Health Policy Tackles Joint Challenges of Pandemic and Natural Disaster Preparedness

September 23, 2021 | Adrianna Evans

firefighter-standing-in-front-of-wildfire_1200x740.jpgEach September marks National Preparedness Month. This year, public health emergency preparedness professionals look back on 20 years since the 9/11 attacks—the event that effectively launched the preparedness field—while actively responding to COVID-19.

The 9/11 attacks highlighted the need for a broad, coordinated approach to preparedness for terrorist attacks, natural disasters, pandemics, and other emergency situations. 9/11 encouraged the establishment of the Office of Public Health Emergency Preparedness or OPHEP (now the office of the Assistant Secretary for Preparedness and Response or ASPR), the Homeland Security Act of 2002, and the Pandemic and All-Hazards Preparedness Act (PAHPA) among other outcomes. Preparedness professionals persisted through other major emergencies in the past two decades, including Hurricane Katrina, Hurricane Sandy, severe wildfires, and H1N1—yet none have been as massive in size and scope as COVID-19.

Following critical emergencies, state preparedness policy adapts to new challenges. Current policies look to establish a more systems-based approach for emergencies. Policies resulting from both the pandemic and recent natural disasters build resiliency in different sectors with an emphasis on a more secure supply chain. In the future, businesses involved in the supply chain, utilities, and schools may play a larger role in preparedness for all emergencies. Proposed legislation provides insight on current priorities in the field and future directions.

The Influence of COVID-19 on Pandemic Preparedness

State legislation has changed in response to the herculean task of defeating the worst pandemic in a century, with a significant legislative focus on pandemic preparedness. Some bills are broad, and others propose specific changes to long-term care, education, and heavily disrupted supply chains. These bills reflect movement towards better, cross-sector preparedness for the next pandemic.

Some bills seek to improve their preparedness programs ahead of the next pandemic. States such as California (AB 1207) and Hawaii (SB 1362) are assessing current preparedness to highlight improvements for the future. The California bill proposes creating a task force to study lessons learned from the COVID-19 pandemic and recommend best practices. The Hawaii bill proposes a statewide community assessment to facilitate planning and response. Texas also enacted a bill (SB 1780) to establish the Texas Epidemic Public Health Institute, which supports pandemic preparedness among other activities.

Legislators are also recognizing the importance of preparedness for long-term care facilities after they were home to so many COVID-19 outbreaks. Proposed legislation creates study commissions (NJ A 4050 and NJ A 4015), centralizes command (NJ S 2790), and establishes guidelines (WA SB 5294) for pandemic response in long-term care facilities.

COVID-19 has also critically impacted schools and students. Although the shift to virtual classrooms was necessary for social distancing and mitigating COVID-19, some students experienced learning loss. Proposed legislation works to improve schools’ preparedness for pandemics and other emergencies. In Massachusetts, (H 487) proposes mandatory education for students and faculty on emergency preparedness for “weather, natural disasters, viruses, and human made disasters.” Virginia enacted (SJ 308), which establishes the Joint Legislative Audit and Review Commission to examine the pandemic’s impact on schools, students, and educators, as well as evaluate schools’ future preparedness.

COVID-19 also highlighted weaknesses in the supply chain of critical medicines and medical supplies. As a result, Washington state introduced (HB 1567) to create a strategic stockpile of food, sanitation, medicine, and personal protective equipment (PPE). Massachusetts introduced a bill requiring healthcare facilities to report on PPE supply (S 253).

Conversely, COVID-19 put a legal spotlight on public health authority, including which leaders may declare emergencies, how long those declarations can last, and who can make other major public health decisions during emergencies. Depending on the outcomes, this discussion could change the decision-making process for emergency measures for response, recovery, or mitigation during future pandemics.

Preparedness for Severe Natural Disasters

A recent report shows that severe weather and natural disasters are highly likely to become increasingly common. Incidents over the last several years such as the 2021 winter storm in Texas, or the record-breaking 2020 California wildfire season illustrate a greater need for preparedness for severe, complex disasters. The severe outcomes of Hurricane Ida underscore the time sensitive nature of this need.

Beyond COVID-19, current state preparedness policy anticipates the trend towards more severe natural disasters and helps build the infrastructure to respond to them. In response to the fires that plagued California in 2020 and 2021, California legislators proposed changes to existing legislation to encourage projects that create fire adapted communities (AB 9). In Massachusetts, legislators introduced a bill establishing a flood mitigation and preparedness program (H 955) that gives local governments the money to fortify communities against floods and educate the public about flood preparedness.

Hawaii policy reflects an interest in preparing for severe hurricanes and disasters. Legislators introduced a bill limiting how closely trees are planted to evacuation routes and creating guidelines for  maintain trees currently along those routes (HI SB 687). The legislature also introduced a bill establishing a safe home program that would provide funds for wind resistive devices on homes (HI HB 947). As a result of Hurricane Sandy, New York proposed legislation to ensure the delivery of medical supplies and medication during hurricanes or other disasters (A 01905 and S 01086). Since recent disasters have highlighted weaknesses in the electrical and power grid, New Jersey introduced legislation to require public utilities to disclose information about their preparedness plans, including service reliability and communications plans (A 4022).

With the benefit of hindsight, the 9/11 attacks, COVID-19 pandemic, and other recent severe disasters point to a need for greater preparation for widespread, long-lasting emergencies. A more unified approach, spanning different systems and hazards will be helpful to build resiliency and responsiveness, particularly as public health authority during emergencies becomes uncertain. The current state policy landscape indicates a desire to better prepare for such emergencies, but it’s impossible to know if these measures are enough until the next critical emergency hits. In the meantime, ASTHO will continue to monitor legislation.