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Ready Or Not 2021: Protecting the Public's Health from Diseases

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Ready Or Not 2021: Protecting the Public's Health from Diseases ISSUE REPORT Ready or Not: PROTECTING THE PUBLIC’S HEALTH FROM DISEASES, DISASTERS, AND BIOTERRORISM 2021 MARCH 2021 Acknowledgements The National Health Security Preparedness Index (NHSPI) is a joint Trust for America’s Health (TFAH) is a nonprofit, nonpartisan initiative of the Robert Wood Johnson Foundation, the University public health policy, research, and advocacy organization that of Kentucky, and the University of Colorado. TFAH wishes to promotes optimal health for every person and community and recognize and thank Glen Mays and Michael Childress of the makes the prevention of illness and injury a national priority. NHSPI for their collaboration and expertise as well as the Robert The Ready or Not report series is supported by generous Wood Johnson Foundation for its continued funding support. grants from the Robert Wood Johnson Foundation, with Ready or Not and the NHSPI are complementary projects that additional support from The California Endowment, W.K. work together to measure and improve the country’s health Kellogg Foundation and The Kresge Foundation. Opinions security and emergency preparedness. TFAH looks forward to a in this report are TFAH’s and do not necessarily reflect the continued partnership. views of its funders. TFAH BOARD OF DIRECTORS Gail Christopher, D.N. Stephanie Mayfield Gibson, M.D. Eduardo Sanchez, M.D., MPH Chair of the Board Director Chief Medical Office for Prevention Executive Director U.S. COVID-19 Response Initiative American Heart Association National Collaborative for Health Equity Resolve to Save Lives Umair A. Shah, M.D., MPH Former Senior Advisor and Vice President Cynthia M. Harris, Ph.D. Secretary of the Health W.K. Kellogg Foundation Associate Dean for Public Health Washington State David Fleming, M.D. Director and Professor Vince Ventimiglia, JD TFAH Distinguished Visiting Fellow and Vice Institute of Public Health President Chair, TFAH Board of Directors Florida A&M University Collaborative Advocates Robert T. Harris, M.D., FACP David Lakey, M.D. Leavitt Partners Treasurer of the Board Chief Medical Officer and Vice Chancellor for Senior Medical Director Health Affairs TRUST FOR AMERICA’S HEALTH General Dynamics Information Technology The University of Texas System LEADERSHIP STAFF Theodore Spencer, M.J. Octavio Martinez Jr., M.D., MPH, MBA, FAPA John Auerbach, MBA Secretary of the Board Executive Director President and CEO Co-Founder Hogg Foundation for Mental Health J. Nadine Gracia, M.D., MSCE Trust for America’s Health The University of Texas at Austin Executive Vice President and Chief Operating Officer John A. Rich, M.D., MPH Co-Director of the Center for Nonviolence and Social Justice Drexel University School of Public Health REPORT AUTHORS EXTERNAL REVIEWERS Matt McKillop, MPP This report benefited from the insights and expertise of the following external reviewers. Although Senior Health Policy Researcher and Analyst they have reviewed the report, neither they nor their organizations necessarily endorse its findings or recommendations. TFAH is extremely grateful to these reviewers for their time and expertise. Dara Alpert Lieberman, MPP Director of Government Relations James Blumenstock Shelley A. Hearne, DrPH Senior Vice President Deans Sommer and Klag Professor for Public Rhea K. Farberman, APR Pandemic Response and Recovery Health Advocacy Director of Strategic Communications and Policy Association of State and Territorial Health Director, Center for Public Health Advocacy Research Officers (ASTHO) Johns Hopkins University Bloomberg School of Public Health CONTRIBUTING AUTHOR Dr. Oxiris Barbot, M.D. Adjunct Assistant Professor David Fleming, M.D. Kendra May Columbia University Mailman School of Public TFAH Distinguished Visiting Fellow and Vice Consultant Health and Senior Fellow for Public Health and Chair, TFAH Board of Directors Social Justice at the JPB Foundation Former New York City Health Commissioner 2 TFAH • tfah.org TABLE OF CONTENTS TABLE Table of Contents Ready or Not Executive Summary .................................................4 Sidebar: COVID-19 and Emergency Preparedness: Tragic Lessons ..............6 2021 Interview: Earning Vaccine Confidence in Communities of Color ..............12 SECTION 1: ASSESSING STATES’ PREPAREDNESS .........................15 Indicator 1: Nurse Licensure Compact .................................16 Indicator 2: Hospital Participation in Healthcare Coalitions ..................18 Indicators 3 and 4: Accreditation .....................................20 Indicator 5: Public Health Funding ....................................22 Indicator 6: Water System Safety.....................................24 Indicator 7: Access