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Defining Disease Forecasting and Modeling Disease forecasting, generated by disease models, helps the public health workforce understand potential future outbreaks. Learn more about disease forecasts and models. Disease forecasting is important in describing potential future outbreaks that will affect the population and demand for health services in a given geographic area. Forecasts pull input from various sources (e.g., disease models, demographic, mobility, and intervention impact data). Individual forecasts can also be part of an ensemble forecast to improve accuracy. Forecasts can cover any length of time, but most target a window of several weeks to a few months. A subset of forecasts, known as nowcasts, seek to estimate present conditions, or those expected to occur imminently. Disease models are mathematical tools that are foundational components of disease forecasts. They estimate quantifiable factors that are impossible or impractical to directly measure, (e.g., future hospitalizations from a given disease, or its infection count in a population). Although models can be useful for specific questions, they do not give as complete a picture as a forecast. There are four major disease model types: Mechanistic. Attempts to simulate biological and/or social processes of transmission based on assumptions from prior or experimental data. Statistical. Relies on past data (such as infections or death) to predict future trends and can incorporate some assumptions about intervention application and uptake. Quality and quantity of past data can be a major limitation, and some models may suggest biological improbabilities. Agent. Simulates individual risks and behaviors in a population. These are highly complex, computationally very expensive to develop and run and require vast amounts of data and strong assumptions. Ensemble. Like their forecasting counterparts, they compile models and outputs, mitigating the risk of relying on one data point. While raising the overall confidence in output, they require coordination of many models to be built and simulated, which can be complex and costly unless the models already exist (such as for COVID-19 case counts). Forecasts and Models Work Together While disease forecasts and models are often conflated, they are discrete concepts. Forecasts offer a general prediction, whereas models are the mathematical pieces forecasters use to create them. Weather forecasts are commonplace, and their weekly predictions are often reasonably accurate. In contrast, predicting a big storm’s individual factors (e.g., rainfall, wind speed, lightning strikes) fall to the job of models. Together, those models help meteorologists better understand the weather and generate a forecast. In a public health context, disease forecasting informs public health officials, health care providers, and policymakers about potential risks and guide decision-making regarding preventive measures, resource allocation, and response strategies. Meanwhile, disease models aim to simulate the behavior of infectious diseases under different scenarios, allowing researchers to explore and evaluate various factors that influence disease transmission. Considerations for Decision-Making Decision-makers should consider scope and limitations of forecasts and models. They may consider adding inputs—such as projections for economic and long-term impacts. Examples include economic impacts of school closures, costs of more staffing ahead of an outbreak, and supply chain shortage forecasts for personal protective equipment (PPE). Decision-makers at all levels should consider using modeling to answer more specific, practical questions rather than predicting overall trends. Forecasts can cover different geographic scales. Public health leaders will need granular, local data to most effectively inform decision-making and communications. Novel conditions and pathogens may not have readily available data to inform models or forecasts, which will affect their predictive ability. Health officials must effectively communicate these limitations to decision-makers and the public. Examples of Forecasts and Models CDC’s COVID-19 Forecast for Hospitalizations (ensemble forecast) shows the number of daily COVID-19 hospitalizations reported in the United States from the prior two months and projected daily COVID-19 hospitalizations over the coming four weeks. Information sources are independent teams meeting submission and data quality requirements. CDC’s FluSight (ensemble forecast) has many contributing teams and models that predicts the upcoming weekly laboratory confirmed influenza hospital admissions both nationally and by state. Johns Hopkins University’s Center for Systems Science and Engineering county-level risk model for COVID-19 in the United States. This model leverages epidemiological data, mobile phone data, demographic and socioeconomic information, and behavioral metrics. The Global Epidemic and Mobility Framework simulates the global spread of infectious diseases by mathematically representing infection dynamics, population geographies, and population mobility patterns. Additional Resources Disease modeling for public health: added value, challenges, and institutional constraints Predictive Models for Forecasting Public Health Scenarios: Practical Experiences Applied during the First Wave of the COVID-19 Pandemic Applying infectious disease forecasting to public health: a path forward using influenza forecasting examples Technology to advance infectious disease forecasting for outbreak management CDC-RFA-OT18-1802 2018-2024 article yes

Learn how health departments can focus their infectious disease prevention efforts in this brief.

