Certain high-consequence pathogens, such as Ebola, H5N1, mpox, measles, and even rabies, are infrequently seen in healthcare settings, but still challenge the resilience of our healthcare and public health systems. The term high-impact pathogens (HIPs) may be a fitting designation due to their implications for healthcare preparedness and response. The CORHA Policy Workgroup led a discussion on this topic at the 2025 CSTE Annual Conference in Grand Rapids, Michigan. The discussion highlighted major gaps in HIP preparedness and response and informed how CORHA can address challenges, guide efforts, and lead progress against these threats; this summary captures these key themes.
Inconsistencies and unfamiliarity can shape HIP Responses
Inconsistencies in responding to HIPs affect both public health and healthcare. Some healthcare facilities may not have experience with HIPs.
For example, one session participant shared an example of measles exposures in a healthcare setting. They described a lack of clarity around who was responsible for monitoring patients, visitors, and healthcare workers. This example also highlighted that roles and responsibilities across state Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Programs, hospital occupational health programs, and other entities are often blurred. Inconsistencies in collaboration across local and state levels of public health further compound these challenges, as some local jurisdictions automatically involve HAI/AR Programs in HIP responses, while others leave them out entirely, potentially missing opportunities for training, capacity building, and the engagement of public health staff with relevant expertise. While there still may be ongoing confusion, CORHA and partners like CSTE are well-positioned to help improve coordination to better prevent and address outbreaks in healthcare settings.
Building Trust and Reducing Fear of Penalties
Issues with trust between healthcare facilities and public health agencies also present a critical gap. Fear of regulatory penalties or legal consequences can make facilities hesitant to share information or admit mistakes during and after an outbreak. Public health is often perceived as intertwined with licensing and enforcement bodies, fueling anxiety during HIP investigations.
It is essential to create an environment where facilities feel safe reporting issues, raising questions, and requesting consultative support without fear of punishment. As one participant noted during the CSTE session, “People are afraid of being ‘dinged’ by public health.” Clarifying the role of public health and establishing strong relationships with clear, open communication channels between public health and healthcare can help mitigate this fear.
Advocating for Standardized Processes for Effective Responses
To clearly define the role of HAI/AR Programs in HIP responses, we must address several remaining gaps. Advocating for processes for both public health departments and healthcare facilities can help ensure that relevant teams and resources are not overlooked during these events. Some areas where clearer guidance can be provided include:
- Involvement of Preparedness Teams: Regional treatment centers and preparedness teams, both within healthcare facilities and public health departments, can be key partners to HAI/AR Programs. Additional resources to support effective coordination and collaboration among these teams can help strengthen response efforts.
- Integration of Information: Developing and integrating standardized templates and plans/processes that incorporate HIP and other infectious disease information can ensure HAI staff are looped in immediately during a response.
- Occupational Health Coordination: For healthcare worker exposures to HIPs, the role of public health vs occupation health at the facility needs to be further clarified. Occupational health departments in facilities may be contracted outside the hospital and public health will need to work with these companies which may not be reachable on weekends and holidays for urgent response to exposures.
A clear approach can improve HIP responses. Some jurisdictions have found success in pairing health departments with hospital risk management teams to navigate these urgent HIP responses. Given some of the gaps discussed, there may be a promising path forward for CORHA to support improved collaboration on HIPs in the future.
Next Steps for CORHA in HIP Response
So, how does CORHA move forward? A few ways CORHA can help address these challenges and fill the gaps in HIP response are:
- Educate on the need for clear guidance articulating the HAI/AR Program’s role in HIP responses.
- Promote collaboration across public health programs such as between preparedness teams and HAI/AR Programs, and facility driven occupational health teams, through education on how public health systems work, roles within public health departments, and communication processes between healthcare and public health.
- Encourage development of standardized processes to ensure effective, consistent, and verifiable responses to HIPs.
- Highlight successful models, like health departments working with risk management teams, that can be replicated in other jurisdictions.
- Foster trust and open communication between public health agencies and healthcare facilities through routine meetings, correspondence, and strong leadership through CORHA’s partner organization networks.
Ultimately, bridging these gaps will enable public health and healthcare partners to respond to HIP threats more efficiently, effectively, and with greater confidence. As CORHA evolves following recent strategic planning, it is poised to convene and connect stakeholders, leverage the expertise of its partners organization members, and ultimately drive this work forward to promote change.
What do you think? Let us know what opportunities you see for CORHA to improve how public health and healthcare collaborates to prevent, detect, and respond to outbreaks of HIPs and email us at: [email protected].