Strengthen your knowledge of wastewater surveillance ethics, with firsthand insights on key challenges and considerations from state health agencies and partners.
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
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.
ASTHO letter to the White House Requesting Funding For a National Monkeypox Response
On April 4, 2022, the U.S. Senate indicated that they have reached an agreement on a $10 billion bipartisan emergency supplemental funding bill for the federal COVID-19 response.
In-depth analysis on state health policy surrounding immunization. This is part of ASTHO's annual legislative prospectus series.
During the COVID-19 pandemic, public health authority has been used to require the use of face masks and encourage social distancing, and other measures. In several states these legal authorities have been challenged and, in many jurisdictions, limited or eliminated by the legislature. Maintaining the legal authority to prevent and control the spread of infectious disease is crucial to preparing for and addressing disease outbreaks.
In-depth analysis on state health policy surrounding immunization. This is part of ASTHO's annual legislative prospectus series.
The State Health Policy portfolio includes an annual legislative prospectus series. This document is from 2021 and addresses the COVID-19 pandemic.
ASTHO Legislative Prospectus | Prevention 2024 state legislative action on infectious disease control and prevention.
Insight and Inspiration: Conversations for Public Health Leaders ASTHO is honored to present Insight and Inspiration, the premier webinar series designed to motivate public health leaders as they respond to new and ongoing public health challenges. The nation’s preeminent thought leaders, authors, and strategic thinkers offer attendees strategies to further develop their leadership skills as well as ground themselves and their teams even amid crisis. This series is open to governmental public health professionals at all stages of their careers. Check out upcoming opportunities and previous session recordings below to take your leadership to the next level. website
Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes
Read about deference to ACIP vaccine recommendations in state and territorial vaccine policy, following recent changes to the committee.
Downstream Effects of CDC Adopting ACIP Recommendations for COVID-19 and MMRV Vaccines Downstream Effects of CDC Adopting ACIP Recommendations Susan Kansagra, Andy Baker-White, Meredith Allen, Kimberly Martin, Ericka McGowan Learn about the downstream effects of CDC adopting ACIP recommendations for COVID-19 and MMRV vaccines, as states examine how their policies and laws intersect. On Oct. 6, CDC adopted the recommendations that the Advisory Committee on Immunization Practices (ACIP) made in September — specifically, individual-based decision-making for COVID-19 vaccine and separate measles, mumps, and rubella vaccine, and the varicella vaccine in toddlers. The adoption of these recommendations now sets in motion a cascade of other processes that influence access to vaccines. In addition, several states have begun to examine how their state level policy and laws intersect with ACIP recommendations given the delay in adoption and the uncertainty of the process going forward. COVID-19 Vaccine Recommendation CDC adopted the recommendation for shared clinical decision-making for the COVID-19 vaccine for those six months and older. The adoption of this ACIP recommendation has a ripple effect on coverage and access: It enables states to begin ordering COVID-19 vaccine under the Vaccines for Children program. It allows state Medicaid programs that link coverage to ACIP recommendations to cover the cost of the vaccine. It enables pharmacists to provide the COVID-19 vaccine under the federal PREP act declaration — as opposed to or in addition to state law, which varies by state. Many state health departments issued standing orders and executive orders to enable pharmacists to administer in the meantime. It requires health insurers to cover the cost of the vaccine, as the Affordable Care Act ties insurance coverage requirements to ACIP recommendations. Though, prior to the meeting, health insurers indicated they would do so anyway this year. MMRV Recommendation The CDC also adopted the recommendation for separate varicella (V) and measles, mumps, rubella (MMR) vaccines rather than the MMRV vaccine (combined measles, mumps, rubella, varicella) for children under four years. As background, current guidance allows either MMRV or MMR + V to be administered to children 12-47 months. However, because of a small but higher risk of febrile seizures for dose one, they are recommended to be administered separately (MMR + V), unless families express a preference for MMRV. Only about 15% of children currently receive MMRV for the first dose, and the general consensus is that this decision will result in some changes but not significantly impact