Public Health Preparedness Archives

COVID-19, Five Years Later: Will We Heed the Public Health Lessons?

(Washington, DC – April 17, 2025) – March 2025 marked the five-year anniversary of the declaration of COVID-19 as a pandemic. This milestone offers an opportunity to reflect on the heroic work of healthcare providers and the public health workforce in limiting the pandemic’s impact on Americans’ health. Public health professionals across the country worked tirelessly on the frontlines—often facing unprecedented challenges, personal risk, and even harassment—while providing essential services such as contact tracing, coordinating testing, distributing and administering vaccines, and offering life-saving guidance to communities. Their dedication and expertise were vital to the national response and demonstrated the indispensable role of public health infrastructure in protecting American lives during a crisis.

It is also a time to remember the pandemic’s toll in illness, lives lost, and social and economic disruption. Finally, this anniversary presents an opportunity to consider what can be learned from the pandemic and how those lessons can be applied to protect the nation’s health and economic security during future emergencies.

According to the World Health Organization, COVID-19 deaths worldwide have exceeded seven million. In the U.S., at least 1.2 million people have died from COVID-19, according to the Centers for Disease Control and Prevention (CDC).

While the public health emergency has ended, COVID-19 infections are still occurring, albeit at a much lower rate. Staying up to date with vaccination remains one of the most effective tools to prevent severe illness, hospitalization, and death from COVID-19—especially when combined with other preventive measures, as appropriate, based on current community transmission levels and individual risk factors.

We continue to face numerous public health risks that demand action, including a multi-state measles outbreak, a tuberculosis outbreak, bird flu, and environmental threats. All of this is happening as federal budget cuts threaten the capacity of federal, state, and local public health departments to respond to emergencies, while workforce reductions risk the loss of sorely needed public health expertise and experience.

COVID-19 Funding Ended the Emergency and Strengthened Public Health Readiness

The COVID-19 pandemic demanded an unprecedented public health response, including funding to modernize the nation’s public health infrastructure and expand its workforce. New funding for CDC’s Data Modernization Program increased the number of healthcare facilities using electronic case reporting (eCR) to report infectious disease cases to public health agencies—from 153 in January 2020 to over 50,000 in February 2025. eCR enables real-time disease tracking, allowing for a faster response to outbreaks. Additional examples include the Public Health Infrastructure Grant, which provides funding to health departments nationwide to support innovative investments in workforce, systems, and services tailored to meet their communities’ specific health priorities and challenges; the establishment of a new Center for Forecasting and Outbreak Analytics at the CDC to model and predict outbreak trends; and the expansion of CDC’s National Wastewater Surveillance System, now implemented in 46 states and the District of Columbia. These critical new capacities are at risk due to federal budget cuts.

What the Pandemic Taught Us

The lessons of the pandemic are numerous and should be applied to strengthen the public health system. Doing so would help ensure that the nation is better prepared for future risks. These lessons include:

Protecting CDC’s mission—including its comprehensive focus on both chronic and infectious diseases—is essential, because healthier communities, particularly those with a lower burden of chronic disease, are more resilient during emergencies and recover more quickly.
A modernized and interoperable health data infrastructure is critical for real-time disease tracking. Such systems allow healthcare and public health officials to target resources where they are needed most. The progress made in data modernization since 2020 must be sustained.
Public health and healthcare readiness, along with surge capacity, are critical in an emergency. Healthcare workforce shortages during the acute phases of the pandemic placed tremendous strain on the system’s ability to manage the surge of patients. The emergency readiness of the healthcare delivery system must be fortified. State public health laboratories were also vital in identifying cases and tracking disease spread. Most states have laboratory surge plans that helped them expand testing capacity during peaks in pandemic transmission. Telehealth was a critical platform for healthcare access during the pandemic, and reimbursement for telehealth services should be preserved.
A strong emergency preparedness system is vital to the nation’s economic security. The COVID-19 emergency led to major economic disruptions and the largest employment loss in the U.S. since World War II. A 2023 study by a team of economists estimated that the pandemic’s impact on the U.S. economy through the end of 2023 was $14 trillion. Going forward, protecting the nation’s economy will require systems and capacities that can prevent a small number of disease cases from escalating into an outbreak—and eventually a pandemic.
The pandemic highlighted the nation’s health and economic disparities and their impact on health outcomes during emergencies. While all communities may face health emergencies, the impacts are not felt equally. Communities with higher rates of chronic disease and underlying health conditions often experience worse outcomes—disparities rooted in systemic barriers such as income inequality, housing instability, discrimination, poor air and water quality, and gaps in healthcare access. Advancing health equity by addressing these challenges is essential to building a more resilient and prepared nation.
The COVID-19 vaccines saved lives and reduced the severity of illness. The rapid development of the vaccines, along with an expansive system to administer them, played a critical role in the national response. According to a Commonwealth Fund study published in December 2022, COVID-19 vaccines prevented an estimated 18.5 million hospitalizations, 3.2 million deaths, and at least $1 trillion in healthcare spending in the U.S. during the first two years of the vaccination program (December 2020 through November 2022). Continued investment in vaccine development, manufacturing and distribution readiness, and other medical countermeasures is essential. mRNA vaccine technology is well-positioned to quickly produce effective vaccines against future virus variants.
The pandemic exacerbated misinformation and disinformation about vaccine safety, particularly on social media. Vaccine education that shares accurate information and builds confidence is essential. These programs should acknowledge that some people—while open to learning more—have questions and want space to make their own decisions. Healthcare and public health officials should seek opportunities to listen and respond to individuals’ questions and concerns.

