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March-July 2026

Highly Pathogenic Avian Influenza Scientific Symposium <!-- All events will be virtual and are listed in ET. Please check back often, as the agenda is subject to change. --> On Thursday, April 25, 2024, ASTHO hosted a virtual symposium to facilitate a discussion between public health leaders and scientists driving the U.S. government’s response to Highly Pathogenic Avian Influenza (HPAI). The event was moderated by ASTHO CEO Joseph Kanter, MD, MPH, and featured leaders from ASTHO, the Infectious Diseases Society of America, the Council of State and Territorial Epidemiologists, and federal partners. The focus of the event was: Highlighting current science and epidemiology of HPAI. Providing an overview of the current outbreak. Outlining potential actions for averting or managing further spread or crossover. Identifying scientific areas requiring additional investigation and guidance. website False

Public Health TechXpo and Futures Forum Come to the Public Health TechXpo and Futures Forum! TechXpo, tech expo, public health, data modernization, public health event, astho, association of state and territorial health officials, public health officials, territorial health officials, state health officials, public health workforce, public health workers, data solutions, nation health features, data management, data platforms, virtual event exploring challenges, data architecture, technology solutions, data lakes, health of all people, monitoring health threats, real time, health care, healthcare ASTHO Public Health TechXpo and Futures Forum 2023 website

Health Equity Summit: A Movement for Justice health equity summit, public health infrastructure, commitment to health equity, health equity leaders, racial equity, advancing health equity, public health and racism, racism as a public, people of color, public health issue, centers for disease control, racial inequities, address racial, medical students, health equity, united states, diversity equity and inclusion, equity summit, health outcomes, disease control and prevention, public health system, racial justice, social justice, black americans, public health, control and prevention cdc website

In this online course designed for public health agencies, you will explore key components and tools for braiding and layering funding.

ASTHO Change Management eLearning Course article no

This virtual learning prepares data teams and their agency to build their understanding of data visualization’s role in public health.

Virtual course provided by ASTHO's e-learning center focused on building capacity among states based around health equity-focused TA requests.

Change Management eLearning Course website yes

This training is designed to be used with the ASTHO Opioid Use Disorder Toolkit: Supporting the Public Health Response in Maternal, Child and Adolescent Health to “role play” or practice what you learned about screening, referring, and offering support to people who are at risk for or experiencing substance use or opioid use disorder.

Explore ASTHO’s blog for expert perspectives on public health trends, policy updates, and strategies driving healthier communities.

Outcomes and Implications of ACIP’s Vote on the Hepatitis B Vaccine for Newborns Implications of ACIP Vote on Hepatitis B Vaccine for Newborns Susan Kansagra, Andy Baker-White, Kim Martin, Jessica Baggett Learn about the outcomes and implications of the December 2025 ACIP vote on the hepatitis B vaccine for newborns. On Dec. 4 and 5, the Advisory Committee on Immunization Practices (ACIP) held a long-anticipated meeting featuring two major topics of discussion: the hepatitis B birth dose and the pediatric vaccine schedule. The committee voted on two questions related to the pediatric hepatitis B vaccine schedule, both of which passed. To briefly summarize the outcome of the meeting, ACIP shifted from recommending a universal birth dose of the hepatitis B vaccine for all newborns to individualized decision-making for newborns born to HBsAg-negative mothers. There was no change to the recommendation for infants born to HBsAg-positive mothers or whose HBsAg status is unknown. CDC has not yet adopted these changes. In the meantime, many states are taking actions to provide clarity to providers and promote public confidence in the vaccine. How States Are Taking Action In response to (and in some cases before) the new ACIP recommendations, several states issued recommendations, guidelines, standing orders, executive directives, and health alerts for providers to provide clarity. States Recommending or Encouraging the Full Vaccine Series Some states are issuing their own guidance and recommendations for the hepatitis B vaccine series or encouraging providers to adhere to the series as is it was before the new ACIP recommendations: The Northeast Public Health Collaborative released a consensus statement before the ACIP meeting recommending the hepatitis B vaccine birth dose and a schedule that aligns with clinical recommendations. Collaborative members also issued statements reaffirming their adherence to established hepatitis B vaccine recommendations, including Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island. Maryland also released guidance for parents and caregivers about its childhood immunization recommendations. States in the West Coast Health Alliance issued statements supporting the universal birth dose of the hepatitis B vaccine. These states include California, Hawaii, Oregon, and Washington. Many individual states also issued statements affirming the recommendation for the continued use of the hepatitis B vaccine birth dose, including Arizona, Colorado, Illinois, Michigan, New Mexico, and Vermont. States Issuing Standing Orders and Executive Directives At least two states issued a standing order or executive directive related to the hepatitis B vaccine: The Maryland Department of Health issued a standing order to ensure hepatitis B vaccine access for infants and children in the state. The standing order authorizes qualified health care providers to administer the hepatitis B vaccine and outlines the policies and procedures for administering the vaccine. In New Jersey, the acting health commissioner issued an executive directive recommending the hepatitis B vaccine birth dose and full series. States Issuing Public Health Alerts and Advisories Well before the recent ACIP meeting, the Maine CDC issued a health advisory to providers recommending the hepatitis B vaccine birth dose and full series. Since the ACIP meeting, at least two other states have released provider advisories. Maryland issued a letter to providers laying out the state’s hepatitis B vaccine recommendations, and New Hampshire issued a health alert with a continued recommendation for the full hepatitis B vaccine series and birth dose. In addition, Vermont sent a guidance letter to the providers in the state’s vaccine program. States Reexamine State Statutes and Agency Rules Linking to ACIP Recommendations Over the last several months, many states have proposed and enacted legislation to move away from sole reliance on ACIP recommendations. More recently, Massachusetts adopted H 4761, authorizing the health commissioner — in consultation with a newly established committee on immunization recommendations — to review and issue alternative standards to ACIP recommendations. States are also proposing changes to agency rules related to school and childcare immunization requirements. For example, Colorado’s health department has issued a proposed rule to modify the state’s standards for school and childcare immunization requirements and to align its rules with recent changes to state statute. Additional Considerations for States If CDC adopts the proposed ACIP recommendations, states can consider the following actions. Hepatitis B Screening States should continue to work with health care providers to close gaps in hepatitis B screening and follow-up for infants of HBsAg-positive mothers. Data show the most common cause of perinatal infection occurs when a mother with hepatitis B gives birth and the infant does not receive follow-up postexposure prophylaxis. Insurance Coverage While public and private insurance, including the Vaccines for Children program, are still required to cover the hepatitis B vaccine, such as any birth doses given to infants of HBsAg-negative mothers under shared clinical decision-making, states can consider creating additional coverage requirements. Some states have passed policies on insurance coverage, and other states have proposed legislation related to other vaccine coverage. Implementation of Shared Clinical Decision-Making While health care providers and parents have the flexibility to determine their approach for infants of HBsAg-negative mothers (i.e., continuing to recommend/give a birth dose), ACIP recommendations that rely on shared clinical decision-making have increased provider questions on how to have and document these conversations. States can work with medical associations, provider boards, and health care partners to ensure clinicians understand how to apply shared clinical decision-making recommendations. This includes educating staff in birthing hospitals, community clinics, and pediatric practices on how to counsel parents and document informed discussions. Jurisdictions can also develop or adapt educational materials and decision aids that clearly outline benefits, risks, timing, and follow-up options to support both providers and parents. More information on shared clinical decision-making is available from CDC and Common Health Coalition. States can also encourage providers and birthing institutions to examine workflows, Immunization Information System documentation, and follow-up to ensure scheduling of future doses. Implications for Vaccine Supply States can examine vaccine supply through the Vaccines for Children program to understand how the new recommendations impact supply of single antigen hepatitis B vaccines. If a significant percentage of the population receives vaccines on a different timetable, it could impact supply and timing for other vaccinations, given the reliance on combination vaccines for hepatitis B dose two and three, which can include DTaP, polio, and Hib vaccines. Supplemental Resources Common Health Coalition: Vaccine Resources December 2025 ACIP Meeting: Hepatitis B Updates for Health Leaders (PDF) Vaccine Integrity Project – Hepatitis B by Centers for Infectious Disease Research and Policy Understanding the Benefits of Vaccines: Common Questions by HealthyChildren.org Childhood Vaccinations (PDF) by Your Local Epidemiologist Hep B Birth Dose Media Toolkit by Hepatitis B Foundation Reframing the Conversation About Child and Adolescent Vaccinations by Frameworks Institute CDC: ACIP Shared Clinical Decision-Making Recommendations ACIP Meeting Materials for Public Posting: Hepatitis B Birth Dose Briefing Document (PDF) Hepatitis B Birth Dose Vaccination (PDF) article yes

