– Executive Summary –
The COVID-19 pandemic highlighted critical weaknesses in the coordination between public health preparedness (PHP) and emergency management (EM) in the United States. While both play essential roles in disaster response, PHP, led by the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS), focuses on response to public health emergencies. In contrast, EM, overseen by the Federal Emergency Management Agency (FEMA) and the Department of Homeland Security (DHS), manages response to natural and manmade disasters. This structural separation has led to inefficiencies at the federal, state, and local levels, as seen during the COVID-19 response, where competing jurisdictional authority resulted in delays and fragmented operations. Addressing this divide is essential to strengthening national preparedness.
This thesis examines how PHP and EM can be better integrated to enhance resilience, collaboration, and alignment with the National Preparedness Goal (NPG). The NPG establishes a unified framework for the United States to prepare for, prevent, respond to, and recover from all hazards by building and sustaining core capabilities across five mission areas: Prevention, Protection, Mitigation, Response, and Recovery.[1] Using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, the research synthesizes government reports, academic literature, and case studies to assess key internal and external factors shaping these systems. The analysis identifies key strengths within PHP and EM. PHP has strengths in a specialized mission-focused scope and unique legal authorities that allow for rapid emergency declarations. EM’s strengths lie in its operation under a structured coordination framework, mainly through utilizing the National Incident Management System (NIMS), a standardized framework that enables coordination among all levels of governmental and nongovernmental organizations during a disaster, and the Incident Command System (ICS), a flexible hierarchical structure within NIMS that provides a standardized approach to command and control, to ensure organized disaster response efforts. However, significant weaknesses exist. PHP and EM face persistent funding and workforce shortages. Additionally, PHP struggles with inconsistent integration into NIMS, creating operational disconnects with EM agencies. Meanwhile, jurisdictional conflicts between PHP and EM further complicate disaster response, as demonstrated during COVID-19, where FEMA assumed many operational roles despite HHS’s statutory authority.
There are several opportunities to enhance PHP-EM coordination, primarily improved cross-agency collaboration. Expanded utilization of population health data and systems, particularly social vulnerability data, could improve real-time resource allocation and target response in emergencies. Additionally, EM could expand its work in resiliency and mitigation projects to better prepare for and reduce the severity of disasters. Despite these opportunities, emerging threats continue to challenge national preparedness. Increasingly complex and compounding disasters require greater coordination between PHP and EM, as any disaster impacts both EM and PHP focus areas.
To address these challenges, this study recommends further research and analysis into the full integration of PHP into EM at the federal, state, and local levels, with a particular focus on stabilizing funding and workforce needs, clarifying leadership roles to prevent jurisdictional conflicts, and leveraging the strengths and opportunities identified in both systems to build a more robust and adaptive disaster response framework. By confronting these systemic issues, PHP and EM can work more cohesively to enhance national preparedness and ensure a more efficient, integrated response to future public health emergencies.
[1] U.S. Department of Homeland Security, National Preparedness Goal, 2nd ed. (Washington, DC: Department of Homeland Security, 2015), 1.
