Learn about health legislative priorities through the end of 2025, related to Medicaid and Medicare, the Affordable Care Act, site-neutral payments, and more.
Federal funding that supports public healthy emergency preparedness is critical. Read the latest on PAHPA and more in the Health Policy Update.
Discover how improving public health data infrastructure can create more robust care for people with disabilities in this blog post.
Learn about the importance of including animals in emergency planning in this blog post.
Learn how Michigan has applied lessons learned a year later from a radiological exercise 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
State Policy Trends in Cybersecurity and Public Health Preparedness Maggie Nilz Learn how states are including cybersecurity in their emergency preparedness work in this Health Policy Update. Cybersecurity is an increasingly important component of public health preparedness as state cybersecurity policy intersects with public health agency responsibilities. Public health agencies rely on interconnected digital systems and critical infrastructure for disease surveillance, laboratory reporting, emergency communications, and health data management, making cybersecurity critical to maintaining these functions. Beyond compromising sensitive data and potentially harming patients, cyber incidents can disrupt essential public health services, including emergency response operations. Health care data breaches have steadily increased over the last 15 years, highlighting growing risks for government and health systems. A recent report showed that more than 7,000 health care data breaches were reported to the Department of Health and Human Services since 2009, and reported HIPAA data breaches in 2023 were nearly double the number recorded in 2018. Meanwhile, preparedness capacity has lagged: as of 2022, only 13% of local health departments reported being prepared for cyber-related disruptions, and recent scans show cybersecurity is rarely included in emergency preparedness planning. In response at the federal level, HHS recently announced it is undoing a 2024 reorganization by returning department-wide technology responsibilities to the Office of the Chief Information Officer while refocusing the Office of the National Coordinator for Health Information Technology on improving nationwide health IT interoperability and data sharing. In recent years, state and territorial legislatures have begun to address these gaps by incorporating cybersecurity into preparedness, health care oversight, and statewide governance structures. These legislative trends signal a need to integrate cybersecurity into emergency operations plans, strengthen cross-sector coordination, and safeguard the continuity of public health services. Some of the most recent policies considered and enacted by legislatures treat cyber incidents as emergencies, expand reporting requirements, and strengthen cyber governance. Cyber Incidents Are Being Built into Emergency Preparedness Frameworks In response to these growing threats, jurisdictions have begun incorporating cyber response into emergency plans and strategies, reinforcing cybersecurity as essential to preparedness. These developments highlight growing awareness that cyber incidents can disrupt critical services, much like natural disasters. In 2025, New York enacted S 7672, which requires municipal entities and public authorities report cybersecurity incidents and demands for ransom to the state Division of Homeland Security and Emergency Services. In addition, it directs the Director of the Office of Information Services to establish cybersecurity training and protection standards for state systems as well as require cybersecurity training for state and local government employees. Virginia is currently considering HB 83, which would establish a volunteer Cyber Civilian Corps within the state IT agency to provide rapid assistance during cybersecurity incidents affecting municipalities, nonprofits, education, and critical infrastructure. Preparedness efforts also extend beyond legislation to executive action. In February 2026, Minnesota Governor Tim Walz authorized $1.2 million in state disaster assistance to support response efforts and restore critical systems in response to a cyber incident that disrupted digital services in Saint Paul on July 29, 2025. Additionally, the National Governors Association has included cybersecurity as a primary consideration for planning and preparedness in their latest edition of the Public Health Emergency Playbook. Health care and Public Health Critical Sectors Are Facing New Cyber Requirements