Preparedness for Public Health Emergencies at Risk Amid Federal Funding and Workforce Instability, New Report Finds
Ready or Not 2026 finds wide variation in state preparedness and warns that federal disruption could weaken emergency readiness nationwide
(Washington, DC – May 7, 2026) – Amid deep federal staffing cuts, grant terminations, and other far-reaching changes to the federal public health system, a new report from Trust for America’s Health (TFAH) finds wide variation in states’ readiness for disease outbreaks, natural disasters, and other health emergencies. The report warns that national preparedness depends not only on state capacity, but also on strong and stable federal health and preparedness systems, sustained intergovernmental coordination, and long-term investment in public health infrastructure.
Ready or Not 2026: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism measures the nation’s readiness for public health emergencies through 10 indicators of state preparedness, including healthcare workforce mobility, state public health funding, laboratory surge planning, access to paid sick leave, and community water system safety. This year’s report also includes a special feature on how federal workforce reductions and funding instability could weaken preparedness nationwide.
“The nation faced the most severe flu season in nearly a decade, the highest annual measles case count since 1991, and devastating weather-related emergencies, even as federal public health funding, staffing, and operational support were destabilized,” said Dr. J. Nadine Gracia, President and CEO of TFAH. “These challenges make clear that emergency preparedness cannot rely on a patchwork of limited and unpredictable resources. Effective readiness requires strong federal leadership, stable investment, and coordinated action across states and communities, especially as the United States prepares to host matches during the 2026 World Cup.”
As TFAH marks its 25th anniversary, the report highlights how decades of federal investment, policy development, and programmatic progress helped build the preparedness systems now under strain. The report places states and the District of Columbia into three performance tiers for emergency preparedness: 20 states in the high-performance tier, 17 states and the District of Columbia in the middle-performance tier, and 13 states in the low-performance tier.
High-Performance Tier – 20 states
CA, CO, CT, DE, FL, IL, KS, MA, MD, ME, MT, NC, NH, NJ, PA, RI, UT, VA, VT, WI
Middle-Performance Tier – 17 states and the District of Columbia
AR, AZ, DC, GA, HI, ID, IN, LA, MO, ND, NE, NV, NY, OH, OR, SC, TN, WA
Low-Performance Tier – 13 states
AL, AK, IA, KY, MI, MN, MS, NM, OK, SD, TX, WV, WY
These benchmarks provide policymakers and health officials with a roadmap for strengthening emergency preparedness in their jurisdictions.
Other key findings from the report include:
Public Health Funding: Most states increased or maintained their public health funding in fiscal year 2025. At least 12 states reduced state public health funding.
Water Safety: On average, 6 percent of residents in each state were served by a community water system with at least one health-based violation, mainly concentrated in smaller, rural, and socioeconomically disadvantaged communities. A federal assessment also found critical or high-risk cybersecurity vulnerabilities in dozens of drinking water systems.
Seasonal Flu Vaccination: The percentage of U.S. residents who received a vaccination against influenza continued to decrease from pre-COVID-19 pandemic levels. The 2024-25 flu season saw the highest hospitalization rates since 2010–2011 and the most pediatric deaths in any non-pandemic season since reporting began in 2004.
Avoidable Mortality: Wide variation persists across states in deaths from preventable and treatable causes before age 75. Rates in the highest-burden states are more than twice those in the lowest. Racial and ethnic disparities compound these gaps in most states, and low overall rates do not necessarily indicate equitable outcomes.
Paid Sick Leave: Access to paid sick leave varies widely across U.S. regions—from 98 percent of workers in Pacific states to 67 percent in East South Central states—and gaps are most concentrated among low-wage, part-time, and service-sector workers. Paid sick leave reduces disease transmission, supports business continuity, and is increasingly recognized by employers as an important part of preparedness infrastructure.
Policy Recommendations for Improving Emergency Preparedness:
The report outlines steps the Administration, Congress and federal agencies should take to strengthen the nation’s health and economic security:
- Provide stable, flexible, and sufficient funding for public health preparedness, workforce, and data modernization to help ensure every state has the systems needed to protect residents.
- Restore the federal public health workforce and capabilities reduced in 2025.
- Reauthorize the Pandemic and All-Hazards Preparedness Act.
- Strengthen outbreak and pandemic readiness by supporting immunization, public health surveillance, and antimicrobial resistance efforts.
- All levels of government should adopt strategies and accountability metrics to incorporate community resilience and health equity into preparedness.
- Accelerate development, stockpiling, and distribution of vaccines, therapeutics, diagnostics, and other medical countermeasures.
- Bolster healthcare system readiness, including cross-state credentialing and investment in Health Care Readiness programs.
- Expand preparedness for extreme weather and environmental health threats.
Read the full report
Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.
