Public Health Emergency Preparedness After COVID-19

Centennial Issue
COVID-19 Public Health

Policy Points:

  • The critical task of preparedness is inseparable from the regular work of advancing population health and health equity.

On February 26, 2020, President Donald J. Trump held a press conference to discuss a novel coronavirus spreading around the world. “Johns Hopkins, highly respected, … they did a study, comprehensive, the countries best and worst prepared for an epidemic,” the president declared from the White House briefing room. “And the United States, we’re rated No. 1.”1

He was not misinformed. Released in October 2019, the study, known as the Global Health Security Index, was the product of a two-and-a-half-year effort involving leading emergency preparedness researchers and practitioners from around the world. The United States scored an 83.5 out of 100 points and was top ranked in five of six categories, including prevention, early detection and reporting, rapid response and mitigation, sufficient and robust health system, and compliance with international norms.2

A little more than two years after President Trump’s press conference, more than one million Americans would be dead from SARS-CoV-2 infection. The impact of the pandemic to the US economy would be estimated at more than $16 trillion.3 Far from being the most-ready nation on the planet, the United States has been exposed as especially ill-prepared for the greatest public health crisis in a century—and the US approach to public health emergency preparedness has come due for reexamination.

Public health emergency preparedness has been defined as “the capability of the public health and health care systems, communities, and individuals to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities.”4 In this paper, we trace the history of this effort in the United States, from the terrorist attacks of September 11, 2001, to the present. Then, we propose a new vision for the field of public health emergency preparedness for the future, one that is integrally connected to a future vision for public health.

Open Access


1. Johns Hopkins HUB. Here’s the Johns Hopkins study the President referenced in his coronavirus news conference. coronaviruscovid-19-649-em0-art1-dtd-health/. Published February 27, 2020. Accessed September 12, 2022.
2. Nuclear Threat Initiative and Center for Health Security, Johns Hopkins Bloomberg School of Public Health. Global Health Security Index: building collective action and accountability. Published October 2019. Accessed September 12, 2022.
3. Cutler DM, Summers LH. The COVID-19 pandemic and the $16 trillion virus. JAMA. 2020;324(15):1495-1496. 10.1001/jama.2020.19759.
4. Nelson C, Lurie N, Wasserman J, Zakowski S. Conceptualizing and defining public health emergency preparedness. Am J Public Health. 2007;97(Suppl.1):S9-11. 2007.114496.

Sharfstein JM, Lurie N. Public Health Emergency Preparedness After COVID-19. Milbank Q. 2023;101(S1): 653-673.