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Every year, ASTHO performs an annual environmental scan to identify these policy and programmatic priorities. The most recent scan occurred from June 2019 to May 2020. Through ongoing collection of data from a variety of sources—including state and territorial health improvement plans and strategic plans, documentation of discussion topics from ASTHO’s weekly calls with state and territorial health officials, requests for technical assistance, and subject matter expert input on trends and issues emerging in the field. These priorities will be ASTHO’s “2021 resolutions” as we enter a new year.

Many pharmaceutical companies urgently began developing a COVID-19 vaccine earlier this year to reduce the spread of the virus as the threat of a pandemic loomed. Fast forward several months and millions of COVID-19 cases later, states and territories are preparing to distribute a potential vaccine with preliminary plans for distributing a COVID-19 vaccine due to the CDC in October.

Conditioning school attendance on student vaccinations is an evidence-based way of maintaining and increasing vaccine coverage. State law establishes school vaccination requirements which apply not only to public schools but often to private schools and childcare facilities as well. All states allow an exemption for those where a vaccine poses a medical risk. Several states also allow non-medical exemptions, often based on an asserted religious, philosophical, or personal belief of the parents or child opposing vaccinations. However, a few states have recently abolished all non-medical exemptions.

As public health officials lead the pandemic response, clear direction-setting in every state and territories is vital to assure our planning and implementation is fair and focused on those most at need. These are not entirely unprecedented times—1918 pandemic flu killed almost 700,000 Americans. Even then, despite increasing understanding of respiratory disease transmission, many leaders—including public health leaders—downplayed the pandemic and refused to take effective steps to limit large gatherings and encourage mask wearing. Changing behavior, or introducing new social norms, was as difficult then as it is now. We have to learn from history if we are to effectively respond to our present reality.

If there is any word to describe 2020 it is “unprecedented,” with the work of health agencies front and center since COVID-19 emerged in the U.S. But as we approach Public Health Thank You Day and the Thanksgiving season, ASTHO wants to send a special appreciation to our entire state and territorial public health workforce. We have been so impressed by your tireless work to address COVID-19 in your jurisdictions and you have wowed us all with your dedication and commitment to the work of health protection and improvement. Thank you all for all you do to keep your communities healthy!

Anticipating a rapid deployment of COVID-19 vaccines as they are authorized, the CDC developed COVID-19 Vaccination Program Operational Guidance in collaboration with state and local jurisdictions to outline how each jurisdiction will make an authorized vaccine widely available. In addition to the operational plans, there is a legal framework of federal and state laws supporting the distribution and administration of the FDA-authorized vaccines.

Each year the U.S. battles seasonal influenza, leaving millions of people sick, hospitalized, or worse. As COVID-19 cases continue to rise, it is crucial for all eligible individuals to receive a flu vaccine to help reduce the likelihood of contracting both flu and COVID-19.

The 2019-2020 flu season had approximately 5 million fewer illnesses than the previous year. Thanks to COVID-19 mitigation efforts like social distancing and increased handwashing—coupled with a higher rate of flu vaccinations among the public this year—this all likely led to a milder end to the 2019-2020 flu season and start of the 2020-2021 flu season.

According to the federal government, a homebased individual is someone who requires the help of another person or supportive device to leave the home, someone who is advised against leaving the home by a physician, and/or someone for whom it is extremely taxing to leave the home. Compared to non-homebased adults, homebased people are more likely to be older, have lower income, and belong to racial minority groups—as well as live with disabilities, chronic health conditions, and comorbidities. Individuals who are homebased therefore tend to be at increased risk for COVID-19 morbidity and mortality.

For many individuals living with disabilities, inaccessible vaccination websites have been a significant barrier to receiving the COVID-19 vaccine. Recent studies have found that many vaccination websites do not reliably meet accessibility standards. This brief discusses how several disability rights laws apply to COVID-19 vaccine registration websites and offers considerations for state and territorial health agencies as they work to improve website accessibility for people living with disabilities.