We Need to Act on the Pandemic’s Lessons

Increased, sustained, and flexible public health funding is essential. The pattern of boom-and-bust funding cycles has left the system with serious preparedness gaps. Funding levels must be increased, and flexible funding is critical because it allows state and local health officials to quickly target and deploy resources where they are most needed. Investment in workforce growth and retention is also crucial.
Invest in prevention to improve health and reduce healthcare spending. As a nation, we don’t spend enough on public health and prevention. Investments in these areas yield healthier communities and significant long-term savings. Typically, less than five percent of the nation’s nearly $5 trillion in annual health spending is directed to public health and prevention programs.
Numerous sectors have a role to play in improving the public’s health. These partnerships should include public health, healthcare, educators, community–based organizations, faith leaders, the business community, and others. Strong relationships established before a crisis are central to an effective emergency response.
Public trust in government is critical during health emergencies. The politicization of public health has weakened the system and threatens its ability to respond effectively to future crises. Upholding scientific integrity—empowering public health experts to make recommendations based on the best available information—is essential for effective emergency response. Public health authorities must be preserved, and public health agencies must be effective communicators who can clearly explain the rationale behind their guidance. Timely and transparent communication with the public is essential. Public health officials also understand the importance of maintaining strong, ongoing relationships with community organizations and leaders—not just during emergencies. A diverse public health workforce that reflects the communities it serves is also key to building trust.

Closing Thoughts

The COVID-19 pandemic was a tragic event, worsened in part by an inadequate early response. Failing to learn from the pandemic experience would only compound the tragedy. The task now facing policymakers at all levels is to invest in policies and programs that will fortify our public health system—ensuring it is fully prepared to respond quickly to future emergencies—and to restore trust in the system so it can function effectively when lives are on the line.

TFAH’s annual report series, Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, identifies key strengths, areas for improvement, and recommendations to enhance the nation’s emergency preparedness.

To learn more about TFAH’s recommendations for a stronger public health system, read our 2024 report: Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress.

Ready or Not 2025: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

Trust for America’s Health (TFAH) held an in-person Congressional briefing on our recent report, Ready or Not 2025: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

The report assesses state and national preparedness and details how to strengthen the nation’s readiness for health emergencies and thereby protect health and economic security in every community. Its special feature on the H5N1 Bird Flu discusses steps the country should take to prevent the outbreak from evolving into a pandemic.

The in-person briefing featured subject matter experts and highlighted policy recommendations to aid policymakers in improving the nation’s emergency preparedness.

Statement of J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health on HHS Reorganization, Reductions in Force, and Public Health Funding Cuts

(Washington, DC – April 4, 2025) – Trust for America’s Health, a nonpartisan, nonprofit public health policy, research, and advocacy organization, is deeply concerned about the announced reorganization of federal health agencies and the broad and immediate impact of reductions in force across the U.S. Department of Health and Human Services (HHS). The impact of these actions will be heightened by the Administration’s decision to pull back public health funding already at work in states and local communities at a time when the country is experiencing infectious disease outbreaks, including measles cases in 20 jurisdictions and bird flu, rising rates of chronic disease, and devastating hurricanes, tornadoes, and wildfires.

Our serious concern is that these actions will negatively impact Americans’ health. Health that is now at greater risk due to what will be slower and less effective responses to disease outbreaks and environmental disasters, and fewer programs to surge public health and healthcare capacity in response to emergencies, ensure vaccine access, support mental health and prevent drug overdose, safeguard the food supply, and address the nation’s chronic disease crisis.

The federal government plays a critical role in securing the nation’s health through the work and expertise of numerous HHS agencies affected by these changes, such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Administration for Strategic Preparedness and Response (ASPR), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Assistant Secretary for Health (OASH). It also includes offices and institutes dedicated to addressing health disparities, such as my former office, the HHS Office of Minority Health whose statutory mission is to provide national leadership, resources, and coordination to improve the health of racial and ethnic minority populations and to eliminate health disparities.

Congress has long indicated its intent for federal agencies to undertake activities to protect and advance the nation’s health through authorizing and appropriations legislation. Fundamental changes impacting the Department’s ability to execute activities and programs directed by Congress should be made through a deliberate process involving Congress.

CDC’s comprehensive mission and expertise save lives. Congress has directed CDC to work on infectious and non-infectious diseases and conditions through authorizing legislation and appropriations bills. As an example, the bipartisan PREVENT Pandemics Act (P.L. 117-328) defined the obligations of the CDC Director to be “investigation, detection, identification, prevention, or control of diseases or conditions to preserve and improve public health domestically and globally and address injuries and occupational and environmental hazards.” The reported loss of CDC’s staff expertise to prevent chronic disease, birth defects, injuries, environmental hazards, and other leading causes of death and disability will directly impact the ability of the Department to carry out these important activities.

Furthermore, about 80 percent of CDC’s domestic budget goes directly to states, localities, tribal organizations, community and faith-based organizations, universities, healthcare systems, and other partners. When emergencies happen, the expertise of CDC staff and the funding and technical assistance CDC provides to state and local health departments are critical to waging an effective response. That was the case when Hurricane Helene hit North Carolina and Tennessee, during the East Palestine, Ohio train derailment, and the Los Angeles area wildfires. Cuts to CDC make every community more vulnerable to health threats and would be particularly detrimental to local public health infrastructure in rural communities and other underserved areas.

