and medical 

Strategic Objective 4, Priority 

4.5: Expand outreach to increase 

the numbers of trained workers 

and volunteers with appropriate 

Activity 1.3.8: CBOs can partner with local 

governments to develop a messaging campaign 

to encourage financial donations through 

existing mechanisms such as the National 

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donations and 

volunteers. 

qualifications and competencies 

Strategic Objective 4, Priority 

4.6: Effectively manage and use 

nonmedical volunteers and 

affiliated, credentialed, and 

licensed (when applicable) 

healthcare workers 

Donations Management Network 

Activity 1.3.9: SLTT governments and CBOs 

(e.g., Voluntary Organizations Active in Disasters, 

National Voluntary Organizations Active in 

Disasters, American Red Cross) can partner with 

the state coordinator for volunteers before a 

disaster by developing a volunteer and donation 

management plan or developing memoranda of 

understanding 

Activity 4.5.3: Before incidents, federal 

partners will and state and local governments 

and private sector businesses can identify 

requirements and the minimal effective number 

of surge staff needed, as well as local, state, 

regional, and federal sources of surge staff (e.g., 

temporary/intermittent agency staff, volunteers, 

and local government staff) outside of health 

departments, assign them to likely response 

tasks suited to their reassignments, and ensure 

that available skills and competencies match 

defined response requirements 

Activity 4.6.4: Federal partners will work with 

voluntary organizations not traditionally involved 

in national health security to assist them in 

defining roles in incident response and 

identifying ways they can contribute to 

community resilience in incident prevention, 

protection, mitigation, response, and recovery 

phases 

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(2) Public health. 

Developing and 

sustaining federal, 

state, local, and 

tribal essential 

public health 

security capabilities, 

including the 

following: 

- - - -

(A) Disease Strategic Objective 3: Ensure Strategic Objective 3: Ensure comprehensive 

situational comprehensive health situational health situational awareness to support decisionawareness awareness to support decision- making before incidents and during response and 

domestically and making before incidents and recovery operations: All activities 

abroad, including during response and recovery 

detection, operations Strategic Objective, 5 Priority 5.2: Strengthen 

identification, and national capacities and capabilities globally to 

investigation. Strategic Objective 5, Priority 

5.2: Strengthen national 

capacities and capabilities globally 

to detect diseases in a timely 

manner 

detect diseases in a timely manner: All activities 

(B) Disease Strategic Objective 2, Priority Strategic Objective 2, Priority 2.1: Create 

containment 2.1: Create and/or refine decision- and/or refine decision-making frameworks and 

including capabilities making frameworks and coordinated processes that consider both MCMs 

for isolation, coordinated processes that and NPIs when making research, advanced 

quarantine, social consider both MCMs and NPIs development, and acquisition decisions related 

distancing, and when determining the best to countermeasures and determining the best 

decontamination. approaches to reducing adverse 

health effects of particular 

incidents of concern 

Strategic Objective 2, Priority 

approaches to reducing adverse health effects of 

particular incidents of concern: All activities 

Strategic Objective 2, Priority 2.3: Focus 

research and translation on NPIs to ensure that 

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2.3: Focus research and translation 

on NPIs to ensure that evidence is 

accurate and actionable 

evidence is accurate and actionable: All activities 

(C) Risk Strategic Objective 1, Priority Activity 1.1.1: State governments and 

communication and 1.3: Build a culture of resilience by professional societies can create templates and 

public preparedness. promoting physical, behavioral, 

and social health; leveraging 

health and community systems to 

support health resilience; and 

increasing access to information 

and training to empower 

individuals to assist their 

communities following incidents 

toolkits for communities to tailor with audiencespecific messages on community connectedness, 

