National Health Security Strategy

Objectives

The National Health Security Strategy 2023–2026 sets a whole-of-nation framework to prepare for, protect against, respond to and recover from the health effects of public health emergencies and disasters. It seeks a secure, resilient and adaptive nation that works across sectors, prioritises capability-based improvement, and addresses the needs of at-risk people and underserved communities.[1][2]

• Strengthen health care and public health systems to manage concurrent emergencies and unknown threats by understanding community needs, improving readiness and infrastructure, building workforce capacity, sustaining access to care, and integrating risk communication.[2][3][4]
• Build community resilience, promote health equity and reduce disparities before, during and after pandemics, extreme weather events and mass-casualty disasters, including through support for mental and behavioural health, healthy behaviours, culturally competent mitigation and action on structural and social determinants of health.[5][4]
• Improve protection against emerging and re-emerging threats, particularly zoonotic disease, antimicrobial resistance and climate-related risks, through integrated human, animal, plant, food and environmental health surveillance.[2][6][7]
• Safeguard agricultural production, reduce spillover and antimicrobial-resistance risks, and protect health-sector systems, medical devices and patient information against cybersecurity threats.[8]
• Ensure a resilient and sustainable public health industrial base and supply chain that can rapidly develop and deploy safe medical countermeasures by expanding domestic manufacturing, diversifying suppliers and distribution channels, strengthening international partnerships, and promoting innovation and equitable access.[2][9][10][11]
• Apply innovation, partnerships, equity and integrity to health security policy, capability development, decision-making and public communications.[2]
• Maintain statutory preparedness goals covering integration, public health capabilities, medical preparedness and surge capacity, support for at-risk individuals, coordination, continuity of operations, medical countermeasures, community resilience, zoonotic disease, food and agriculture, and global health security.[12][13]

Implementation

Implementation uses a whole-of-nation model involving federal, state, local, tribal and territorial governments; regional entities; communities; health care and public health organisations; emergency management; biomedical research; private industry; non-governmental organisations; and animal, plant and environmental health partners.[1]A separate 2023–2026 Implementation Plan is intended to guide federal action and recommend activities for subnational partners, industry and communities.[1]

• Engage communities throughout preparedness, response and recovery to assess needs, design and exercise plans, reach underserved groups, build social connectedness and work with trusted local leaders and messengers.[4][14]
• Develop threat-agnostic, rapidly deployable response capabilities, using evidence from previous events and strengthening critical infrastructure, public health supply chains, workforce resilience and surge capacity for simultaneous hazards.[15][3]
• Expand tiered networks linking national expertise to regional, state, territorial and local capacity for specialty care, emergency medical services, post-hospital health and social services, and patient surges.[4]
• Strengthen recruitment, retention, diversity, training and deployment of health and public health workers, including community-embedded personnel and staff in rural and underserved areas; support cross-jurisdictional practice arrangements, liability guidance and crisis standards of care.[4][14]
• Improve infrastructure through measures including ventilation, air filtration and disinfection, emergency telehealth, in-home visit support, and deployable telehealth critical-care systems, while addressing unequal access to digital services.[4]
• Modernise surveillance through interoperable systems, common data standards, secure electronic exchange, closer-to-real-time integration, technical workforce development and a One Health approach across local to global levels.[7]
• Standardise demographic and socioeconomic data collection and reporting, including race, ethnicity and disability status, while engaging under-represented communities and protecting transparency and privacy.[8]
• Strengthen international early warning through partnerships, data-sharing agreements and sustained political, financial and technical support, including work through the Global Health Security Agenda.[7]
• Coordinate risk communication among public authorities, community leaders, medical organisations, commercial entities, civil society, media and technology platforms to provide transparent, accessible, culturally and linguistically appropriate information and counter misinformation, disinformation and malinformation.[14][7]
• Establish evidence-based cybersecurity standards for health care and public health technologies, data systems, telehealth and medical devices; support central guidance, cyber-hygiene, personnel investment, legacy-system upgrades and incident mitigation planning.[10]
• Build supply-chain resilience through domestic production and storage, supplier and location diversity, redundant capacity, diversified distribution, real-time government-industry information sharing, quality assurance, production subsidies, tax incentives and skilled-worker development.[9][10][11]
• Maintain domestic and global clinical research networks that can pivot rapidly to regulatory-level trials, streamline manufacturing and regulatory processes, and support adaptable medical-countermeasure technologies.[11]
• Assess preparedness through the statutory four-year cycle of a national strategy, implementation plan and evaluation of preceding progress, supplemented by preparedness evaluations, drills and exercises, including tests of medical surge capacity.[12]

