Preparedness Policy Highlights for Trending Public Health Threats

September 08, 2023 | Adrianna Evans

hpu-firefighter-disaster-site-forest-flood.jpgNational Preparedness Month provides an important opportunity to reflect and consider lessons learned from public health emergencies like the COVID-19 pandemic and mpox response, natural disasters like the Hawaii wildfires and Vermont flooding, and human caused emergencies like recent cyberattacks against major healthcare systems. While communities transition from emergency response to long-term monitoring and recovery, the federal government and states are taking legislative action to improve emergency preparedness capabilities.

A critical federal law supporting public health emergency preparedness and response, the Pandemic and All Hazards Preparedness Act (PAHPA), is up for reauthorization this year. The COVID-19 pandemic has heavily influenced the nation’s approach to public health preparedness, and the next iteration of PAHPA will need to reflect areas for improvement. ASTHO has gathered and shared input from health agencies on this important piece of legislation. Further, Congress is also considering policy options to support public health in the case of a nuclear war in the Health Impacts of Nuclear War Act.

State Legislative Trends in Public Health Preparedness

Over the past year, state legislation has tracked incidents in the news, with bills addressing wildfires, school safety, cybersecurity incidents, and critical hospital issues.

Climate Resiliency

Following policy trends from recent years, jurisdictions are finding ways to respond to climate and health trends. After the record-breaking wildfire seasons in California in 2020 and in Canada this year, jurisdictions want to better prepare. Oregon (SB 872) enacted legislation this year that will better prevent and prepare for wildfires through cross sector and multilevel collaboration. California is considering AB 609—evaluating new aerial firefighting technologies and updated technology—as well as SB 675, which would require the Wildfire and Forest Resilience Task force to create guidance for prescribed grazing programs for fire prevention.

Washington is using legislation to facilitate climate resiliency through planning and infrastructure (HB 1181). Virginia is using legislation to prepare for various climate related incidents including floods and droughts through new offices, funds, and plans (SB 1149).

School Preparedness

Over the last several years, there have been many serious school shootings such as Uvalde, Parkland, and Covenant. Rates of gun violence and school shootings are rising, underscoring the need for better preparedness in schools. In 2023, three states enacted legislation improving school preparedness by certifying providers of staff training and student education. Maine’s LD 892 requires school boards to annually approve a comprehensive health and safety and emergency management plan that meets nationally recognized practices.

Oregon’s HB 2902 encourages schools to instruct students in preparing for natural disasters specific to their region and requires the Department of Education to develop guidance used for instruction. SB 999 in Texas requires companies providing active shooter training to students or employees at a public school or institution of higher education to use certified instructors and possess a Texas Commission on Law Enforcement certification at the company level.

Some jurisdictions also focused on emergency drills in schools. This year, Connecticut enacted legislation requiring the Department of Emergency Services and Public Protection to conduct a study of the number of fire and crisis response drills in schools and their efficacy (HB 6846). Minnesota is considering two bills (HF 2097 and SF 2010) that provide criteria for active shooter drills, require notice of a pending drill to parents and legal guardians, and require alternative safety education for students who are opted out of participating.

Still other jurisdictions have focused on communications during emergencies in schools. Oregon recently enacted HB 3584, requiring schools to adopt policies for notifying the community after responding to a safety threat in a school. In Massachusetts (HD 554) and New York (S 5489), legislators introduced bills requiring panic alarms or other alerting mechanisms in public elementary and secondary schools in the event of an active shooter or other incident. Massachusetts also introduced H 426, which would provide automated communication between first responders and schools during emergency situations.

While not specific to violence in schools, Hawaii enacted a law (SB 830) establishing a critical emergency response pilot program in Oahu for selected public and charter schools and Iowa’s legislature considered a bill (HF 608) addressing preparedness for students with disabilities by requiring emergency planning and staff training for students with epilepsy or seizure disorders.

Hospital Preparedness

Considering challenges with staffing and surge capacity through COVID, policy makers are considering bills that would improve hospital preparedness. This year, Virginia enacted HB 900, which waives licensing to allow hospitals and nursing homes to add temporary beds during declared emergencies, and SB 827, requiring every hospital with an emergency department to have a security plan based on a risk assessment of the emergency department.

Massachusetts is considering bills that would require the department of public health to create a Hospital Capacity Coordination Dashboard to manage hospital capacity and available beds in hospitals (H 2156), and direct insurance carriers to waive prior authorization requirements impacting the transportation or discharge of patients from hospitals during emergencies (HB 733). Hawaii is considering legislation to allow hospitals to stop elective surgeries during emergencies to ensure facilities have enough bed capacity (SB 1018).


Cyber-attacks on public health and healthcare, such as the recent attack on a parent healthcare company with facilities in multiple states, have the power to disrupt medical services, endanger the privacy of health information, and impact multiple states at once. In light of this, policy makers are highlighting the importance of cybersecurity. This year New Jersey enacted A 4836, requiring the incorporation of cybersecurity into the state’s emergency operations plan. Vermont recently enacted H 291, which creates a Cybersecurity Advisory Council charged with evaluating cybersecurity readiness and developing a strategic plan to protect public and private information from cyberattacks. Minnesota is considering HF 1960, which would protect telecommunications systems during emergencies by adding cyberattacks to the list of situations in which the governor may declare a peacetime emergency.


State and territorial health agencies continue to face a variety of new public health emergencies. The policies discussed here demonstrate how policymakers and health agencies can work together to better serve communities during and after emergencies. ASTHO will continue to monitor state and territorial health policy throughout the year, as well as share resources addressing state and territorial preparedness policies.