Outbreaks: Protecting Americans from Infectious Diseases

A medical professional dons protective gear during the Ebola outbreak.

A snapshot of efforts to prevent and control infectious diseases in states shows that just five states received a high score, meeting eight out of 10 indicators (Maryland, Massachusetts, Tennessee, Vermont, and Virginia) while one (Arkansas) met only two.

The Issue:

While some improvements have been made over the past decade in the country’s ability to protect Americans from, and respond to, emerging infectious diseases, wide variations exist from state to state, raising questions as to our ability to respond to new threats, such as Ebola.

Key Findings:

Trust for America’s Health, with funding from the Robert Wood Johnson Foundation, assessed each state’s policies and capacities to protect people from infectious diseases using 10 indicators to measure areas of high priority and concern. They found:

  • Preparing for emerging threats—Only 27 states and the District of Columbia met or exceeded the average score for Incident Information and Management in the National Health Security Preparedness Index™.
  • Vaccinations—Only 14 states vaccinated at least half their population against seasonal flu.
  • Healthcare associated infections (HAIs)—One in every 25 people hospitalized each year contracted an HAI. Only 10 states improved their performance in this area.
  • Sexually transmitted infections—New HIV infections rose among young gay men (up 22%) and young black men (up 48%). Thirty-seven states have in place the necessary reporting requirements to help prevent further transmission of HIV.
  • Food safety—38 states met the national performance target of testing 90 percent of reported E.coli cases within four days.


For our system to better match modern global disease threats, the authors recommend updating our public health system around a core set of abilities that include investigative capabilities to quickly diagnose outbreaks, containment strategies, drilling and training for hospital responses, improving reporting and implementation of infection control practices, and streamlined and effective communication channels.

About the Study:

The 10 indicators used in this study were selected in consultation with leading public health and health care officials. 



Media Contacts

Melissa Blair

Robert Wood Johnson Foundation (609) 627-5937

Additional Media Contact: Albert Lang

Trust for America’s Health (202) 864-5941