social capital, and health resilience 

Activity 1.1.2: Federal partners will work with 

academia to evaluate and report on the best 

uses of traditional media (e.g., print and visual 

media) and new media (e.g., social media and 

mobile health technologies) to promote social 

connections among community members 

Activity 1.3.1: State and local governments, 

CBOs, and the private sector can promote 

general population training in health-related 

areas such as first aid, cardiopulmonary 

resuscitation, psychological first aid, and selfand family-care 

Activity 1.3.2: CBOs can use routine 

community meetings and events to disseminate 

culturally and linguistically appropriate 

information on the topic of health resilience and 

sponsor events to encourage planning for 

incident response and recovery 

Activity 1.3.5: State and local government 

and NGOs can implement trainings and exercises 

for volunteers on effective and educated 

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bystander response 

Activity 1.3.7: State and local governments, 

academia, CBOs, and the private sector can 

integrate messaging on health resilience into 

national educational initiatives, such as 

!Γ̼Ϊͻ̮̠’ή ͵Ϊ̼Χ̠Ϊ̼!θ͸ΛΔ ̠Δ̸ ̠ΔΔΎ̠΍ ͻΔ͆΍Ύ̼ΔϪ̠ 

messaging 

Activity 3.5.6: State health departments can 

coordinate with local health department public 

information officers (PIOs) to develop guidelines 

for effective use of social media for public 

communications 

Activity 5.4.1: Federal partners will work with 

partner countries, the media, academic, and 

nongovernmental stakeholders, as well as the 

private sector, to foster and refine emergency 

alert systems and risk communication to notify 

communities in preparation for and during an 

emergency 

(D) Rapid Strategic Objective 2: Enhance Strategic Objective 2, Priority 2.1: Create 

distribution and the national capability to produce and/or refine decision-making frameworks and 

administration of and effectively use both medical coordinated processes that consider both MCMs 

medical countermeasures and non- and NPIs when making research, advanced 

countermeasures. pharmaceutical interventions 

Strategic Objective 2, Priority 

2.1: Create and/or refine decisionmaking frameworks and 

coordinated processes that 

consider both MCMs and NPIs 

when determining the best 

development, and acquisition decisions related 

to countermeasures and determining the best 

approaches to reducing adverse health effects of 

particular incidents of concern. All activities 

Strategic Objective 2, Priority 2.2: Increase 

nonfederal stakeholder engagement within 

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approaches to reducing adverse 

health effects of particular 

incidents of concern 

Strategic Objective 2, Priority 

2.2: Increase nonfederal 

stakeholder engagement within 

PHEMCE processes 

Strategic Objective 2, Priority 

2.4: Expand and improve national 

capacity to manufacture, obtain, 

distribute, and dispense medical 

countermeasures 

Strategic Objective 5, Priority 

5.4: Strengthen national 

capacities and capabilities globally 

to respond to public health 

emergencies of international 

concern 

PHEMCE processes: All activities 

Strategic Objective 2, Priority 2.4: Expand 

and improve national capacity to manufacture, 

obtain, distribute, and dispense medical 

countermeasures: All activities 

Activity 5.4.4: Federal partners will work 

with partner countries, intergovernmental 

organizations, and the private sector to improve 

availability of public health emergency MCMs by 

increasing global production capacity, 

procurement, and stockpiling while taking into 

account the access and functional needs of atrisk individuals 

Activity 5.4.5: Federal partners will work with 

domestic and international partners to 

strengthen the infrastructures, policies, and 

operational frameworks needed to rapidly 

deploy public health MCMs, personnel, and other 

public health and medical assistance across 

countries in response to emergencies 

Activity 5.4.7: Federal partners will 

collaborate with pharmaceutical companies 

producing MCMs to educate partner countries 

about U.S. regulatory standards, emergency use 

authorizations (EUAs), investigational new drugs 

(INDs), and stockpiling to facilitate the 

international deployment of MCMs during a 

public health emergency 

(3) Medical. Strategic Objective 4: 

Enhance the integration and 

Strategic Objective 4: Enhance the 

integration and effectiveness of the public 

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Increasing the 

preparedness, 

response 

capabilities, and 

surge capacity of 

hospitals, other 

healthcare facilities 

(including mental 

health and 

ambulatory care 

facilities and which 

may include dental 

health facilities), and 

trauma care, critical 

care, and emergency 

medical service 

systems, with 

respect to public 

health emergencies 

(including related 

availability, 

accessibility, and 

coordination), which 

shall include 

developing plans for 

the following: 

effectiveness of the public health, 

healthcare, and emergency 

management systems 

health, healthcare, and emergency management 

systems: All activities 

(A) 

Strengthening public 

health emergency 

medical and trauma 

management and 

treatment 

Strategic Objective 4: Enhance 

the integration and effectiveness 

of the public health, healthcare, 

and emergency management 

systems 

Activity 4.2.1: Federal partners will 

incentivize the implementation of existing tools 

that promote the coordination of care in an 

event (e.g., patient-tracking tools, EHR 

compatibility features) 