Disease Forecasting and Modeling Data for Public Health Action Disease Forecasting Benefits Public Health Planning Disease forecasting and modeling help prepare public health departments for future infectious disease outbreaks and epidemics. Disease forecasting and modeling data can be powerful tools for state and local health agencies (S/THAs) that respond to outbreaks, develop appropriate policies, and ensure interventions have maximum impact. Actions for which decision-makers can leverage such data include: Surveillance. Forecasts and modeling help public health agencies anticipate the spread of disease or outbreaks. This advance warning allows public health officials to inform public health recommendations, preparation, and response. Communication. Disease forecasts help relate the risk of disease outbreaks to various audiences accurately and quickly, which, in turn, can inform messages on important preventive measures and encourages compliance with recommended interventions. Resource allocation. Modeling data can help decision-makers better allocate resources by predicting where and when disease outbreaks are likely to intensify and create the greatest need. Evaluation. Forecasts and modeling can help make evaluating the effectiveness of public health policies and interventions more efficient by comparing predicted outcomes with observed data and adjusting as needed. Considerations Informed by S/THA Forecasting Jurisdictions with forecasting experience identified key indicators to monitor as part of outbreak forecasting, which fall into three main categories: Epidemic spread indicators (e.g., symptom monitoring, morbidity and mortality data, percent positivity, regional pictures of transmission). Health care system capacity (e.g., essential and/or surge personnel, available beds, ventilator usage, and supply of personal protective equipment. Public health capacity for testing capacity and contact tracing. Further considerations for S/THAs: Know your strengths. Identify the unique skillsets among partners in public health, academia, and the private sector and consider how they foster reciprocal relationships. Recognize capacity/expertise gaps. Consider leveraging partnerships for specific types of analytics expertise while exploring internal capacity building opportunities (e.g., job shadowing and resource-sharing programs on workflows and methodologies). Engage legal and compliance teams. Ensure policy and practice are aligned among partners. Explore data access/sharing pipelines. Connect public, private, academic partners, and their audiences. Start small. Identify discrete forecasting and modeling projects to demonstrate success. Identify decision-makers’ needs. Provide quick access to analyses, metrics, dashboards. Michigan Used Models and Forecasting for Hep C Cases In response to Hepatitis C virus (HCV) in young adults from 2010-2018, the Michigan Department of Health and Human Services (MDHHS) simulated how HCV treatment could significantly reduce HCV prevalence among young people who inject drugs, especially for those both previously or currently injecting drugs. MDHHS used several novel predictors to paint a local picture of probable HCV diagnoses among residents up to age 40. These predictors included measures related to a variety of population characteristics (e.g., access to transportation, college education, presence of non-family households) and public health indicators (e.g., heroin treatment admissions, newborns with neonatal abstinence syndrome, and sexually-transmitted infections). MDHHS also leveraged county-level assessments of HCV vulnerability to identify locations for new syringe services programs in the state. MDHHS has recognized several modeling and analytics use cases that benefitted their work during responses to HCV and COVID-19: Short-term forecasts (i.e., weeks) helped predict likely transmission patterns and potential ranges of projections. Longer-term forecasts (i.e., months) explored scenarios based on new recommendations and policy changes. Retrospective counterfactuals evaluated the impact of policies or other changes by examining “what-if” situations. MDHHS is considering using forecasts and models for COVID-19, influenza epidemics, tuberculosis vulnerability, and C. auris spread. Resource constraints require decision-makers and public health practitioners to consider how they are using available resources for the highest return on investment. Models generated momentum to respond to threats and evaluate whether interventions were successful. CDC-RFA-OT18-1802 2018-2024 article yes

This brief dives into the impact of the COVID-19 pandemic on the ability of people with disabilities to access vital health care services during the public health emergency.