Beyond emergency response frameworks, jurisdictions are also adopting cybersecurity reporting and planning requirements for health care and public health organizations. Companion bills in Tennessee (HB 511/SB 555) would require health care providers and facilities to notify their contracted health insurers of cybersecurity incidents. In Maine, LD 2103 would require hospitals to adopt cybersecurity plans to protect patient data and maintain operations, and must include cybersecurity training for employees and board members. New Jersey is looking to adopt and implement a more comprehensive cybersecurity plan across all sectors. This session, legislators have introduced at least two cyber security bills: A 3231 would require “sensitive businesses” (defined as those engaged in financial, essential infrastructure, or health care industries) to report cybersecurity incidents to the New Jersey Cybersecurity and Communications Integration Cell (NJCCIC) when they are aware of their occurrence and would require NJCCIC to conduct a cybersecurity audit within 30 days of notification. A 3283 would require the same “sensitive businesses” to implement cybersecurity programs in accordance with standards adopted by NJCCIC and certify compliance annually. As states expand reporting and cybersecurity requirements, these obligations may intersect with public health reporting and continuity planning. States Are Strengthening Government Cyber Governance and Coordination In addition to sector-specific requirements, jurisdictions are also strengthening the governance structures responsible for coordinating cybersecurity, improving their ability to respond to large-scale incidents affecting public systems. Legislation enacted recently in Texas and California aim to improve coordination among state government by establishing a state agency centralizing cybersecurity incident prevention and response (Texas HB 150) and mandating the development of a cybersecurity playbook to strengthen information sharing (California AB 979). A 2024 bill enacted in Puerto Rico (PC 1530) requires commonwealth agencies to develop and implement a cybersecurity program, which must include a yearly risk assessment as well as vulnerability assessment. At least three jurisdictions are currently considering bills strengthening established cybersecurity programs, with two states recently passing legislation. Utah recently enacted a bill authorizing the Utah Cyber Center to conduct voluntary cybersecurity risk assessments for critical infrastructure and coordinate with government entities on infrastructure safety (HB 165). Utah also enacted legislation creating a specific funding stream for the Center to use for various activities, including implementing a statewide cybersecurity plan and conducting assessments for governmental entities (SB 123). Kansas enacted HB 2574, which would require chief information security officers for the executive, legislative, and judicial branches to adopt cybersecurity programs based on a nationally recognized standard for governmental entities. Finally, Florida recently passed SB 7024, which would expand the state’s public record exemption to include risk assessments, information related to cybersecurity breaches, and information related to data protection, ensuring the confidentiality of sensitive cybersecurity information held by state agencies; the bill is with the governor for final consideration. Key Takeaways for Preparedness Leaders Cybersecurity is critical for preparedness across multiple policy areas, and requires new planning, coordination, and oversight responsibilities. By including cyber incidents into disaster frameworks, standards for health care organizations, and governance, preparedness leaders may find themselves more directly engaged in integrating cybersecurity into emergency operations, exercises, and cross-sector partnerships. For state and territorial health agencies beginning to incorporate cybersecurity into their preparedness plans, agencies such as the Cybersecurity and Infrastructure Security Agency provide jurisdictional support and resources to guide this work. article yes
Learn how the Pandemic and All-Hazards Preparedness Act impacts public health emergency readiness and proposed changes to this legislation.
This post features input from departments in North Carolina, South Carolina, and Texas to learn more about their experiences of post-hurricane environmental health issues, as well as advice and best practices for responding to these challenges.
Learn how health agencies are prioritizing children’s health as they develop public health emergency preparedness planning in this blog.
