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Appendix A: NHSS Statutory Requirements

National Health Security Strategy (NHSS) 2023-2026

Nurse working at the reception desk in the private clinic

Every four years, Congress directs HHS to prepare three documents: the NHSS Strategy, Implementation Plan, and Evaluation of Progress of the previous NHSS. The Strategy document and accompanying Implementation Plan are required to describe potential emergency health security threats and identify the process for achieving the preparedness goals of the Public Health Service (PHS) Act, and to identify and respond to such threats.[3​9]


  1. Integration: Integrating public health and public and private medical capabilities with other first responder systems, including through –
    1. The periodic evaluation of Federal, State, local, and tribal preparedness and response capabilities through drills and exercises, including drills and exercises to ensure medical surge capacity for events without notice; and
    2. Integrating public and private sector public health and medical donations and volunteers.
  2. Public health: Developing and sustaining Federal, State, local, and tribal essential public health security capabilities, including the following:
    1. Disease situational awareness domestically and abroad, including detection, identification, investigation, and related information technology activities.
    2. Disease containment including capabilities for isolation, quarantine, social distancing, decontamination, relevant health care services and supplies, and transportation and disposal of medical waste.
    3. Risk communication and public preparedness.
    4. Rapid distribution and administration of medical countermeasures.
    5. Response to environmental hazards.
  3. Medical: Increasing the preparedness, response capabilities, and surge capacity of hospitals, other health care facilities (including pharmacies, mental health facilities, and ambulatory care facilities and which may include dental health facilities), and trauma care, critical care, and emergency medical service systems, with respect to public health emergencies (including related availability, accessibility, and coordination), which shall include developing plans for the following:
    1. Strengthening public health emergency medical and trauma management and treatment capabilities.
    2. Fatality management.
    3. Coordinated medical triage and evacuation to appropriate medical institutions based on patient medical need, taking into account regionalized systems of care.
    4. Rapid distribution and administration of medical countermeasures.
    5. Effective utilization of any available public and private mobile medical assets (which may include such dental health assets) and integration of other Federal assets.
    6. Protecting health care workers and health care first responders from workplace exposures during a public health emergency or exposures to agents that could cause a public health emergency.
    7. Optimizing a coordinated and flexible approach to the emergency response and medical surge capacity of hospitals, other health care facilities, critical care, trauma care (which may include trauma centers), and emergency medical systems.
  4. At-risk individuals:
    1. Taking into account the public health and medical needs of at-risk individuals, including the unique needs and considerations of individuals with disabilities, in the event of a public health emergency.
    2. For the purpose of this chapter, the term “at-risk individuals” means children, pregnant women, senior citizens and other individuals who have access or functional needs in the event of a public health emergency, as determined by the Secretary.
  5. Coordination: Minimizing duplication of, and ensuring coordination between, Federal, State, local, and tribal planning, preparedness, and response activities (including the State Emergency Management Assistance Compact and other applicable compacts). Such planning shall be consistent with the National Response Plan, or any successor plan, and National Incident Management System and the National Preparedness Goal.
  6. Continuity of operations: Maintaining vital public health and medical services to allow for optimal Federal, State, local, and tribal operations in the event of a public health emergency.
  7. Countermeasures: Promoting strategic initiatives to advance countermeasures to diagnose, mitigate, prevent, or treat harm from any biological agent or toxin, chemical, radiological, or nuclear agent or agents, whether naturally occurring, unintentional, or deliberate.
  8. Medical and public health community resiliency: Strengthening the ability of States, local communities, and tribal communities to prepare for, respond to, and be resilient in the event of public health emergencies, whether naturally occurring, unintentional, or deliberate by –
    1. Optimizing alignment and integration of medical and public health preparedness and response planning and capabilities with and into routine daily activities; and
    2. Promoting familiarity with local medical and public health systems.
  9. Zoonotic disease, food, and agriculture: Improving coordination among Federal, State, local, Tribal, and territorial entities (including through consultation with the Secretary of Agriculture) to prevent, detect, and respond to outbreaks of plant or animal disease (including zoonotic disease) that could compromise national security resulting from a deliberate attack, a naturally occurring threat, the intentional adulteration of food, or other public health threats, taking into account interactions between animal health, human health, and animals’ and humans’ shared environment as directly related to public health emergency preparedness and response capabilities, as applicable.
  10. Global health security: Assessing current or potential health security threats from abroad to inform domestic public health preparedness and response capabilities.

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