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2010 Report: Public Health Preparedness

Overview of Preparedness in the U.S. Insular Areas: Territories, Commonwealths, and Freely Associated States

Snapshots of Island Preparedness

American Samoa

American Samoa Flag American Samoa consists principally of five volcanic islands and two coral atolls covering some 76.2 square miles. (An atoll is an island of coral that encircles a lagoon.) It is located approximately 2,300 miles southwest of Hawaii and about 2,700 miles northeast of Australia. The capital of American Samoa is Pago Pago.

  • Emergency plans and equipment funded by the PHEP cooperative agreement supported critical response operations following the tsunami that struck the shores of American Samoa in fall 2009.
  • To compensate for the lack of formal public health training available in American Samoa, the Department of Health is working to provide practical training in basic epidemiology and public health for the existing and future workforce, the majority of whom are now recruited from clinical programs.


Guam Flag The U.S. territory of Guam is the largest and southernmost of the Mariana Islands in the Micronesian region of the western Pacific. It encompasses 212 square miles and is located some 3,800 miles southwest of Honolulu and 1,500 miles south of Tokyo. Hagatna is the capital of Guam.

  • PHEP funding supported the development of emergency response plans used to prepare the public health community and the public for a predicted strike by super typhoon Melor on Guam and the Northern Mariana Islands in fall 2009. Super typhoons have winds of at least 115 mph (185 km/h).
  • Guam is planning to upgrade their current laboratory to a BSL-2 facility for work involving agents of moderate potential hazard to personnel and the environment. The establishment of this laboratory will eliminate the traditional week-long wait for confirmatory results from California.

Republic of the Marshall Islands (RMI)

Republic of the Marshall Islands Flag The RMI is part of the larger geographic region known as Micronesia, or “Little Islands,” and is made up of 29 coral atolls, each comprising many smaller islets, and 5 single islands. The total land area of the approximately 1,225 islands and islets is about 70 square miles, which are spread across a sea area of over 750,000 square miles. RMI’s capital, Majuro, lies some 2,300 miles southwest of Honolulu and nearly 2,000 miles southeast of Guam.

  • Due to the lack of electricity in some areas and a recent energy crisis in the capital, RMI adopted the use of solar power as a main power source for communications equipment, lighting, and water treatment, in not only remote island atolls but within the main capital as well.
  • Emergency plans, training, and equipment funded by the PHEP cooperative agreement has supported critical response operations following the many events hitting RMI on an annual basis. Of particular note in 2009 were floods, the H1N1 pandemic influenza response, and the tsunami warning.

Federated States of Micronesia (FSM)

Federated States of Micronesia Flag The FSM is a grouping of 607 small islands in the Western Pacific lying just above the Equator and about 2,500 miles southwest of Hawaii. While the country’s total land area amounts to only 270 square miles, it occupies more than one million square miles of the Pacific Ocean, and spans over 1,700 miles from east to west. The FSM capital, Palikir, is located on the island of Pohnpei.

  • In fall 2009, public health workers traveled for two weeks by boats to deliver the first shipment of H1N1 vaccine to the dispersed islands.
  • FSM is focusing on training for first responders and obtaining a better radio communication system for emergencies, including the use of solar-powered systems on remote islands where electricity is unavailable for regular use.

Commonwealth of the Northern Mariana Islands (CNMI)

Commonwealth of the Northern Mariana Islands Flag Located just north of Guam, the CNMI is a 300-mile archipelago consisting of 14 islands, with a total land area of 183.5 square miles. The principal inhabited islands are Saipan (the capital), Rota and Tinian; the northern islands are largely uninhabited. Saipan is 3,300 miles from Honolulu; 5,625 from San Francisco; 1,272 miles from Tokyo; and 3,090 miles from Sydney.

  • CNMI is working toward enhancing surveillance by increasing the workforce and implementing an electronic disease reporting system.
  • Emergency response plans supported by the PHEP cooperative agreement enabled the CNMI public health community to prepare their workforce and the public for a threatened strike by super typhoon Melor in fall 2009. Super typhoons have winds of at least 115 mph (185 km/h).

Republic of Palau

Republic of Palau Flag The Palau archipelago consists of more than 500 islands in the Pacific Ocean stretching over 150 miles, with a total land area of 188 square miles. Only eight of the islands are permanently inhabited. The capital of Palau, Koror, lies 3,997 miles west/southwest of Honolulu; 813 miles south of Guam; and 530 miles from Manila.

  • Palau is working to address gaps in emergency preparedness knowledge and skills identified for health care workers, emergency response personnel, staff, volunteers, and targeted populations in the general public.
  • The public health community in Palau is using geographic information system coordinates to identify vulnerable populations.

Puerto Rico

Puerto Rico Flag Puerto Rico consists of one main island and several smaller islands with a total land area of 3,435 square miles between the Atlantic Ocean and the Caribbean Sea. It is located approximately 1000 miles southeast of Florida and 50 miles west of the U.S. Virgin Islands. The capital of Puerto Rico is San Juan.

  • Puerto Rico is planning to establish a biological (BSL-2 and 3) and chemical (Level 2) emergency laboratory to serve its own population and those of its Caribbean neighbors.
  • Puerto Rico uses global positioning and geographic information systems to ensure better preparedness for identified special populations such as the elderly, children, and tourists. In addition, Puerto Rico has developed an electronic reporting system for emergency management that is compliant with CDC’s Public Health Information Network.

U.S. Virgin Islands (USVI)

U.S. Virgin Islands Flag The USVI are located between the Atlantic Ocean and the Caribbean Sea, some 1100 miles southeast of Florida and 50 miles east of Puerto Rico. USVI consists of 4 larger islands and some 50 smaller islands for a total of about 133 square miles. The USVI capital, Charlotte Amalie, is located on the island of St. Thomas.

  • The USVI are conducting trainings in the National Incident Management System and the National Response Plan.
  • In fall 2009, H1N1 vaccination campaigns were conducted in all schools on the islands of St. Thomas, St. Croix, and St. John.


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