What’s Driving Public Health Legislation in 2026? What’s Driving Public Health Legislation in 2026? Beth Giambrone Learn about the prospective legislative landscape for public health in 2026 from chronic to infectious disease and more. Drawing from ASTHO’s legislative tracking efforts and member feedback, the State Health Policy team identified five key issues state and island legislatures will likely address in their upcoming sessions. The resulting tool, ASTHO’s 2026 Legislative Prospectus Series, provides public health leaders and policymakers with a synopsis of the topics, recent policy trends, and anticipated legislation in upcoming sessions. Public Health Funding and Administration While the federal government has invested in long-term public health through legislation such as the Public Health Infrastructure Grant and the Prevention and Public Health Fund, states are preparing for possible reductions or cancellations in federal funding. The Public Health Funding and Administration Prospectus highlights state efforts to improve public health investments, such as creating public health rainy day funds, while still balancing their budgets. States also enacted legislation that improves core public health services at the state and local levels, a trend that ASTHO sees continuing into 2026. Access to Care The Access to Care Prospectus focuses on policies that reduce gaps in health care services for communities across the United States. In 2025, ASTHO saw enacted legislation that strengthened the utilization of community health workers who serve as vital links between individuals and health service providers, through certification programs and Medicaid coverage requirements. States also considered policies supporting access to health care in rural areas, where individuals have limited access to health care providers and facilities. Iowa’s HF 972 directs the health department to seek CMS approval for a new funding model that would support rural health providers. The prospectus also addresses legislation supporting women at multiple stages of life by increasing access to doulas, establishing programs providing increased maternal care in rural areas, and supporting women in perimenopause with increased information and access to treatment. Behavioral Health More than one in five people in the United States experience mental illness and opioid overdose is a leading cause of death. Given this, state legislatures continue to consider legislation to strengthen behavioral health systems, address unregulated substances, and promote access to overdose prevention tools — discussed in the Behavioral Health Prospectus. In 2025, at least 13 states considered legislation to strengthen behavioral health crisis services. Washington enacted HB 1813, directing managed care organizations to establish or expand arrangements with behavioral health administrative services organizations to provide crisis services for Medicaid enrollees. State legislatures also considered bills to expand clinical research or regulate substances such as psilocybin and ibogaine, with at least three states enacting legislation to allow psilocybin prescribing if FDA approved. Additionally, at least 10 states considered legislation allowing for the study of ibogaine as a potential treatment for conditions such as PTSD and opioid use disorder. Infectious Disease Prevention While some infectious diseases are declining in the United States, others — like measles — are increasing. This year’s Infectious Disease Prevention Prospectus explores legislative policies to combat infectious disease through prevention, testing, and treatment. While the Advisory Committee on Immunization Practices (ACIP) updated vaccine recommendations for children and adults, several states enacted legislation expanding the sources they use for developing policies related to school immunization, universal vaccine purchase programs, and more. States also considered expanding access to testing and treatment that prevents the spread of sexually transmitted infections. At least seven states enacted bills requiring or expanding syphilis screenings during pregnancy to combat rising congenital syphilis rates, while at least ten jurisdictions considered bills expanding access to HIV pre and/or post exposure prophylaxis. Healthy Food and Chronic Disease The Healthy Food and Chronic Disease Prospectus highlights legislative efforts to address food’s impact on public health and combat chronic disease. In 2025, several states considered legislation prohibiting the sale of food products that contain certain artificial dyes and/or chemical preservatives, with West Virginia enacting HB 2354 to prohibit the sale or manufacturing of food containing certain dyes or preservatives. Similarly, at least three states enacted legislation prohibiting foods containing certain dyes or preservatives in school meals. States also sought to promote nutritious food choices in their USDA SNAP benefits, with at least four states enacting legislation directing their state health departments to apply for waivers that would prevent individuals from using SNAP funds to purchase candy and soft drinks. Current Outlook for the 2026 Sessions In 2026, 46 states will hold legislative sessions (Montana, Nevada, North Dakota, and Texas do not meet in even numbered years). Most states will conclude their sessions by June 30, with at least 20 states scheduled to conclude in April. Additionally, 24 states carry over 2025 bills into the 2026 session, including some bills mentioned in the prospectus briefs. Because of this, ASTHO expects a large amount of legislative activity in the first few months of the year. The ASTHO State Health Policy team will monitor legislation related to the Legislative Prospectus Series and other public health issues during the 2026 sessions and provide a mid-session update in the spring. OE22-2203 PHIG article yes