Activity 4.2.2: Federal partners will provide 

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capabilities. guidance for how to modify existing information 

systems (e.g., EHR systems, immunization 

information systems) to better support national 

health security goals 

Activity 4.2.3: Federal partners will work with 

nonfederal stakeholders (e.g., Joint Commission) 

to support the widespread application of 

principles of disaster risk reduction and 

mitigation 

Activity 4.2.4: Hospitals, providers, and 

academia can explore how existing telemedicine 

programs and technologies can be redirected in 

an event to address surge and increase access in 

areas affected by disaster, including rural 

communities 

Activity 4.2.5: Nonfederal stakeholders can 

promote community support of hospitals during 

a disaster by developing continuity-of-operations 

plans that address the relocation of personnel, 

the performance of essential functions, and the 

devolution of services (when the transfer of 

essential functions is required) using the 

guidance provided in Continuity Guidance 

Circular 1 and 2, published by FEMA 

Activity 4.2.6: SLTT government planners can 

evaluate their continuity plans and capabilities 

using Continuity Assistance Tool (CAT), published 

by FEMA 

(B) Fatality - - Activity 4.2.7: Federal partners will enhance 

existing fatality management capabilities by 

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management developing policy and procedural 

recommendations for a mass fatality response in 

a resource-scarce environment in which 

operations may need to be modified to account 

for limited personnel, infrastructure, or 

equipment and supplies 

(C) Coordinated 

medical triage and 

evacuation to 

appropriate medical 

institutions based on 

patient medical 

need, taking into 

account regionalized 

systems of care. 

- - Activity 3.2.12: Federal partners will 

develop alternative protocols for patient triage 

that seek to identify higher levels of efficiency for 

electronic medical records and EHRs during 

casualty surges 

Activity 4.3.4: Federal partners will work 

with nonfederal stakeholders to create guidance 

on how to plan for and engage populations with 

enhanced privacy needs (e.g., domestic violence 

victims) for evacuation and sheltering 

(D) Rapid Strategic Objective 2: Enhance Strategic Objective 2, Priority 2.1: Create 

distribution and the national capability to produce and/or refine decision-making frameworks and 

administration of and effectively use both medical coordinated processes that consider both MCMs 

medical countermeasures and non- and NPIs when making research, advanced 

countermeasures. pharmaceutical interventions development, and acquisition decisions related 

to countermeasures and determining the best 

approaches to reducing adverse health effects of 

particular incidents of concern. All activities 

Objective 2, Priority 2.2: Increase nonfederal 

stakeholder engagement within PHEMCE 

processes: All activities 

(E) Effective 

utilization of any 

- - Activity 4.1.5: Healthcare coalitions can 

encourage member organizations to voluntarily 

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available public and 

private mobile 

medical assets 

(which may include 

such dental health 

assets) and 

integration of other 

federal assets. 

share information about their mobile medical 

assets and training on those mobile medical 

asset platforms that could potentially be used 

through the Emergency Management Assistance 

Compact (EMAC) 

(F) Protecting 

healthcare workers 

and healthcare first 

responders from 

workplace exposure 

during a public 

health emergency. 

- - Activity 2.3.2: Federal partners will work with 

SLTT governments and professional societies to 

assess, develop, improve and strategies for 

implementing research findings related to NPIsincluding PPE, social distancing, and other 

community mitigation strategies- to enhance 

translation of research into practice 

Activity 4.6.1: Nonfederal stakeholders can 

adopt common (pathogen-specific) standards for 

personal protective equipment for responders 

and volunteers based on federal guidance 

(G) Optimizing a 

coordinated and 

flexible approach to 

the medical surge 

capacity of hospitals, 

other healthcare 

facilities, critical 

care, trauma care 

(which may include 

trauma centers), and 

Strategic Objective 4 Priority: 

Build upon and improve routine 

systems and services as a 

foundation for incident response 

and risk reduction, focusing on 

common elements that leverage 

the alignment of routine 

capabilities with those needed 

during an incident 

Activity 4.1.1: Federal partners will develop 

tools and guidance for the inclusion of 

nontraditional organizations (e.g., utility 

agencies, pharmacies, human service 

organizations) in the regional preparedness 

planning process, including information on how 

to incentivize nontraditional organizations to join 

and remain active participants 

Activity 4.1.2: Federal partners working in 

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emergency medical 

systems. 