Dozens of states have estimated their funding losses based on the announced claw-back of pandemic era funding, funding intended to help states not only protect against COVID-19 infections but also build their disease detection infrastructure to protect residents during future health emergencies. The abrupt cancellation of these funds is impacting critical on-the-ground health protection activities, including bird flu testing, measles vaccinations, the electronic data systems that make the sharing of information between healthcare facilities and public health agencies more timely and efficient, public health laboratory modernization, bioterrorism preparedness, and programs to support mental health and prevent suicide and substance misuse. These cuts won’t only be felt in Washington, DC, or Atlanta—the Texas Department of State Health Services is losing nearly $877 million in funding, including staff and laboratories that are critical to its measles response. The Arkansas Department of Health, Human Services, and Education reports that it lost over $179 million in federal funding. Colorado reports losing more than $230 million, Illinois reports losing more than $400 million, Michigan reports losing more than $390 million, and Minnesota will lose approximately $200 million.

TFAH is dedicated to improving the nation’s health. The Administration’s goal of lowering rates of chronic disease in the U.S. is an important one. We want to work with the Administration and Congress on implementing evidence-based solutions to preventing and addressing chronic disease and other health challenges facing the country, as outlined in our Blueprint for Strengthening Public Health for the New Administration and Congress report. Our immediate appeal to federal policymakers, including Secretary Kennedy, is to not dismantle the nation’s health promotion infrastructure without careful review and input from Congress and health experts on how to make systems more effective and efficient while also adhering to the foundational ethos of medicine: first, do no harm.

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.

New Report Measures States’ Preparedness for Public Health Emergencies, Including Infectious Disease Outbreaks and Extreme Weather Events

Special Feature Examines the Threat of H5N1 Bird Flu and How to Guard Against Its Spread

(Washington, DC – March 27, 2025) – A new report assessing national and state preparedness to protect residents’ health during emergencies found that 29 states placed in the middle or low-performance tier for emergency preparedness, and that all states can do more to strengthen their readiness.

During 2024, the nation experienced a significant number of public health emergencies, ranging from infectious disease outbreaks to weather-related disasters. These emergencies demonstrate the urgent need for sustained investment in public health infrastructure and emergency preparedness, both of which are critical to the nation’s overall health and national and economic security.

Ready or Not 2025: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health (TFAH), measures states’ readiness for a range of health emergencies based on 10 indicators, including healthcare system readiness, state public health funding, public health laboratory surge capacity, employee access to paid time off, and community water system safety.

The report, now in its 22^ndyear of publication, places states and the District of Columbia into three performance tiers for emergency preparedness. This year’s report placed 21 states and DC in the high-performance tier, 16 states in the middle-performance tier, and 13 states in the low-performance tier.

Table 2: State Public Health Emergency Preparedness State Performance, by scoring tier, 2024
Performance Tier	States	Number of States
High Tier	CO, CT, DC, DE, FL, GA, ID, MA, MD, ME, MO, NC, NH, NJ, OH, PA, RI, UT, VA, VT, WA, WI	21 states and DC
Medium Tier	AL, AR, AZ, CA, IA, IL, IN, KS, KY, ND, NE, NY, OK, SC, TN, TX	16 states
Low Tier	AK, HI, LA, MI, MN, MS, MT, NV, NM, OR, SD, WV, WY	13 states

The report provides federal, state, and local policymakers and health officials with benchmarks and policy recommendations that outline how jurisdictions can strengthen their emergency preparedness.

“Strengthening communities for public health emergencies requires sustained investment, planning, and multi-sector cooperation,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Recent public health emergencies, from measles and tuberculosis outbreaks to wildfires and extreme heat, demonstrate the need for consistent investment in public health infrastructure and workforce and programs that support health in every community – because a healthy community will be more resilient when emergencies happen.”

The report includes a special feature on H5N1 bird flu, including recommendations from public health experts on steps the country should take to protect against the outbreak evolving into a pandemic. The feature discusses the importance of extensive testing programs and collaborative efforts including ways in which public health officials are working with partners in the agriculture and veterinary medicine sectors to control the outbreak.

New to the report this year is a performance indicator measuring avoidable mortality—deaths caused by preventable or treatable conditions. This indicator measures deaths before age 75 that could be prevented through effective public health measures or averted with timely healthcare interventions. Higher rates of avoidable mortality indicate gaps in public health and healthcare systems, which can weaken a community’s ability to respond to and recover from public health emergencies.

Overall, the report finds areas of strength and areas for improvement.

Areas of strong performance include:

Nurse Licensure Compact: More states have adopted the nurse licensure compact that allows nurses to work in any member state with a single multistate license. The compact is a tool for enabling healthcare facilities to surge nursing staff during an emergency. As of January 2025, 41 states belong to the nurse licensure compact, an increase from the previous year.
Public Health and Emergency Management Accreditation: Most states have achieved accreditation through the Public Health Accreditation Board (PHAB) and/or the Emergency Management Accreditation Program (EMAP). Accreditation helps agencies strengthen emergency readiness by fostering continuous improvement, establishing clear governance structures, and enhancing coordination. Accredited states also benefit from well-defined processes and robust monitoring and evaluation systems—key factors in effectively responding to public health emergencies and disasters.
Water Safety: In most states, 95 percent of households get their water from a municipal water system that did not have any water safety violations.

