National Legal Paradigms for Public Health Emergency Responses

The COVID-19 pandemic has exposed significant weaknesses of the U.S. federalist system in controlling major infectious disease threats. At the root of American failures to adequately respond is a battle over public health primacy in emergency preparedness and response. Which level of government—federal or state—should actually “call the shots” to quell national emergencies? Constitutional principles of cooperative federalism suggest both levels of government are responsible. Yet, real-time applications of these principles, coupled with dubious national leadership, contributed to horrific public health outcomes across America. No one seeks a “repeat performance” of U.S. COVID-19 response efforts to forthcoming major health threats. Avoiding it entails substantial changes. Expansive interpretations and executions of core federal emergency powers illuminate new paradigms for Twenty-first century public health crisis planning, preparedness, and response where states remain key players, but the feds are primary play-callers.