Strategic Objective 4, Priority 

4.1: Define and strengthen 

healthcare coalitions and regional 

planning alliances across all 

incident phases 

collaboration with academia and the community 

will build the evidence base around coalition 

effectiveness, including developing and testing 

metrics of coalition performance 

Activity 4.1.5: Healthcare coalitions can 

encourage member organizations to voluntarily 

share information about their mobile medical 

assets and training on those mobile medical 

asset platforms that could potentially be used 

through the Emergency Management Assistance 

Compact (EMAC) 

Activity 4.1.6: Federal partners, in 

collaboration with healthcare coalitions, will 

establish guidance for the development, 

implementation, evaluation, and improvement of 

health system emergency management 

programs (e.g. doctrine) 

Activity 4.2.1: Federal partners will 

incentivize the implementation of existing tools 

that promote the coordination of care in an 

event (e.g., patient-tracking tools, EHR 

compatibility features) 

(4) At-risk 

individuals--

- - - -

(A) Taking into 

account the 

individuals with 

disabilities public 

health and medical 

Strategic Objective 4, Priority 

4.3: Ensure that the integrated, 

scalable system can meet the 

needs of at-risk individuals 

Activity 1.1.5: CBOs and the faith community 

can identify at-risk individuals and connect them 

with personal and logistical support 

Activity 1.3.4: State and local governments 

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needs of at-risk 

individuals, including 

the unique needs 

and considerations 

of, in the event of a 

public health 

emergency. 

can encourage the identification of safe places 

for children post-disaster, including emergency 

care and effective supports for reconstitution of 

routine child care services within the community 

Strategic Objective 4, Priority 4.3: Ensure 

that the integrated, scalable system can meet 

the access and functional needs of at-risk 

individuals. All activities 

Activity 5.2.6: Federal partners will work with 

partner countries, intergovernmental 

organizations, NGOs and SLTT governments to 

enhance detection and reporting of public health 

threats affecting refugee, internally displaced, 

and migrant populations 

(5) Coordination. Guiding Principle: Strategic 

Alignment: The NHSS will 

Activity 1.2.6: Federal partners will work in 

conjunction with academia and SLTT 

Minimizing contribute to the achievement of governments to incorporate a framework to 

duplication of, and the National Security Strategy and guide the integration of culturally and 

ensuring PPDs, and should guide health linguistically appropriate community education 

coordination initiatives that contribute to the efforts for professionals on recovery planning 

between, federal, security of communities across 

state, local, and the nation Activity 4.5.1: Federal partners will explore 

tribal planning, options to incentivize states to adopt the model 

preparedness and Strategic Objective 2, Priority interstate EMS licensure compact language for 

response activities 2.1: Create and/or refine decision- events that do not meet the threshold for a 

(including the State making frameworks and gubernatorial disaster declaration 

Emergency coordinated processes that 

Management consider both MCMs and NPIs 

Assistance when determining the best 

Compact). Such approaches to reducing adverse 

planning shall be health effects of particular 

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- 

 

 

 

consistent with the 

National Response 

Plan, or any 

successor plan, and 

National Incident 

Management 

System and the 

National 

Preparedness Goal. 

incidents of concern 

Strategic Objective 4: Enhance 

the integration and effectiveness 

of the public health, healthcare, 

and emergency management 

systems 

(6) Continuity of 

operations. 

Maintaining vital 

public health and 

medical services to 

allow for optimal 

federal, state, local, 

and tribal operations 

in the event of a 

public health 

emergency. 

Activity 3.5.9: Federal partners will conduct 

cybersecurity risk assessments of healthcare 

systems, with the goal of developing contingency 

plans for continuity of operations in the event of 

a cyberincident that leverage existing 

cybersecurity risk assessment resources 

Activity 4.2.5: Nonfederal stakeholders can 

promote community support of hospitals during 

a disaster by developing continuity-of-operations 

plans that address the relocation of personnel, 

the performance of essential functions, and the 

devolution of services (when the transfer of 

essential functions is required) using the 

guidance provided in Continuity Guidance 

Circular 1 and 2, published by FEMA 

Activity 4.2.6: SLTT government planners can 

evaluate their continuity plans and capabilities 

using the Continuity Assistance Tool (CAT), 

published by FEMA 

(7) Strategic Objective 2: Enhance the 

national capability to produce and 

Strategic Objective 2: Enhance the national 

capability to produce and effectively use both 

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Countermeasures. 

