[Weekly Compilation of Presidential Documents Volume 43, Number 42 (Monday, October 22, 2007)]
[Pages 1364-1372]
[Online from the Government Publishing Office, www.gpo.gov]

<R04>
Directive on Public Health and Medical Preparedness

October 18, 2007

 Homeland Security Presidential Directive/HSPD-21

Subject: Public Health and Medical Preparedness

Purpose

    (1) This directive establishes a National Strategy for Public Health 
and Medical Preparedness (Strategy), which builds upon principles set 
forth in Biodefense for the 21st Century (April 2004) and will transform 
our national approach to protecting the health of the American people 
against all disasters.

Definitions

    (2) In this directive:
    (a) The term ``biosurveillance'' means the process of active data-
gathering with appropriate analysis and interpretation of biosphere data 
that might relate to disease activity and threats to human or animal 
health--whether infectious, toxic, metabolic, or otherwise, and 
regardless of intentional or natural origin--in order to achieve early 
warning of health threats, early detection of health events, and overall 
situational awareness of disease activity;
    (b) The term ``catastrophic health event'' means any natural or 
manmade incident, including terrorism, that results in a number of ill 
or injured persons sufficient to overwhelm the capabilities of immediate 
local and regional emergency response and health care systems;
    (c) The term ``epidemiologic surveillance'' means the process of 
actively gathering and analyzing data related to human health and 
disease in a population in order to obtain early warning of human health 
events, rapid characterization of human disease events, and overall 
situational awareness of disease activity in the human population;
    (d) The term ``medical'' means the science and practice of 
maintenance of health and prevention, diagnosis, treatment, and 
alleviation of disease or injury and the provision of those services to 
individuals;
    (e) The term ``public health'' means the science and practice of 
protecting and improving the overall health of the community through 
disease prevention and early diagnosis, control of communicable 
diseases, health education, injury prevention, sanitation, and 
protection from environmental hazards;
    (f) The term ``public health and medical preparedness'' means the 
existence of plans, procedures, policies, training, and equipment 
necessary to maximize the ability to prevent, respond to, and recover 
from major events, including efforts that result in the capability to 
render an appropriate public health and medical response that will 
mitigate the effects of illness and injury, limit morbidity and 
mortality to the maximum extent possible, and sustain societal, 
economic, and political infrastructure; and
    (g) The terms ``State'' and ``local government,'' when used in a 
geographical sense, have the meanings ascribed to such terms 
respectively in section 2 of the Homeland Security Act of 2002 (6 U.S.C. 
101).

Background

    (3) A catastrophic health event, such as a terrorist attack with a 
weapon of mass destruction (WMD), a naturally-occurring pandemic, or a 
calamitous meteorological or geological event, could cause tens or 
hundreds of thousands of casualties or more, weaken our economy, damage 
public morale and confidence, and threaten our national security. It is 
therefore critical that we establish a strategic vision that will enable 
a level of public health and medical preparedness sufficient to address 
a range of possible disasters.
    (4) The United States has made significant progress in public health 
and medical preparedness since 2001, but we remain vulnerable to events 
that threaten the health of large populations. The attacks of September 
11 and Hurricane Katrina were the most significant recent disasters 
faced by the United States, yet casualty numbers were small in 
comparison to the 1995 Kobe earthquake; the 2003 Bam, Iran, earthquake; 
the 2004 Sumatra tsunami; and what we would expect from a 1918-like 
influenza pandemic or large-scale WMD attack. Such events could

