Health Security National Action Plan

Objectives

The National Action Plan provides a dynamic United States framework for strengthening capacities to prevent, detect and respond to public-health emergencies and other International Health Regulations (2005) hazards, while avoiding unnecessary interference with international traffic and trade. It addresses gaps and sustains strong capacities identified through the 2016 Joint External Evaluation (JEE), using the JEE’s 19 technical areas and indicators as organising guidance for action through 2018–2020.[1][2][3][4]

• Strengthen legal and policy arrangements, sustainable cross-sector coordination and the United States International Health Regulations National Focal Point, including alignment across federal, state, local, tribal and territorial authorities.[4][5][6]
• Prevent health threats through antimicrobial-resistance surveillance and stewardship, a formal One Health approach to zoonotic diseases, food-safety systems, biosafety and biosecurity, and effective immunisation delivery.[7][8][9][10][11][12]
• Detect threats through resilient laboratory networks, modern diagnostics, interoperable surveillance and reporting systems, rapid information exchange, safe specimen sharing and a skilled multidisciplinary workforce.[13][14][15][16][17]
• Respond effectively through multi-hazard preparedness plans, exercises, emergency operations centres, case management, medical countermeasures, international deployment arrangements and risk communication.[18][19][20][21][22]
• Strengthen readiness for chemical, radiological and nuclear events, including laboratory and biodosimetry capacity, medical countermeasures, decontamination, population monitoring and specialised workforce development.[23][24][25][26][27]
• Maintain preparedness at international points of entry, particularly non-designated ports, by improving public-health guidelines, detection, assessment, reporting, response capacity and access to specialised officers.[28][29]

Implementation

Implementation uses a whole-of-government, multisectoral model led by the Office of the Assistant Secretary for Preparedness and Response within the Department of Health and Human Services, which maintains the United States International Health Regulations National Focal Point. More than 40 federal departments and agencies work with state, local, tribal and territorial authorities, non-governmental organisations, laboratories, healthcare providers, academia, industry and international partners.[2][30][31]

• Coordinate delivery through the federal International Health Regulations Working Group, chaired by the Assistant Secretary for Preparedness and Response, with lead departments and agencies responsible for technical-area actions, partner coordination and progress reporting.[31][4]
• Align actions with the National Security Strategy, National Health Security Strategy, National Biodefense Strategy, National Response Framework, Global Health Security Agenda and related domestic and international preparedness frameworks.[2][30][4]
• Implement actions through established programmes and shared operational systems, including laboratory networks, surveillance platforms, training programmes, public-health grants, exercises, emergency-management standards and corrective-action processes.[18][32][14][19]
• Integrate human, animal, plant and environmental health through One Health coordination, zoonotic-disease prioritisation, joint surveillance, laboratory collaboration, outbreak response and workforce training.[7][9][33][34]
• Strengthen prevention delivery through public-health laboratory expansion, whole-genome sequencing, antimicrobial-resistance networks, foodborne-outbreak systems, biosafety oversight, vaccine access and targeted support for underserved populations.[35][10][36][11][37]
• Improve surveillance and notification by developing interoperable electronic reporting, electronic case reporting, electronic health-record integration, joint analysis of human and animal data, and standard operating procedures for timely reporting to the World Health Organization, Food and Agriculture Organization and World Organisation for Animal Health.[15][38][16][39]
• Build response capacity through national, regional and local exercises, accredited emergency operations centres, common concepts of operations, highly infectious disease transport arrangements, cross-border deployment tools, community engagement and trained risk-communication personnel.[40][20][41][42][43]
• Use the 2016 JEE baseline, exercises, after-action reviews, corrective-action plans, capacity assessments and technical indicators to monitor implementation. Federal monitoring was scheduled from November 2018, followed by a January 2019 interagency review, a February 2019 progress report and biannual action-item reviews until a further JEE tentatively planned for mid-2021.[3][31]
• Adapt the framework to new legislation, policies, programmes, technologies, administrative approvals, priorities and available resources. Activities operate within participating agencies’ mandates and budgets and remain subject to congressional appropriations and subnational funding limitations.[2][3][30]

