Disaster Discourse: The Hagerty Blog

The Public Health Importance of the Operational Readiness Review and Expansion Recommendations

The Centers for Disease Control and Prevention (CDC) has developed the Public Health Emergency Preparedness and Response (PHEP) Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health.  Commonly referred to as PHEP Capabilities, the 2018 edition builds on lessons learned since 2011 and, most crucially, enlarged the medical countermeasure strategy to include mass vaccination. These standards inform the Operational Readiness Review (ORR) – a tool used by state and local health departments to critically analyze their medical countermeasure (MCM) dispensing operations and capacity for federal public health preparedness grant funding. The ORR, which initially only focused on four capabilities, is set to expand to all 15 capabilities. This expansion can be further built-out, and can provide an opportunity to reevaluate how communities address each capability and how state and local public health departments’ planning efforts post-COVID-19 should account for all capabilities.

CDC’s PHEP and Response Capabilities – 2018 Update: Source

The ORR Overview

At their core, ORRs are conducted to provide an evidence-based assessment process to identify strengths and challenges with operational readiness. The PHEP Cooperative Agreement (CoAg) requires awardees to complete the ORR process for federal public health preparedness grant funding.

The initial ORR process focused predominantly on large scale medical countermeasure distribution and dispensing with prophylaxis in the event of an intentional release of anthrax. The 2018 PHEP capabilities expanded scenario planning to include Pandemic Influenza, including medical countermeasure distribution for mass vaccination events. With the expansion of the 2018 PHEP capabilities, the ORR required a reimagining of its own for 2020.

The Projected 2021 ORR Expansion

The COVID-19 pandemic has highlighted gaps in public health planning, preparedness, and incident response. This moment provides a unique opportunity to take an essential step and expand the ORR process even more and improve our national capacity to accurately assess program standards across jurisdictions, offer meaningful data to demonstrate program impact, identify regional partnership opportunities, and provide an accurate picture of national public health readiness.

The inclusion of all 15 capabilities within the ORR was scheduled for Budget Period (BP) 2 in 2020, with medical countermeasure operational readiness on or by 2022. All Tier 1 capabilities were proposed to be established by 2024. As COVID-19 has strained public health preparedness resources, CDC has waived the requirement to complete the ORR for BP2. Further expansion of the ORR process and technology now would help the CDC and the PHEP program better understand recipient planning and operational strengths, areas of improvement, and technical assistance needs across all capabilities.

Recommendations for Further ORR Expansion Amidst COVID-19

The plans to expand the ORR in 2019 and 2020 did not anticipate the COVID-19 pandemic radically shifting priorities for public health practitioners. As we turn our preparedness efforts towards a new threat, the expanded ORR would play an important role in determining the nation’s next steps in preparedness, including:

  • Community Recovery should include economic recovery efforts that align with public health initiatives. Currently, PHEP Capability 2 focuses heavily on mental and behavioral health; however, the pace of a community’s economic recovery can have cascading impacts on the overall response and pre-incident preparedness, to include their resident’s mental and behavioral health.
  • Emergency Public Information and Warning must include substantial questions regarding rumor control and dispelling misinformation. Currently, PHEP Capability 4 has been crucial in fighting against misinformation and rumor control. Continuing to expand on this capability, building ORR questions directing awardees to critically analyze their capacity, and strengthening the use of social media and rumor control would develop public health’s ability to properly inform the public of their risks and how to stay safe.
  • Nonpharmaceutical Interventions must be highlighted in the ORR, with specific requests for metrics associated with compliance. Nonpharmaceutical interventions (PHEP Capability 11) have been an essential part of public health preparedness for a long time; however, implementation strategies have varied widely across the country and there has not been a standard way to measure their effectiveness. As we have seen during this pandemic, nonpharmaceutical interventions, such as social distancing, isolation, quarantine, and hygiene, are imperative for flattening the infection curve. Additionally, each awardee has had varying compliance metrics for the adoption of mask-wearing and social distancing within their jurisdiction. These metrics – including how many individuals were compliant and what proven behavioral change initiatives increased compliance – should be identified and reflected in the ORR to address future capabilities and improve communication of requirements.
  • Public Health Surveillance and Epidemiological Investigation should include the operability of contact tracing on a large scale. PHEP Capability 13 should consist of tracking, tracing, and testing a large portion of the population. States and local governments scrambled to find a proper strategy for contact tracing and often still have difficulties.


COVID-19 has highlighted challenges in preparedness programs and the ORR provides an established resource to review operational readiness across all 15 capabilities. Reimagining the ORR based on lessons-learned in tandem with COVID-19 After Action Reports (AARs) will position the nation for quick adaption of corrective actions.

Hagerty Can Help!

Hagerty Consulting can help your public health department with a wide array of COVID-19 preparedness and response operations, including medical countermeasure dispensing planning, AARs, and exercises. Hagerty can provide an impartial review of PHEP capabilities for your departments’ ORR, thus building a more resilient preparedness cadre.

Hagerty has developed interim response assessments and AARs during the COVID-19 pandemic to redirect response efforts, adopting best-practice methods quickly in the process. The ORR and AARs are required elements of the PHEP CoAg and serve as a trustworthy source for enhancing public health preparedness in real-time and future responses. Expanding upon the systems we already have at our disposal, and strengthening their potential use, will build upon our national capacity to respond to the next pandemic.

Alexandra Koch is a managing associate and public health emergency management professional with strong knowledge and experience in public health emergency preparedness and response. As a ORISE Fellow at the Centers for Disease Control and Prevention’s Division of State and Local Readiness she validated Public Health Emergency Preparedness (PHEP) Cooperative Agreement (CoAg) awardee data and assisted in the rewrite efforts for the 2019 – 2024 PHEP CoAg. She also has assisted Fulton County Board of Health for their Anthrax dispensing plans by optimizing POD locations using RealOpt.