[[Page 1365]]

immediately overwhelm our public health and medical systems.
    (5) This Strategy draws key principles from the National Strategy 
for Homeland Security (October 2007), the National Strategy to Combat 
Weapons of Mass Destruction (December 2002), and Biodefense for the 21st 
Century (April 2004) that can be generally applied to public health and 
medical preparedness. Those key principles are the following: (1) 
preparedness for all potential catastrophic health events; (2) vertical 
and horizontal coordination across levels of government, jurisdictions, 
and disciplines; (3) a regional approach to health preparedness; (4) 
engagement of the private sector, academia, and other nongovernmental 
entities in preparedness and response efforts; and (5) the important 
roles of individuals, families, and communities.
    (6) Present public health and medical preparedness plans incorporate 
the concept of ``surging'' existing medical and public health 
capabilities in response to an event that threatens a large number of 
lives. The assumption that conventional public health and medical 
systems can function effectively in catastrophic health events has, 
however, proved to be incorrect in real-world situations. Therefore, it 
is necessary to transform the national approach to health care in the 
context of a catastrophic health event in order to enable U.S. public 
health and medical systems to respond effectively to a broad range of 
incidents.
    (7) The most effective complex service delivery systems result from 
rigorous end-to-end system design. A critical and formal process by 
which the functions of public health and medical preparedness and 
response are designed to integrate all vertical (through all levels of 
government) and horizontal (across all sectors in communities) 
components can achieve a much greater capability than we currently have.
    (8) The United States has tremendous resources in both public and 
private sectors that could be used to prepare for and respond to a 
catastrophic health event. To exploit those resources fully, they must 
be organized in a rationally designed system that is incorporated into 
pre-event planning, deployed in a coordinated manner in response to an 
event, and guided by a constant and timely flow of relevant information 
during an event. This Strategy establishes principles and objectives to 
improve our ability to respond comprehensively to catastrophic health 
events. It also identifies critical antecedent components of this 
capability and directs the development of an implementation plan that 
will delineate further specific actions and guide the process to 
fruition.
    (9) This Strategy focuses on human public health and medical 
systems; it does not address other areas critical to overall public 
health and medical preparedness, such as animal health systems, food and 
agriculture defense, global partnerships in public health, health threat 
intelligence activities, domestic and international biosecurity, and 
basic and applied research in threat diseases and countermeasures. 
Efforts in those areas are addressed in other policy documents.
    (10) It is not possible to prevent all casualties in catastrophic 
events, but strategic improvements in our Federal, State, and local 
planning can prepare our Nation to deliver appropriate care to the 
largest possible number of people, lessen the impact on limited health 
care resources, and support the continuity of society and government.

Policy

    (11) It is the policy of the United States to plan and enable 
provision for the public health and medical needs of the American people 
in the case of a catastrophic health event through continual and timely 
flow of information during such an event and rapid public health and 
medical response that marshals all available national capabilities and 
capacities in a rapid and coordinated manner.

Implementation Actions

    (12) Biodefense for the 21st Century provides a foundation for the 
transformation of our catastrophic health event response and 
preparedness efforts. Although the four pillars of that framework--
Threat Awareness, Prevention and Protection, Surveillance and Detection, 
and Response and Recovery--were developed to guide our efforts to defend 
against a bioterrorist attack, they are applicable to a broad array of 
natural and manmade public health and medical challenges

[[Page 1366]]

and are appropriate to serve as the core functions of the Strategy for 
Public Health and Medical Preparedness.
    (13) To accomplish our objectives, we must create a firm foundation 
for community medical preparedness. We will increase our efforts to 
inform citizens and empower communities, buttress our public health 
infrastructure, and explore options to relieve current pressures on our 
emergency departments and emergency medical systems so that they retain 
the flexibility to prepare for and respond to events.
    (14) Ultimately, the Nation must collectively support and facilitate 
the establishment of a discipline of disaster health. The specialty of 
emergency medicine evolved as a result of the recognition of the special 
considerations in emergency patient care, and similarly the recognition 
of the unique principles in disaster-related public health and medicine 
merit the establishment of their own formal discipline. Such a 
discipline will provide a foundation for doctrine, education, training, 
and research and will integrate preparedness into the public health and 
medical communities.