Priority monitoring activities include integrated surveillance and data sharing, situational awareness, disease detection and investigation, assessment of disparities, supply-chain visibility, quality assurance, cybersecurity standards and community feedback.[7][8][11][12]The supplied material does not specify a unified set of quantitative targets, reporting schedules, named accountability bodies, detailed delivery timetables or budget allocations for 2023–2026.[9][16][10][11]

Monitoring & Evaluation

Monitoring and evaluation centre on integrated, timely surveillance, preparedness assessment and information sharing across health security systems. The strategy requires a four-year cycle comprising a national health security strategy, an implementation plan and an evaluation of progress from the preceding strategy.[12]Surveillance is intended to support early detection, situational awareness, inequity analysis, emergency response and supply-chain resilience, but the supplied material does not establish a single quantified performance framework, common reporting template or named accountability body for 2023–2026.[1][7][10][11][12]

• Integrate human, animal, plant, food and environmental surveillance data to identify outbreaks, zoonotic risks and other emerging threats promptly.[2][6][7]
• Modernise surveillance through interoperable systems, common data standards, secure electronic exchange, closer-to-real-time data integration, strengthened laboratory capacity and linkages between electronic health records and national syndromic surveillance.[9][16][7]
• Standardise and analyse demographic and socioeconomic data, including race, ethnicity and disability status, to identify disparities and assess effects on underserved communities and at-risk individuals, while protecting transparency and privacy.[2][8]
• Assess preparedness and response capabilities through periodic evaluations, drills and exercises, including tests of unannounced medical surge capacity.[12]
• Monitor priority operational areas including disease detection and investigation, containment, information technology, medical countermeasure delivery, health-system surge capacity, antimicrobial-resistant infections, antibiotic use, infection prevention and control, staffing, supplies and data-system capacity.[5][6][12][13]
• Track supply-chain vulnerabilities through real-time government-industry information sharing to inform capacity investments, stockpiling, distribution requirements and resilience measures; apply quality-assurance standards, including for diagnostic tests.[11]
• Use minimum evidence-based cybersecurity standards, central guidance and cyber-hygiene practices to safeguard health care and public health technologies, patient data and medical devices.[10]
• Use community needs assessments, exercises, feedback and bidirectional communication to adapt preparedness and risk communication for health-literacy, linguistic, socioeconomic, disability and other local needs.[4][14]
• Establish capabilities to identify, track and counter misinformation, disinformation and malinformation, recognising that these can impair adherence to health guidance, situational awareness, response and recovery.[16][14][7]
• Strengthen international data sharing and situational awareness, including through the Global Health Security Agenda, to support early warning of threats originating outside the United States.[7]
• Use reported contextual measures, rather than specified strategy targets, including a 36% reduction in Public Health Emergency Preparedness funding and a 54% reduction in Hospital Preparedness Program funding between 2003 and 2019; more than 2.8 million antibiotic-resistant infections and over 35,000 associated deaths annually; an 18% fall in deaths from antibiotic-resistant infections since 2013; and 18 pathogens classified as urgent, serious or concerning by the Centers for Disease Control and Prevention.[5][6]

Costing & Financing

Financial sustainability is presented as essential to health security, particularly for infrastructure, workforce capacity, surveillance, cybersecurity, medical countermeasures, domestic manufacturing, supply chains and research.[1][5][7][10][11]The material identifies investment needs and several potential financing tools, but does not provide an overall strategy budget, costed implementation plan, allocation by institution, quantified funding gap, financing target or macroeconomic assumptions.[5][4][14][7][10][11]

• Provide sustained financing for health care, medical research, public health systems and personnel, including infrastructure, data systems, supplies and medical countermeasures.[5]
• Address resource requirements for resilient infrastructure, workforce recruitment, retention and training, mental and behavioural health, climate resilience, telehealth and long-term recovery.[4][14]
• Fund surveillance modernisation steadily and sustain political, financial and technical support for global health security and early-warning activities.[7]
• Invest in cybersecurity programmes, specialised personnel and upgrades to legacy health-sector systems.[10]
• Support domestic manufacturing, diversified and redundant supply chains, clinical research and medical-countermeasure development; potential mechanisms include production subsidies, tax incentives and sustained public and private research funding.[10][11]
• Respond to rural hospital financial constraints and wider shortages in workforce, equipment, infrastructure and service capacity, although no associated amounts are specified.[9][16]
• Address insufficient incentives for antibiotic development and market entry through new economic models and private-sector collaboration, alongside investment in antimicrobial-resistance research, rapid diagnostics and treatment options.[12]
• Recognise that Public Health Emergency Preparedness and Hospital Preparedness Program funding declined from 2003 to 2019, while short-term supplemental appropriations increased funding from 2020 onwards.[5]
• Recognise an estimated annual United States health care cost exceeding 4.6 billion US dollars in 2021 for treating six antibiotic-resistance threats.[15]