PrEP is a powerful tool to reduce new HIV infections; expanding access to PrEP is a priority within the federal Ending the HIV Epidemic in the U.S. initiative. One way to increase access to PrEP is by allowing pharmacists to prescribe and dispense it.

The Florida Department of Health created an effective algorithm to automate syphilis laboratory result processing that improves case assignment accuracy and prioritization. This tool outlines key steps and considerations for jurisdictions looking to adopt the algorithm.

Health providers have widely used telehealth to mitigate the spread of COVID-19 infection and to improve access to healthcare services thanks in large part to policy changes and regulations. This brief explores how state and territorial health agencies (S/THAs) are responding to COVID-19 through telehealth policy and operational changes, as well as how telehealth has quickly emerged as a tool to improve health equity.

ASTHO, in collaboration with CDC, provided full-time disability and preparedness specialists to 17 jurisdictions to better meet the needs of people with disabilities. In this brief, specialists share their thoughts on why people living with disabilities may be hesitant to get the COVID-19 vaccine and some approaches public health officials can take to address vaccine hesitancy in people living with disabilities.

An issue brief by ASTHO and the Duke University Margolis Center for Health Policy that highlights considerations for state health officials as they look to maximize the benefits of COVID-19 therapeutics.

Board-certified forensic pathologists play a critical role in public health by investigating death so as to better serve the living. Despite forensic pathology’s contribution to public health surveillance, prevention, and response, the discipline remains largely under-resourced and over strained. These briefs spotlight the critical role that international medical graduates play in minimizing forensic pathology workforce shortages and spotlights a local effort to address financial disincentives for medical graduates entering the field and highlights federal funding opportunities and resources for state partners looking to minimize forensic pathology workforce shortages.