Critical Components of Public Health and Medical Preparedness

    (15) Currently, the four most critical components of public health 
and medical preparedness are biosurveillance, countermeasure 
distribution, mass casualty care, and community resilience. Although 
those capabilities do not address all public health and medical 
preparedness requirements, they currently hold the greatest potential 
for mitigating illness and death and therefore will receive the highest 
priority in our public health and medical preparedness efforts. Those 
capabilities constitute the focus and major objectives of this Strategy.
    (16) Biosurveillance: The United States must develop a nationwide, 
robust, and integrated biosurveillance capability, with connections to 
international disease surveillance systems, in order to provide early 
warning and ongoing characterization of disease outbreaks in near real-
time. Surveillance must use multiple modalities and an in-depth 
architecture. We must enhance clinician awareness and participation and 
strengthen laboratory diagnostic capabilities and capacity in order to 
recognize potential threats as early as possible. Integration of 
biosurveillance elements and other data (including human health, animal 
health, agricultural, meteorological, environmental, intelligence, and 
other data) will provide a comprehensive picture of the health of 
communities and the associated threat environment for incorporation into 
the national ``common operating picture.'' A central element of 
biosurveillance must be an epidemiologic surveillance system to monitor 
human disease activity across populations. That system must be 
sufficiently enabled to identify specific disease incidence and 
prevalence in heterogeneous populations and environments and must 
possess sufficient flexibility to tailor analyses to new syndromes and 
emerging diseases. State and local government health officials, public 
and private sector health care institutions, and practicing clinicians 
must be involved in system design, and the overall system must be 
constructed with the principal objective of establishing or enhancing 
the capabilities of State and local government entities.
    (17) Countermeasure Stockpiling and Distribution: In the context of 
a catastrophic health event, rapid distribution of medical 
countermeasures (vaccines, drugs, and therapeutics) to a large 
population requires significant resources within individual communities. 
Few if any cities are presently able to meet the objective of dispensing 
countermeasures to their entire population within 48 hours after the 
decision to do so. Recognizing that State and local government 
authorities have the primary responsibility to protect their citizens, 
the Federal Government will create the appropriate framework and 
policies for sharing information on best practices and mechanisms to 
address the logistical challenges associated with this requirement. The 
Federal Government must work with nonfederal stakeholders to create 
effective templates for countermeasure distribution and dispensing that 
State and local government authorities can use to build their own 
capabilities.
    (18) Mass Casualty Care: The structure and operating principles of 
our day-to-day public health and medical systems cannot meet the needs 
created by a catastrophic

[[Page 1367]]

health event. Collectively, our Nation must develop 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. Mass casualty care response must be 
(1) rapid, (2) flexible, (3) scalable, (4) sustainable, (5) exhaustive 
(drawing upon all national resources), (6) comprehensive (addressing 
needs from acute to chronic care and including mental health and special 
needs populations), (7) integrated and coordinated, and (8) appropriate 
(delivering the correct treatment in the most ethical manner with 
available capabilities). We must enhance our capability to protect the 
physical and mental health of survivors; protect responders and health 
care providers; properly and respectfully dispose of the deceased; 
ensure continuity of society, economy, and government; and facilitate 
long-term recovery of affected citizens.
    (19) The establishment of a robust disaster health capability 
requires us to develop an operational concept for the medical response 
to catastrophic health events that is substantively distinct from and 
broader than that which guides day-to-day operations. In order to 
achieve that transformation, the Federal Government will facilitate and 
provide leadership for key stakeholders to establish the following four 
foundational elements: Doctrine, System Design, Capacity, and Education 
and Training. The establishment of those foundational elements must 
result from efforts within the relevant professional communities and 
will require many years, but the Federal Government can serve as an 
important catalyst for this process.
    (20) Community Resilience: The above components address the supply 
side of the preparedness function, ultimately providing enhanced 
services to our citizens. The demand side is of equal importance. Where 
local civic leaders, citizens, and families are educated regarding 
threats and are empowered to mitigate their own risk, where they are 
practiced in responding to events, where they have social networks to 
fall back upon, and where they have familiarity with local public health 
and medical systems, there will be community resilience that will 
significantly attenuate the requirement for additional assistance. The 
Federal Government must formulate a comprehensive plan for promoting 
community public health and medical preparedness to assist State and 
local authorities in building resilient communities in the face of 
potential catastrophic health events.

