The United States continues to face diverse and evolving health security threats from a variety of origins such as emerging infectious diseases, natural disasters, and other biological threats. These threats can be natural, accidental, or deliberate as the current health security environment is diverse, complex, and ever changing. The Office of the Assistant Secretary for Preparedness and Response (ASPR) coordinates the development, implementation, and evaluation of the National Health Security Strategy (NHSS) and National Biodefense Strategy (NBS) in an effort to address these threats and advance the U.S. health security enterprise through prevention, preparedness, response, recovery, and mitigation efforts.1,2,3
This article is the second in a series of articles aimed to provide education regarding key national health security concerns such as new and evolving 21st century health threats, federal government mitigation strategies used to support state, local, tribal, and territorial (SLTT) authorities, and future health security priorities. If you have not yet read article one, Introduction to the National Health Security Strategy and National Biodefense Strategy, consider doing so for additional background information.
The NHSS offers a health security threat assessment identifying emerging trends in the complex and diverse threat landscape. The 2019-2022 NHSS focuses on threats that have not been emphasized in previous preparedness activities; threats that have evolved or increased in severity; and low risk threats that can potentially have catastrophic impacts. This includes extreme weather, infectious disease with pandemic potential, chemical, biological, radiological, and nuclear threats, and cyber and health technology vulnerabilities. Strategic approaches to address this threat landscape are as follows:
- Creating distribution networks to incentivize the U.S. health care system to collaborate and function efficiently in matters of national health security;
- Capitalizing on the advanced biomedical research and biopharmaceutical manufacturing infrastructure to promote innovation and improvements in the medical countermeasure (MCM) sector;
- Empowering communities, family units, and individuals with preparedness and response information to improve their resilience to health security threats; and,
- Helping stakeholders and decision-makers understand the real risks from these threats.2
The Coronavirus Disease 2019 (COVID-19) pandemic has further exposed vulnerabilities in national security infrastructure and underscored the need for adaptable, reliable, and resilient medical and public health systems that enable effective response operations. Pathogens with pandemic potential require swift response and simultaneous health threats, such as COVID-19 and coinciding weather disasters, require unique mitigation efforts. In addition, a pandemic event can create opportunities for malicious actors to exploit health security vulnerabilities and catalyze interest in deliberate attacks against the nation.
Critical concerns exacerbated by the COVID-19 pandemic include:
- Disruptions to the medical product supply chain due to dependence on foreign sourcing of raw materials and active pharmaceutical ingredients.
- Increased vulnerability to COVID-19 for health disparity populations (e.g., racial/ethnic minorities, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities).
- Increased vulnerability of vital public health and health care technology.
The NHSS and NBS have both played an integral role in improving preparedness to disasters and public health emergencies. During the COVID-19 pandemic, a strategic approach is being taken to emphasize collaboration between the nation’s communities and stakeholder networks to address health security threats, including supply chain, health technology, and health disparities. Several resources are available to help address these areas, including:
- COVID-19 supply chain management and drug shortage updates from the Academy of Managed Care Pharmacy.
- HHS’s Healthcare System Cybersecurity Readiness and Response Considerations.
- Health equity guidance and resources from the Centers for Disease Control and Prevention.
- What threats are you most concerned about in your jurisdiction or work?
- What health security priorities should be included in the next iteration of the NHSS?
- How can national strategies such as the NHSS better inform and support your work?
The COVID-19 pandemic has demonstrated that there are areas to continue to improve national strategies, and feedback from stakeholders such as local health departments is essential before, during, and after a public health emergency. Response on the local level is critical for the nation’s communities’ health and endurance. Sara Garrington, the Emergency Preparedness and Response Manager from the Tri-County Health Department serving Adams, Arapahoe, and Douglas Counties in Colorado, participated in the 2021 NACCHO Preparedness Summit on-demand session titled National Health Security and National Biodefense Strategy: Adapting to Evolving Health Security Threats When Crisis is Commonplace. ASPR presenters discussed Sara’s thoughts on top health security priorities moving forward given the COVID-19 environment and evolving threat landscape.
Per Garrington, “although it is challenging to pinpoint priorities with various future unknowns, it is important for the Tri-County Health Department to focus on being capability-based versus threat-based. All threats are interconnected (e.g., climate change, increase in infectious disease outbreaks, etc.) and how we respond to and mitigate the consequences of these incidents through our response infrastructure is directly tied to our capabilities. Because the future is unknown, there is an ongoing need to continue to build capacity and capability depth rather than plan for the specifics of a particular threat.”
As the 2023-2026 NHSS is being developed, ASPR is looking for input from stakeholders on the following:
If you represent a local health department in your area and would like to submit feedback, email NHSS@hhs.gov.
Please continue to follow this topic series as we further cover the following features of national health security concerns and corresponding mitigation strategies:
- Key Accomplishments and Priorities of the NBS
- Examining the National Health Security Strategy Through a Local Health Department Lens
- Health Security Issues of Concern from the Federal Government Perspective
- Looking to the Future: Informing Development of the 2023-2026 NHSS
1. U.S. Department of Health & Human Services, Office of the Assistant Secretary for Preparedness and Response. HHS Office of the Assistant Secretary for Preparedness and Response. Retrieved on June 7, 2021 from: https://www.phe.gov/about/aspr/Pages/default.aspx
2. U.S. Department of Health & Human Services, Office of the Assistant Secretary for Preparedness and Response. National Health Security Strategy (NHSS). Retrieved on June 7, 2021 from: https://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx
3. U.S. Department of Health & Human Services, Office of the Assistant Secretary for Preparedness and Response. National Biodefense Strategy. Retrieved on June 7, 2021 from: https://www.phe.gov/Preparedness/biodefense-strategy/Pages/default.aspx