How 9/11 Shaped the Future of Public Health Preparedness: Q&A with Meredith Allen

September 08, 2026 | Taylor Francis

September 11, 2026, marks 25 years since the deadliest terrorist act in history. The 9/11 attacks left a forever impact — on the public, on first responders, (e.g., fire, EMS, law enforcement, the public health community) and on public health preparedness efforts. Today, local, state, and federal agencies continue to work together to ensure proper coordination, resources, and readiness for future emergencies.

As the nation memorializes 9/11, Meredith Allen, vice president of Health Security at ASTHO, reflects on that day and explores how it shaped the future of public health preparedness. She details public health’s role in such events, recounts response efforts, and explains immediate and long-term effects on the field, a quarter-century later.

What is the role of public health in catastrophic and mass casualty events such as 9/11?

Mass casualty events like 9/11 intersect with all aspects of public health. In the immediate moments and hours following the attacks, it was an emergency response and rescue event. While traditional first responders (fire, police, and EMS) respond immediately to the site, the public health community begins its response by coordinating with hospitals to prepare for mass casualties. Public health responders anticipate and monitor the supplies and equipment needed by the health care community to respond to such an event. They may also activate plans to request additional material and personnel from surrounding jurisdictions and across the country.

Health registries have been created following 9/11 to help monitor those who were exposed at the site for illnesses such as respiratory conditions, cancers, and mental health impacts. While any large-scale emergency will impact the public's mental health, 9/11, an intentional attack, caused widespread trauma, grief, anxiety, and fear — not just in the immediate New York City and Washington, D.C. regions but throughout the country. Public health is integral in the development of communication with the public and the long-term recovery of the nation.

What did public health preparedness look like 25 years ago?

Public health preparedness as we know it today did not exist, as much of the focus was on infectious disease outbreaks and control. The 9/11 attacks and response solidified public health’s role in emergency response and recovery. Its emergency communication, environmental health, surveillance, mental health recovery, and health care coordination efforts truly demonstrated how pivotal public health is to any large-scale response or emergency.

How did this horrific historical event change public health preparedness in the immediate and long term?

Much of what is public health preparedness today is directly related to the events of 9/11. Congress recognized the need for additional funding to ensure public health and health care were adequately resourced to plan and prepare for emergencies, creating the Hospital Preparedness Program and expanding what is now the Public Health Emergency Preparedness program. These two grants provide the majority of the funding used by state and local public health departments today to plan and exercise with public health and health care partners, procure and maintain supply stockpiles, and retain staff to respond in an emergency.

One of the biggest response lessons we learned from 9/11 was the necessity of increased coordination between and among local, state, and federal agencies. In a response of this size, almost every governmental agency had a role to play at all levels. The need to ensure that each understood their mission and responsibilities (as well as the other agencies'), along with maintaining clear means of communication, became apparent. This led to the development of what is now the Administration for Strategic Preparedness & Response (ASPR). ASPR was tasked with developing coordination among the multiple agencies that formed a fragmented national response system.

What systems and workforce training improvements have been made?

I think the biggest workforce training improvement since 9/11 is the inclusion of public health formally in the emergency response structure. Public health staff now have a permanent seat in emergency operations centers and participate in Incident Command System and National Incident Management System training alongside traditional responders.

This has allowed the public health workforce to become better trained in response, improve coordination across different sectors, serve as the link between health care and emergency response, and better manage/distribute supplies and medical countermeasures.

Can you describe any remaining and/or ongoing needs within public health preparedness, as we reflect on 9/11 25 years later?

As we approach 25 years since 9/11, two needs stand out to me: securing stable, flexible funding for public health preparedness and caring for and supporting the nation’s public health workforce.

Without sustainable, flexible adequate funding, public health departments are not able to maintain adequate staffing levels, participate in ongoing exercises and trainings, and continue to serve as the link between emergency response and health care. The Pandemic and All-Hazards Preparedness Act (PAHPA) allows for the funding of state and local public health preparedness programs/health care coordination, and continuation of the strategic national stockpile and ASPR. It is essential that Congress reauthorize PAHPA for our country to continue to prepare for disasters like 9/11.

Additionally, we need to ensure ongoing support for our public health workforce. The past decade, public health has responded to numerous emergencies, like Zika virus, the COVID-19 pandemic, Mpox outbreaks, floods, wildfires, extreme heat, and numerous foodborne outbreaks such as the more recent Cyclosporiasis. The workforce has worked countless extra hours and experienced burnouts, which often leads to high levels of staff turnover and shortages. Providing proper support to the public health workforce not only requires sustainable funding but also creating a supportive and positive work culture.

How else can the United States continue to improve and expand public health preparedness?

As I think back to the days that immediately followed 9/11, what immediately comes to mind is how communities came together to support each other. Public health preparedness not only relies on the everyday work of countless public health professionals but also on the strength of communities.

Volunteering at your local health department as part of medical reserve corps, the Red Cross, or other community service organizations can assist the nation in preparing for an emergency response. We can all honor those who rushed to help others on 9/11 at their own risk, by continuing that spirit of community engagement and volunteerism.

Reviewed by Lisa Peterson, MPH, Senior Director, Preparedness.