Learn more about recent federal and Supreme Court cases that impact public health policy.

Strengthening Public Health Systems: CNMI Food Safety Program Spotlight Strengthening Public Health Systems: CNMI Food Safety Spotlight Anya Groner, Taylor Francis Learn a few essential steps for strengthening public health systems, as exemplified by CNMI and their work to adopt the FDA Food Code. Public health systems are designed to protect and improve population health. These vital systems — from food safety programs to disease surveillance — help to prevent disease, respond to health threats, and ultimately improve well-being. To best benefit communities, public health agencies must remain committed to strengthening these existing systems. The Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory in the western Pacific with a population of approximately 50,000, models this work in their exceptional efforts to improve their food safety system. Managing the risks of foodborne illness requires clear guidelines, government support, and regulatory authority. Yet, when the Environmental Health Disease Prevention Program (EHDP), part of the Commonwealth Healthcare Corporation in CNMI, conducted a voluntary review of their food regulations, the jurisdiction met only a small percentage of the FDA retail program standards, which define what constitutes a highly effective and responsive program for the regulation of retail food establishments. From there, EHDP launched an ambitious plan for the jurisdiction to adopt the FDA Food Code for the first time. The EHDP Office spent several years analyzing the legal and technical implications of adopting the FDA Food Code and garnering leadership support. In November 2024, it was officially adopted — an extraordinary accomplishment. EHDP will now embark on a five-year implementation process which has a strong focus on training, technical assistance, and partnerships with local stakeholders — with an emphasis on education instead of enforcement. Their journey serves as an example for other jurisdictions working to strengthen their public health systems. Getting Started Building better systems starts with identifying opportunities to strengthen those already in place. When EHDP reviewed their existing local regulations against the 2017 FDA Food Code, they found that theirs fell short of the criteria related to risk factor interventions, good retail practices, and effective compliance and enforcement measures. This led to the realization that they needed to strengthen their food safety program and adopt their first FDA Food Code. Pangelinan 1 - CNMI Food Safety Program Spotlight By moving from their old code to the FDA code, EHDP shifted from a focus on basic sanitation to foodborne illness risk factors. With limited resources and staffing challenges, it was vital that the EHDP team knew where to focus their workload and how to streamline inspections. This change will also help EHDP better protect the public’s health. Measuring Progress As health agencies embark on building better systems, it’s vital to have a specific measure to assess progress against. EHDP spent several years working toward adopting the 2022 FDA Food Code. Their previous regulations were outdated, vague, and inconsistent. Plus, there was a lack of clarity around critical food safety practices, like cooking temperatures, cooling procedures, and sanitization. The retail food program standards gave the team a measure to assess their food safety program compared to other programs nationally and helped them better understand gaps. Getting Buy-In and Mobilizing Stakeholders Two additional essential steps are garnering support and coordinating action. For EHDP, there was a lot of training to get internal support not just within the team but also from leadership. Fortunately, the adoption process to implement new regulations was fairly smooth. Their next focus is building the infrastructure, training the staff, and ensuring that the local operators have access to the necessary equipment, supplies, and sample policies. They are also looking to offer certified Food Protection Manager training to food operators. EHDP plans to focus on small behavioral changes, making sure everyone’s on the same page with employee health so retail food establishments can meet the requirements on employee health and reporting. Every September, EHDP hosts food safety week as part of Food Safety Education Month and brings together food handlers and food operators — some of whom are familiar with the FDA Food Code due to working in the continental United States. The EDPH team always talks to them about potential changes that could come about from this new code and, so far, have received great feedback. Pangelinan 2 - CNMI Food Safety Program Spotlight Collaborating with Partners As with any effective public health initiative, collaborating with partners at all levels is crucial – as agencies can learn from others’ skills and experiences. At both the federal and local levels, EHDP worked closely with their FDA retail specialists who provided technical support and training throughout the process. The team also did a three-year mentorship with Northern Nevada Public Health, which helped them improve their field inspections and strengthen internal policies and procedures. These were the key steps in making progress towards the standards and preparing for adoption. In addition, ASTHO connected EHDP with other health departments who had gone through the food code adoption process, enabling them to hear their firsthand insights and practical guidance. The team is willing to support other Pacific Island jurisdictions, like American Samoa, as they work to adopt the FDA Food Code for the first time, too. Pangelinan 3 - CNMI Food Safety Program Spotlight Celebrating Successes It’s always important to take a step back and acknowledge wins throughout essential public health work. EHDP’s work towards the FDA Food Code strengthened the team's skills and expanded training opportunities, as they shifted from focusing on rules and regulations to risk-based inspection and partnering with food operators — emphasizing education, prevention, and collaboration, to get everyone on board. Their biggest success, however, is of course adopting their first FDA Food Code. Pangelinan 4 - CNMI Food Safety Program Spotlight In Conclusion Through EDPH’s efforts to improve their food safety program, they are reducing foodborne illness, protecting public health, and safeguarding their community. As exemplified in CNMI, improving public health systems takes time and hard work — but with that investment comes key successes that benefit communities for years to come. CDC-HHS - $1,000,000 article yes