access to vaccines: The adoption of this recommendation means that VFC will no longer cover MMRV for children under four, but it continues to cover separate MMR and V vaccines. Since many state Medicaid plans tie vaccine coverage to ACIP recommendations, coverage of MMRV by state Medicaid will vary depending on this language, though separate MMR and V vaccines would continue to be covered. Private insurers can choose to cover MMRV and will likely continue to in the short term but are not required to. They are required to cover separate MMR and V vaccines. How States Are Preparing for the Future As it stands now, ACIP recommendations, particularly for respiratory viral season, are not that different than prior years – with influenza, RSV, and the COVID-19 vaccine recommended (the latter with shared clinical decision making). However, the delayed and unpredictable process has led many states to examine how closely they are tied to ACIP in law, regulation, or practice. Over 600 statutes across U.S. states and territories reference ACIP — whether for pharmacist vaccine authority, school entry, health care worker or other requirements. States have considered a variety of actions to ensure they maintain access to vaccinations for their jurisdictions including: Passing or introducing legislation that allows the state health department to use ACIP guidance from previous years or recommendations from other bodies (e.g., medical provider organizations) in state law, as it relates to school entry, pharmacist authority, and others. Issuing standing orders and executive orders to enable pharmacists to administer vaccines in the absence of ACIP recommendations. Examining Medicaid state plan language to determine how to interpret requirements when ACIP is referenced and considering updates to that language (e.g., North Carolina). Issuing state requirements for insurers on vaccine coverage (e.g., Oregon, California, Hawaii). Examining use of state funds to purchase vaccines. Supplemental Resources Tracking State Actions on Vaccine Policy and Access by KFF Vaccine Resources by the Common Health Coalition States Take Action to “Immunize” Vaccine Access by Mandy Cohen, Julian Polaris, and Liz Dervan Vaccine Integrity Project — Fall Immunization Information by the Center for Infectious Disease Research and Policy Special Thanks - Blog - Downstream Effects of CDC Adopting ACIP Recommendations Padding Block - Large Related Content - Blog - Downstream Effects of CDC Adopting ACIP Recommendations article yes
Learn how to use strategic public health messaging to effectively gain support from decision-makers and drive change.
San Diego Academic Health Partnership Strengthens Service During COVID-19 and Beyond San Diego Academic Health Partnership Strengthens Service Mayela Arana Learn how the Academic Health and Human Services Department in San Diego strengthens service, research, workforce development, and more in the region. In San Diego County, the connection between academia and public service continues to grow stronger, shaping the future of health and human services. With over 8,200 employees serving a diverse population of 3.3 million residents, the County of San Diego Health & Human Services Agency (HHSA) plays a crucial role in advancing health, housing, and social services across the region. Recognizing the immense value of bridging education with real-world public service, HHSA and San Diego State University (SDSU) formed an Academic Health and Human Services Department (AHHSD): the Live Well Center for Innovation & Leadership (LWCIL), a first-of-its-kind initiative in San Diego County. This partnership is more than just a collaboration; it’s a transformative effort to strengthen education, research, workforce development, and service in the region, inspired by collaborative successes during COVID-19. A Vision Years in the Making Even before the COVID-19 pandemic, leaders at HHSA, SDSU, and SDSU’s College of Health and Human Services (CHHS) recognized the opportunity to deepen their relationship through an Academic Health Department (AHD) partnership. Many of those contributing to HHSA’s success began their journey at SDSU, with over half of the agency’s leadership team and a significant portion of its workforce having graduated from SDSU, particularly from CHHS. With a long history of partnering to provide real-world experiences for students, collaborating on research, and developing practice-informed curriculum, formalizing the partnership to integrate academia and health and human services practice was a natural next step. An Academic-Public Health Partnership in Action HHSA and SDSU’s longstanding relationship initially focused on student field experiences, research collaboration, and workforce development across select schools and decentralized departments but went on to have a major impact on the ground — most notably, enhancing HHSA’s COVID-19 response. Mobilizing Promotoras for Outreach and Support SDSU and HHSA worked together on recruitment, training, and