In today’s interconnected world, people, packages, and animals can circumnavigate the globe in less than a day. This speed of connection makes it easier to visit far-flung family members, conduct overseas business, and seek a better or safer life — but it also allows for the rapid spread of diseases that threaten the health of every community.
Diseases with pandemic potential are becoming increasingly common as humans encroach upon the natural world, putting people in closer contact with animals and environments that can spread illness. The capacity of frontline health organizations to swiftly and efficiently contain illness has not always kept pace with how quickly diseases now spread.
One agency essential to preventing the spread of disease is the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine. This division serves as a first line of defense against global health threats by managing a network of quarantine stations that play a vital part in identifying infectious diseases and preventing their spread before they enter communities.
More than 1 million travelers enter the United States on a typical day through 300 ports of entry. The Division of Global Migration and Quarantine manages quarantine stations at the 20 international airports and land-border crossings where most international travelers arrive. It is responsible for screening sick travelers, notifying other passengers about possible exposures, and restricting the importation of animals or products that may carry disease.
The CDC asked the National Academies of Sciences, Engineering, and Medicine (NASEM) to convene a group of experts to assess the division and make recommendations based on its performance during Covid-19. This working group, which we participated in, commended the division and its workers for responding admirably to the Herculean task they faced. They were asked to use new tools and intervene at an unprecedented scale.
Yet the division’s responses were impeded because it lacked modern data systems, a well-trained workforce capable of surge capacity, adequate funding, and strong legal powers.
The NASEM report, “Improving the CDC Quarantine Station Network’s Response to Emerging Threats,” offers a roadmap for supporting and strengthening the Division of Global Migration and Quarantine to anticipate and respond effectively to prevent the next pandemic before it takes hold. Here are some of the report’s key recommendations. We and our colleagues hope the CDC and federal government will adopt them to prepare for — and help stop — the next pandemic.
Consistent and increased funding. Core funding for the Division of Global Migration and Quarantine has stagnated over the past decade, even as the agency has faced more frequent and complex threats, like Middle East Respiratory Syndrome, Zika, Ebola, the H1N1 flu, and now Covid-19. The division relies heavily on boom-or-bust surge funding, but needs more reliable funding streams to adequately support its immense responsibilities.
To avoid costly delays, the review committee recommends that the Department of Health and Human Services create a surge fund the division can quickly access during an emergency outbreak.
While the division oversees more than 300 ports of entry, it has funding to operate only 20 quarantine stations, limiting its ability to quickly contain widespread disease threats. The CDC should explore a user-fee program that would, for example, charge maritime and aviation industries for the quarantine and regulatory services it provides them. This could provide consistent funding to run these stations.
Expand CDC’s regulatory authority during public health emergencies. During the Covid-19 pandemic, virtually all CDC orders made under the Public Health Service Act were legally challenged, and many were significantly delayed or blocked by federal courts. The CDC needs to be given ample powers to act decisively in public health emergencies. Congress should modernize this act to ensure that the CDC has the authority to effectively prevent or mitigate current and future public health threats — while still ensuring protections for individual rights and freedoms.
Build a robust and resilient workforce. During Covid-19, the agency has struggled with many unfilled positions and inadequate staffing that led to lapses in coverage at quarantine stations, burnout, and high turnover. The NASEM committee recommended a recruitment, training, and retention plan committed to diversity, equity, and inclusion, along with innovative strategies to meet its unique workforce needs. The committee suggested a “Ready Reserve Corps” of well-trained and experienced professionals who would be pre-approved and available to meet a surge in workforce needs during emergencies.
Develop playbooks for future emergencies. The Division of Global Migration and Quarantine needs detailed plans and playbooks based on the most worrisome and likely infectious disease threats. It should develop these in collaboration with key international organizations, as well as state, local, and tribal health agencies. Plans should be informed by the lessons learned during the response to Covid-19 and include considerations for equity and the ethical care of vulnerable populations.
Embrace new technologies. The division should expand innovative technologies to help detect outbreaks and slow the spread of diseases. Such technologies can help gather health data from large numbers of incoming travelers, trace disease transmission, and alert travelers to exposures. In tandem, it should develop a system to ensure that technologies are used ethically and respect privacy rights.
Add a maritime unit. As Covid-19 took hold, cruise ships became a significant source of transmission. To improve the ability to collaborate with the cruise industry to prevent disease, the CDC’s maritime unit should be permanently housed within its Division of Global Migration and Quarantine.
Now is the time to invest in this critical agency and shore up the U.S.’s first line of defense against diseases that threaten its national and global wellbeing.
Michele Barry is a professor and senior associate dean of Global Health at Stanford University, director of the Stanford Center for Innovation in Global Health, a member of the Board of Global Health for the National Academy of Medicine, and chair emeritus of the Consortium of Universities for Global Health. Lawrence O. Gostin is a professor and faculty director of the O’Neill Institute for National and Global Health Law at Georgetown Law, director of the World Health Organization Collaborating Center on Public Health Law and Human Rights, and author of “Global Health Security: A Blueprint for the Future” (Harvard University Press, 2021).
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