Only 20 states are prepared for a public health emergency, a new Trust for America’s Health report found.
The “Ready or Not 2026: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism” report groups states into three performance tiers: high, middle and low. States were grouped based on their performance across 10 indicators: adoption of the nurse licensure compact; accreditation by the Public Health Accreditation Board and the Emergency Management Accreditation Program; state public health funding trends; community water system compliance; access to paid sick leave; seasonal influenza vaccination coverage; Leapfrog hospital safety grade; public health laboratory surge planning; and avoidable mortality. Read more about the methodology here.
In 2025, the U.S. faced a test of its public health emergency preparedness infrastructure after multiple disease outbreaks, natural disasters and changes to federal funding and policy. HHS eliminated thousands of positions across the CDC and the Administration for Strategic Preparedness and Response, and terminated more than $12 billion in pandemic-era public health grants. This combination put the nation’s remaining preparedness system at risk, according to the report.
The report found a number of improvement areas for public health preparedness, including:
- Varying access to paid sick leave, especially among low-wage, part-time and service-sector workers. Paid sick leave reduced disease transmission and increases recognition by employees of important preparedness infrastructure
- Flu vaccination rates remain low in many states.
- Stronger patient safety performance in hospitals, which can help maintain care quality and manage surge capacity during emergencies.
- Significant disparities in avoidable mortality persist across states and population groups.
- Aging infrastructure and increased weather-related threats harbor growing challenges to preparedness.
Here are the states, and the District of Columbia, that are the most and least prepared for a public health emergency:
High tier
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Illinois
- Kansas
- Maryland
- Massachusetts
- Maine
- Montana
- New Hampshire
- New Jersey
- North Carolina
- Pennsylvania
- Rhode Island
- Utah
- Vermont
- Virginia
- Wisconsin
Middle tier
- Arkansas
- Arizona
- District of Columbia
- Georgia
- Hawaii
- Idaho
- Indiana
- Louisiana
- Missouri
- Nevada
- New York
- North Dakota
- Nebraska
- Ohio
- Oregon
- South Carolina
- Tennessee
- Washington
Low tier
- Alabama
- Alaska
- Iowa
- Kentucky
- Michigan
- Minnesota
- Mississippi
- New Mexico
- Oklahoma
- South Dakota
- Texas
- West Virginia
- Wyoming
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