16 States That Are Least Prepared for the Next Pandemic

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With the COVID-19 pandemic mostly behind us now, it’s tempting to breathe a sigh of relief and relax. But that might not be the wisest move.

Instead, it probably makes more sense to prepare for the possibility of a new pandemic sometime in the future.

Recently, the nonprofit Trust for America’s Health completed its latest annual analysis of national and state preparedness for public health emergencies.

The organization found that 16 states are particularly underprepared for the next time another pandemic or other type of health emergency strikes. Other states are in better shape. Here’s where all 50 states fall on one of three tiers of preparedness: low, middle or high.

How preparedness was evaluated

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Trust for America’s Health based its judgment on nine top-priority indicators of state emergency preparedness. They are:

  • Adoption of the Nurse Licensure Compact (NLC). This is based on whether a state has adopted the Nurse Licensure Compact, which allows registered and practical nurses “to practice in any member state with a single multistate license, eliminating the need for emergency declarations,” according to Trust for America’s Health.
  • Accreditation status of state public health and emergency management systems. These two indicators include whether states are accredited by the Public Health Accreditation Board and/or the Emergency Management Accreditation Program.
  • State public health funding trends. This is based on whether states increased their public health funding in fiscal year 2023 or at least held it steady.
  • Community water system safety. This includes whether citizens receive water that meets standards set by the Safe Drinking Water Act.
  • Use of paid time off. This is based on the percentage of the employed population that uses paid time off during the course of a month.
  • Flu vaccination rate. This looks at whether states achieve a 70% target for annual population vaccination.
  • Patient safety in hospitals. This is based on the percentage of hospitals with a top ranking of “A” from the nonprofit Leapfrog Group.
  • State public health laboratory surge capacity. This focuses on whether a state’s public health laboratory has a plan for a six- to eight-week surge in testing capacity.

Low-tier states

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These 16 states perform poorly in terms of emergency preparedness, according to Trust for America’s Health:

  • Alaska
  • California
  • Hawaii
  • Indiana
  • Kentucky
  • Louisiana
  • Michigan
  • Minnesota
  • North Dakota
  • Nevada
  • New York
  • Oregon
  • South Dakota
  • Texas
  • West Virginia
  • Wyoming

Middle-tier states

Woman stocking up on water and wearing a face mask at the grocery store
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These 13 states fall right in the middle of the rankings in terms of emergency preparedness:

  • Arkansas
  • Delaware
  • Iowa
  • Idaho
  • Illinois
  • Maryland
  • Missouri
  • Montana
  • New Hampshire
  • New Mexico
  • Oklahoma
  • Utah
  • Wisconsin

High-tier states

man quarantined at home
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These are the 22 states that perform best in terms of emergency preparedness:

  • Alabama
  • Arizona
  • Colorado
  • Connecticut
  • District of Columbia
  • Florida
  • Georgia
  • Kansas
  • Massachusetts
  • Maine
  • Mississippi
  • North Carolina
  • Nebraska
  • New Jersey
  • Ohio
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • Tennessee
  • Virginia
  • Vermont
  • Washington

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