Areas for improvement include:

Avoidable Mortality: Avoidable mortality—deaths from preventable or treatable causes—varies widely across the country, reflecting differences in healthcare access, public health infrastructure, and underlying social and economic factors. Some states have significantly lower rates of avoidable deaths, while others face persistently high burdens. Geographic disparities are evident, with avoidable mortality rates highest in parts of the Southeast and Appalachia. Some states in the Great Plains and Mountain West also experience high rates. In contrast, states in the Northeast and Upper Midwest generally have lower rates. Additionally, Black and American Indian/Alaska Native populations frequently experience the highest rates of avoidable deaths, often due to barriers to good health within their communities. These disparities underscore the importance of ensuring that all residents have access to effective public health and healthcare services.
State Public Health Funding: Fourteen states reduced public health funding in FY 2024, three more than the eleven that reduced funding in FY 2023. The reduction may be related to the loss of COVID-19 response funding but is important to track particularly as states are also facing reductions in federal health and emergency preparedness funding.
Limited Access to Paid Time Off: On average, only about half of workers in each state used some form of paid time off during a given month. Access to paid time off allows people to avoid spreading illness in the workplace. Employers who provide employees with paid sick leave are not only helping to control the spread of infections within their community, they are also supporting their business stability and helping to safeguard the local economy.
Low Flu Vaccination Rates: Too few people are vaccinated against seasonal flu. During the 2023 – 2024 flu season only 47 percent of the population (ages six months and older) were vaccinated against the flu, down from the previous year and well short of the 70 percent goal established by Healthy People 2030. Improving flu vaccination rates can protect health, particularly for people at higher risk of serious flu outcomes and can reduce demand on the healthcare system. Improved rates also help guard against the potential for significant economic toll of a severe flu outbreak due to higher healthcare costs and lost business productivity.

Recommendations for Improving Emergency Preparedness:

Provide stable, sufficient funding for public health capabilities, including Centers for Disease Control and Prevention’s (CDC) public health emergency preparedness funds that go to states, territories, and localities, and continue to modernize health data systems to improve detection of new threats.
Reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) to improve the nation’s readiness to manage a spectrum of health threats.
Prevent and respond to infectious disease threats by funding CDC’s National Immunization Program and Antimicrobial Resistance Solutions Initiative.
Reduce health disparities in the impact of emergencies by improving demographic data collection and reporting and by targeting health investments where they are most needed. Community readiness can also be improved by engaging populations that are disproportionately impacted into the emergency planning process.
Accelerate the development and stockpiling of vaccines, therapeutic medicine, and diagnostic testing for faster distribution during emergencies.
Ensure healthcare system readiness through increased cross-state credentialing for nurses and other healthcare professionals and by fortifying the Administration for Strategic Preparedness and Response’s Health Care Readiness program.
Expand and fully fund CDC’s initiatives to address extreme weather and other environmental threats.

Read the full report

Un nuevo informe mide la preparación de los estados ante emergencias de salud pública, incluidos brotes de enfermedades infecciosas y fenómenos meteorológicos extremos

Un artículo especial examina la amenaza de la gripe aviar H5N1 y cómo protegerse contra su propagación

(Washington, DC, 27 de marzo de 2025): Un nuevo informe que evalúa la preparación nacional y estatal para proteger la salud de los residentes durante emergencias ha revelado que 29 estados se sitúan en un nivel medio o bajo de rendimiento en cuanto a preparación ante emergencias, y que todos los estados pueden hacer más para reforzar su preparación.

Durante 2024, el país experimentó un número significativo de emergencias de salud pública, desde brotes de enfermedades infecciosas hasta desastres climáticos. Estas emergencias demuestran la urgente necesidad de una inversión sostenida en infraestructura de salud pública y preparación para emergencias, ambos aspectos cruciales para la salud general y la seguridad nacional y económica del país.

Ready or Not 2025: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, publicado hoy por Trust for America’s Health (TFAH), mide el nivel de preparación de los estados ante una variedad de emergencias sanitarias basándose en 10 indicadores, entre ellos, la preparación del sistema de salud, la financiación estatal de salud pública, la capacidad de los laboratorios de salud pública de responder ante emergencias, el acceso de los empleados a tiempo libre remunerado y la seguridad del sistema de agua comunitario.

El informe, que se publica desde hace 22 años, clasifica a los estados y al Distrito de Columbia en tres niveles de desempeño en materia de preparación ante emergencias. El informe de este año clasificó a 21 estados y al Distrito de Columbia en el nivel de alto desempeño; a 16 estados, en el nivel de desempeño medio; y a 13 estados, en el nivel de bajo desempeño.

Nivel de alto desempeño: 21 estados y el Distrito de Columbia

CO, CT, DC, DE, FL, GA, ID, MA, MD, ME, MO, NC, NH, NJ, OH, PA, RI, UT, VA, VT, WA, WI

Nivel de desempeño medio: 16 estados

AL, AR, AZ, CA, IA, IL, IN, KS, KY, ND, NE, NY, OK, SC, TN, TX

Nivel de bajo desempeño: 13 estados

AK, HI, LA, MI, MN, MS, MT, NV, NM, OR, SD, WV, WY

El informe ofrece a los responsables de formular políticas y a los funcionarios de salud federales, estatales y locales parámetros de referencia y recomendaciones de políticas que delinean cómo las jurisdicciones pueden fortalecer su preparación para emergencias.