community outreach. They successfully recruited 40 community health workers for a Promotoras program, which initially helped with contact tracing within the highest-risk communities. The Promotoras also identified where people needed assistance (e.g., food, services). SDSU provided support by organizing food pantries in high-risk areas, while the Promotoras took food to those in need. As vaccines became available, HHSA trained the Promotoras on messaging and communications to dispel misinformation and to encourage vaccine uptake. The Promotoras also helped those in the highest-risk communities get appointments at the county vaccination sites. Expanding Public Health Capacity with Nursing Students In addition, SDSU and HHSA worked together to train and deploy nursing faculty, students, and recent graduates in county vaccination efforts. From January through March of 2021, the SDSU School of Nursing partnered with Champions for Health, the local nonprofit arm of the San Diego Medical Society, to train 200 vaccinators. Once trained on the proper storage and administration of the COVID-19 vaccine, faculty-led groups of undergraduate nursing students administered vaccines at community sites in primarily underserved areas of the county — many organized by the San Diego Black Nurses Association. In addition to providing surge capacity staffing to support community and public health efforts, the partnership allowed students to complete clinical hours required for graduation during the pandemic when students were restricted from other clinical sites. Many of the students and graduates who served as temporary contact tracers and case investigators transitioned into full-time positions within HHSA as the COVID-19 response scaled back. Formalizing Collaboration for Lasting Impact Given the tangible value of their collaboration demonstrated during the COVID-19 pandemic, HHSA and SDSU chose to use and adapt the national AHD model — gaining access to the growing, nationwide network of AHD partnerships that inform their goal of sustaining a high-impact academic-practice partnership. They formalized the partnership with a public signing of an overarching five-year memorandum of agreement (MOA) in October 2022 that launched the bold vision of creating San Diego County’s first and only AHHSD. They assigned an additional MOA specifically addressing joint research and data sharing in December 2024, and an addendum supporting agency-wide student field experiences is underway. With formal agreements across all key areas, the foundation will be in place for increased and accelerated collaboration by summer 2025. Building on the regional collective impact vision called Live Well San Diego, the AHD partnership adopted joint branding as LWCIL. An active Steering Committee, co-chaired by HHSA’s Deputy Chief Administrative Officer and CHHS’s Dean, meets quarterly and represents the highest-level leadership for each organization. Members include key leaders in HHSA operations, human resources, and strategy, and the directors from each of its eight service departments. On the academic side at SDSU, the Steering Committee includes representatives from the six schools and multiple institutes within CHHS. Setting Partnership Priorities LWCIL co-created and recently adopted a joint, multi-year Strategic Roadmap to guide the next three years of the partnership’s development and its contribution to a healthy, equitable, safe, and thriving San Diego region. It is organized around four high-impact priority areas: People Success: Build a diverse, competent, and engaged health and human services workforce, including students and both partners’ workforces. Research & Data Excellence: Inform and improve academia, policy, and practice with rigorous and relevant research. Service to Community: Integrate academia, practice, and community to advance equity and eliminate health disparities. Leadership & Sustainability: Create a nationally recognized academic-practice model with innovative leadership committed to improving academia, policy, and practice. Subcommittees for each priority area, co-chaired by leaders from both organizations, have launched and created action plans tied to advancing the Strategic Roadmap. In addition, emerging workgroups are aligning work plans. Next steps include: Assessing what is already in place and integrating it into the partnership. Developing a standardized and streamlined process for students to complete internships at HHSA. Leveraging opportunities to bridge research and practice and, where appropriate, in collaboration with the community. Investing in capacity has been essential in moving the partnership forward and providing coordination. The director of LWCIL is a “boundary spanning” position, co-funded by SDSU and HHSA. Additional staff support has assisted the partnership, including two HHSA Management Fellows engaged in a year-long program. Advice for Others Seeking to Establish AHD Partnerships HHSA and SDSU offer the following tips