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Homeland Security Presidential Directive 21

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Homeland Security Presidential Directive 21 (HSPD-21): Public Health and Medical Preparedness (Oct. 18, 2007) (full-text).

Overview Edit

HSPD-21 is built on the principles of earlier directives — HSPD-9 and HSPD-10 — which collectively describe the role of the federal government in building a national capability to detect a biological event.

HSPD-21 addresses preparedness for "catastrophic health events," which are defined as

any natural or manmade incident, including terrorism, that result in a number of ill or injured persons sufficient to overwhelm the capabilities of immediate local and regional emergency response and health care systems.

HSPD-21 articulated a vision for protecting the nation from catastrophic disease outbreaks in humans that included a call for a national biosurveillance capability that enhances the timeliness of detection and the quality of situational awareness for response. The national biosurveillance capability described in HSPD-21 relies on, among other things:

  • (1) strong clinician awareness and laboratory diagnostic capacity;
  • (2) a national “common operating picture” that provides a comprehensive picture of the health of communities and the associated threat environment by incorporating information from human health, animal health, agricultural, meteorological, environmental, intelligence, and other data; and
  • (3) a nationwide epidemiologic surveillance system that is robust enough to identify specific disease incidence and prevalence and flexible enough to tailor analyses to new syndromes and emerging diseases.

In calling for such a national capability, HSPD-21 reflects the centrality of state and local resources in supporting the capability, stating that state and local government officials should be involved in system design and that the capability should be principally aimed at enhancing the capabilities of state and local governments.

HSPD-21 stresses the importance of:

  • Establishing a biosurveillance capability that can provide “early warning” of a biological attack or naturally occurring disease outbreak and can provide ongoing near real-time information about an event as it unfolds;
  • Fostering medical countermeasure stockpiling and distribution so that communities are able to "distribute and dispense countermeasures to their populations within 48 hours after a decision to do so";
  • Transforming the "national approach to health care in the context of a catastrophic health event” and developing a “disaster medical capability that can immediately re-orient and coordinate existing resources within all sectors to satisfy the needs of the population during a catastrophic health event";
  • Formulating a "comprehensive plan for promoting community public health and medical preparedness to assist State and local authorities in building resilient communities."

HSPD 21 establishes a Public Health and Medical Preparedness Task Force that comprises: The Secretaries of HHS, Homeland Security, Defense, State, Agriculture, Commerce, Labor, Transportation, and Veterans Affairs; the Directors of the Office of Management and Budget and National Intelligence; and the Attorney General.

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