“Fortalecer a las comunidades en situaciones de emergencia de salud pública requiere de inversión sostenida, planificación y cooperación multisectorial”, afirmó la Dra. J. Nadine Gracia, máster en ciencias de epidemiología clínica, presidenta y directora ejecutiva de Trust for America’s Health. “Las recientes emergencias de salud pública, desde brotes de sarampión y tuberculosis hasta incendios forestales y calor extremo, demuestran la necesidad de una inversión constante en infraestructura y personal de salud pública, así como en programas que apoyen la salud en todas las comunidades, ya que una comunidad sana será más resiliente cuando se presenten emergencias”.

El informe incluye un artículo especial sobre la gripe aviar H5N1, con recomendaciones de expertos en salud pública sobre las medidas que el país debería tomar para evitar que el brote se convierta en una pandemia. Este artículo analiza la importancia de los programas de pruebas exhaustivas y los esfuerzos de colaboración, incluidas las formas en que los funcionarios de salud pública están trabajando con socios en los sectores agrícola y veterinario para controlar el brote.

Una novedad en el informe de este año es un indicador de desempeño que mide la mortalidad evitable (muertes causadas por afecciones prevenibles o tratables). Este indicador mide las muertes antes de los 75 años que podrían prevenirse con medidas eficaces de salud pública o evitarse con intervenciones sanitarias oportunas. Tasas más altas de mortalidad evitable son indicativas de deficiencias en los sistemas de salud pública y de atención médica, lo que puede debilitar la capacidad de una comunidad de responder y recuperarse de las emergencias de salud pública.

En general, el informe identifica áreas de fortaleza y áreas de mejora.

Las áreas de desempeño destacado incluyen:

Pacto para la licencia de enfermería: Más estados han adoptado el pacto para la licencia de enfermería, que permite a los enfermeros trabajar en cualquier estado miembro con una única licencia multiestatal. El pacto es una herramienta que permite a los centros de salud aumentar el personal de enfermería durante una emergencia. A partir de enero, 41 estados pertenecían al pacto para la licencia de enfermería, lo que representa un aumento respecto del año anterior.
Acreditación en salud pública y gestión de emergencias: La mayoría de los estados han obtenido la acreditación a través de la Junta de Acreditación de Salud Pública (PHAB) o el Programa de Acreditación para la Gestión de Emergencias (EMAP). La acreditación ayuda a las agencias a fortalecer su preparación para emergencias, ya que promueve la mejora continua, establece estructuras de gobernanza claras y mejora la coordinación. Los estados acreditados también se benefician de procesos bien definidos y sistemas sólidos de monitoreo y evaluación —factores clave para responder eficazmente ante emergencias y desastres de salud pública.
Seguridad del agua: En la mayoría de los estados, el 95 % de los hogares obtiene agua de un sistema municipal que no presenta ninguna infracción de seguridad hídrica.

Las áreas de mejora incluyen:

Mortalidad evitable: La mortalidad evitable (muertes por causas prevenibles o tratables) varía ampliamente en todo el país, lo que refleja las diferencias en el acceso a la atención médica, la infraestructura de salud pública y los factores sociales y económicos subyacentes. Algunos estados tienen tasas significativamente más bajas de muertes evitables, mientras que otros enfrentan cargas persistentemente altas. Las disparidades geográficas son evidentes, con las tasas de mortalidad evitable más altas en partes del sureste y los Apalaches. Algunos estados de las Grandes Llanuras y las Montañas del Oeste también experimentan tasas altas. En cambio, los estados del noreste y el Alto Medio Oeste generalmente tienen tasas más bajas. Además, las poblaciones negras e indígenas estadounidenses/nativas de Alaska con frecuencia experimentan las tasas más altas de muertes evitables, a menudo debido a las barreras para acceder a una buena salud en sus comunidades. Estas disparidades subrayan la importancia de garantizar que todos los residentes tengan acceso a servicios de salud pública y atención médica eficaces.
Financiamiento estatal de la salud pública: Catorce estados redujeron el financiamiento de la salud pública en el año fiscal 2024, tres más que los once que lo hicieron en el año fiscal 2023. Esta reducción puede estar relacionada con la pérdida de fondos para la respuesta al COVID-19, pero es importante hacer seguimiento de esto, especialmente porque los estados también enfrentan recortes en los fondos federales destinados a la salud y la preparación ante emergencias.
Acceso limitado a tiempo libre remunerado: En promedio, solo la mitad de los trabajadores en cada estado utilizaron algún tipo de tiempo libre remunerado durante un mes determinado. El acceso a tiempo libre remunerado permite a las personas evitar la propagación de enfermedades en el lugar de trabajo. Los empleadores que ofrecen a sus empleados licencia por enfermedad remunerada no solo ayudan a controlar la propagación de infecciones en su comunidad, sino que también apoyan la estabilidad de su negocio y contribuyen a salvaguardar la economía local.
Bajas tasas de vacunación contra la gripe: Muy pocas personas se vacunan contra la gripe estacional. Durante la temporada de gripe 2023-2024, solo el 47 % de la población (de seis meses o más) se vacunó contra la gripe, una cifra inferior a la del año anterior y muy por debajo del objetivo del 70 % establecido por Healthy People 2030. Mejorar las tasas de vacunación contra la gripe puede proteger la salud, en particular la de las personas con mayor riesgo de sufrir desenlaces graves a causa de la gripe, y puede reducir la demanda del sistema sanitario. Mejorar las tasas también ayuda a prevenir el posible impacto económico significativo de un brote grave de gripe debido al aumento de los costos de atención médica y la pérdida de productividad empresarial.