Data-Sharing Strategies to Support Access to Care Interventions Anna Bartels, Chikamso Chukwu Learn how primary care offices improve community access to health care in this Health Policy Update. Every state public health agency houses a Primary Care Office (PCO), which monitors the effectiveness of that jurisdiction’s health system. HRSA funds PCOs to identify communities with health professional shortages, and PCOs may also administer workforce programs to place providers in those communities. To identify which communities are experiencing shortages, PCOs collect state-level data on where health care providers work, what services they offer, and how many hours they spend on patient care. PCOs also track data on community needs, such as household income levels and community transportation options, to create a holistic picture of whether health care is truly accessible. PCOs across the country have explored different policy pathways to access reliable, accurate data, including laws that support PCO access to certain data sets, cross-sectoral relationships, and data-sharing agreements. According to ASTHO’s national PCO workforce assessment, over 85% of PCOs are part of a formal data-sharing arrangement, with licensing boards and Medicaid agencies serving as two of the most common data sources. This health policy update describes several types of actions jurisdictions have taken to support PCO data access. New Hampshire Law Allows the PCO to Survey Providers During License Renewals The New Hampshire PCO’s Health Professions Data Center administers a survey tied to health care providers’ medical license renewals that gathers self-reported provider and practice data, such as where providers work, how many hours per week are spent delivering direct patient care, and anticipated changes in capacity over the next five years. New Hampshire law outlines the scope of the survey and authorizes the PCO to collect, store, analyze, and report on health care workforce supply and capacity through surveying during license renewal. Although survey responses are the primary source of data on the health care workforce, data from the state’s all payer claims database housed within the Medicaid division provides supplemental information. Given the type of data involved, legal agreements are required between the PCO, licensing agencies, and relevant parties to maintain privacy for providers. These data are critical for the PCO to evaluate current and future capacity — especially in regions with limited providers — and proactively focus recruitment efforts on those communities. Colorado Braids Data Collection Strategies Across Multiple Sources While the Colorado PCO has relied on a similar law that authorizes collecting licensure data for more than 10 years, its data collection efforts have since expanded. The state now collects and integrates data across 16 different sources, each requiring a different procurement strategy. While some data sources are simple to access because they are public use files (e.g., Medicare provider data), other sources — namely state agencies — require the PCO to submit an application or enter into a memorandum of understanding or contract for access. Pursuing multiple data sources in this way takes significant effort and staff time, necessitating the health department to supplement HRSA’s PCO cooperative agreement funding with other sources, including state appropriations and private funding. A commitment to collaboration and investment and a willingness to build new relationships and processes from scratch support the Colorado PCO’s wide-ranging data collection strategy. Iowa Builds on Existing Relationships to Access Provider Data Iowa’s PCO has a long-standing relationship with the University of Iowa and a joint interest in health care workforce data. Currently, the PCO purchases provider phone survey information from the University of Iowa’s existing program and receives data on a biannual basis. The university’s data collection is part of its own research efforts and not collected on behalf of the PCO, so while the data are broader than what the PCO needs, it is still a valuable source of provider information. Because of this existing arrangement, the PCO could pursue a more expansive agreement (that would likely require additional funding) and expand the scope of the data, such as by adding data collection on provider residence or sliding fee scales. Other PCOs may consider approaching partners that have pieces of the data they need so there is an established relationship in place that may be expanded as new resources become available. PCOs Secure Access to Medicaid Claims Data State Medicaid agencies are another frequent data partner for PCOs, with at least 16 receiving provider data from their state Medicaid agency in various formats. In some states the Medicaid agency shares a point-in-time file with the PCO, who may manually recode the data before submission to HRSA. In other states, the PCO has direct access to the Medicaid claims processing system to independently extract the necessary data points. The nature of the partnership between the PCO and Medicaid agency may vary based on the state’s organizational structure (e.g., whether the PCO and Medicaid agency sit within the same department). However, a PCO seeking access to Medicaid claims data should be prepared to justify the need for the data, articulate how it can support the Medicaid agency, and develop the necessary relationships to support a workable solution for both parties. Conclusion Each PCO and state health agency has its own unique structure, and there is no “right” way to collect health care provider practice or access data. However, exploring how different jurisdictions approach these processes can help PCOs think strategically about new initiatives and relationships. ASTHO will continue tracking PCO success stories and remains available to facilitate connections among health agency staff. 2 UD3OA22890-13-00 article yes