(A) Promoting 

strategic initiatives 

to advance 

countermeasures to 

diagnose, mitigate, 

prevent, or treat 

harm from any 

biological agent or 

toxin, chemical, 

radiological, or 

nuclear agent or 

agents, whether 

naturally occurring, 

unintentional, or 

deliberate. 

effectively use both medical 

countermeasures and nonpharmaceutical interventions 

medical countermeasures and nonpharmaceutical interventions: All activities 

Activity 5.4.4: Federal partners will work with 

partner countries, intergovernmental 

organizations, and the private sector to improve 

availability of public health emergency MCMs by 

increasing global production capacity, 

procurement, and stockpiling while taking into 

account the access and functional needs of atrisk populations 

Activity 5.4.5: Federal partners will work with 

domestic and international partners to 

strengthen the infrastructures, policies, and 

operational frameworks needed to rapidly 

deploy public health MCMs, personnel, and other 

public health and medical assistance across 

countries in response to emergencies 

Activity 5.4.7: Federal partners will 

collaborate with pharmaceutical companies 

MCMs to educate partner countries about U.S. 

regulatory standards, emergency use 

authorizations (EUAs), investigational new drugs 

(INDs), and stockpiling to facilitate the 

international deployment of MCMs during a 

public health emergency 

(8) Medical and Strategic Objective 1: Build Strategic Objective 1: Build and sustain 

public health and sustain healthy, resilient healthy, resilient communities: All activities 

community communities 

resiliency. 

Strategic Objective 4: 

Activity 4.1.3: Local health departments can 

work with nonprofit hospitals to identify ways in 

Strengthening Enhance the integration and which the hospitals can contribute to community 

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the ability of states, effectiveness of the public health, health resilience by addressing issues identified 

local communities, healthcare, and emergency ͻΔ ̠ ̮ΛΓΓΎΔͻθϥ’ή ͸̼̠΍θ͸ Δ̸̼̼ή ̠ήή̼ήήΓ̼Δθ, as 

and tribal management systems described in the Affordable Care Act 

communities to 

prepare for, respond Strategic Objective 4, Priority Activity 4.2.3: Federal partners will work with 

to, and be resilient 4.2: Build upon and improve nonfederal stakeholders (e.g., Joint Commission) 

in the event of routine systems and services as a to support the widespread application of 

public health foundation for incident response principles of disaster risk reduction and 

emergencies, and risk reduction, focusing on mitigation) 

whether naturally common elements that leverage 

occurring, the alignment of routine 

unintentional, or capabilities with those needed 

deliberate during an incident 

(A) optimizing Strategic Objective 1 Priority: Activity 3.2.11: SLTT health and emergency 

alignment and Build a culture of resilience by management departments can develop 

integration of promoting physical and strategies for integrating new technologies and 

medical and public behavioral health; leveraging day- SA products, tools, and standards into routine 

health preparedness to-day health and community practice 

and response systems to support health 

planning and resilience; and increasing access Strategic Objective 4, Priority 4.2: Build upon 

capabilities with and to information and training to and improve routine systems and services as a 

into routine daily empower individuals to assist foundation for incident response and risk 

activities; and their communities following 

incidents 

Strategic Objective 4 Priority: 

Build upon and improve routine 

systems and services as a 

foundation for incident response 

and risk reduction, focusing on 

common elements that leverage 

the alignment of routine 

capabilities with those needed 

reduction, focusing on common elements that 

leverage the alignment of routine capabilities 

with those needed during an incident: All 

activities 

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during an incident 

(B) Promoting 

familiarity with local 

medical and public 

health systems. 

Guiding Principle: Community 

Engagement: An inclusive, 

proactive approach will be used to 

foster effective partnerships and 

collaboration within and among 

communities, and the needs and 

contributions of individuals will be 

integrated into national health 

security efforts 

Activity 1.1.4: Local governments, CBOs, and 

the private sector can empower constituents to 

engage in their communities' resilience, 

response, and recovery activities by creating 

culturally sensitive guidance based on 

sociocultural research 

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Appendix E: References
 

1 Public Health Emergency. (2012, December 18). At-risk individuals. Retrieved from 

http://www.phe.gov/Preparedness/planning/abc/Pages/at-risk.aspx 

2 Public Health Service Act (PHS), 42 U.S.C. 300hh-1 § 2802 (2013), as added by the Pandemic and AllHazards Preparedness Act of 2006 (PAHPA), Public Law 109-417 § 103 (2006, December 19). Retrieved 

from http://www.gpo.gov/fdsys/pkg/PLAW-109publ417/pdf/PLAW-109publ417.pdf. Amended by the 

Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), Public Law 113-5 § 101 

(2013, March 13). Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-113publ5/pdf/PLAW113publ5.pdf 

