Washington, Idaho rank high for public health emergency preparedness

A new report shows that Idaho and Washington state ranked “high” among states prepared to handle public health emergencies, while Oregon ranked “low.”

The report, published by Trust for America’s Health, a nonprofit, nonpartisan public health group, evaluated 10 different criteria. The criteria included public health and emergency management accreditation, states’ participation in compacts that allow for cross-state nursing practices, water system safety and vaccination rates.

Matt McKillop, senior health policy researcher and analyst at Trust for America’s Health, said Washington ranked among the top states for emergency preparedness both this year and last, and Idaho moved from the middle tier to the high tier in 2025.

One area that contributed to both states’ high scores was their participation in the Nurse Licensure Compact, which allows nurses from one state to provide care in another. It can increase hospitals’ ability to respond to public health emergencies.

“If they are in need of additional nursing staffing, they can really seamlessly integrate nurses from other neighboring states,” McKillop said.

Washington also had a flu vaccination rate of 52% in 2023-2024, which was above the national average of 47%. The state also had a higher usage of paid time off, which McKillop said helps to reduce the spread of infectious diseases. 

Idaho scored in the high tier thanks to increased investments in public health, high patient safety ratings at hospitals and high ratings for water system safety. 

However, Idaho fell far behind other states in flu vaccinations, with only a 38% vaccine rate.

Flu vaccination rates are a major public health indicator not only in terms of preventing influenza, McKillop said, but in reflecting the effectiveness of public health campaigns that promote vaccinations generally. 

That includes vaccines for diseases such as measles or RSV, which have seen a recent resurgence.

“(The flu vaccine is) important in and of itself, but it’s also a signal for other types of vaccinations that people might be receiving,” he said.

Idaho has generally seen low vaccine acceptance rates, McKillop noted, with Idaho’s Southwest District Health voting last year to halt its COVID-19 vaccine program.

Oregon, meanwhile, scored on the low tier in both 2024 and 2025. The state did have several strong public health indicators, including mandated sick leave and a flu vaccine rate a little higher than the national average, at 48%. 

But the state also reduced its public health funding, and scored low in water system safety. McKillop said inconsistent public health funding hampers health officials’ ability to respond at the pace that’s needed.

“That could potentially create dangerous gaps in public health infrastructure,” he said. “Especially in emergencies when we need to be able to be nimble and to respond quickly.”

TFAH representatives also emphasized the importance of federal public health funding. Roughly 80% of the Centers for Disease Control and Prevention’s domestic budget goes to external partners such as local health departments. That federal funding has seen major cuts recently from the Trump administration.

Umair Shah, former Secretary of Health for Washington state and a member of the board of directors for TFAH, said continually investing in public health is essential for emergency preparedness.

“We want to have effective and efficient government, absolutely,” Shah said. “But we can’t just cut for the purpose of cutting. We have to be really mindful of the impact on people.”

Shah said federal spending cuts are similar to mistakes from the past where public health has been underfunded.

“We blow the infrastructure, we remove the people and all of a sudden something happens and now we’re playing catch up,” he said. “And we’re spending more resources to make ourselves respond to that emergency.”

J. Nadine Gracia, president and CEO of TFAH, said investments in public health have made a major difference in recent years. 

She cited the National Wastewater Surveillance System and updated data systems bought with COVID-19 emergency funding that allowed small public health departments to transmit data faster as examples of public health success from increased funding.

As other needs emerge, including outbreaks of measles and a looming threat of bird flu that could affect public health and the economy, Gracia said increasing and sustaining funding for public health is essential.

“That is vital to our health security, that is vital to our economic security, and that’s vital to our overall national security,” she said.