to agencies looking to develop or expand AHD partnerships, based on their experiences: Secure leadership commitment: Ensure the highest-level leaders are committed to the partnership’s success and sustainability. LWCIL started with the support of the dean, deputy chief administrative officer, and directors within both organizations who continue to be actively involved as members of the Steering Committee and subcommittees. By doing so, they have helped set priorities, identified staff to participate, and continuously champion the partnership within their respective organizations. Start small: Build from what already exists between the partners, leverage willing internal resources, and celebrate early successes. LWCIL started with conversations focused on workforce development because of existing relationships and shared interests. Those conversations eventually evolved to include collaborating on rigorous equity-focused research and partnering to address needs identified by the community, such as housing stability for our older adult population and food insecurity. The subcommittee structure was created to support those shared priorities; however, it began with smaller, more narrowly focused conversations. Be strategic: Create a common agenda/plan that aligns with the goals of both organizations, making it easier for already-stretched organizations to commit to and benefit from the partnership. LWCIL's co-creation of a multi-year Strategic Roadmap allowed the partners to discuss the many opportunities for collaboration and integration, and to prioritize. It now guides where the partnership is going and helps keep everyone focused on what they collectively decided is important. Then, grow: By getting systems in place and understanding the benefits and challenges between two organizations (HHSA and SDSU), LWCIL is setting the stage for expansion to include other local universities. Take time to plan and set up structures: Creating the LWCIL Strategic Roadmap was a six-month process that engaged leadership from both organizations. This was critical for identifying priorities and direction, including what structures and systems needed to be organized so the work could move forward. Learn more about San Diego’s Live Well Center for Innovation & Leadership and AHD partnerships, or explore other workforce development resources from the Public Health Foundation. If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact
HHS Budget Hearings Chart New Direction for Public Health Budget Hearings Chart New Direction for Public Health Catherine Jones Learn about the key policy/funding themes that emerged from HHS Secretary Robert F. Kennedy’s testimony during the May 2025 budget hearings. In May 2025, HHS Secretary Robert F. Kennedy Jr. appeared before the House and Senate Appropriations Committees as well as the Senate Health, Education, Labor, and Pensions (HELP) Committee to discuss the Trump Administration's proposed FY26 HHS budget. On May 2, President Trump released his “Skinny Budget,” which formed the basis of much of the questioning Sec. Kennedy received from members of both parties. These hearings illuminated a sweeping reorganization of HHS and other federal agencies, signaling a dramatic shift in public health priorities and funding. Seven key themes emerged from the testimony, highlighting how these priorities are being advanced through the Make America Healthy Again (MAHA) initiative and the newly proposed Administration for a Healthy America (AHA). The President’s Budget Appendix, released in late May, reaffirms these policy and funding proposals. Reorganizing HHS and CDC The blueprint for HHS calls for consolidating various agencies under the new AHA, including HRSA, SAMHSA, and parts of CDC. In the hearings, Republicans broadly supported MAHA and AHA initiatives, mentioning the need to disrupt bureaucratic inefficiencies, reduce regulatory hurdles, and improve health care delivery. Democrats expressed concerns about program disruptions, layoffs, and FY25 appropriated funds that remain undisbursed. A handful of Democrats pressed Sec. Kennedy on whether he would spend FY26 funds, as appropriated by Congress; he responded affirmatively. When asked who authorized the staff layoffs, Sec. Kennedy gave inconsistent responses claiming ownership in one hearing and later attributing decisions to the Department of Government Efficiency. Public Health Preparedness and Prevention Preparedness and prevention were central topics, especially in the HELP Committee hearing. The proposed elimination of the Hospital Preparedness Program and cuts to the Public Health Emergency Preparedness Program would result in a net loss of hundreds of millions of dollars in federal support. HELP Committee Chair Sen. Bill Cassidy (R-LA) voiced concerns about the implications for under-resourced and rural states. Sec. Kennedy emphasized CDC’s legal responsibility for national pandemic response and called for reauthorization of the Pandemic and All-Hazards Preparedness