Partnering with Legislative Staff to Improve Long COVID Outcomes Partner with Legislators to Improve Long COVID Outcomes Amelia Poulin and Sidnie Christian Learn how health departments can secure legislative understanding and support for Long COVID recovery efforts. Long COVID challenges public health systems, impacting individuals’ health, workforce participation, and community well-being. State and territorial health departments are leading efforts to track, understand, and mitigate the health and economic effects through surveillance, education, and coordinated care initiatives.  To maintain and expand these efforts, health department programs can secure legislative understanding and support. This requires cultivating longstanding, trust-based relationships with legislators and their staff. Strategic engagement helps legislators view health departments as indispensable partners in addressing complex public health issues with broad social and economic implications. Build Longstanding Relationships with Legislative Staff Legislative staff are often the most consistent points of contact in a lawmaker’s office and play a central role in shaping policy advice. Regular engagement strengthens trust and visibility, helps maintain productive relationships, and ensures consistent communication with legislative offices. Health agencies can achieve this by: Engaging early and often: Identify key legislative staff for health department programs to brief on emerging Long COVID data, evolving needs, and program outcomes throughout the year. These conversations provide context and set the stage for trust before policy requests. Over time, they can lead to invitations for health department representatives to provide expert input. Positioning the program as a trusted, nonpartisan source: Health department leaders can provide timely, objective information about Long COVID’s impact on local hospitals, schools, and employers. Demonstrating responsiveness: Following up on constituent inquiries related to Long COVID testing or benefits shows legislators that the health department is directly addressing concerns in their districts.   Program staff can play a key role by developing briefing materials, success stories, and district-level data to share internally with leadership or policy offices for dissemination to legislators.   Note: Health department staff should align engagement with internal communication protocols. They may centralize outreach through a legislative or government affairs office that coordinates messaging and ensures compliance with statutes and lobbying restrictions. Identify Objectives and Tailoring Asks Before reaching out to legislative staff, health department leaders should clearly define their goals (e.g., funding for post-COVID clinics, data infrastructure, or research partnerships). When health departments align requests with legislative priorities, those proposals may seem more feasible or be more likely to gain support. Keys to doing so include: Understanding legislator priorities: Review voting history, public statements, and committee membership (e.g., health, workforce, budget). Identify shared interests such as workforce participation, economic productivity, or small business resilience. Choosing the right messenger: Personal narratives from constituents affected by Long COVID related to the sub-issue (e.g., a small business owner struggling to return to work, a teacher navigating disability benefits, or a parent managing caregiving responsibilities) can be effective. Consider pairing stories with district-specific data to illustrate scope. State health departments can also amplify impact by working with local health jurisdictions to paint a larger picture of how Long COVID impacts communities in the region. For example, drawing connections between workforce impacts across multiple counties can demonstrate to legislators that Long COVID affects the state’s overall economic resilience, not just isolated communities. This approach can help legislative staff see statewide trends and understand how targeted investments could yield system-wide benefits. Crafting the message: Use plain, non-technical language to describe Long COVID (e.g., “lingering symptoms after COVID infection” rather than “post-acute sequelae”). Consider emphasizing economic impacts (e.g., missed work or school days, productivity losses, and long-term disability claims) and framing the health department as a problem solver that helps businesses/families recover and navigate challenges, rather than a requester for resources. Communicate Effectively Legislators are often time constrained. Clear, concise, and locally relevant messages are most effective. To build an effective ask of a legislator’s office, health department staff can: Use their language: Translate public health concepts into legislative priorities (e.g., “economic competitiveness,” “community stability,” “health care access”). Incorporate local data: Share district-level statistics on Long COVID cases or workforce absences, as data allows (e.g., “in your district, an estimated 5,000 workers have missed more than two weeks of work due to Long COVID”). Combine data with moral resonance: Pair values-based appeals (e.g., “every resident and their family deserve the chance to live and work at their full potential”) with supporting evidence (“yet one in four adults in this district continue to experience symptoms six months after infection, limiting their ability to contribute to the workforce and community”). Leave behind resources: Provide one-page infographics or briefing sheets summarizing data and program activities. Follow up to reinforce conversations with updates, success stories, and progress metrics. Anticipate Policy Dynamics and Counterarguments Legislative discussions may surface alternative policy ideas or misconceptions about Long COVID and health agency program roles. Consider preparing for opportunities to: Answer questions: Public health leaders should be prepared to clearly explain the department’s legal authority, the evidence base for Long COVID programs, and the partnerships that support implementation. Consider explaining how scientific research, emerging epidemiologic data, and best practices inform Long Covid programs and how partnerships with hospitals, clinics, and community organizations help ensure effective service delivery. Clear, concise explanations help legislators understand the health department’s scope and role, build credibility, and preempt misconceptions that could undermine support for program priorities. Acknowledge unintended consequences: Demonstrate awareness of policy trade-offs and propose pragmatic solutions. For example: A proposal to expand Long COVID benefits might raise concerns about budget constraints. Health department leaders could suggest phased implementation or pilot programs in high burden areas. Understand alternatives: Be prepared to discuss other proposed interventions and show how the health department’s approach complements them. For example: If a legislator suggests employer-led sick leave policies as the primary solution to Long COVID, the health department could explain that monitoring Long COVID prevalence and providing patient support can help ensure workers’ safe return to their jobs, complementing workplace policies. Leverage rulemaking: When statutory change is limited, use administrative rulemaking and public comment to align implementation with public health intent.   Conclusion Building lasting, credible relationships with legislative staff allows health departments to move from reactive engagement to a proactive strategy. By pairing constituent stories with district-specific data, aligning messages with economic and moral values, and maintaining year-round communication, public health leaders can secure sustained support for Long COVID initiatives. These strategies not only advance Long COVID priorities but also strengthen the overall policy capacity and visibility of public health agencies, positioning them as trusted, solutions-oriented partners in state governance.   article yes

Strengthen your knowledge of wastewater surveillance ethics, with firsthand insights on key challenges and considerations from state health agencies and partners.

This brief discusses the difficulty of maintaining compassion and empathy during public health crises, which ultimately leads to a phenomenon called compassion fatigue. 

