Whenever there is a situation with potential to threaten public health, the first health contact should be the assistant secretary for health. The ASH serves as the primary advisor to the secretary of the U.S. Department of Health and Human Services on matters involving the nation’s public health and oversees the Office of Public Health and Science for the Department. Given this responsibility and the HHS’s authority as the primary agency for coordinating the nation’s public health and medical response, the ASH seems the right official to be granted the authority for determining which health agencies should be involved during the immediate response to this threat, recognizing that different agencies might be involved at different times during the response, and the level of the response may vary.
Additionally, it should be the ASH’s responsibility to ensure that there is no duplication or gaps in response, needed resources are available in a timely fashion, and that there is effective coordination and transfer of information between the various HHS agencies and other key stakeholders such as other federal and state agencies, health care providers, nongovernment organizations, businesses, and the public.
Further, the ASH should be charged with determining when and how the early (emergency) response to a public health threat moves into the long-term monitoring and management phase and ensuring the transfer of all needed data, information, and resources to the responsible agency. And the ASH also should have responsibility—in consultation with independent experts such as the Institute of Medicine—for assessing and reassessing the extent and time scale of the longterm phase, which should be proportionate to the public health risks and the scientific evidence.
Finally, the ASH would take the lead in defining the roles and responsibilities of the various agencies involved in a public health response—who takes the lead, how the expertise of various agencies is used, and how efforts would be coordinated.
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