Recomendaciones para mejorar la preparación ante emergencias:

Proporcionar financiación estable y suficiente para las capacidades de salud pública, incluidos los fondos de preparación para emergencias de salud pública de los Centros para el Control y la Prevención de Enfermedades (CDC) que se destinan a estados, territorios y localidades, y continuar modernizando los sistemas de datos de salud para mejorar la detección de nuevas amenazas.
Reautorizar la Ley de Preparación para Pandemias y Todo Tipo de Peligros (PAHPA) con el fin de mejorar la preparación del país para gestionar diversas amenazas a la salud.
Prevenir y responder a las amenazas de enfermedades infecciosas financiando el Programa Nacional de Inmunización y la Iniciativa de Soluciones para la Resistencia a los Antimicrobianos de los CDC.
Reducir las disparidades de la salud en el impacto de las emergencias mejorando la recopilación y la presentación de datos demográficos y dirigiendo las inversiones en salud donde más se necesitan. La preparación comunitaria también puede mejorarse involucrando a las poblaciones que resultan afectadas de manera desproporcionada en el proceso de planificación para emergencias.
Acelerar el desarrollo y el almacenamiento de vacunas, medicamentos terapéuticos y pruebas de diagnóstico para una distribución más rápida durante las emergencias.
Garantizar la preparación del sistema de salud aumentando la acreditación interestatal de enfermeras y otros profesionales de la salud y fortaleciendo el programa de Preparación para la Atención Médica de la Administración de Preparación y Respuesta Estratégicas.
Ampliar y financiar completamente las iniciativas de los CDC para abordar las amenazas climáticas extremas y otras amenazas ambientales.

Lea el informe completo

Trust for America’s Health es una organización de políticas de salud pública, investigación y defensoría sin fines de lucro y no partidista que promueve la salud óptima para todas las personas y comunidades, y hace de la prevención de enfermedades y lesiones una prioridad nacional.

Ready or Not 2025: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism

Measles Cases Reported in Thirty Jurisdictions

Health officials remind the public: Measles is serious and very contagious; being vaccinated is the best defense.

Measles is an airborne, highly contagious disease that can be very severe. However, people have the power to protect themselves and their children with the measles-mumps-rubella (MMR) vaccine.

Although measles was declared eliminated in the U.S. in 2000, ongoing cases in thirty jurisdictions illustrate that the illness can spread easily in communities with pockets of unvaccinated people. As of May 1, 935 confirmed measles cases have been reported nationally with the largest number of cases occurring in Texas (683 as of May 2). Most of the Texas cases were in school-age children. Of the cases reported in 2025, 96 percent were people who were unvaccinated or with unknown vaccination status, and 13 percent of cases have resulted in hospitalization.

Sadly, three deaths have occurred as a result of the current outbreaks in Texas and New Mexico. In late February, the Texas Department of State Health Services reported the first death resulting from the state’s outbreak. The death occurred in a child who was not vaccinated. A second death of a New Mexico adult who tested positive for measles and was also unvaccinated, was reported in early March. Any measles death is particularly tragic because such deaths are preventable.

Here’s what you need to know about measles.

Measles is highly contagious. You can contract measles by breathing air contaminated by an infected person or touching an infected surface. The measles virus can linger in the air for several hours after an infected person coughs or sneezes.
Measles symptoms usually include a fever, rash, cough, and red eyes. Someone who is infected with measles can spread the infection to others before they notice symptoms, especially in the four days before or after a rash develops.
Measles can lead to serious health consequences especially for babies and young children including hearing loss, brain swelling, pneumonia, and even death. Anyone who is not protected against measles is at risk, but children under the age of five, pregnant women, and people with weakened immune systems are particularly susceptible and are at risk for more serious outcomes.
Data show that unvaccinated people have a 90 percent likelihood of contracting measles if they are exposed. One out of five people who contract measles will require hospitalization.
If you have been exposed to someone with measles or display symptoms, like a rash that spreads from the face to the rest of the body, you should isolate and contact a healthcare provider immediately.
Vaccination is the most effective way to avoid contracting measles. The measles-mumps-rubella (MMR) vaccine has been in use since 1971 with the measles vaccine dating back even further to 1963. The MMR vaccine has been shown to be 97 percent effective for people who have received the full series (two doses). After the measles vaccine was introduced, reported cases in the U.S. dropped by 97% in just three years.
Children between the ages of 6 – 11 months can be given the MMR vaccine in areas with measles cases, but most children receive their first dose between 12 and 15 months. Babies younger than 6 months are not yet ready for vaccination, which is why older children and adults who interact with infants should be fully vaccinated.

Resources for further information:

Measles Symptoms and Complications | Measles (Rubeola) | CDC

Measles Vaccination | Measles (Rubeola) | CDC

Vaccinate Your Family: Measles Resources (Vaccinate Your Family)

Measles Vaccination: Know the Facts (Infectious Disease Society of America)

Revised May 5, 2025

2024 Year in Review and Looking Ahead to 2025

During 2024, Trust for America’s Health (TFAH) continued its work to create a more resilient, trusted, and equitable public health system, and a healthier nation.

TFAH continued its work in a number of critical issue areas to improve the nation’s health, including emergency preparedness, public health funding, chronic disease prevention, the role of food and nutrition policy in stemming the nation’s obesity crisis, preventing substance misuse and suicide, supporting healthy aging, and addressing the health impacts of climate change and other environmental health risks.