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

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

The COVID-19 pandemic spotlighted health inequities at national, state, and local levels. This report details the role immunization can play in reducing these disparities, informed directly by conversations ASTHO held with state equity and immunization leaders from March-July 2021. These conversations have been distilled into 20 key actions health agencies can take to make an impact.

On Feb. 26, 2024, ASTHO's CMO issued a statement in response to several measles outbreaks currently occurring in the United States.

Current Measles Outbreaks Should Alarm Every American and Highlight the Critical Importance of Vaccination Programs ARLINGTON, VA—John Wiesman, DrPH, MPH, secretary of health at the Washington State Department of Health and immediate past president of the Association of State and Territorial Health Officials (ASTHO) testified today before the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) on the growing number of infectious disease outbreaks impacting the country. The hearing, “Vaccines Save Lives: What Is Driving Preventable Disease Outbreaks?” provided members of Congress the opportunity to discuss the current measles outbreaks affecting several states, along with children’s health and vaccinations and significant gaps in public health funding for programs to address preventable outbreaks. “Every American should be alarmed by the current measles outbreaks occurring in many states. Measles is an entirely preventable disease and we must redouble our efforts as a nation to spread the truth that vaccines save lives and address parental concerns about vaccinating their children,” says Wiesman. “No one should live in fear of contracting this disease and it is part of my mission as a public health official to protect the lives of American people. I am deeply grateful to the Senate HELP Committee for bringing broader awareness to the importance of vaccinations and better understanding the current gaps that exist in the public health system. Addressing these outbreaks will require a strong and coordinated response from federal, state, and local governments.” Wiesman recently authored an op-ed citing concerns about the nation’s public health system, which has suffered as a result of chronic underfunding as the population continues to grow. We are constantly reacting to crises rather than working to prevent them, Wiesman says. ASTHO and 80 other organizations are requesting Congress to raise CDC’s budget 22 percent by 2022 to address growing public health threats, including support for state and territorial vaccination programs, in order to protect our nation’s health system. For more information and to read Wiesman’s testimony, visit the committee’s website. ASTHO Press Release Boilerplate website yes

Health Officials Encourage Flu Shots to Protect Pregnant Women and Infants ARLINGTON, VA—Flu season has arrived in the United States and with influenza activity on the rise, being vaccinated against the flu for people six months and older remains the best line of defense to prevent illnesses, hospitalizations, and deaths caused by influenza. This is particularly true for older adults, children under five, and pregnant women. However, many people do not receive an annual flu shot, even though they have been shown to offer significant public health benefits. New CDC data show that two-thirds of pregnant women are not protected against flu. As the 2017-2018 flu season gains momentum, health officials are recommending that pregnant women talk to their healthcare provider about getting a flu shot to protect them and their babies throughout the flu season. Peak flu activity in the United States most often occurs from December through February, but can last as late as May.  While it is best to get a flu shot before the start of influenza season, vaccinations received later may still provide protection. With early data pointing to a moderately severe flu season, getting vaccinated is more important than ever. “It’s not too late to get vaccinated,” says Randall W. Williams, an obstetrician/gynecologist and director of the Missouri Department of Health and Senior Services. “Many state health departments, working with local healthcare providers and other partners, have robust influenza vaccination campaigns underway and are working hard to scale up efforts to protect mothers and babies from the flu.” State and territorial health departments play an integral role in ensuring access to vaccines, providing public education on vaccine preventable diseases, and galvanizing community partners and healthcare provider to improve vaccination rates. These efforts and partnerships are needed to encourage the population to take the initiative to get vaccinated and to ensure access to the more than 148 million vaccines that have been distributed across the country. CDC’s Advisory Committee on Immunization Practices recommends flu shots for all women who are or will be pregnant during the flu season. Pregnant women are at increased risk of complications due to the flu. Changes in the immune system, heart, and lungs make a pregnant woman more susceptible to influenza. ASTHO partnered with the American College of Obstetricians and Gynecologists and the American College of Nurse Midwives to create a suite of resources that public health professionals and healthcare providers can use to educate and promote influenza vaccination among pregnant women. ASTHO Press Release Boilerplate website yes

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

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

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

Learn about the importance of immunization information systems to public health in this Health Policy Update.