Public Health Preparedness book cover row of ambulancesAll three editors work at the John F. Kennedy School of Government, Harvard University. Arnold M. Howitt is faculty co-director of the school’s Program on Crisis Leadership and senior adviser of its Ash Center for Democratic Governance and Innovation. Herman B. “Dutch” Leonard is George F. Baker, Jr. Professor of Public Management at the Kennedy School and faculty co-director of its Program on Crisis Leadership. David Giles is associate director of and senior research associate at the Program on Crisis Leadership.

Q: What are the biggest challenges in public health emergency preparation today?

A: In the United States, the greatest challenge is unevenness in capacity from one jurisdiction to another. Many major cities and other areas have extremely good emergency capacity, but some cities, smaller communities and rural areas are not as well served. In part, this stems from budget issues, but also from shortfalls of expert and experienced public health personnel.

To compensate for any local capacity gaps, it is important to have effective “vertical” and “horizontal” cooperation – that is, across individual communities or counties and from local to state and federal governments. Several of the case studies in our book – notably those about Ebola, H1N1 and West Nile virus – show how critical those intergovernmental ties are.

Q: What have we learned from encounters with emergent infectious disease in the 21st century?

A: This is still a critical public health issue – and one that could be extraordinarily dangerous worldwide should a new, highly lethal, highly contagious infectious disease appear. It takes months to develop, manufacture and distribute vaccines against new strains of flu, and we have yet to develop vaccines for some serious infectious diseases. The Ebola outbreak in West Africa in 2014, moreover, revealed organizational capacity and political issues at the WHO and in global health more generally. Nevertheless, considerable progress has been made over the past two decades in girding ourselves for such events.

We have more detailed and more operational plans in place for dealing with emergent infectious disease – and greater capacity to improvise from these plans as circumstances might dictate. In the US, there are more frequent trainings and exercises for biological events, and disease surveillance systems are broader and more active and communicate findings better within the public health and health care communities.

Q: Are public health, law enforcement and emergency response prepared to meet bioterrorism threats?

A: The health care system remains highly fragmented. The cases in our book about SARS in Toronto and the anthrax attacks, among others, provide important illustrations of this problem. But more and more, response planning is inter-disciplinary and inter-agency, bringing together public health with traditional first response organizations, including police, fire, emergency management and National Guard, as well as health care organizations.

Public health increasingly regards itself as having “first response” responsibilities – and that is a major advance over what prevailed even in the 1990s. There is still a long way to go in creating integrated emergency management systems, but we have made progress that can continue if funding for such activities holds up – a major if.

Q: What sets this book apart from other publications that explore public health challenges?

A: As a collection of detailed case studies, the book provides provocative examples of actual public health emergencies in a way that encourages readers to analyze on their own and discuss their insights with colleagues. As students of public policy, the editors oversaw each of these cases every step of the way from selection of topic, through research and writing. We have focused on issues of problem discovery, analysis, decision making, collaboration among diverse institutions and implementation of operations. Such perspectives are not always represented in the traditional public health and medical literature.

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