to Paid Time Off...................................26 Indicator 8: Flu Vaccination Rate .....................................28 Indicator 9: Patient Safety in Hospitals ................................30 Indicator 10: Public Health Laboratory Surge Capacity .....................32 Indicators Performance Matrix by State ................................34 SECTION 2: RECOMMENDATIONS FOR FEDERAL AND STATE POLICY ACTIONS ....36 Priority Area 1: Provide Stable, Sufficient Funding for Domestic and Global Public Health Security..................................................36 Priority Area 2: Prevent Outbreaks and Pandemics ........................39 Priority Area 3: Build Resilient Communities and Promote Health Equity in Preparedness ...................................................41 Priority Area 4: Ensure Effective Leadership, Coordination, and Workforce . 43 Priority Area 5: Accelerate Development and Distribution of Medical Countermeasures . 45 Priority Area 6: Ready the Healthcare System to Respond and Recover .........47 Priority Area 7: Prepare for Environmental Threats and Extreme Weather ........49 APPENDIXES .....................................................50 Year in Review – 2020 Health Threats Incidents and Actions .................50 Report Methodology ..............................................63 Endnotes ........................................................67 Editor’s note: This report was being prepared during a presidential transition. We have included comments in the report where we have noted action on TFAH policy recommendations by the Biden administration. View this report online at www.tfah.org/report-details/readyornot2021 MARCH 2021 EXECUTIVE SUMMARY Ready or Not Executive Summary 2021 The past year, 2020, will long be remembered as the year more than 2 million people lost their lives due to a global pandemic. Not since the 1918 influenza pandemic has a single event so urgently demonstrated the criticality of a strong public health system. This Ready or Not report has tracked the country’s level of public health emergency preparedness since 2003. For nearly two decades, it has asked the fundamental question: “are we ready?” Unfortunately, the COVID-19 crisis has provided a clear answer: an emphatic “no.” The COVID-19 crisis has illuminated In addition, the pandemic has once the urgent need for federal, state, local, again demonstrated and exacerbated tribal, and territorial leaders to take the impact of structural racism, both aggressive steps to shore up the nation’s historic and current, on the health and preparedness for all types of emergency well-being of communities of color and events. The pandemic put a spotlight Tribal Nations. Acknowledging the on a public health system hollowed- lingering health impacts of slavery and out by years of insufficient funding. the treatment of native peoples and Health departments were overstretched, addressing current day racist policies, responding to the pandemic with systems, and attitudes must be part archaic technologies1 and with of building the nation’s resilience. overworked staff who faced threats In short, equity is not separate from and retribution.2 These gaps were preparedness. Ensuring an equitable all the more critical in 2020 because opportunity for the health and well- the federal government failed to take being of all residents before a disaster an evidence based, leadership role in creates more resilient communities the pandemic response, with many during an emergency. Equity must be an decisions being left to states that would explicit and foundational principle in all ordinarily be federally coordinated. emergency planning. Achieving equity It also demonstrated the harm that in all facets of emergency response can be done when science and public requires including equity accountability health expertise are stifled by political metrics in emergency preparation and interference and misinformation. management. MARCH 2021 Foundational capabilities are necessary throughout the public health system, “A powerful aspect of this report is its long history objectively from the Centers for Disease Control measuring states’ preparedness. This year’s recommendations and Prevention (CDC) to state, local, tribal, and territorial health are almost identical to past years. Had the nation paid more departments, including:3 attention to pandemic threats and TFAH’s commonsense and l Health monitoring and assessment, consistent recommendations, this country would be in a very comprising surveillance, different place today.” epidemiology, and laboratory capacity; Shelley A. Hearne, DrPH l All-hazards preparedness and response; Johns Hopkins University Bloomberg School of Public Health l Policy development and support; l Public communications; It is also important to note that the threats. They are not tailored to an l Community
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