tive leadership. No single entity has the responsibility, the authority, and the resources for orchestrating the activities of the System to protect the U.S. population from microbial threats of public health significance that originate abroad.

To fill this void, the primary activities of the CDC quarantine stations should shift from the legacy and historical activity of inspection to the provision of strategic national public health leadership for Quarantine System activities. Such leadership, carried out in collaboration with the Division of Global Migration and Quarantine (DGMQ) and the scientific and organizational capacity of CDC, would improve national preparedness for crises caused by microbial threats of public health significance that originate abroad. The Quarantine Core should provide similar strategic leadership to the Quarantine Network. The committee concluded that the stations’ traditional primary activities should continue but should consume only a fraction of their time.

The Core’s leadership role stems naturally from the unique responsibility of federal government to assure2 action for health (IOM, 2003, p. 34) as well as from CDC’s position as a lead federal agency for protecting the health of Americans. The Core alone has the appropriate expertise, resources, and experience to provide strategic national public health leadership to the Quarantine Network. At the same time, the committee recognizes that from both a historical and a constitutional perspective, protecting the public’s health has primarily been a function of the states and their localities3 (IOM, 2003). Accordingly, the Core must take extra care to collaborate with—as well as respect the jurisdictional authorities of—its state and local partners as it assumes this leadership role. In addition, the Core should be careful to respect preexisting systems and infrastructures that states and localities may have already developed and put into place. The committee emphasizes the need for cooperation, flexibility, and partnership among the Core and its partners in the recommendations that follow.

This chapter begins with a vision of a Quarantine Network that reflects the committee’s sense of how best to protect against microbial threats of public health significance at U.S. ports of entry. Subsequently, the committee presents seven recommendations designed to help the quarantine sta-


In this report, “to assure” means to make sure that necessary public health services are provided to all members of society by encouraging the requisite actions, requiring them, or providing the services directly. For an in-depth description of the assurance function in public health, see The Future of Public Health, pp. 45-47 (IOM, 1988).


It should be noted, however, that while the Constitution grants states and localities primary responsibility for protecting the public’s health, the federal government has specific legal authorities over quarantine in the United States (Gostin, 2000).

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