3 U.S. Department of Health and Human Services (HHS). (2009, December). National health security 

strategy of the United States of America. Washington, D.C. Retrieved from 

http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdf 

4 White House. (2010, May). National security strategy. Washington, D.C. Retrieved from 

http://www.whitehouse.gov/sites/default/files/rss_viewer/national_security_strategy.pdf 

5 White House. (2011, March 30). Presidential policy directive/PPD-8: National preparedness. 

Washington, D.C. Retrieved from http://www.dhs.gov/presidential-policy-directive-8-nationalpreparedness 

6 Federal Emergency Management Agency (FEMA). (2014, July 24). National preparedness goal. 

Retrieved from http://www.fema.gov/national-preparedness-goal 

7 White House. (2011, March 30). Presidential policy directive/PPD-8: national preparedness. 

Washington, D.C. Retrieved from http://www.dhs.gov/presidential-policy-directive-8-nationalpreparedness 

8 Patient Protection and Affordable Care Act, Public Law 111-148 (2010, March 23). Retrieved from 

http://www.gpo.gov/fdsys/granule/PLAW-111publ148/PLAW-111publ148/content-detail.html 

Page 93 
 

 

 

 

 

 

 

 

 

9 DeSalvo, K., Lurie, N., Finne, K., Worrall, C., Bogdanov, A., Dinkler, A., Babcock, S., & Kelman, J. (2014). 

Using Medicare data to identify individuals who are electricity dependent to improve disaster 

preparedness and response. American Journal of Public Health, 104 (7), 1160–1164. 

doi:10.2105/AJPH.2014.302009 

10 Manyika, M., Chui, M., Brown, B., Bughin, J., Dobbs, R., Roxburgh, C., & Byers, A. H. (2011, May). Big 

data: The next frontier for innovation, competition and productivity. McKinsey Global Institute. Retrieved 

from 

http://www.mckinsey.com/insights/business_technology/big_data_the_next_frontier_for_innovation 

11 Public Health Emergency. (2014, September 12). Science preparedness. Retrieved from 

http://www.phe.gov/Preparedness/planning/science/Pages/default.aspx 

12 Melillo, J. M., Richmond, T., & Yohe, G. W. (Eds.). (2014). Climate change impacts in the United States: 

The third national climate assessment. Washington, D.C.: U.S. Global Change Research Program. 

Retrieved from http://nca2014.globalchange.gov/ 

13 For more information on PHEMCE, please see Public Health Emergency. (2013, May 30). Public health 

emergency medical countermeasures enterprise. Retrieved from 

http://www.phe.gov/Preparedness/mcm/phemce/Pages/default.aspx 

14 U.S. Department of Agriculture. (2014). About us: Extension. Retrieved from 

http://www.csrees.usda.gov/qlinks/extension.html 

15 U.S. Department of Health and Human Services. (2009, December). National health security strategy 

of the United States of America. Washington, D.C. Retrieved from 

http://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdf 

16 National Prevention Council. (2011, June). National prevention strategy. Rockville, Md.: HHS, Office of 

the Surgeon General. Retrieved from http://www.surgeongeneral.gov/initiatives/prevention/strategy/ 

17 Federal Emergency Management Agency. (2011, September). National disaster recovery framework: 

Strengthening disaster recovery for the nation. Washington, D.C. Retrieved from 

http://www.fema.gov/media-library-data/20130726-1820-25045-5325/508_ndrf.pdf 

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18 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and 

Response, Hospital Preparedness Program. (2012, January). Healthcare preparedness capabilities: 

National guidance for healthcare system preparedness. Washington, D.C. Retrieved from 

https://www.phe.gov/preparedness/planning/hpp/reports/documents/capabilities.pdf 

19 U.S. Department of Health and Human Services. (2012, December). Public health emergency medical 

countermeasures enterprise (PHEMCE) implementation plan. Washington, D.C. Retrieved from 

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20 HHS, CDC. (2012, August 28). Nonpharmaceutical interventions (NPIs). Retrieved from 

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65 Federal Advisory Committee Act of 1972, Public Law 92-463, 5 U.S.C. § 5 (1972, October 6). 

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FOR MORE INFORMATION, CONTACT: 

United States Department of Health and Human Services 

Office of the Assistant Secretary for Preparedness and Response
 

Hubert H. Humphrey Building, Room 638G
 

200 Independence Ave., SW
 

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(202) 205-2882
 

www.hhs.gov 

www.phe.gov