Learning from Experience: The Public Health Response to West Nile Virus, SARS, Monkeypox, and Hepatitis A Outbreaks in the United States

Over the past three years, the U.S. Department of Health and Human Services (HHS) has made significant investments in state and local public health in an effort to enhance public health emergency preparedness. The RAND Corporation was contracted to work with the HHS Office of the Assistant Secretary for Public Health Emergency Preparedness (OASPHEP) to develop resources and to prepare analyses to help describe and enhance key aspects of state and local public health emergency preparedness. As part of this contract, RAND was asked to study the response of state and local health departments to recent disease outbreaks -- specifically, Severe Acute Respiratory Syndrome (SARS), monkeypox, West Nile virus, and Hepatitis A -- to address the following questions: (1) How did the public health system in the United States respond to each of these disease outbreaks? What were the roles of federal, state, and local health departments, health care providers, community organizations, and other groups, and how did they interact? (2) In what ways did recent federal investment contribute to public health preparedness? (3) What lessons does the public health response to these outbreaks have for future preparedness, particularly to address the threat of bioterrorism? What improvements are needed to public health infrastructure in the United States and in functional capabilities to address a public health emergency? (4) Was the Centers for Disease Control (CDC) guidance helpful in building capacity for health departments to respond to the outbreaks studied? Are there areas in which guidance is still needed?