Biosurveillance

    (21) The Secretary of Health and Human Services shall establish an 
operational national epidemiologic surveillance system for human health, 
with international connectivity where appropriate, that is predicated on 
State, regional, and community-level capabilities and creates a 
networked system to allow for two-way information flow between and among 
Federal, State, and local government public health authorities and 
clinical health care providers. The system shall build upon existing 
Federal, State, and local surveillance systems where they exist and 
shall enable and provide incentive for public health agencies to 
implement local surveillance systems where they do not exist. To the 
extent feasible, the system shall be built using electronic health 
information systems. It shall incorporate flexibility and depth of data 
necessary to respond to previously unknown or emerging threats to public 
health and integrate its data into the national biosurveillance common 
operating picture as appropriate. The system shall protect patient 
privacy by restricting access to identifying information to the greatest 
extent possible and only to public health officials with a need to know. 
The Implementation Plan to be developed pursuant to section 43 of this 
directive shall specify milestones for this system.
    (22) Within 180 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
Defense, Veterans Affairs, and Homeland Security, shall establish an 
Epidemiologic Surveillance Federal Advisory Committee, including 
representatives from State and local government public health 
authorities and appropriate private sector health care entities, in 
order to ensure that the Federal Government is meeting the goal of 
enabling State and local government public health surveillance 
capabilities.

[[Page 1368]]

Countermeasure Stockpiling and Distribution

    (23) In accordance with the schedule set forth below, the Secretary 
of Health and Human Services, in coordination with the Secretary of 
Homeland Security, shall develop templates, using a variety of tools and 
including private sector resources when necessary, that provide minimum 
operational plans to enable communities to distribute and dispense 
countermeasures to their populations within 48 hours after a decision to 
do so. The Secretary of Health and Human Services shall ensure that this 
process utilizes current cooperative programs and engages Federal, 
State, local government, and private sector entities in template 
development, modeling, testing, and evaluation. The Secretary shall also 
assist State, local government, and regional entities in tailoring 
templates to fit differing geographic sizes, population densities, and 
demographics, and other unique or specific local needs. In carrying out 
such actions, the Secretary shall:
    (a) within 270 days after the date of this directive, (i) publish an 
initial template or templates meeting the requirements above, including 
basic testing of component distribution mechanisms and modeling of 
template systems to predict performance in large-scale implementation, 
(ii) establish standards and performance measures for State and local 
government countermeasure distribution systems, including demonstration 
of specific capabilities in tactical exercises in accordance with the 
National Exercise Program, and (iii) establish a process to gather 
performance data from State and local participants on a regular basis to 
assess readiness; and
    (b) within 180 days after the completion of the tasks set forth in 
(a), and with appropriate notice, commence collecting and using 
performance data and metrics as conditions for future public health 
preparedness grant funding.
    (24) Within 270 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
Defense, Veterans Affairs, and Homeland Security and the Attorney 
General, shall develop Federal Government capabilities and plans to 
complement or supplement State and local government distribution 
capacity, as appropriate and feasible, if such entities' resources are 
deemed insufficient to provide access to countermeasures in a timely 
manner in the event of a catastrophic health event.
    (25) The Secretary of Health and Human Services shall ensure that 
the priority-setting process for the acquisition of medical 
countermeasures and other critical medical materiel for the Strategic 
National Stockpile (SNS) is transparent and risk-informed with respect 
to the scope, quantities, and forms of the various products. Within 180 
days after the date of this directive, the Secretary, in coordination 
with the Secretaries of Defense, Homeland Security, and Veterans 
Affairs, shall establish a formal mechanism for the annual review of SNS 
composition and development of recommendations that utilizes input from 
accepted national risk assessments and threat assessments, national 
planning scenarios, national modeling resources, and subject matter 
experts. The results of each such annual review shall be provided to the 
Director of the Office of Management and Budget and the Assistant to the 
President for Homeland Security and Counterterrorism at the time of the 
Department of Health and Human Services' next budget submission.
    (26) Within 90 days after the date of this directive, the Secretary 
of Health and Human Services shall establish a process to share relevant 
information regarding the contents of the SNS with Federal, State, and 
local government health officers with appropriate clearances and a need 
to know.
    (27) Within 180 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
State, Defense, Agriculture, Veterans Affairs, and Homeland Security, 
shall develop protocols for sharing countermeasures and medical goods 
between the SNS and other Federal stockpiles and shall explore 
appropriate reciprocal arrangements with foreign and international 
stockpiles of medical countermeasures to ensure the availability of 
necessary supplies for use in the United States.