The Key Role of Cross-Sector Partnerships in Navigating Barriers Keon Lewis Community partnerships are critical to public health's mission to promote optimal health for all — learn more. Public health departments’ mission and vision statements often share certain values and goals aimed at improving the public’s well-being. Rather than just reactively responding to immediate health threats as they come, public health departments aim to take a more proactive approach through strategies that prevent the future spread of diseases, injury, or other incidences of harm. These actions support their visions of creating communities where all residents can thrive and achieve their full health potential. Strong community partnerships are critical to public health departments’ ability to fulfill their goals. Recognizing this, the Robert Wood Johnson Foundation introduced the Culture of Health Framework in 2015. As a leading national philanthropic organization focused on dismantling barriers to optimal health for all, the framework’s foundation is built upon the following action areas: Making Health a Shared Value. Creating Health. More Equitable Communities. Strengthening Integration of Health Systems and Services. Fostering Cross-Sector Collaboration. The COVID-19 pandemic and its aftermath underscored the factors that created challenges to health outcomes for underserved communities; it also demonstrated the importance of sustaining strong cross-sector partnerships. Public health’s ability to align its goals with the community it serves is vital to efforts to save lives. This alignment allows public health departments to leverage the diverse resources and lived experiences that community partners bring. Recognizing the unique concomitant relationship that it has with government funding, public health departments are now going to have to pivot their strategies to achieve their missions. As public health departments experience budget and personnel cuts, its ability to promote optimal health for all and mitigate the social determinants of health is now even more reliant upon the strength of collaborative partnerships. The Public Health Paradox Public health has always been a component of our nation’s health care system, which primarily reflects specific health issues that have impacted our communities. Rather than focusing on the foundational issues that exacerbate these long-term gaps in underserved communities, government systems often allocate funding based on specific diseases or chronic health issues impacting community health. Although diseases and chronic health issues are significant public health elements that need to be addressed, there are significant nonmedical factors that play just as vital a role in influencing community health outcomes. Identified by the World Health Organization (WHO) and adopted by CDC as the social determinants of health, these variables — which include elements such as social and community construct, economic stability, and education access — have become the central driving force of public health. “The Public Health Funding Paradox,” an article from Sage Journals, offers a great perspective on how an intriguing paradox has been created due to this relationship between public health and government systems. The article underscores the complexity of governmental funding that helps to advance public health strategies while there still exist harmful policies that create barriers for certain communities. The Flint water crisis in Michigan demonstrated this paradox. Flint citizens experienced lead poisoning and death from Legionnaires’ Disease, underscoring how a community’s ability to thrive can be quickly impacted by economic difficulty and leadership decisions made by the accompanying government. The Power of Partnership Public health has long had to combat a barrage of stigmas and policy hurdles. Even at the height of the COVID-19 pandemic, public health departments were not only in contention against the virus but also against the influence of viral misinformation that questioned their practices, strategies, and purposes. Despite these barriers, the nation witnessed the power of true cross-sector partnerships. Health care and grassroot organizations quickly found common ground to help address the needs of underserved populations. From addressing food insecurity to mental health and transportation barriers, communities successfully pivoted toward hope and found ways to save lives. Nonprofit organizations also created innovative and impactful peer-to-peer funding models that enabled them to fulfill their missions in spite of budget cuts. During this time, community health workers became a vital public health resource. As conduits between departments and local communities, community health workers became a necessary element to re-reestablishing trust in systems and care. Although the work of frontline workers and support staff served a critical role in mitigating the future spread of COVID-19, advocates and allies at the grassroots level also played an invaluable role in promoting health for all. As “The Public Health Funding Paradox” demonstrated, public health departments are only as effective as their accompanying government systems. If the leadership within these respective systems fails to align and empathize with their public health counterparts, then as a community we inevitably repeat a vicious cycle that results in poor health outcomes. Identifying Alternative Routes Cross-sector partnerships serve a vital role in enabling public health systems to better serve their communities. Budget cuts and stricter policies have created barriers for local and statewide agencies, academic institutions, and nonprofit organizations. The ability to develop essential personnel, continue pertinent research, and utilize mitigating practices have been inhibited by these barriers. It has become increasingly evident that, rather than focusing on reactive strategies, public health must go upstream and address the social needs of our communities. With cuts to funding, public health systems have to do more with less, making it more difficult to address diseases and chronic health problems. Working upstream to address root causes of health outcomes is one way to better leverage thinner resources. As our public health systems continue to work diligently to monitor, support, and mitigate community health barriers, there is still more research needed to explore the most effective cross-sector partnership frameworks. Public health’s efforts must remain intentional in developing comprehensive health advisory coalitions, leadership development cohorts, civic and community engagement projects, and paradigm shifts in academic curricula. The leaders and changemakers of tomorrow require growth in their competencies today. Cross-sector partnerships must continue to build their foundations upon systems of trust and transparency. Public and private health systems, the social sector, and other community stakeholders can partner to improve the population’s overall well-being while simultaneously achieving a mutually beneficial “social return on investment.” Public health’s ability to align with the achievement of optimal health for all requires more than just serving on the front line when a crisis occurs — it is critical that these departments must continuing enhancing their collaborative partnerships and community engagement. article yes

