Nicole Lurie on Public Health Emergencies

April 1, 2014

As the nation's top official for public health emergencies since 2009, Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, has led response and recovery efforts for everything from the H1N1 pandemic to Hurricane Sandy, while working to prepare for any range of future disasters. In this Q&A, Dr. Lurie, who at the invitation of Dean Linda P. Fried will speak at the Mailman School on Friday, April 4, shares her thoughts on the critical role of science in responding to public health emergencies, the importance of being a good neighbor, and why health insurance is an essential item for your personal disaster kit.


It seems there is a new disaster practically every day. The recent mudslide in Washington State, the chemical spill in West Virginia, wildfires, hurricanes, earthquakes, tornadoes, mass shootings, the measles outbreak. What qualifies as a public health emergency? When does your office get involved?

Any threat to public health could become an emergency, that’s why it’s so important for our healthcare system to be robust and capable of withstanding adversity. We have to respond with the system we have in place so it’s crucial that those day-to-day systems are prepared to support their communities, surge when needed, and continually demonstrate resilience.

Our office is involved every day in helping states and local communities become better prepared across the spectrum of public health and medical readiness. In an emergency, when the state or local community indicates a need for our help, our office provides support—whether it’s additional personnel to augment state or local providers, technical assistance or policies that need to be changed or set to meet the emergency need.

You’ve said that when disaster strikes having strong social connections is crucial. Does this mean we should all get to know the people living next door?

Absolutely! And check on those neighbors to see what they may need before an emergency occurs so you’re ready to help. The person next to you is the first possible responder in an emergency. Strong social connections also help people cope with the psychological stress of disasters.

I’ll tell you about a story from Hurricane Sandy. There was a quadriplegic resident living in a high-rise building where the power had gone out. His friends were with him, tweeting when his battery was getting low. There was a whole brigade of volunteers running up the stairs, taking his battery to charge at the fire station, and running it back up to him. How do you scale that spontaneous helping behavior? It starts by knowing who is in your community and knowing your neighbor. 

You recently wrote an op-ed arguing that the Affordable Care Act makes Americans better prepared for disaster. Please explain.

One of the biggest indicators of how you will fare after a disaster is how you were doing before it. If you are able to get the care you need day to day, then you will be healthier and better able to care for yourself, or others, in a crisis which means you and your community become more resilient. The ACA makes it so that literally millions more Americans can see a doctor with insurance coverage they buy on the Healthcare Marketplace. I highly recommend adding health insurance to everyone’s disaster preparedness kit.

Aftermath of Hurricane Sandy, 2012

A lot of people, including New York Governor Andrew Cuomo, felt the experience of Hurricane Sandy highlighted the threat of climate change. Do you share the concern that hurricanes and other natural disasters could happen with more frequency and intensity because of climate change?

Climate change holds significant potential to impact health. There are more and more data that indicate that changes in climate are affecting the frequency or intensity of natural disasters. There’s also evidence to suggest an increase in infectious disease, especially vector-borne diseases. Because natural disasters, extreme weather events and other climate-related stressors, and emerging and reemerging diseases pose short and long-term threats to public health, careful planning and preparedness are essential components of healthy, resilient communities. This doesn’t just mean planning to respond and recover—but also to mitigate and adapt.

Speaking of Sandy, how do you think the recovery has gone? How would you grade the New York metro area?

I spent quite a bit of time in the New York City area after the hurricane. The healthcare infrastructure suffered significant damage. Two of the hospitals that were pinnacles of the NYC healthcare system had to evacuate and close. They both renovated and began providing care within a year. That’s great progress. Agencies at the U.S. Department of Health and Human Services are providing grants to help with the recovery of health and human services. ASPR [Assistant Secretary for Preparedness and Response, Dr. Lurie's office] and the Centers for Disease Control are working together to provide grants for health care and public health research to support long-term recovery and provide a body of evidence community members and local leaders can use in making evidence-based decisions. New York City has been a leader in thinking about how to rebuild systems that truly foster resilience. But it’s important to remember that for the community as a whole, recovery will take years.

Where are the biggest needs in disaster preparedness and response? What are the biggest unanswered questions? What can the public community do to help?

One of the biggest unanswered questions, and one thing my office has elevated as a priority, is developing good practices for a “science response” to events. In every crisis, new scientific questions are revealed, and the scientific community needs to be poised to do rapid science in order to inform the active response, but also build new knowledge to ensure we are never in the same situation twice. For example, during the Deep Horizon oil spill, I learned that in the past 20 years the U.S. experienced almost 3,000 oil spills, yet we still didn’t know much about long-term health impacts. We need to be able to approve and implement scientific protocols rapidly so we can make sure every time we respond, it is with better and better science.

Watch Nicole Lurie's talk at the Mailman School on April 4: