National Health Security Strategy

Health care and public health (HPH) systems play a vital role in maintaining national health security during both steady state and emergency response. As seen during the COVID-19 pandemic, health care facilities and public health departments endured surges in patients, workforce shortages, and supply scarcity. Underserved communities, which face ongoing challenges accessing health care, are disproportionally impacted by emergencies. Additionally, extreme weather, infectious disease spread, and cyberattacks can occur simultaneously, further stressing HPH infrastructure and workforce. A bolstered and diverse health workforce along with resilient and adaptable health infrastructure can strengthen the nation’s preparedness, response, and recovery capabilities and capacity.

Strategic Goal 1 Focus Areas

Siloed human, animal, plant, food, and environmental health surveillance systems can reduce data sharing capacity and hinder response. By modernizing these surveillance systems, the United States can facilitate swifter, more seamless electronic data exchange and implement a more rapid emergency response. Furthermore, expanding the collection of demographic data would allow U.S. public health surveillance systems to better capture health impacts on underserved communities and at-risk individuals.

Strategic Goal 2 Focus Areas

The COVID-19 pandemic exposed vulnerabilities in the nation’s ability to provide public health supplies critical to mitigating the spread of SARS-CoV-2 and to reducing morbidity and mortality. Many of these supply chain challenges are not unique to the COVID-19 pandemic. Offshore manufacturing and just-in-time supply chain practices can disrupt the U.S. public health supply chain in the event of extreme weather, shifting geopolitical forces, global competition for resources – especially in times of high demand – and other factors, including concerns related to ethical production. These challenges illustrate the need to build more sustainable domestic manufacturing capacities that are resilient to shifting demand, can be adapted for new and emerging health security threats, and can meet the health needs of the whole population, especially during public health emergencies and disasters.

Strategic Goal 3 Focus Areas

The 2023-2026 NHSS builds on lessons learned from COVID-19 in the guiding principles, strategic goals and objectives, and Implementation Plan. The 2023-2026 features enhanced focus on several health care and public health challenges exacerbated during COVID-19 and other public health emergencies, including supply chain resiliency, health care and public health workforce capacity, risk communication, and health equity.

The 2023-2026 NHSS serves as a companion to other national security strategies such as the National Security Strategy, the National Defense Strategy, and the National Biodefense Strategy. Within the national security enterprise, the NHSS focuses on health. The NHSS aims to strengthen and adapt public health and health care preparedness and response to address evolving public health challenges across all aspects of preparedness, response, and recovery.

The NHSS offers an assessment of the current and future threat environment, including:

• Emerging Infectious Diseases (EIDs): Pandemic pathogens can spread quickly, upend daily life, and have cascading health, social, economic, and political consequences. Additionally, antimicrobial resistance (AMR) continues to threaten human, animal, and environmental health as pathogens adapt to evade the current repertoire of drugs used to combat them.

• Climate Change: Climate change can disrupt critical infrastructure, worsen chronic health conditions, mental health, and health disparities, and drive the spread of disease. As global temperatures rise and more extreme physical effects of climate change take place, there is an increased risk of global competition for resources and surges in international population displacement.

• Chemical, Biological, Radiological, and Nuclear (CBRN) Threats and Biotechnology: Advancements in biotechnology increase the risk of accidental biological incidents, laboratory-acquired infections, and misuse such as the creation of bioweapons. Intentional use of CBRN materials continue to be a threat to the U.S.

• Cyberattacks: Cyberattacks on health technology can disrupt patient care and supply chains, put electronic patient data at risk, and worsen health outcomes.

• Unknown Threats and Concurrent Public Health Emergencies and Disasters: Concurrent incidents with negative health consequences strain the public health supply chain and response personnel, leading to economic instability and adverse impacts on patient care. Communities with chronic health disparities are especially vulnerable to compounding climate risks, such as a hurricane during an extreme heat wave.

Achieving health security requires a collective effort between all levels of government, non-government organizations, the private sector, and communities. Partnerships and collaboration are crucial to preparing for, responding to, and recovering from the adverse health effects of public health emergencies and disasters. Key national health security partners include:

Potential shortages of medical countermeasures and supplies remains a health security challenge. The 2023-2026 NHSS provides a strategy to diversify production of drugs and medical supplies and expand partnerships and transparency to build a more resilient public health supply chain.

Health equity is an important part of all emergency response and recovery actions. Equity is a guiding principle of the 2023-2026 NHSS. The 2023-2026 NHSS Implementation Plan encourages partners to adapt response plans to advance health equity and strengthen the protection of at-risk individuals and underserved communities during public health emergencies and disasters.

The NHSS recognizes that a strong public health, health care, and emergency response workforce is essential to protecting the nation’s health. The NHSS promotes efforts to recruit and retain a workforce with the skills and ability we need to creatively solve health security threats in a complex global environment. A robust, diverse, and well-resourced health care and public health workforce will ensure the U.S. can respond rapidly to national health security threats and maintain the health of communities.

Health security is a collective national effort. Ensuring a health-secure nation is the shared responsibility of federal, state, local, tribal, and territorial governments and public and private partners, non-governmental organizations, academia, professional associations, communities, volunteers, families, and individuals. The 2023-2026 NHSS and Implementation Plan emphasize partnerships and recommend actions that advance preparedness. The NHSS IP offers suggested activities that are intended to be adaptable to the individual needs of the stakeholder.

Successful public health emergency preparedness requires community engagement around preparedness, response, and recovery activities. Inclusive and strategic partnerships with communities fosters health security solutions that meet community-specific needs. The 2023-2026 NHSS Strategy and Implementation Plan outline actions that prioritize community engagement.

To ensure stakeholder perspectives were included in developing this version of the NHSS, public comments were solicited between February 14, 2022, to March 11, 2022, via a Federal Register Notice on any health security threats, challenges, and promising practices that may warrant being addressed in the 2023-2026 NHSS. The 2023-2026 NHSS provides suggested implementation actions and desired milestones for the federal government, and suggested implementation actions for non-federal partners.

Everyone has a role in saving lives and protecting the nation from modern and evolving health security threats. Regional, state, local, tribal, territorial, and private partners may opt to use the NHSS as a roadmap to customize the strategies, objectives, and suggested implementation actions in the NHSS to address health security needs relevant to their agency, community, or business interest.