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Discover how improving public health data infrastructure can create more robust care for people with disabilities in this blog post.

Exercise Excellence: Michigan Reflects on a National Level Exercise Exercise Excellence: Michigan Reflects on a National Level Exercise Adrianna Evans Learn how Michigan's health department collaborated with state and federal partners for a radiation preparedness exercise. In March 2025, the Department of Energy hosted a national level exercise designed to promote radiation readiness. This exercise, called Cobalt Magnet 25, brought together a wide variety of interdisciplinary partners from federal, state, local, and international governments, among other partners. Michigan hosted the exercise. ASTHO’s Director of Preparedness, Adrianna (Annie) Evans, sat down with representatives from the Michigan Department of Health and Human Services (MDHHS) to learn about their experiences with Cobalt Magnet 25, how they’ve applied lessons learned one year later, and how those lessons might be applied to different threats. This blog post will be the first in a series “Exercise Excellence” that shares insights and perspectives from emergency preparedness exercises. This first blog post will share insights from Michigan on Cobalt Magnet 25 overall preparation, planning, collaboration, and more. Tell us about your experience with Cobalt Magnet 25. Jason Smith, Emergency Management Coordinator: While Michigan State Police, our state’s emergency management agency, took a key role with the U.S. Department of Energy on lead exercise planning, MDHHS served as lead exercise planner, player, and co-chaired a public health and environment working group alongside partners from Ontario and the Michigan Department of Environment, Great Lakes, and Energy. MDHHS leveraged this opportunity to initiate internal play and engage local public health and health care partners across the region. This included representation from two health care coalitions, five local health departments, and four major health care systems — many of which were outside the directly affected communities for this scenario. MDHHS activated our emergency coordination center. Overall, the Cobalt Magnet 25 Full Scale Exercise featured over a thousand injects emphasizing field sampling, decontamination, and reception centers. Our participation spanned preparedness, laboratory, environmental health, behavior health, disability health, and communications, including our public information officers. This experience strengthened cross-jurisdictional coordination and enhanced MDHHS's operational readiness for radiological incidents. Terra Riddle, Director, Division of Emergency Preparedness and Response: From my perspective, Cobalt Magnet 25 was impressive. Each player jurisdiction had the opportunity to make the exercise meaningful. It was really great to see all the partners come together and how each jurisdiction worked through these scenarios. It was unique in the communications world due to the depth, richness, and realness of the exercise play. Jay Fiedler, Director, Bureau of Emergency Preparedness, EMS, and Systems of Care: I participated when the larger group convened as part of the planning process. I hadn't seen something like this before in an exercise of this caliber. One of those activities was a briefing held for departmental leadership of state and federal agencies leading into the full exercise. I also served in the response coordinator role in our Community Health Emergency Coordination Center during the exercise itself. What was the preparation and planning process like for this exercise? Fiedler: This was roughly a yearlong planning process facilitated by a federal contractor, but it required extensive engagement with our state and federal partners. Jason worked in regular planning meetings and activities throughout that year. Some ways that the players were pulled together in meetings leading up to the exercise were really valuable for creating partnerships. Our partners from Ontario joined us. We don’t always get to work with them. That helped facilitate enthusiasm for the exercise itself and enhanced coordination between all the players involved. Smith: In addition to the exercise planning itself, the beauty of Michigan hosting Cobalt Magnet 25 was the opportunity to capitalize on existing trainings, whether it be through Counter Terrorism Operations Support, general radiological emergency preparedness training, and programs through CDC — primarily their public health decision-making course for radiological emergencies. There was a lot of training going on behind the scenes to build up awareness and capacity over the year. I thought the education opportunities made the exercise itself a success. Riddle: I'm glad you mentioned that, Jason, because it brought up another thought about the in-depth training led by the federal partners in the communications world. They invited our partners at the state and local levels to participate in radiological and communications training that was pretty niche. Our partners appreciated that this training prepared them for the exercise and it has spurred lot of conversation since about where we go next. This type of scenario requires a lot of collaboration with government agencies across levels of government, different fields, and even other countries. How did you manage that collaboration and what lessons did you learn? Riddle: The big takeaway is that trust built before a crisis sustains coordination during a crisis. This exercise required management across local, state, federal, and international partners with clear roles, consistent communication channels, and shared objectives early on. Fiedler: The pre-meetings were a unique aspect of this exercise and the connections built were really valuable. I hadn't seen that until an exercise of this scope and scale, but will be helpful going forward as we think about how we work and plan exercises as a whole. Smith: One lesson learned was that there is a bigger appetite for training, both in our department and local partners. Michigan has three nuclear power plants. That prevailing threat does build some desire for general awareness throughout the state, particularly among our 45 health departments. We also realized we need to work a little bit more collaboratively with our environmental partners, our agricultural partners, and have a more unified response effort. Riddle: If I can add, there's always an appetite for training and for support for our local partners, but Cobalt Magnet 25 brought visibility into different types of training. Jason explored radiological training. We explored communications training. Now I wonder all the time if there is a partner that could offer new trainings that we haven’t done before. What’s next for MI? Does MI have any other upcoming exercises — radiological/nuclear or otherwise — that you’re looking forward to? Smith: We’re focusing on a comprehensive overhaul of our response plans — not only our radiological nuclear hazards, but also for other functional and hazard specific annexes. In February 2026, we worked with our emergency management agency, local health departments, and health care coalition partners on a severe weather functional exercise. We also have a few workshops and tabletops scheduled for spring 2026 on volunteer management and vector-borne diseases. Additionally, we're prioritizing One Health coordination and formal agreements with agriculture and environmental agencies to strengthen collaboration across the quality-of-life sector. Lastly, we have a climate change tabletop exercise planned in partnership with environmental health teams within MDHHS. These initiatives reflect our commitment to building resilience across multiple hazards while continuing to advance radiological preparedness. Riddle: The depth of relationships continue to be a leading priority. Regardless of the emergency, our teams working together will be our strength. We're all interconnected and that plays into different activities. For example, our patient movement work, which inherently has many partners and requires close coordination like we saw with Cobalt Magnet 25. Exercise Excellence - Radiation Resources article yes

