Heterarchy: An Interorganizational Approach to Securing the United States Against a Pandemic Threat

United States public health and security capabilities are vulnerable to the magnitude and complexity of infectious diseases. Recently, human cases of a new H7N9 influenza in China have underscored the unpredictability of outbreaks. This article analyzes the federal government’s role in addressing an imminent pandemic threat from an organizational perspective, beginning with the Cabinet Departments of Homeland Security (DHS) and Health and Human Services (HHS), which jointly lead pandemic planning and response. This article recommends that these departments, their agencies, and international partners continue building and maintaining a heterarchy, the most optimal interorganizational structure for securing against and responding to a pandemic threat. This requires establishing clear, yet flexible responsibilities and shared systems, terminology, and tools. Given a hypothetical scenario in which a disease is introduced into the United States by a potentially infected foreign migrant entering through a maritime port of entry, current protocol and operations are promising. However, further heterarchical coordination is necessary to appropriately manage all plausible scenarios.