Act. In the House hearing, he also addressed topics such as supply chain independence from China for critical medicines, and adequate funding for the Strategic National Stockpile and Biomedical Advanced Research and Development Authority. Vaccines Sec. Kennedy's past vaccine skepticism drew bipartisan scrutiny. Lawmakers pressed him to affirm support for routine immunizations, particularly amid a measles resurgence. When asked about pediatric vaccinations in the House hearing, Sec. Kennedy demurred wanting to refrain from giving medical advice. In the HELP hearing, he confirmed that funding appropriated for vaccines would be used accordingly and stated that vaccine recommendations would continue to be made by CDC’s Advisory Committee on Immunization Practices (ACIP). However, on May 27, he contradicted that assurance by directing CDC to remove COVID-19 as a recommended vaccine for pregnant women and children — reportedly without ACIP input. It should be noted that on June 9, a directive from Sec. Kennedy offered formal notice of the immediate termination of the current 17 ACIP voting board members. Injury and Violence Prevention Substance use, suicide, and overdose prevention were major topics around injury and violence. The FY26 budget proposes transferring CDC’s National Center for Injury Prevention and Control to AHA but still eliminates a majority of its programs. These programs have driven progress on opioid surveillance and community-based interventions, and reduced rates of overdose. When asked about preserving the SAMHSA State Opioid Response Grant, Sec. Kennedy said he supported harm reduction tools such as naloxone and community care programs but needed to review the specific grant. He acknowledged overdose as a public health crisis and stated that HHS will maintain 500 addiction treatment centers nationwide. He mentioned his commitment to addiction programs and the administration’s keen attention on preventing fentanyl from entering the United States. Additional questions were raised about high alcoholism rates on reservations, general funding for Indian Health Services, and elimination of LGBTQ+ services in the suicide prevention hotline; Sec. Kennedy promised to follow up on these topics. Chronic Disease, Cancer, and Food Safety Throughout the hearings, Sec. Kennedy underscored his steadfast commitment to reducing rates of heart disease, diabetes, cancers, Alzheimer’s and dementia, and other chronic conditions. He also wants to focus on the challenges of rural health care and rural hospital closures, as well as improved access to care for vulnerable populations, such as older Americans, veterans, and people with disabilities. In his testimony, Sec. Kennedy repeated his commitment to address nutrition and physical activity and to prioritize healthy eating in the Head Start program. He is working closely with FDA to phase out harmful dyes. FDA has fast-tracked approval for vegetable substitute dyes for the food industry. Sec. Kennedy is also focused on combating ultra-processed foods stating that “nutrition reform will address the root causes of diseases,” such as cancer. CDC’s Center for Chronic Disease Prevention is proposed for elimination in the budget, and the Diabetes Prevention Program Outcome Study is paused. Children’s and Women’s Health Lawmakers from both parties voiced concern over misinformation leading to declining vaccination rates and a growing measles threat. Youth mental health and social media harms were emphasized. Senators also raised bipartisan objections to the proposed elimination of CDC’s Childhood Lead Poisoning Prevention Program, which is being revisited. He expressed interest in researching environmental causes of autism and not solely focusing on genetics. In the House hearing, he acknowledged racial disparities in maternal care. Despite proposed cuts to programs like the National Breast and Cervical Cancer Early Detection Program, Sec. Kennedy voiced support for women’s health research. He also said he supports dental care, though he offered limited assurance on fluoride access. The budget proposes to close CDC’s Division of Oral Health. Tobacco Control In the House hearing, Ranking Member DeLauro (D-CT) criticized the proposed elimination of CDC’s Office on Smoking and Health. Senators in the HELP hearing emphasized tobacco’s status as the leading preventable cause of death and warned that staffing cuts would undermine decades of progress. Sec. Kennedy acknowledged the concerns but said he needed to review the specifics. He was also asked about FDA’s inaction on regulating illicit Chinese-made vapes targeting U.S. youth. While Sec. Kennedy presented the FY26 budget as a framework for streamlining government and cutting costs, critics argued that it undermines core public health capacities. As Congress enters markup season and prepares to negotiate final programs and funding levels, the outcome of this year’s budget debate will have long-term implications for the U.S. public health system. article yes