Learn how Michigan has applied lessons learned a year later from a radiological exercise in this blog post.

There are a number of court cases playing out across the country that could affect the options state and territorial health officials have to limit the spread of disease and promote health and well-being.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

As COVID-19 emerged and spread in the U.S., people working and residing in long-term care facilities have experienced a significant burden of COVID-19 cases and deaths. As of Oct. 8, deaths associated with these facilities account for 40% of total COVID-19 deaths in the U.S. Health officials have taken measures to improve their funding and capacity.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

With Omicron surges pushing jurisdictions to activate protocols for providing healthcare during crisis, it is important to incorporate disability inclusion into these crisis standards of care.

As COVID-19 spread across the country, governors and health officials invoked their emergency powers to order physical distancing measures designed to reduce social interactions and slow the spread of the disease. Several of these measures, such as stay-at-home orders, business and school closures, public gathering limits, face covering requirements, and others, are being challenged in federal and state courts. Many of the legal challenges include claims of executive overreach and misuse of emergency power as well as allegations of violating individual rights protected by the U.S. Constitution.

Toxic stress contributes to a variety of negative outcomes for children. And unfortunately, COVID-19 has increased the likelihood of children experiencing childhood trauma, adverse childhood experiences (ACEs), and toxic stress. States and territories should have programmatic, and policy mechanisms to both prevent and mitigate the lifelong effects. A CDC Vital Signs Report found that preventing or mitigating ACEs could reduce depressive disorder by 44%, smoking by 33%, and unemployment by 15%.

