WASHINGTON — The Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine (DGMQ) should create an effective and innovative quarantine station model to confront new challenges in preventing the spread of infectious diseases in the U.S., says a new report from the National Academies of Sciences, Engineering, and Medicine.

Improving the CDC Quarantine Station Network’s Response to Emerging Threats says Congress should enhance the legal authority and flexibility of CDC in responding to public health threats by modernizing and improving the Public Health Service Act. The U.S. Department of Health and Human Services and CDC should ensure DGMQ has the necessary financial and personnel resources and infrastructure to meet its responsibilities and achieve its mission.

The DGMQ operates quarantine stations staffed by public health officers at 20 U.S. international airports and land-border crossings with the highest concentrations of incoming international travelers, including in Boston, Chicago, Los Angeles, Miami, and New York City. Over the past two decades, the public health, social, and economic threats posed by infectious diseases have intensified significantly. These threats are compounded by the increasing ease, speed, and range of international travel. Beyond the ongoing COVID-19 pandemic, DGMQ in recent years has responded to outbreaks of SARS, MERS, Zika, West Nile virus, and Ebola.

“The U.S. needs a quarantine station system that can meet the infectious disease challenges we know are ahead of us,” said Georges C. Benjamin, executive director of the American Public Health Association and chair of the committee that wrote the report. “To do that, Congress needs to enhance the nation’s quarantine system network, to include updating the CDC’s legal authority by modernizing the Public Health Service Act. Such an update would ensure it can act appropriately during public health emergencies. These reforms will empower bodies like the DGMQ to complete their essential public health mission and protect the public’s health.”

The report outlines specific steps for DGMQ in order to modernize its quarantine station system to match the needs of a global, mobile world. These include developing criteria for making decisions about adding, deleting, or upgrading the quarantine stations in its network and permanently housing the maritime quarantine unit within DGMQ to address the unique needs of the cruise industry. DGMQ should develop more robust pre- and post-entry processes for travelers by collaborating with other agencies and organizations.

Modernizing Legal and Regulatory Authority
During the COVID-19 pandemic, many of the regulatory authorities granted to the CDC under the Public Health Service Act were challenged or blocked by courts — therefore, reform is needed to modernize the CDC’s authorities and implement the report’s recommended actions. Congress should update the act to ensure CDC has authority to effectively prevent or mitigate current and future public health threats. Reforms should specifically delegate congressional power to provide CDC with the authority it needs to implement science-based public health measures.

Congress should include protections for individual rights and freedoms, including procedural due process, where constitutionally warranted and feasible to challenge any order under the act. It should also ensure that CDC uses its authorities fairly and equitably, the report says.

Strengthening Organizational Capacity
Rather than increases to its core funding, DGMQ has received surge funding for public health emergencies, creating a cycle of boom and bust, which the report says does not support a sustainable or proactive quarantine system that is ready to be deployed. HHS should enable DGMQ to use surge funding more readily, and CDC should explore a user fee program to ensure the division has a consistent source of revenue.

DGMQ is also heavily reliant on temporary personnel, which has resulted in workforce burnout and high turnover. The division should form a personnel plan to address these issues and develop new strategies to support its recruitment needs, the report says. DGMQ should assess its culture and climate as part of this plan, with a focus on diversity, equity, and inclusion.

Mitigating Infectious Disease Risk
The report says DGMQ should create detailed operational plans and playbooks based on the most concerning and likely scenarios for transmissible disease threats — including detailed plans for large-scale isolation and quarantine that might be needed in the future, informed by lessons learned during its initial response to COVID-19. These plans should address ethical and equity issues that will likely arise — especially for housing or caring for special populations — and address language and intercultural needs. Plans should include coordination of legal authority, triage, and transport of ill individuals with nearby health care facilities, and collaboration with state and local officials.

To inform planning, DGMQ and CDC should commission an external evaluation of the effectiveness of travel restrictions and active screening of all international travelers in preventing and mitigating transmission during the current COVID-19 pandemic and the 2014-2015 Ebola outbreaks in West Africa. This evaluation should include psychological benefits, political implications, unintended consequences of screening, resources required, and burdens placed on state and local jurisdictions.

Novel Technologies and Data
The COVID-19 pandemic revealed striking inadequacies in DGMQ’s technology infrastructure, says the report, and the division should increase and improve its use of innovative technology. DGMQ should incorporate and improve on the use of digital technologies to gather health data from travelers, trace transmission, and alert travelers to exposures. The report recommends DGMQ ensure all of these technologies and its data streams follow careful ethical considerations and comply with existing personal data protection regulations by creating an oversight structure.

Improved Coordination
DGMQ should strengthen its partnerships to facilitate coordination during future emergencies, and modernize health communication efforts with travelers to improve compliance and public understanding of disease control efforts — for example, by collaborating with airlines to better inform passengers prior to departure or during ticket purchasing.

The study — undertaken by the Committee on the Analysis to Enhance the Effectiveness of the Federal Quarantine Station Network Based on Lessons from the COVID-19 Pandemic — was sponsored by the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine.

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

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