and spread of communicable diseases from foreign countries into the United States and its possessions (42 U.S.C. §264). To implement this statute, the secretary develops and enforces regulations through the Centers for Disease Control and Prevention (CDC) (8 U.S.C., 42 U.S.C. §70 and §71). CDC has authorized its Division of Global Migration and Quarantine (DGMQ) to carry out many of these regulations through a variety of activities, including the operation of quarantine stations at select ports of entry and the administration of regulations that govern the movement of people, animals, cargo, and conveyances into the United States. For example, DGMQ can detain, medically examine, or conditionally release individuals at U.S. ports of entry who are reasonably believed to be carrying a communicable disease of public health significance (42 CFR §70–71). Also, DGMQ and CDC can set policies to prevent certain animals that pose a public health threat from entering the country (42 CFR §71.32).

QUARANTINE CORE, SYSTEM, AND NETWORK

The committee found the CDC quarantine stations to be one component of a large, complex network of organizations whose collective actions provide limited protection to residents of and travelers to the United States from microbial threats of foreign origin. It became apparent that understanding the role of the CDC quarantine stations in this network would be essential to developing realistic conclusions and recommendations. Consequently, the committee developed a conceptual diagram and vocabulary to visualize and articulate the interrelationships among the stations, the network, and other key actors. The committee used this diagram and vocabulary both during its deliberations and in its report.

The committee found that some members of the network interact primarily or exclusively with the headquarters staff of DGMQ, rather than with individual stations. For instance, the Director of DGMQ has direct contact with the World Health Organization and the Air Transport Association of America.

Other members of the network interact with CDC’s quarantine operations at multiple levels. For example, the issuance of a joint FDA–CDC ban on the importation and interstate trade of African rodents in the wake of the monkeypox outbreak was accomplished through communication among DGMQ leadership, relevant officials at CDC headquarters, and their counterparts at FDA’s main offices in the Washington, DC, area. By contrast, FDA’s field inspectors at U.S. ports of entry interact primarily with the CDC quarantine station in their region.

In addition, the committee found, a subgroup of organizations in the network interacts with the quarantine stations more closely and frequently than the rest of the network. Within this subgroup, some organizations and



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