States Stay Prepared by Supporting the Public Health Workforce Margaret Nilz, Christina Severin Learn how states use policy to support emergency preparedness and bolster the public health workforce. Public health — particularly public health preparedness — continues to experience workforce shortages, driven by longstanding systemic challenges such as chronic underfunding, high turnover, limited recruitment, and an aging workforce. While some jurisdictions report increased capacity to hire and train public health staff in recent years, they often rely on short-term or temporary funding streams, which limit long-term sustainability. State, local, tribal, and territorial health agencies have varying capacities to respond to public health emergencies, particularly in rural and underserved communities. Because a limited workforce can inhibit emergency preparedness efforts, jurisdictions recognize the importance of cultivating a resilient public health preparedness workforce to respond to future emergencies. In recent years, jurisdictions have pursued several policy interventions to bolster the public health preparedness workforce such as legislation supporting front-line clinical staff and first responders, and rulemaking and other executive powers to provide structural and financial support to critical personnel. Legislative Efforts Legislative efforts to increase benefits and support for health care and public health workers can help address the root causes of workforce challenges and lay the groundwork for sustainable, long-term investment in public health preparedness. Laws that establish standards and expectations for the preparedness workforce, including expansions of benefits or additional training, support workforce growth and retention. Since 2024, several jurisdictions expanded mental health benefits and related support for first responders and other preparedness personnel. Both Alaska (SB 103) and California (AB 2859) enacted legislation that allows peer support programs for emergency service personnel. In Alaska, the bill creates programs for entities such as law enforcement agencies, firefighters, and emergency dispatchers, while California’s bill creates programs to serve a variety of health care providers involved in emergency medical care, including physicians, nurses, paramedics, and emergency medical technicians (EMTs). Utah enacted HB 378, which requires the Department of Public Safety to annually distribute information about its critical incident stress management program to first responder agencies. The bill also requires first responder agencies to annually notify employees about the availability of mental health resources, including periodic screenings for employees and continued support for retired or separated first responders and their spouses. On a broader scale, Hawaii SB 3279 recently established a well-being project tasked with mental health trainings and support for several community organizations, including first responders, hospitals, and medical staff. In Washington, HB 2311 directs the state’s Criminal Justice Training Commission to develop resources for first responder wellness, including a peer support network for active and retired first responders and their families. States have also enacted legislation expanding traditional employment-related benefits, including Colorado (HB 24-1219), which expanded certain health benefits for firefighters to include part-time and volunteer firefighters, and Idaho HB 55, which allows retired public employees to volunteer with public employers without it being considered reemployment. In addition, Georgia HB 451 requires state and local entities to provide disability benefits for first responders who experience occupational or volunteer-related post-traumatic stress disorder. Finally, several jurisdictions enacted legislation to support education and training for their public health and health care workforce. For example, Kentucky HB 484 established an emergency medical service education grant program that provides tuition support for students pursuing paramedic certification, wage reimbursement to ambulance providers whose employees pursue certification, and funding for institutions planning to offer EMT, advanced EMT, and paramedic programs. Oklahoma HB 1696 expands eligibility for the Oklahoma Medical Loan Repayment program to include certified nurse practitioners. Two new laws in Puerto Rico require police officers with the Puerto Rico Police Bureau to be certified in first aid or immediate rescue (PC 0859) and adds seminars on sign language, suicide prevention, and conflict mediation to the Bureau’s continuing education training (PC 0543). Other Policy Levers: Beyond the Legislature Jurisdictions can also use non-legislative policy tools to enhance workforce capacity in public health preparedness. This includes rulemaking, where executive agencies use existing legal authority to adopt or amend regulations. Regulations have the force of law and can help support the public health workforce by establishing licensure standards, training requirements, and operational protocols. Wisconsin, following the enactment of AB 576 in 2024, is developing rules to establish a program for peer support and critical stress management teams in the state. And Utah recently adopted rules for its first responder mental health services grant, which helps these professionals pursue a degree or certification as a mental health provider. Government agencies can also leverage grants and contracts to fund and otherwise direct workforce development initiatives, support training programs, and expand capacity in targeted areas. Jurisdictions can strategically direct funds to address skill gaps and assist local, state, tribal, and territorial agencies build a more resilient workforce. One example of this is in Michigan, where in 2024 the state health agency issued a request for grant proposals to award up to $9 million in EMS workforce grants, building on similar awards to address EMS shortages in 2023. Executive orders are another policy option for jurisdictions to consider as they explore different pathways to workforce sustainability. Executive orders are issued by a jurisdiction’s chief executive (often the governor) and direct certain policy actions or activities. Generally, the power to issue an executive order comes from existing law or a jurisdiction’s constitution and, in most cases, does not require legislative approval or review. Several states have leveraged executive orders to advance the public health workforce and support preparedness activities more specifically. For example, Vermont and New Jersey have recently used executive orders to create or extend advisory councils on issues pertinent to public health preparedness. In 2024, Virginia’s governor issued an executive order formalizing the Office of First Responder Wellness, which provides training, counseling, and other resources to first responders in Virginia. In 2023, the governor of Maryland issued an executive order establishing a State of Preparedness directive if there is a risk of public emergency, and the actions state agencies must undertake to promote improved coordination and hazard planning. Key Takeaways Addressing public health emergency preparedness workforce challenges demands strategic, long-term policy solutions, but several implementation options are available. Health agencies can pursue a variety of policy interventions to support and prepare their public health workforce for future emergencies. ASTHO will continue to monitor this important issue and provide updates as appropriate. article yes

The need for food and nutritional assistance is growing. Based on Feeding America’s food insecurity projections released in March, it is anticipated that 42 million people may experience food insecurity this year—up from 35 million pre-pandemic. The job loss in communities as businesses had to shut down or reduce capacity has left many families across the country relying on food banks. In fact, food banks in the Feeding America network distributed 6.1 billion meals to individuals and families during this pandemic, an increase of 43% from 2019. Many of the people who have fallen into food insecurity are experiencing it for the first time in their lives, as our food pantry partners across the country report that 35% or more of the people they’re serving today had never received charitable food prior to the pandemic.

As the number of COVID-19 vaccinations grows, some states are looking at their vaccination rates to determine when to loosen measures that mitigate the spread of COVID-19, such as venue capacity limits, business closure times, and masking requirements. As vaccinations allow businesses to reopen and customers to return, questions have arisen about whether venues or services—especially those that bring people in close contact for long periods of times—such as retail stores, concert venues, entertainment venues, air travel, cruise ships, etc., can require patrons or customers to verify that they received a COVID-19 vaccine. So far, state policy makers have had mixed views on the issue.