Population Health Summit Strengthens Pacific Partnership Anya Groner Read about the inaugural Population Health Summit, which was held in the Commonwealth of the Northern Mariana Islands, and learn how it worked to improve collaboration in the Pacific. For Halina Palacios, chief operations officer of public health for the Commonwealth Healthcare Corporation, it was important to break the mold and host a public health summit in the Pacific instead of the Continental United States. She and her team held the corporation's inaugural Population Health Summit in the Commonwealth of the Northern Mariana Islands (CNMI). With firsthand knowledge of the notable work happening across the Pacific, Palacios hoped to create a venue where public health workers from U.S. territories and freely associated states could share their successes and learn from each other. Improving Pacific Collaboration and Confidence Regional collaboration is not new to the Pacific. During the COVID-19 pandemic, the U.S.-Affiliated Pacific Islands (USAPI) worked together to limit transmission until most of their populations could get vaccinated. Palacios knew that a summit hosted in CNMI would build on this existing regional collaboration. Public health summits are typically held in the continental United States and come with high travel costs, meaning that only one or two representatives from each jurisdiction can attend. As a result, the majority of Pacific public health teams don’t directly benefit from information sharing and networking at such conferences. Holding a summit within the region instead would lower those travel costs and boost attendance. In addition, Palacios felt a local summit would boost confidence in Pacific public health officials: The officials who were able to attend public health conferences in the continental United States sometimes told her they felt imposter syndrome, caused in part by the feeling of being in a tiny minority at a national event and from attending presentations that didn’t necessarily address local realities. Halina Palacios 1 - Population Health Summit Strengthens Pacific Partnership Turning Vision into Reality Putting together a conference is a massive undertaking, but Palacios knew her team could do it. They chose “Navigating Pathways Through the Pacific: Building Healthier and Stronger Island Communities” as the theme of the inaugural summit. Broad and ambitious, it encompassed Palacios’s expansive vision. She wanted the event to encourage public health programs across the Pacific to operate with a population health mindset, addressing not only individual medical concerns but also the social, economic, and environmental factors that influence community health outcomes. Spanning three days, the summit schedule included various plenaries, poster presentations, and panel discussions on behavioral health, public health, and clinical practice — centering topics relevant to the region. The team invited faith group leaders and members of recovery communities to speak alongside specialists from throughout the region. Halina Palacios 2 - Population Health Summit Strengthens Pacific Partnership   Population Health Summit Planning Committee members gather in front of a conference banner.   An Impactful Inaugural Event The inaugural summit occurred this past June in CNMI’s capital city, Saipan, and turnout was high. In addition to strong representation from CNMI, more than 50 people came from off-island to share resources, compare programs, and form new collaborations. Popular topics included data capacity, expanding approaches to behavioral health, technical assistance opportunities, and clinical resources. The impact was immediate. Halina Palacios 3 - Population Health Summit Strengthens Pacific Partnership Two speakers, Oncologist Peter Brett and Dentist Angelina Sabino, with clinics in their respective fields at the Commonwealth Healthcare Corporation, educated attendees on the realities they face treating the community. This session led to post-discussions, opening opportunities to collaborate with other USAPI on addressing oral cancer in the Pacific, which is especially important due to recent reductions in national surveillance, technical assistance, and funding for tobacco prevention programs. Island jurisdictions have high rates of oral cancer as a result of betel nut use with tobacco and high smoking rates — and with patients often seeking treatment in Guam, Hawaii, or elsewhere in Asia, the team knew it was a topic that the summit needed to cover. Another topic of particular interest was research and accountability. A panel discussion, which included Palacios, sought to improve data collection and research across the region. Participants noted the need for a centralized Institutional Review Board in CNMI to review and monitor research on human subjects. Without it, health officials can’t easily standardize research methods and practices. Panelists also expressed a need to set higher expectations for researchers who conduct studies using data from the Pacific Island jurisdictions; many fail to meaningfully share the results of their work with participants or public health teams, often doing little more than emailing a link to an article or a Zoom presentation. Halina Palacios 4 - Population Health Summit Strengthens Pacific Partnership The Population Health Summit purposefully centered on Pacific Island culture — each day, it opened and ended with a prayer. Instead of being part of a tiny minority at a large conference on the mainland, participants saw themselves represented in the daily schedule, with presenters from within their community, speaking on topics that addressed their concerns.   A large group of Population Health Summit attendees convene in a conference room.   Looking Ahead Though only a few months have passed since the summit, new projects and collaborations are underway. Some attendees are contacting presenters to schedule training sessions for staff who couldn’t attend. Others are sharing resources on topics such as men’s behavioral health and accountability. Most encouraging for Palacios are the conversations about the next population health summit: who will host it, when it will be, and what the presentation topics might be. Over the next five years, a new cohort of public health workers will start their careers in CNMI and across the Pacific Island jurisdictions. By then, Palacios predicts that the Population Health Summit will be well established and that standards for the profession will have shifted. Halina Palacios 5 - Population Health Summit Strengthens Pacific Partnership CDC-HHS - $1,000,000 article yes