Strengthening Leadership, Risk Communications, and Preparedness in the Islands Strengthening Public Health Preparedness in the Islands Sidnie Christian, Alyssa Boyea Key strategies in on leadership, risk communications, and preparedness, can help island jurisdictions prepare for and respond to emerging public health threats. ASTHO convened a two-day, in-person workshop in Honolulu from June 25 – 26, bringing together public health preparedness staff from American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaiʻi, the Republic of the Marshall Islands (RMI), and Palau, as well as federal partners from CDC, the Department of Homeland Security, and the Administration for Strategic Preparedness and Response. The workshop focused on leadership and workforce development, risk communications, administrative preparedness, and more to support island areas as they prepare for and respond to natural disasters and other emerging public health threats, of which emerged key learnings that can benefit all island jurisdictions. Leadership and Workforce Development Leading through change requires transparency, trust, and collaboration. Planned change involves assessing readiness for change, identifying resources needed, securing buy-in, and determining a path forward. However, sometimes change can leave little to no time for preparation. Island jurisdictions have encountered challenges in the face of change, with many workshop participants sharing firsthand challenges around retaining institutional knowledge, infrastructure, and receiving assistance from the mainland United States in a timely fashion. As such, change readiness, succession planning, and effective change management practices are of utmost importance in the islands. Key recommendations and takeaways include: Utilizing a reputable framework, such as Kotter 8-Step Change Model, is pivotal for improving change readiness and change management. Change management frameworks and methods can assist with different types of change including structural change, strategic operational change, people-centric change, etc. Trust is hard to build, but easy to lose. Participants spoke about characteristics of high trust relationships including open communication, consistency, good judgement or expertise, and cultural sensitivity, while low trust relationships characteristics include lack of communication, inconsistency, and lack of teamwork. Succession planning is important to ensure institutional knowledge and capabilities remain in the wake of staff turnover or retirement. Identifying the necessary expertise, skills, and capabilities for each role is vital in the case of unplanned changes in staffing. Promising practices include annual review of critical positions, conducting talent calibration sessions, defining action plans, and obtaining buy-in from leadership and relevant partners. Risk Communications The island jurisdictions face emergencies that require creative response efforts. Both Hawaiʻi and RMI demonstrated innovative approaches in risk communications during COVID-19, finding success in forming critical partnerships, utilizing trusted voices within the community, and bridging communication gaps: Hawaiʻi utilized social media to showcase individuals such as doctors, pastors, social media influencers, and even local sports teams getting vaccinated, and utilized trusted voices to deliver messages. Additionally, they translated their materials into three languages (Marshallese, Samoan, and Hawaiʻian), modeling that no one gets forgotten, the true meaning of “ohana.” RMI created a working group with a mix of partners that curated press releases, educational materials, and sitreps, and served as a liaison between RMI Ministry of Health and Human Services and the community. It also partnered with several media outlets (e.g., radio stations, local papers, and other private sectors) and utilized mass text messaging to spread information quickly. The latter proved to resonate with most island jurisdictions who struggle with staying connected to hard-to-reach populations, namely those in more rural and disconnected communities. RMI was able to connect with these populations through WhatsApp to keep them updated throughout the COVID-19 response. Administrative Preparedness Improving administrative preparedness plans and processes ensure timely and efficient access to needed resources for a public health response. Most workshop participants are currently in the process of updating existing administrative preparedness plans, while some are working with other departments to create and implement new plans. Attendees discussed key partnerships for collaboration including other departments, Medical Reserve Corps, and other volunteer organizations. One common key challenge that emerged was around staffing (e.g., finding qualified people to fill vacancies, hiring process issues, making sure positions are competitive, etc.). To address this issue, island jurisdictions can work closely with other departments or jurisdictional agencies to streamline current processes, establish memorandums of understanding with different partners/facilities to assist