[[Page 1369]]

Mass Casualty Care

    (28) The Secretary of Health and Human Services, in coordination 
with the Secretaries of Defense, Veterans Affairs, and Homeland 
Security, shall directly engage relevant State and local government, 
academic, professional, and private sector entities and experts to 
provide feedback on the review of the National Disaster Medical System 
and national medical surge capacity required by the Pandemic and All-
Hazards Preparedness Act (PAHPA) (Public Law 109-417). Within 270 days 
after the completion of such review, the Secretary shall identify, 
through a systems-based approach involving expertise from such entities 
and experts, high-priority gaps in mass casualty care capabilities, and 
shall submit to the Assistant to the President for Homeland Security and 
Counterterrorism a concept plan that identifies and coordinates all 
Federal, State, and local government and private sector public health 
and medical disaster response resources, and identifies options for 
addressing critical deficits, in order to achieve the system attributes 
described in this Strategy.
    (29) Within 180 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
Defense, Veterans Affairs, and Homeland Security, shall:
    (a) build upon the analysis of Federal facility use to provide 
enhanced medical surge capacity in disasters required by section 302 of 
PAHPA to analyze the use of Federal medical facilities as a foundational 
element of public health and medical preparedness; and
    (b) develop and implement plans and enter into agreements to 
integrate such facilities more effectively into national and regional 
education, training, and exercise preparedness activities.
    (30) The Secretary of Health and Human Services shall lead an 
interagency process, in coordination with the Secretaries of Defense, 
Veterans Affairs, and Homeland Security and the Attorney General, to 
identify any legal, regulatory, or other barriers to public health and 
medical preparedness and response from Federal, State, or local 
government or private sector sources that can be eliminated by 
appropriate regulatory or legislative action and shall, within 120 days 
after the date of this directive, submit a report on such barriers to 
the Assistant to the President for Homeland Security and 
Counterterrorism.
    (31) The impact of the ``worried well'' in past disasters is well 
documented, and it is evident that mitigating the mental health 
consequences of disasters can facilitate effective response. Recognizing 
that maintaining and restoring mental health in disasters has not 
received sufficient attention to date, within 180 days after the date of 
this directive, the Secretary of Health and Human Services, in 
coordination with the Secretaries of Defense, Veterans Affairs, and 
Homeland Security, shall establish a Federal Advisory Committee for 
Disaster Mental Health. The committee shall consist of appropriate 
subject matter experts and, within 180 days after its establishment, 
shall submit to the Secretary of Health and Human Services 
recommendations for protecting, preserving, and restoring individual and 
community mental health in catastrophic health event settings, including 
pre-event, intra-event, and post-event education, messaging, and 
interventions.

Community Resilience

    (32) The Secretary of Health and Human Services, in coordination 
with the Secretaries of Defense, Veterans Affairs, and Homeland 
Security, shall ensure that core public health and medical curricula and 
training developed pursuant to PAHPA address the needs to improve 
individual, family, and institutional public health and medical 
preparedness, enhance private citizen opportunities for contributions to 
local, regional, and national preparedness and response, and build 
resilient communities.
    (33) Within 270 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
Defense, Commerce, Labor, Education, Veterans Affairs, and Homeland 
Security and the Attorney General, shall submit to the President for 
approval, through the Assistant to the President for Homeland Security 
and Counterterrorism, a plan to promote comprehensive community medical 
preparedness.

