**1. Introduction**

The nature of public health emergencies demand coordination and collaboration between local, state, regional and national capabilities. Local authorities do not have the capability, alone, to address these catastrophic events. In a Federalism system of governance, such as what exists in the US, the Constitution mandates divisions of power between federal and individual state governments [1]. Consequently, agencies at these different levels are not always naturally aligned to work collaboratively. Other models of government where authoritative territory issues are present also complicates coordination of efforts. A challenging issue is determining who is in charge of the response to emergencies when agencies from different levels are involved. The current COVID-19 pandemic emergency in the US with its lack of national coordination and state testing, consistency in data reporting, and vaccine distribution and public dispensation serves to illustrate this point. To successfully plan, mitigate risk, and respond to the effects of public health emergencies requires

leadership to manage the coordination at all levels. This chapter focuses primarily on the role of leadership in planning for and coordinating a response to a public health emergency. Among many other sources, evidence in the chapter is drawn from research conducted by Preparedness and Emergency Response Research Centers (PERRCs) funded through the Centers of Disease Control and Prevention (CDC) in the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA). In the reauthorization process for PAHPA, the US Senate Subcommittee on Bioterrorism and Public Health Preparedness convened a Roundtable to gather recommendations from national experts on how to strengthen US capacity for an all-hazard public health response. Some recommendations by the panel included increases in preparedness and response research funding, development of performance metrics, and implementation of system capacity assessments [2].

Following the events of September 11, 2001, the importance of integrating and coordinating public health resources with first-responding agencies for planning, training, risk mitigation, and response to public health emergencies was formally recognized. However, the disconnect between these agencies resulted in barriers and conflicts culturally and jurisdictional. In an effort to facilitate this integration, in 2003 public health was included as a first-responder agency by the federal government [3]. This effort was less than successful because federal agencies are organized according to federal guidelines, while public health agencies follow state laws and regulations. This disparate organizational structure is a hinderance to coordination and collaboration. This situation begs for strong, effective leadership.

There are two classic examples of the challenges to coordination from which many lessons can be learned. The first is Hurricane Katrina and the second is the COVID-19 pandemic. These events required a high-level of coordination of international (in COVID-19's case), federal, state, and local public health agencies. These events, on the surface, seemed to be similar to those which have occurred in the past, but the enormity of the required public health response was unexpected.