with emergency procurement, and ensuring staffing vacancies are competitive and match public health classifications. Disease Forecasting A survey on state and territorial expertise and needs for infectious disease forecasts, models, and other outbreak analytic techniques—implemented by ASTHO with support from CDC’s Center for Forecasting and Outbreak Analytics—revealed that respondents from island jurisdictions experienced several barriers that led to limited use of infectious disease forecasts to inform communication and decision making. Challenges noted include limited software access, limited disease modeling capacity or skills, and lack of uniform reporting systems. Through a discussion-based exercise, workshop participants shared their challenges and considerations for ASTHO and CDC to assist with disease forecasting in the island jurisdictions moving forward. Challenges include but are not limited to: Delays with sending samples to labs and receiving results in a timely manner. Without timely results, it is challenging to take swift action. Lack of staff / staff wearing many hats with limited capacity. In most cases, there is no specific communication plan for disease forecasting within the departments. Communication can be challenging without clear processes and channels. Participants noted the desire for additional disease forecasting training and opportunities for collaboration. They suggested an integrated training session with island epidemiologists and other relevant staff to enhance disease forecasting knowledge and communication, as well as strengthen collaboration. Preparing for and Responding to Climate Events From hurricanes to typhoons to volcanic eruptions, the island jurisdictions are no strangers to the effects of changing climate. Willliam “Brandon” Aydlett, science and operations officer at the National Weather Service, and Shelbi Davis, Senior Analyst on the Environmental Health team at ASTHO, offer the following recommendations to island jurisdictions for preparing and responding to unprecedented climate events, as discussed with workshop participants: Create or update standard operating procedures for various climate related responses unique to the island. Always prepare for a category higher storm than is expected. Consider conducting regular vulnerability assessments to better understand areas where the island or its people may be most susceptible to adverse health impacts from climate events. Jurisdictions can learn from one another and find a sense of camaraderie in their preparedness efforts, much like the workshop participants. For example, one island jurisdiction noted that they currently do not have a warehouse to store equipment but are working on a plan to secure one; another jurisdiction, having recently revamped their warehouse, noted that they could assist their island neighbor in this endeavor and provide lessons learned as well as strategies to help secure a warehouse that will fit their needs. Looking Toward the Future Sharing lessons learned with one another and reflecting on how to apply those learnings in respective communities is crucial. Workshop participants shared their intent to share and utilize resources and information shared throughout the workshop with their leadership and team to begin implementing in their jurisdictions, as well as using strategies and skills learned to enhance partnerships. To all the participants and our Hawaiʻian hosts, we say mahalo. Related Resources Modernizing Infrastructure and Facilities for Readiness and Response | ASTHO PH-HERO Workforce Resource Center | ASTHO ASTHO STAR Center | ASTHO Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response | JPHMP article yes
Lessons from previous emergencies, like Zika, can help states create an effective response plan for future emergencies and protect maternal and child health.
People who use electricity-dependent durable medical equipment (DME) at home—such as ventilators and oxygen concentrators—can face life-threatening consequences during a power outage. HHS reports that 2.7 million Medicare beneficiaries rely on electricity-dependent DME to live independently. This ASTHOBrief details the significant challenges that individuals who rely on electricity-dependent DME face during power outages and discuss recent efforts to increase support for this population.
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.
The Homeland Security Exercise and Evaluation Program includes seven exercise types that are either discussion-based or operations-based.
This brief from ASTHO discusses the results of standing up virtual and hybrid emergency operations centers during the covid-19 pandemic.
The Louisiana Department of Health has developed Power Outage Partners, a first-of-its-kind program to recruit owners of stand-by residential generators to recharge the batteries of neighbors’ life support equipment during power outages.
This infographic breaks down the top 10 takeaways from the 2022 Climate and Health Capacity Survey.
An ASTHO brief on the importance of understanding moral injury and burnout, with recommendations on areas of organizational focus.