This brief focuses on how telehealth expansion during the COVID-19 pandemic has increased access to care for pregnant and postpartum women, and made maternal and child health care services like doulas and midwives more accessible.

Health Officials Intensify Zika Prevention Efforts ARLINGTON, VA—State and territorial health officials are redoubling prevention efforts to address the serious public health threats associated with Zika virus and to protect the health of mothers and babies. Yesterday, CDC published an analysis of nearly 1,300 pregnant women with evidence of Zika infection, per data reported by 44 states to the U.S. Zika Pregnancy Registry in 2016. About 1 in 10 pregnant women with confirmed Zika had a fetus or baby with birth defects. In light of these findings, the Association of State and Territorial Health Officials (ASTHO) calls for continued resources to support an aggressive, long-term governmental public health response to Zika, including laboratory, epidemiological, and surveillance capacity, vector control, and public awareness and education campaigns. With most of the women in the study acquiring Zika infection during travel to an area where Zika was present, all jurisdictions within the United States must remain on alert and prepared due to travel-related cases and sexual transmission. Also, with warmer weather and mosquito season approaching, CDC’s new Vital Signs report highlights the need for ongoing vigilance and sustained measures to prevent and manage cases of Zika, diagnose patients, increase lab capacity and vector control, and coordinate Zika-related birth defects surveillance activities, especially in parts of the United States where local transmission through the bite from the specific mosquito capable of carrying the Zika virus is possible. “Public health has a long history of combatting and eradicating mosquito-borne diseases, but ensuring robust epidemiological and laboratory infrastructure across the governmental public health system is critical to stay ahead of the spread of Zika virus,” says Brenda Fitzgerald, ASTHO president-elect and commissioner and state health officer of the Georgia Department of Public Health. “In Georgia, for example, we have limited geographic mosquito surveillance and vector control capabilities. That causes particular concern about the 63 counties at higher risk of Zika transmission due to their dense populations, high rates of poverty, and large numbers of females of reproductive age.” State, territorial, and local health departments play an active role in determining the risk of ongoing local transmission through enhanced surveillance and vector control activities. Health departments, together with healthcare professionals, laboratory experts, and disease control specialists, are working nonstop to protect Americans from Zika and other emerging health threats. Strong collaboration among state and local partners is critical to protecting pregnant women against Zika and connecting affected families with medical, social, and community resources. ASTHO urges sustained investments in public health funding to give state, local, tribal, and territorial health departments the resources needed to pursue a broad range of strategies to prevent Zika virus. ASTHO Press Release Boilerplate website yes

ASTHO Statement on Autism and Vaccines ARLINGTON, VA — ASTHO Chief Medical Officer Susan Kansagra, MD, MBA made the following statement regarding vaccines and autism: “As public health professionals, we unequivocally support the use of vaccines to prevent infectious diseases. The science behind vaccines is robust and well-tested and the overwhelming consensus of scientific evidence is clear that there is no link between vaccines and autism. Vaccines have been rigorously tested and examined for decades. They are one of the most significant public health achievements in human history, having saved countless lives and prevented immeasurable suffering. We all want our kids to be healthy and strong. Please consult your health care provider if you have questions.” ASTHO Press Release Boilerplate website yes

ASTHO issues a statement affirming strong support for routine vaccinations as a vital public health measure to protect individuals and communities from serious infectious diseases.

In honor of ASTHO’s 80th anniversary, a leadership panel—including CEO Michael Fraser, President Anne Zink, Past President Nirav Shah, and Idaho Commissioner of Health Elke Shaw-Tulloch—discusses the unique role ASTHO plays in the public health landscape.

COVID-19 has impacted the ways in which we prevent, detect, and treat tuberculosis infections. In this episode, experts discuss the current state of TB, and the challenges and areas of opportunity posed by the COVID-19 pandemic.

In this podcast episode, Scott Harris and Mei Kwong explore the current state of telehealth during COVID-19 and how it’s being used as a tool to access care, spotlighting examples from public health.