[[Page 1370]]

Risk Awareness

    (34) The Secretary of Homeland Security, in coordination with the 
Secretary of Health and Human Services, shall prepare an unclassified 
briefing for non-health professionals that clearly outlines the scope of 
the risks to public health posed by relevant threats and catastrophic 
health events (including attacks involving weapons of mass destruction), 
shall coordinate such briefing with the heads of other relevant 
executive departments and agencies, shall ensure that full use is made 
of Department of Defense expertise and resources, and shall ensure that 
all State governors and the mayors and senior county officials from the 
50 largest metropolitan statistical areas in the United States receive 
such briefing, unless specifically declined, within 150 days after the 
date of this directive.
    (35) Within 180 days after the date of this directive, the Secretary 
of Homeland Security, in coordination with the Attorney General, the 
Secretary of Health and Human Services, and the Director of National 
Intelligence, shall establish a mechanism by which up-to-date and 
specific public health threat information shall be relayed, to the 
greatest extent possible and not inconsistent with the established 
guidance relating to the Information Sharing Environment, to relevant 
public health officials at the State and local government levels and 
shall initiate a process to ensure that qualified heads of State and 
local government entities have the opportunity to obtain appropriate 
security clearances so that they may receive classified threat 
information when applicable.

Education and Training

    (36) Within 180 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretary of 
Homeland Security, shall develop and thereafter maintain processes for 
coordinating Federal grant programs for public health and medical 
preparedness using grant application guidance, investment 
justifications, reporting, program performance measures, and 
accountability for future funding in order to promote cross-sector, 
regional, and capability-based coordination, consistent with section 201 
of PAHPA and the National Preparedness Guidelines developed pursuant to 
Homeland Security Presidential Directive-8 of December 17, 2003 
(``National Preparedness'').
    (37) Within 1 year after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
Defense, Transportation, Veterans Affairs, and Homeland Security, and 
consistent with section 304 of PAHPA, shall develop a mechanism to 
coordinate public health and medical disaster preparedness and response 
core curricula and training across executive departments and agencies, 
to ensure standardization and commonality of knowledge, procedures, and 
terms of reference within the Federal Government that also can be 
communicated to State and local government entities, as well as academia 
and the private sector.
    (38) Within 1 year after the date of this directive, the Secretaries 
of Health and Human Services and Defense, in coordination with the 
Secretaries of Veterans Affairs and Homeland Security, shall establish 
an academic Joint Program for Disaster Medicine and Public Health housed 
at a National Center for Disaster Medicine and Public Health at the 
Uniformed Services University of the Health Sciences. The Program shall 
lead Federal efforts to develop and propagate core curricula, training, 
and research related to medicine and public health in disasters. The 
Center will be an academic center of excellence in disaster medicine and 
public health, co-locating education and research in the related 
specialties of domestic medical preparedness and response, international 
health, international disaster and humanitarian medical assistance, and 
military medicine. Department of Health and Human Services and 
Department of Defense authorities will be used to carry out respective 
civilian and military missions within this joint program.

Disaster Health System

    (39) Within 180 days after the date of this directive, the Secretary 
of Health and Human Services shall commission the Institute of Medicine 
to lead a forum engaging Federal, State, and local governments, the 
private sector, academia, and appropriate

[[Page 1371]]

professional societies in a process to facilitate the development of 
national disaster public health and medicine doctrine and system design 
and to develop a strategy for long-term enhancement of disaster public 
health and medical capacity and the propagation of disaster public 
health and medicine education and training.
    (40) Within 120 days after the date of this directive, the Secretary 
of Health and Human Services shall submit to the President through the 
Assistant to the President for Homeland Security and Counterterrorism, 
and shall commence the implementation of, a plan to use current grant 
funding programs, private payer incentives, market forces, Center for 
Medicare and Medicaid Services requirements, and other means to create 
financial incentives to enhance private sector health care facility 
preparedness in such a manner as to not increase health care costs.
    (41) Within 180 days after the date of this directive, the Secretary 
of Health and Human Services, in coordination with the Secretaries of 
Transportation and Homeland Security, shall establish within the 
Department of Health and Human Services an Office for Emergency Medical 
Care. Under the direction of the Secretary, such Office shall lead an 
enterprise to promote and fund research in emergency medicine and trauma 
health care; promote regional partnerships and more effective emergency 
medical systems in order to enhance appropriate triage, distribution, 
and care of routine community patients; promote local, regional, and 
State emergency medical systems' preparedness for and response to public 
health events. The Office shall address the full spectrum of issues that 
have an impact on care in hospital emergency departments, including the 
entire continuum of patient care from pre-hospital to disposition from 
emergency or trauma care. The Office shall coordinate with existing 
executive departments and agencies that perform functions relating to 
emergency medical systems in order to ensure unified strategy, policy, 
and implementation.

