摘要：Objectives. To evaluate the Public Health Emergency Preparedness (PHEP) program’s progress toward meeting public health preparedness capability standards in state, local, and territorial health departments. Methods. All 62 PHEP awardees completed the Centers for Disease Control and Prevention’s self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016. Results. Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources. Conclusions. Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure. The September 11, 2001 (9/11), and subsequent anthrax terrorist attacks were pivotal moments in US history. They heightened awareness about the need for system coordination among federal, state, and local governments. In 2002, Congress enacted the Public Health Security and Bioterrorism Preparedness and Response Act and appropriated nearly $1 billion annually to support state and local emergency preparedness and response to address bioterrorism threats; this was a significant effort to increase support for preparedness activities beyond the minimal funding that was available before 9/11. 1–3 In 2006, Congress enacted the Pandemic and All-Hazards Preparedness Act (PAHPA) and enhanced public health preparedness and response by expanding the focus from bioterrorism to all hazards, which includes threats from natural disasters; chemical, nuclear, or radiological incidents; and emerging or reemerging infectious diseases ( Figure 1 ). 4 The Pandemic and All-Hazards Preparedness Reauthorization Act in 2013 (PAHPRA) focused on further strengthening public health preparedness and response and reauthorized PAHPA. 5 Together, PAHPA and PAHPRA continue support for the Public Health Emergency Preparedness (PHEP) program 6 —first named the Public Health Preparedness and Response for Bioterrorism Program in 1999 and renamed the PHEP program in 2005. FIGURE 1— Timeline of Public Health Emergency Preparedness in the United States Since September 11, 2001 The PHEP program provides funding to state, local, and territorial governments to advance public health to prevent, protect, respond, and rapidly recover from health emergencies (chemical, biological, radiological, nuclear, explosives, etc.) that threaten to overwhelm routine business and health security. Furthermore, PHEP supports the advancement of preparedness goals as outlined in the National Health Security Strategy by (1) establishing robust public health emergency management and response programs within state, local, and territorial public health agencies; (2) supporting key public health capabilities necessary for emergency planning and response; (3) ensuring response readiness for public health emergencies and disasters; and (4) promoting the health security of communities. In 2011, to assist state and local public health departments with their strategic planning, the Centers for Disease Control and Prevention (CDC) published national public health preparedness standards. 7 This document enumerated 15 public health preparedness capabilities within 6 public health preparedness domains (biosurveillance, countermeasures and mitigation, information management, community resilience, incident management, and surge management) and listed associated functions within each capability describing elements needed to achieve that capability ( Table 1 ). 7 TABLE 1— Six Domains and 15 Public Health Preparedness Capabilities The purpose of this article is to describe the progress made toward developing preparedness capabilities among PHEP jurisdictions from before the 9/11 terrorist attacks through 2016.