Better Defining Disability Will Make Data More Inclusive and Usable ASTHO, association of state and territorial health officials, access to health care, centers for disease control, syndromic surveillance systems, health outcomes, person with a disability, disaster medical assistance team dmat, mental health conditions, people with disabilities, health disparities, mental health, health equity, public health emergencies, syndromic surveillance, disaster medical assistance teams, disability data, people living with disabilities, disability inclusion Margaret Nilz ASTHO | Syndromic surveillance data on disability prevalence will help people with disabilities in emergencies. Over the past two decades, the frequency and intensity of natural disasters have increased — and will continue to do so. While disasters impact whole communities, past incidents highlight specific effects on people with disabilities, as it is more challenging for them to prepare for and recover from an incident. Understanding the prevalence of disability in a jurisdiction helps fully address the population’s needs. There is not a universally accepted way to collect data on people with disabilities. However, the need for disaggregated data by disability status is critical to helping measure health disparities and underlying factors contributing to inequities. Such data will support the development and continuous evaluation and improvement of public health programs and policies. Key Considerations for Collecting Data on People with Disabilities Disability data is essential for inclusive public health practice. Several factors are important to keep in mind when gathering data on people with disabilities. Participation is critical as exclusion from research can further marginalize already vulnerable groups and limit access to advancements. Accounting for historical trauma/negative impacts helps people with disabilities who are at increased risk of coercion, inclusion without consent, and other exploitation. Unwarranted disability assessments, particularly those implemented with limited evidence of effectiveness, have been shown to have negative mental health impacts on participants with disabilities. Different models of disability provide a reference as programs, services, laws, and regulations are developed. Primary models of disability include the Medical Model, Functional Model, Social Model, and Medical/Rehabilitative Model. Current Measures and Definitions of Disability - Brief - Better Defining Disability Disability Inclusion in National Syndromic Surveillance Program (NSSP) NSSP includes electronic health record (EHR) data from 73% of the nation’s emergency departments (EDs). However, it contains no systemic way to identify people with disabilities. Including disability data within a system as valuable as NSSP can help close gaps in monitoring the impacts of emergencies on people with disabilities. Syndromic surveillance data can guide decision-making during emergencies and policy formation at the local, state, and national levels. There are limitations of using syndromic surveillance data. First, diagnostic codes may not map directly onto functional limitations. Second, codes do not provide information about residual functioning, loss of functioning, or disability severity. Additionally, reporting in EHRs may not be accurate due to input or data errors. Codes can be related to a visit or encounter, even if it does not end up being true for a patient. Furthermore, diagnostic codes reflecting disability may not be used in every encounter and people with disabilities may be missed through using ED data as it only represents a snapshot in time. Benefits of Expanding Disability Data Access and Use Expanding the collection, access, and use of disability data for public health program development and emergency preparedness promotes health equity for people with disabilities. More specifically, this data can inform fiscal, programmatic, service policy, and public health planning decisions. When Disaster Medical Assistance Teams (DMATs) deployed to shelters in North Carolina, CDC’s NSSP team asked health officials if they wanted to integrate these data. Within 24 hours, data from DMATs were available in NSSP, providing a snapshot of health in those shelters. Data were monitored along with ED visits to give a complete picture of the storm’s health impacts. In 2017, Hurricane Harvey made landfall in Texas, resulting in 88 deaths and $125 billion in infrastructure damage. Public health officials used syndromic surveillance to understand increases in ED visits by those who evacuated to the Dallas–Fort Worth (DFW) area. Area hospitals saw roughly 4,400 more ED visits than normal; at least 600 were evacuees. Syndromic surveillance data demonstrated extensive health care services use outside the affected areas by highlighting the importance of surge capacity planning one to four hours outside the disaster area. Ongoing Efforts Through a cooperative agreement with CDC, ASTHO is working with subject matter experts to create a definition of disability for syndromic surveillance. ASTHO conducted key informant interviews with disability professionals to inform the development of this new diagnostic code-based definition, along with four scientific panels to assess the drafting and review of national and state-level pilot testing. An expansion of this kind benefits jurisdictions through increased data capacity for fiscal, programmatic, and service policy decision-making and supporting longitudinal tracking of prevalence and risk. Conclusion Efforts to expand data about people with disabilities can help build public health capacity to monitor the health and well-being of people with disabilities before, during, and after public health emergencies. However, efforts in data collection on disabilities require interoperability and standardization across all systems to be successful. Efforts to contextualize public health emergency data and gather supporting data on impacted populations allow health officials to better turn data into action in pursuit of health equity across public health emergencies. NU38OT000290 website yes