Increasing State Capacity to Respond to Ebola and Other Infectious Disease Threats

April 06, 2016|9:26 a.m.| Alyssa Farmer

The 2014 Ebola outbreak in West Africa was the largest Ebola epidemic in history. In September 2014, CDC announced the first diagnosed case of Ebola in the United States. Since then, national, federal, and state health agencies have worked tirelessly to respond to, prepare for, and prevent additional Ebola cases, as well as other infectious disease outbreaks and emerging threats.

Learning From the Ebola Outbreak

State and local health departments’ roles in infection control and outbreak response are constantly evolving. These agencies play a crucial part in responding to public health threats and outbreaks: they are on the front lines during an outbreak or threat, ensuring that policies and services are established and followed, providing diagnostic testing, and enacting isolation and quarantine measures. During the Ebola outbreak, public health agencies across the nation utilized the existing infectious disease infrastructure in new ways and established enhanced procedures for disease surveillance and monitoring, contact investigation, public awareness and education. Ebola’s limited spread in the United States was due in part to these public health efforts.

During the federal, state and local health agencies’ efforts to control and contain Ebola within the United States, agencies also gained valuable insight and lessons learned. Lessons learned include the need for available and trained staff to maintain capacity, improvements integrating and incorporating partners into incident command structures, and improvements in communication. As a result, public health agencies are currently assessing what is needed to better prepare for and respond to future infectious disease outbreaks. For state and local health agencies, having effective and efficient mechanisms to increase capacity, communication, and coordination efforts across multiple states and stakeholders would be especially important.  

ASTHO’s Role in Improving States’ Response to Infectious Disease and Emerging Threats

There are several ways to help ensure that public health agencies are prepared for and have the capacity to respond to an infectious disease outbreak or emerging threat. One potential strategy includes assisting states in coordination and implementation of Ebola-related work for sustainable healthcare-associated infection (HAI) programs. This would allow for a more effective and coordinated public health response to emerging disease threats. Another promising strategy involves accelerating state capacity building around healthcare infection control assessment and outbreak response by assessing stakeholder and partner infection control needs, enhancing communications, and identifying and disseminating promising practices and policy solutions to states.

In an effort to support state capacity and coordination efforts, ASTHO, in partnership with CDC, is launching several initiatives to enhance infectious disease outbreak response across the nation. ASTHO (in collaboration with CDC, the Council of State and Territorial Epidemiologists (CSTE), and NACCHO) has assembled an HAI Outbreak Council. Modeled on the Council to Improve Foodborne Outbreak Response, this council acts as a multidisciplinary working group, incorporating public health and healthcare associations with federal agencies and convening together to increase collaboration across relevant areas of expertise in order to reduce HAIs. ASTHO has also developed the Healthcare and Infection Control Gateway to share information with state and federal public health leadership and disseminate resources and tools from state and territorial health agencies on Ebola, HAIs, and infectious disease outbreak response in healthcare settings.

Other ASTHO activities to improve states’ capacity and coordination will include in-person state meetings to share lessons learned and identify implementation steps. During these meetings, states would have the opportunity to address experiences, identify successes and challenges, and showcase tools for use at the state level. Another activity to enhance capacity may include an infection control workshop to refine infectious disease and preparedness programs’ roles and responsibilities in state outbreak response. Through this training, health agencies could work through hypothetical scenarios for infectious disease outbreaks, identify current gaps and challenges and adapt lessons learned for other applications in their own states. Lastly, ASTHO hopes to develop a suite of public health communication tools on promising practices and resources, as well as a tool to help states enhance their coordination efforts.

Health agencies play an important role during infection control and response. ASTHO’s activities and strategies outlined above may help states improve their readiness and capacity to respond to public health threats, share lessons learned and promising practices, and ultimately enhance health agencies’ coordination plans and procedures. With comprehensive training, increased capacity, and enhanced organization, public health agencies will be better equipped to prepare for and deal with potential infectious disease outbreaks.  

For more information on how ASTHO is helping states improve their infectious disease response, please visit ASTHO’s Healthcare and Infection Control Gateway, and find other initiatives and resources on ASTHO’s Infectious Disease page. If you would like to submit relevant materials or resources for inclusion on ASTHO’s webpages, please contact Alyssa Farmer (

Alyssa Farmer

Alyssa Farmer, MPH, is an analyst for immunization and infectious disease at ASTHO. In this position, she supports ASTHO projects related to pandemic influenza, Ebola, healthcare-associated infections, and immunizations. Alyssa received a Master of Public Health degree from East Tennessee State University with a focus in epidemiology.