A Public Health Emergency (PHE) is a formal designation invoked when a health crisis exceeds the capacity of routine governmental response mechanisms. This declaration signals an imminent or existing threat that requires extraordinary measures and resources. The PHE designation carries specific legal and operational weight, activating emergency powers, funding streams, and regulatory flexibilities intended to streamline the response to a large-scale health threat.
Defining a Public Health Emergency
A PHE is defined as an occurrence or imminent threat of an illness or health condition that poses a high probability of large-scale mortality or serious long-term disability. This includes threats caused by biological, chemical, or nuclear agents, or natural disasters that severely compromise public health. To qualify for a federal PHE declaration, the situation must demonstrate that local and state public health resources are overwhelmed.
The event must be serious, sudden, unusual, or unexpected, warranting a response that exceeds ordinary public health measures. Examples include infectious disease outbreaks, such as the COVID-19 pandemic, and widespread health risks following natural catastrophes like severe flooding.
Authority and Criteria for Declaration
The authority to declare a PHE is split between domestic and international bodies, each operating under distinct legal frameworks.
Domestic Authority
In the United States, the Secretary of Health and Human Services (HHS) is the federal authority to make this determination under Section 319 of the U.S. Public Health Service Act. This grants the HHS Secretary discretion to declare an emergency based on a disease or disorder that presents a public health emergency, or when a significant outbreak or bioterrorist attack exists.
International Authority
On the global level, the World Health Organization (WHO) Director-General declares a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR). A PHEIC is defined as an extraordinary event that poses a public health risk to other nations through the international spread of disease, requiring a coordinated international response. The determination is guided by an Emergency Committee of international experts who advise the Director-General on the event’s severity, the risk of international spread, and the potential for travel or trade restrictions. A PHEIC declaration places a legal duty on all 196 countries bound by the IHR to respond promptly and transparently.
Operational Changes Triggered by a PHE
The formal declaration of a PHE unlocks specific government powers and resources designed to accelerate the response.
Funding and Resources
The HHS Secretary gains immediate access to “no-year” funds appropriated to the Public Health Emergency Fund to rapidly address immediate needs. This funding allows for the swift execution of contracts, issuance of grants, and support for investigations into the cause and prevention of the health threat.
Regulatory Waivers
A declaration also triggers the ability to waive or modify certain federal regulations, streamlining healthcare delivery during the crisis. Under Section 1135 of the Social Security Act, the HHS Secretary can temporarily suspend requirements related to Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These waivers ensure sufficient healthcare services are available, such as modifying hospital bed limits to expand surge capacity or temporarily waiving physician licensing requirements across state lines.
Regulatory flexibility extends to the Health Insurance Portability and Accountability Act (HIPAA) to allow for the sharing of patient information for treatment purposes during the emergency. A PHE also allows for the mobilization of federal assets, including the deployment of emergency personnel and the authorization of emergency use products, like vaccines or treatments, to the affected areas.
Ending and Reviewing Emergency Status
A federal PHE is not an indefinite status; it is subject to periodic review and renewal by the HHS Secretary. The declaration is set for a maximum duration of 90 days, after which it must be officially renewed or it will expire. This renewal cycle ensures that the justification for the emergency powers is regularly assessed based on the evolving nature of the threat.
The status is officially terminated when the HHS Secretary determines that the threat has subsided or that the situation can be managed effectively through standard public health measures. Termination of the PHE carries immediate consequences, as the associated emergency funding and regulatory waivers automatically expire.