National Health Security Strategy

    (42) The PAHPA requires that the Secretary of Health and Human 
Services submit in 2009, and quadrennially afterward, a National Health 
Security Strategy (NHSS) to the Congress. The principles and actions in 
this directive, and in the Implementation Plan required by section 43, 
shall be incorporated into the initial NHSS, as appropriate, and shall 
serve as a foundation for the preparedness goals contained therein.

Task Force and Implementation Plan

    (43) In order to facilitate the implementation of the policy 
outlined in this Strategy, there is established the Public Health and 
Medical Preparedness Task Force (Task Force). Within 120 days after the 
date of this directive, the Task Force shall submit to the President for 
approval, through the Assistant to the President for Homeland Security 
and Counterterrorism, an Implementation Plan (Plan) for this Strategy, 
and annually thereafter shall submit to the Assistant to the President 
for Homeland Security and Counterterrorism a status report on the 
implementation of the Plan and any recommendations for changes to this 
Strategy.
    (a) The Task Force shall consist exclusively of the following 
members (or their designees who shall be full-time officers or employees 
of the members' respective agencies):
 (i)         The Secretary of Health and Human Services, who shall serve 
            as Chair;
 (ii)        The Secretary of State;
 (ii)        The Secretary of Defense;
 (iii)       The Attorney General;
 (iv)        The Secretary of Agriculture;
 (v)         The Secretary of Commerce;
 (vi)        The Secretary of Labor;
 (vii)       The Secretary of Transportation;
 (viii)      The Secretary of Veterans Affairs
 (ix)        The Secretary of Homeland Security;
 (x)         The Director of the Office of Management and Budget;
 (xi)        The Director of National Intelligence; and
 (xii)       such other officers of the United States as the Chair of 
            the Task Force may designate from time to time.
    (b) The Chair of the Task Force shall, as appropriate to deal with 
particular subject matters, establish subcommittees of the Task Force 
that shall consist exclusively of members of the Task Force (or their 
designees under subsection (a) of this section), and

[[Page 1372]]

such other full-time or permanent part-time officers or employees of the 
Federal Government as the Chair may designate.
    (c) The Plan shall:
 (i)         provide additional detailed roles and responsibilities of 
            heads of executive departments and agencies relating to and 
            consistent with the Strategy and actions set forth in this 
            directive;
 (ii)        provide additional guidance on public health and medical 
            directives in Biodefense for the 21st Century; and
 (iii)       direct the full examination of resource requirements.
    (d) The Plan and all Task Force reports shall be developed in 
coordination with the Biodefense Policy Coordination Committee of the 
Homeland Security Council and shall then be prepared for consideration 
by and submitted to the more senior committees of the Homeland Security 
Council, as deemed appropriate by the Assistant to the President for 
Homeland Security and Counterterrorism.

General Provisions

    (44) This directive:
    (a) shall be implemented consistent with applicable law and the 
authorities of executive departments and agencies, or heads of such 
departments and agencies, vested by law, and subject to the availability 
of appropriations and within the current projected spending levels for 
Federal health entitlement programs;
    (b) shall not be construed to impair or otherwise affect the 
functions of the Director of the Office of Management and Budget 
relating to budget, administrative, and legislative proposals; and
    (c) is not intended, and does not, create any rights or benefits, 
substantive or procedural, enforceable at law or in equity by a party 
against the United States, its departments, agencies, instrumentalities, 
or entities, its officers, employees, or agents, or any other person.

Note: An original was not available for verification of the content of 
this directive.