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September 9, 2026
Quarterly Article
Mary-Margaret A. Fill
William Schaffner
Back to The Milbank Quarterly
Policy Points:
Context: Over the last decade, the United States has encountered numerous infectious disease-related public health threats, observed declines in life expectancy and childhood vaccination rates, and experienced rapid changes and reorganizations to the domestic public health system. There is a window of opportunity for state leaders and policymakers to strengthen state, tribal, local, and territorial public health infrastructure amidst a changing federal landscape in order to ensure optimized infectious disease control in the United States.
Methods: This perspective synthesizes evidence from the public health literature and draws on the collective experience of the authors working in the applied public health field. We offer considerations for state leaders and policymakers to ensure optimized infectious disease control in the United States though state-led initiatives and direction.
Findings: Although many public health activities related to infectious disease detection, investigation, control, and prevention are funded and directed by federal public health authorities, state, tribal, local, and territorial health departments have held the legal authority for this work since the early 19th century. Recent changes and relative instability at the federal level are noteworthy; however, “all responses are local” and the ultimate authority to detect, investigate, control, and prevent the spread of infectious diseases in the United States falls to states.
Conclusions: State leaders have a duty and responsibility to protect the health of their population and ensure a posture of readiness to effectively respond to infectious disease health threats. States can step forward and embrace innovation in this space to ensure optimized infectious disease control in the United States prior to the next emerging infectious disease public health threat.