New World Screwworm Insights and Action Steps Shalini Nair Learn about the recently confirmed human case of New World screwworm in the United States, plus action steps to stay prepared for this evolving threat. CDC, in coordination with the Maryland Department of Health, recently confirmed a human case of New World screwworm (NWS) in the United States associated with the ongoing outbreak in Central America. Prior to late 2023, NWS was present in South America and certain countries of the Caribbean, and a biological barrier in eastern Panama prevented the pest from spreading through Central America. Although the United States has experienced travel-associated cases from countries where NWS is endemic in the past, this is the first travel-associated case from a country affected in this outbreak. The parasite, most often seen in animals (especially livestock), was confirmed on Aug. 4 in a Maryland resident with recent travel to El Salvador — a country affected by the current outbreak. While the risk to public health in the United States remains low at this time, it is important for state and territorial health officials to stay informed and prepared for this evolving threat. What Is New World Screwworm? New World screwworm, or Cochliomyia hominivorax, is a parasitic fly whose larvae (maggots) feed on healthy tissue. NWS flies are attracted to and lay eggs on and inside of open wounds, which leads to myiasis, or a parasitic infestation in which fly larvae burrow into the flesh of the affected host. While NWS can affect various warm-blooded animals, most commonly livestock and wildlife, it does not spread between humans and animals. Further, the fly is not a carrier of vector-borne disease. Risk factors for contracting NWS myiasis include: An open wound (even wounds as small as a tick bite may attract the flies). A weakened immune system. A medical condition that contributes to bleeding or open sores. Spending extended amounts of time outdoors or near livestock in areas where NWS flies are present. NWS infestation can be very painful. In humans, symptoms may include unexplained skin wounds or lesions that worsen over a few days, bleeding from an open sore, the presence or feeling of maggots around or in open wounds, and a foul-smelling odor at the infestation site. Larvae can also be present in the nose, eyes, mouth, or ears. In animals, signs may include irritated behavior, head shaking, presence of larvae in wounds, and the smell of decay; animals may also stop eating and self-isolate. There is currently no drug-only cure for NWS but effective treatment consists of quick and thorough removal of larvae. The USDA also maintains a list of EPA-registered pesticides to use against NWS on pastures, agricultural buildings, livestock, and other animals. Framework for Outbreak Prevention NWS was formerly eradicated from the United States in the 1960s, following a large-scale, coordinated effort and the creation of a “barrier” zone between NWS-endemic South America and NWS-free Central and North America. While subsequent outbreaks have occurred since then, the last confirmed (and later eradicated) U.S. outbreak of NWS was in the Florida Keys in 2016, affecting wild Key deer. However, NWS has slowly migrated northward towards the southern U.S. border since the emergence of a new outbreak in Panama in 2023. In the 1950s, USDA developed a successful method for eradicating NWS, referred to as sterile insect technique (SIT). This method involves the mass-rearing and release of sterilized male flies into infested areas to mate with wild females, resulting in nonviable eggs and a vast reduction in the target fly population. It has been used in the United States and across North and Central Mexico and was successful in maintaining eradication until the outbreak in recent years. Addressing the Current Outbreak USDA and HHS have initiated proactive measures to address the current threat to the United States. This includes CDC collaborating with health care professionals, state and local health departments, and tribal organizations to prepare for the potential arrival of NWS in the United States and developing clinical guidance and other resources for health care and public health partners on how to identify and respond to NWS myiasis cases in humans. Additionally, USDA is taking comprehensive action in coordination with U.S. Government partners to protect the United States and prevent the further spread of NWS. In May, USDA suspended imports of cattle, horses, and bison from Mexico, following recent detections of NWS as close as 370 miles from the border. In June, USDA announced the construction of an $8.5 million sterile NWS fly production facility in South Texas, aimed at bolstering their ability to control and eliminate this pest. Also, the new NWS Domestic Readiness and Response Policy Initiative outlines a five-pronged plan to mitigate the threat of NWS. In response to the travel-associated human case, USDA has initiated targeted surveillance for NWS in nearby areas of Washington, D.C., Maryland, and Virginia. As of September 5, no trap results have come back positive for NWS flies. Need-to-Know Information for Health Officials Veterinary Considerations Currently, the potential threat of NWS looms largest for livestock such as cattle, horses, and pigs — although no infestations in animals have been identified in the United States since the outbreak in Key Deer was eradicated in 2017. Coordination between public health agencies and the agricultural and animal health sectors is strongly encouraged as part of a One Health approach to strengthening disease surveillance. Veterinarians should report any suspicious cases in any animal species immediately to their state animal health official and to USDA-APHIS. HHS recently authorized FDA to issue emergency use authorizations for drugs to treat infestations in animals, should they be necessary. While no FDA-approved drugs currently exist for treating NWS infestation in animals in the United States, this may expedite the use of drugs approved for other purposes or those available in other countries to treat NWS-infested animals. Food Safety NWS is not transmitted through consuming appropriately cooked meat or poultry products. In addition, all livestock used for food production in the United States must pass inspection both before and after slaughter, and the presence of infestations or treatment residues that deem meat unsafe for human consumption will prevent the affected product from entering the food supply. Current Human Epidemiologic Situation Over the years, the United States has experienced occasional travel-associated cases of NWS in people traveling from endemic countries; however, the confirmation of a travel-associated case of NWS in Maryland marks the first human case of this parasitic infestation in the United States from the outbreak area. The patient has since recovered, and officials confirmed that there is no indication that the infestation spread to other humans or animals. At this time, there are no active human cases in the United States. The risk to public and traveler health in the United States remains low, and cases of NWS in humans remain much lower than animal cases in countries affected by the current outbreak in Mexico and Central America. Public health officials are encouraged to promote clinician awareness of NWS and consider developing coordinated public communications resources as necessary. Diagnosing and Reporting Suspected Human NWS Infestations Health care providers should remain aware of the risks in patients who have traveled to areas affected by the current outbreak, in addition to those where NWS is endemic. If a human case is suspected, providers should report it immediately to their local or state health department for further investigation. Any maggots found in suspected cases should be placed into a leak-proof container filled with 70% ethanol for proper disposal, and providers should contact CDC’s DPDx team for further specimen submission instructions. Proper disposal of suspected NWS larvae is critical to preventing the parasite from spreading to the environment. If a suspect case is identified, contact CDC (newworldscrewworm@cdc.gov) to obtain the case report form and case investigation guide. ASTHO will continue to monitor developments on this emerging public health issue. Supplemental Resources Overview of NWS – CDC About New World Screwworm Clinical Overview of New World Screwworm Acerca de la miasis por el gusano barrenador del Nuevo Mundo Información clínica sobre la miasis por el gusano barrenador del Nuevo Mundo Lab Identification of New World Screwworm (PDF) Local/State Public Health Departments Epi On Call by CSTE Clinical or Diagnostic Assistance – CDC Clinical inquiries and patient management related questions: parasites@cdc.gov or 404-718-4745. Direct after-hours inquiries to CDC’s Emergency Operations Center at 770-488-7100. Diagnostic assistance for suspected human cases: dpdx@cdc.gov. USDA New World Screwworm New World Screwworm: What You Need to Know PDF (English and Spanish) New World Screwworm Story Map Screwworm: An International Threat to Human and Animal Health (PDF) Veterinarians Report any suspicious cases immediately to your state animal health official and APHIS office. Insect Bite Prevention – CDC Preventing Mosquito Bites Preventing Mosquito Bites While Traveling About Permethrin-Treated Clothing and Gear How to Prevent Mosquito and Tick Bites Insect Repellents Repellents: Protection Against Mosquitoes, Ticks and Other Arthropods Reviewed by - Susan Kansagra article yes