Monitoring & Evaluation

The National Action Plan uses the 2016 Joint External Evaluation (JEE) of United States implementation of the International Health Regulations (2005) as its central baseline, applying 19 technical areas, targets and indicators across prevention, detection, response, hazards and points of entry. It combines self-assessment, external peer review, operational monitoring and periodic reassessment, with a further JEE envisaged for 2021.[1][3][44]

• Link action items, responsible lead agencies and progress reporting to JEE recommendations and indicators; the federal International Health Regulations Working Group, chaired by the Assistant Secretary for Preparedness and Response, develops, updates, implements and tracks the plan.[31][4]
• Conduct federal monitoring from November 2018, hold an interagency progress review in January 2019, publish a progress report and revised plan where necessary in February 2019, and review action items biannually until the proposed 2021 JEE.[31]
• Report International Health Regulations self-assessment results to the World Health Organization and strengthen National Focal Point protocols, event risk assessment and notification arrangements with the World Health Organization, Food and Agriculture Organization and World Organisation for Animal Health.[44][16][39]
• Use national, regional and subnational exercises, after-action reviews, corrective-action plans and lessons-learned processes to test preparedness, emergency operations, risk communication, laboratory systems, medical countermeasure deployment and response to chemical, radiological and biological incidents.[18][19][45][40]
• Monitor antimicrobial resistance through laboratory surveillance, susceptibility testing, whole-genome sequencing, stewardship reporting and National Healthcare Safety Network data. Planned measures include reducing by 50% the time to detect and characterise drug-resistant enteric pathogens and by 25% the time from notification to susceptibility-result reporting for multistate outbreaks.[46][35][47]
• Track food-safety and laboratory capacity through sequencing coverage, state whole-genome sequencing capability and PulseNet certification. Milestones include sequencing capacity in 95% of states and certification of 70% of state laboratories in 2018, with capacity in all 50 states and 95% certification planned for 2019.[10][48]
• Assess electronic reporting, surveillance integration and workforce requirements through electronic case-reporting pilots, interoperable electronic health-record activities, syndromic-surveillance training, capacity inventories and state, local, tribal and territorial workforce surveys.[15][38][17][49]
• Maintain technical monitoring of zoonotic diseases, laboratory systems, biosafety and biosecurity, vaccine delivery, emergency operations, points of entry, chemical incidents and radiation emergencies through JEE indicators, inspections, reporting systems, exercises, validation, accreditation and capacity assessments.[50][11][12][13][20][29][51]

Several sections provide capacity levels and operational measures but do not establish a single quantitative results framework, comprehensive reporting timetable or independent accountability mechanism beyond the JEE process, designated agencies, internal oversight, standard operating procedures and exercise-based review.[3][11][52]

Costing & Financing

The plan is not a budget or commitment document. Its activities are drawn from programmes approved under current budgets and remain subject to administrative approvals, annual federal priority-setting, congressional authorisation or appropriation, and resource constraints affecting state, local, tribal and territorial authorities.[3][30][2]

• Implement activities through participating federal departments' and agencies' established mandates, programme cycles and budgets, while allowing the framework to adapt to changes in legislation, programmes, technology, financial resources and competing priorities.[2][3][30]
• Use identified programme mechanisms, including the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement, federal grants, technical assistance and existing workforce-development programmes, to support preparedness capacities where applicable.[37][14][49]
• Assess resource needs for laboratory networks, specimen collection and transport, biosafety oversight, workforce development, risk communication, medical countermeasures, emergency exercises, chemical preparedness and radiation biodosimetry.[32][53][54][43][23][26]
• Recognise funding-dependent activities, including bioassay development, establishment of a Department of Defense biodosimetry centre and network, technology transfer, performance testing, communications research and emergency-management training tools.[55][25][56][57]
• Consider a crisis-response funding option for complex incidents that do not receive Stafford Act declarations and align organisational budgets with corrective-action and process improvements.[52]

No total cost, detailed allocation, expenditure estimate, funding-gap assessment, financing formula, currency value or economic assumption is specified in the supplied material.[3][30][26]