Progress and Risks

The nation’s public health system is at an inflection point; progress has been made in many areas but there are also continuing and potential new risks to the nation’s health. The following are examples of areas of progress and areas of risk.

Areas of progress:

Drug overdose deaths, including from fentanyl, are down. The reduction can be credited in part to the increased availability of treatment options and the adoption of harm reduction strategies such as readily available naloxone, the overdose reversal drug, in many communities. However, disparities persist, with overdose rates increasing in many Black and Native American communities.
COVID-19 infection rates are currently low across the country, a testament to what can be achieved when the public health community rallies and has the funding and resources necessary to meet an immediate challenge.
Investments in public health data modernization, wastewater surveillance, and the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics have improved the nation’s ability to identify and track emerging health threats. The Center has awarded more than $100 million to partners who are technologically advancing the use of outbreak data to control infectious disease spread.
Fifty-nine state and local health departments have earned Age-Friendly Public Health Systems Recognition Status through TFAH’s Age-Friendly Public Health Systems initiative by making healthy aging a core function of the department. In addition, four public health organizations and 154 individual public health practitioners have been recognized as public health champions.
Fifteen states and D.C. have adopted paid sick leave laws which require private employers to provide paid sick leave to employees attending to their own or a family member’s health. Alaska, Missouri, and Nebraska will require employers to provide paid sick leave beginning in 2025. Paid sick leave has been a long-standing TFAH policy recommendation.

Areas of risk:

Public health faces a serious funding cliff as monies infused into the public health system as part of the pandemic response are expiring or in some cases rescinded. The loss of such funding returns the public health system to the state of underfunding it experienced for decades prior to the global pandemic. TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations called attention to the critical need to increase investment in public health on a sustained basis.
The COVID-19 pandemic exposed serious gaps in the nation’s emergency infrastructure that have not been fully addressed. Furthermore, misinformation about the pandemic, particularly about lifesaving COVID-19 vaccines, contributed to an uptick in mistrust of public health officials that could lead to more vaccine hesitancy and challenges to important public health authorities, all of which could make containing future disease outbreaks more difficult.
New disease outbreaks such as the H5N1 Bird Flu could grow.
Rates of recommended childhood vaccinations are down.
Health disparities continue to impact the nation. Rates of chronic disease are on the rise in every community but are higher, for example, among many communities of color and in rural communities, due to structural barriers to health like access to healthy and affordable food, secure housing, and opportunities for physical activity in those communities.
Health risks are also increasing due to an increase in the number and severity of weather-related incidents including extended periods of extreme heat and extreme heat in regions of the country unaccustomed to such weather.

Working With Partners and Providing Leadership to Strengthen the Nation’s Public Health Ecosystem

TFAH released its Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress in October, after consultation with more than 45 experts, practitioners, organizations, and community members. The Blueprint provides the incoming Administration and Congress a policy roadmap for improving the nation’s health, economy, and national security within six priority areas: 1) invest in public health infrastructure and workforce, 2) strengthen prevention, readiness, and response to health security threats, 3) promote the health and well-being of individuals, families, and communities across the lifespan, 4) advance health equity by addressing structural discrimination, 5) address the non-medical drivers of health to improve the nation’s health outcomes, and 6) enhance and protect the scientific integrity, effectiveness, and accountability of agencies charged with protecting the health of all Americans.

Working with partners across multiple sectors is central to TFAH’s work. TFAH staff led or participated in a number of coalitions during 2024, including the Coalition for Health Funding, the CDC Coalition, the Common Health Coalition, the Well-Being Working Group, the Injury and Violence Prevention Network, National Alliance for Nutrition and Activity, the Coalition to Stop Flu, the Adult Vaccine Access Coalition, the Age-Friendly Ecosystem Collaborative, the National Alliance to Impact the Social Determinants of Health, the National Commission on Climate and Workforce Health, and the National Council on Environmental Health & Equity.

Advocating for Evidence-Based Solutions

A healthy community supports the health of individuals and families by creating access to non-medical drivers of health such as secure housing, transportation, quality healthcare, high-quality childcare and educational opportunities, and jobs that pay a living wage. Such health security supports individuals, families, communities, and the nation’s economy.

Throughout the year, TFAH convened partners to strategize ways to effectively advance health promoting policies and programs at the federal and state levels. In addition, TFAH staff worked with numerous federal agencies and offices, like CDC, FDA, and SAMHSA, as well as public health organizations such as the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), Big Cities Health Coalition, and the National Governors Association to advance policies and garner support for programs that will improve Americans’ health. Among TFAH’s legislative goals for 2024 and moving into 2025 are increased and sustained investment in public health agencies, infrastructure, and programs; passage of a new Farm bill that provides access to nutrition support programs; reauthorization of the Pandemic and All Hazards Preparedness Act and the Older Americans Act; and passage of the Public Health Infrastructure Saves Lives Act and the Social Determinants of Health Act.

These advocacy efforts earned numerous policy wins, including the U.S. Department of Agriculture’s (USDA) updates to school meals formulas and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefit food packages that aligns with TFAH recommendations.

TFAH’s core annual reports, which track data and recommend policy solutions in the areas of emergency preparedness, public health funding, preventing substance misuse and suicide, and addressing the nation’s obesity crisis, continue to be a critical source for data trends and evidence-based policy and program solutions for health officials, policymakers, other decision-makers, and advocates across the country.