PHIG Recipients Accelerating Procurement Processes Melissa Touma Learn how PHIG recipients are advancing procurement processes to advocate for continued public health infrastructure investment, using thoughtful targets and tracking progress. Timely procurement is a cornerstone of effective public health infrastructure. Under CDC’s Public Health Infrastructure Grant (PHIG), recipients are encouraged to strengthen their procurement systems so that resources reach communities swiftly and efficiently. As jurisdictions continue to modernize their systems, several PHIG recipients are leading innovative practices that not only reduce procurement cycle times but also enhance transparency, accountability, and collaboration. By setting thoughtful targets and tracking progress, agencies can demonstrate improvements in procurement efficiency and make a strong case for continued investment in public health infrastructure. Best Practices for Setting Targets for the PHIG Procurement Timeliness Measure The PHIG performance measure A2.2: Procurement Timeliness tracks the median number of calendar days from when procurement documentation is received to when a contract is fully executed. It helps agencies assess and improve the efficiency of their procurement processes, particularly those funded by federal awards. Setting realistic and meaningful targets for procurement timeliness is essential for tracking progress and driving improvement. Clear, data-informed targets help agencies identify bottlenecks, allocate resources effectively, and measure the impact of process changes over time. When targets are both ambitious and achievable, they can motivate teams, guide continuous improvement efforts, and support accountability across departments. To get on track: Start with a baseline. Use historical data to establish a procurement cycle time. If data is not yet available, begin with a small sample and refine over time. Segment by procurement type. Consider setting distinct targets for various types of procurement (e.g., contracts vs. purchase orders) if they follow different timelines. Engage stakeholders. Collaborate with procurement, finance, and program staff to understand bottlenecks and set achievable goals. Align with system improvements. Adjust targets to reflect expected gains in efficiency, especially when implementing a new contract lifecycle management system or process improvements. Document assumptions and limitations. When setting targets, note any contextual factors (e.g., staffing shortages, policy changes) that may affect procurement timelines. Review and adjust regularly. As systems mature and data quality improves, revisit and refine targets to reflect new capabilities and expectations. Best Practices from PHIG Recipients Several PHIG recipients have adopted replicable strategies to improve procurement timeliness, aligning with best practices from the National Association of State Procurement Officials and principles of collaborative procurement partnerships that emphasize cross-functional coordination and interagency engagement. Here are some best practices and examples of how PHIG recipients are moving to improve their procurement systems: Establish a robust and effective data collection system that offers automated data capture, comprehensive coverage, regular audits, and validation. For example: Illinois Department of Public Health currently uses Smartsheet to streamline procurement tracking and plans to implement DocuSign’s Contract Life Management (CLM) system to track procurement in 2026. Seattle & King County Public Health utilizes Agiloft, a Contract Lifecycle Management platform, to manage procurement from planning to closeout. Connecticut Department of Public Health built a custom Grants Management System using Dynamics 365 and Power BI, enhancing visibility and reporting. Tennessee Department of Health developed a low-code Contract Tracking and Reporting Application using Caspio, improving efficiency and data accuracy. Utilize a CLM System to improve efficiency, enhance transparency and accountability and ensure compliance and risk management. For example: Iowa Department of Health and Human Services is rolling out Cobblestone, a full-spectrum CLM system that guides users through procurement pathways and supports contract execution and management.  Connecticut Department of Public Health utilizes its new Grant Management System built into Dynamics 365 and Power Bi.  Seattle & King County Public Health utilizes Agiloft, a CLM platform. Establish a dedicated, centralized team that oversees and executes procurement activities for the entire agency. For example: Illinois centralized its procurement function by assigning a team of five people to improve collaboration and consistency across the agency. Connecticut is building a centralized team to support program staff through the procurement process. Institutionalize procurement capacity building, training, and customer support. For example: Louisville Metro Department of Health and Wellness placed a trainer on the procurement and contracting team to build the capacity of all grants/contract managers across the agency. Training materials and documents are available for staff to reference and build programmatic capacity. Connecticut established a customer support team within its Operational Support Unit to assist staff with procurement needs. Foster a working relationship with external agencies or divisions that play a role in the procurement approval process. For example: Illinois includes state purchasing officers in weekly procurement meetings to enhance communication and problem-solving. Foster cross-functional collaboration and learning through internal procurement meetings and engagement. For example: Santa Clara Public Health Department created a Grants/Fiscal Community of Practice to foster cross-functional learning. Procurement as a Strategic Lever for Public Health Improving procurement timeliness is more than a technical fix — it's a strategic investment in public health readiness and resilience. By embracing data-driven tools, centralizing expertise, fostering collaboration, and exploring emerging technologies, public health agencies are reducing delays while building the infrastructure to respond swiftly to community needs, emergencies, and long-term health goals. As these best practices continue to spread and evolve, they offer a roadmap for other jurisdictions to modernize procurement and maximize the value of every public health dollar. Next, explore how two state recipients are transforming procurement and grant management — ultimately delivering faster, more reliable services to the communities that need them most. As more PHIG recipients work to modernize their procurement systems, sharing strategies and lessons learned becomes increasingly valuable. What strategies has your agency found most effective in improving procurement timeliness? We invite you to join the conversation and contribute your insights to help strengthen public health infrastructure nationwide. Send us an email at phig@astho.org! article yes