Understanding the U.S. Public Health System’s Response to Pandemics

By Nadav Morag, Ph.D., University Dean of Security Studies

CTU’s Global Security Series offers background on current national and homeland security topics. In this series, University Dean of Security Studies, Dr. Morag, focuses on an often unaddressed area of homeland security: pandemics and its impact on public health. In this third installment, learn more about the many agencies involved when an infectious disease becomes a pandemic.

CTU Homeland Security Degree - Pandemic - FenceMost people are unaware of what is or who becomes involved when a pandemic strikes. In this post, I explore the institutions and mechanisms that exist in the United States to track and cope with pandemic outbreaks in this country and worldwide. As you read, consider your part in this complex process. What can you do to minimize the potential spread of disease in your community?

Understanding public health systems in the United States

Similar to most any public sector organization, the public health system in the United States is large and varied between State, Federal, and non-governmental entities, which include:

  • Over 3,000 county and city health departments and local Boards of Health,
  • 59 State and territorial health departments,
  • Tribal health departments
  • More than 16,000 public and private laboratories,
  • A number of units within several Federal departments and agencies, such as the Department of Agriculture,
  • Hospitals and other healthcare providers, and finally
  • Non-governmental organizations (NGOs), such as the Red Cross.

Not all of these entities are immediately involved when a pandemic strikes, but given the broad range of issues these public health organizations address, the potential to become involved exists. For example, while safe sex education isn’t directly related to a pandemic, safe sexual practices can certainly contribute to mitigating disease and potential pandemics. Likewise, healthcare providers and hospitals are mostly concerned with day-to-day medical issues, but if a pandemic does occur, these entities will be placed on the front line, serving people affected by the pandemic.

State-level involvement

In keeping with the Constitution’s 10th Amendment, most public health authority exists at the State level, providing State entities the ability to exercise police powers, including: enforcing safety and sanitary codes, conducting inspections, mandating the reporting of certain diseases to State authorities, compelling isolation or quarantine, and licensing heath care workers and facilities. When a pandemic occurs, the State acts as the primary agent ensuring proper reporting of disease. The State is also responsible for implementing best practices to prevent the spread of the pandemic, which might include isolation and quarantine of people, communities or geographic areas.

Federal involvement

In most cases, the Federal government provides a supporting role. The most well-known and vital Federal agency related to pandemics is the CDC, or Centers for Disease Control, based in Atlanta. The CDC provides funding, training, technical assistance, laboratory support, data analysis and other supporting activities. Of course, the Federal government also gets involved in other, lessor-known ways that affect pandemics, including exerting influence on these public health policies (i.e. tax breaks and funding programs), leading national security concerns, and getting involved in other issues from transportation to education. In terms of controlling the spread of pandemics, the Federal government can invoke their legal authority to control access to the United States, adding restrictions at International airports, seaports and borders.

In the event of a pandemic outbreak, a number of agencies are involved beginning with the Department of Homeland Security that will coordinate overall incident management with a single point of contact at the State level. The Department of Health and Human Services (HHS) will determine lead contacts for public health and emergency response activities within affected areas, and as necessary, the Department of Agriculture (USDA) will liaise with State and local veterinary officials. The Federal government will also lead International outreach efforts to ensure a coordinated response to the threat. The CDC will make its facilities and experts available to help track the disease and try to find ways to cope with the outbreak, including developing pharmacological tools to prevent the disease from spreading and to minimize its impact. As in other homeland security crisis situations, the states can also call upon locally based National Guard agencies to receive mutual aid from other states and cities. 

As you can see, a pandemic requires a swift, coordinated effort between multiple public organizations, at both the State and the Federal level. This post only touches on the surface, but provides a taste of the complexities of the system. A great deal of thought has been put into planning, training, and strategizing in the context of pandemic threats (as well as assimilating lessons-learned from previous outbreaks) but any system can be overwhelmed and a massive pandemic outbreak is likely to tax resources to the breaking point.

Ultimately, there is no substitute for personal preparedness and self-reliance. If a pandemic outbreak occurs, citizens will need to keep themselves informed, minimize contact with others via social distancing, and be prepared to be self-reliant until the pandemic has run its course, or until the local, the State and the Federal agencies are able to come up with a good medical solution to the problem.


CTU Faculty - Nadav MoragNadav Morag, Ph.D., is University Dean of Security Studies, at CTU. He works on projects for the Department of Homeland Security and the Department of Defense and is a published author on terrorism, security strategy, and foreign policy. Connect with Dr. Morag on Twitter @CTUSecurity.


Image credit: Flickr/Shaire Productions


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