Making Healthy Aging a Core Function of Local Health Departments

Through its Age-Friendly Public Health Systems Initiative (AFPHS), TFAH continues to provide guidance and resources to state and local health departments to help them promote healthy aging in their communities. During 2024, AFPHS co-hosted the 2024 National Healthy Aging Symposium with the U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion. The symposium brought together speakers from sectors across all levels of government, philanthropy, academia, nonprofits, community-based organizations, tribal representatives, and others who shared their perspectives on important topics related to healthy aging including caregiving, brain health, the caregiving workforce, transportation, housing, and social engagement. TFAH also launched the Age-Friendly Ecosystem Collaborative to continuously engage organizations and sectors central to healthy aging.

Supporting Public Health Communicators

TFAH continues to be a managing partner of the Public Health Communications Collaborative (PHCC). PHCC provides no-cost messaging resources and communications training to state and local health departments to help the field effectively address the public’s information needs on public health issues. The Collaborative was first established during the COVID-19 pandemic and now works across the public health sector on such issues as H5N1 Bird Flu, Mpox, protecting health during periods of extreme heat, and vaccine confidence. Its training materials include resources on strengthening public health through community engagement, responding to misinformation, and using social media in health communications. The PHCC newsletter is shared with over 38,000 opted-in subscribers, and its website has earned over 1.2 million page views since its launch in 2020.

Looking Ahead

The 2025 calendar year promises to be pivotal for the nation’s health. TFAH looks forward to bringing evidence-based policy recommendations to the new Administration and Congress, particularly on issues such as emergency preparedness, chronic disease prevention, mental health, veterans’ and rural health, and investing in prevention to reverse the pattern of increasing healthcare spending without better health outcomes. We are committed to making the case for policies and programs that address the non-medical drivers of health in order to promote the nation’s health and economic security.

The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations

National Immunization Month Highlights Lifesaving Benefits of Vaccines

August 2024

National Immunization Awareness Month sponsored by the National Public Health Information Coalition (NPHIC) and observed every August, highlights the lifesaving benefits of vaccines. During the month, activities will raise awareness of the importance of vaccinating people of all ages against serious and sometimes deadly diseases. The awareness month also celebrates the successes of immunizations and educates Americans about vaccine safety and effectiveness.

According to a study by the Commonwealth Fund, from December 2020 through November 2022, COVID-19 vaccines prevented approximately 18.5 million hospitalizations and 3.2 million deaths in the U.S., but the lifesaving impact of vaccines extends far beyond COVID-19. Vaccines have dramatically reduced the spread of diseases like measles, polio, and whooping cough, protecting countless individuals and communities.

According to new data published this month by the CDC, among children born during 1994-2023, routine childhood vaccinations will have prevented about 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths over the course of their lifetimes.

Unfortunately, numerous factors have led to a decline in vaccination rates in recent years including healthcare disruptions during the COVID-19 pandemic and the spread of misinformation about vaccine safety and effectiveness. In some cases, this has resulted in outbreaks of once-controlled diseases, including measles and to a lesser degree polio, jeopardizing the progress we have made.

According to the American Association of Immunologists, getting vaccinated protects against the spread of infectious diseases by helping our immune systems fight infection. Vaccines work by introducing a weakened or inactive form of a virus or bacteria to the body. This triggers the immune system to develop antibodies, creating a kind of shield against future infection. When a large portion of the population is vaccinated, it creates “herd” or community-level immunity, making it difficult for diseases to spread, even protecting those who haven’t been vaccinated themselves.

The public health benefits of vaccines include:

Disease Prevention: Vaccines are highly effective at preventing serious illnesses like measles, mumps, rubella, polio, diphtheria, tetanus, whooping cough, chickenpox, shingles, influenza, and pneumonia. These diseases can cause severe complications, hospitalization, and even death.

Reduced Healthcare Costs: Vaccines are a cost-effective way to prevent illness and its associated medical expenses. Vaccination programs save billions of dollars in healthcare costs each year.

Protection for Populations at Higher Risk: Vaccines are especially important for protecting those with developing immune systems (infants) or weakened immune systems, such as older adults and people with certain chronic illnesses.

Global Health Impact: Vaccination programs have had a significant impact on global health. They have helped to virtually eliminate smallpox and dramatically reduced the burden of other diseases worldwide.

To build on and sustain the health benefits of vaccines, TFAH’s 2024 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report includes a number of important recommended policy actions to strengthen the nation’s vaccine infrastructure:

Increased Funding: Congress should provide at least $1.1 billion per year to support vaccine infrastructure and delivery, including programs promoting equitable vaccine distribution.
Insurance Coverage: Congress and states should ensure first-dollar coverage for recommended vaccines under commercial insurance and for uninsured populations.
Minimizing Exemptions: States should minimize vaccine exemptions for schoolchildren, and healthcare facilities should increase vaccination rates of healthcare workers.
New Vaccine Development: Congress should create incentives for new-product discovery to prevent and fight resistant infections including therapeutics, diagnostics, and prevention products such as vaccines.
Strengthening Influenza Defenses: Congress should strengthen the pipeline of influenza vaccines, diagnostics, and therapeutics.
Countering Vaccine Misinformation:The spread of misinformation about vaccines can lead to vaccine hesitancy and lower vaccination rates. TFAH calls for promoting accurate information from trusted sources to increase vaccine confidence.

According to research published in The Lancet, since 1974, vaccination has prevented 154 million deaths worldwide. By ensuring equitable access to vaccines, promoting accurate information, and investing in research and education, we can continue to harness the power of vaccines and build a healthier future for all.