Factors that support public health infrastructure recovery in Puerto Rico and US Virgin Islands after Hurricanes Irma and Maria


  • S. Carolina Luna-Pinto, MPH
  • Jessica Irizarry Ramos, MS, PhD
  • Yanelis Gonzalez, MPH
  • Nairimer Berrios Cartagena, MS
  • Samuel Taveras, MEd, MPH




public health infrastructure, recovery, United States territories, linkages, basic infrastructure


This paper describes the factors that support recovery of public health infrastructure (PHI), including conditions that facilitated or hindered recovery in United States (US) territories impacted by hurricanes Irma and Maria. A deductive approach was used to categorize data from five organizations that received crisis hurricane recovery (CHR) funds from the Centers for Disease Control and Prevention.* Spending was grouped into five infrastructure gaps: (1) human resources, (2) informatic upgrades, (3) equipment, (4) minor repairs, and (5) preventive maintenance. Unanticipated PHI costs, facilitators, and hinderances to PHI recovery were identified. Most (72 percent) of the $53,529,823 CHR funding was used to address infrastructure gaps in (1) human resources (56 percent), (2) informatics (16 percent), (3) equipment (13 percent), (4) minor repairs (10 percent), and (5) preventive maintenance (5 percent). Most of the

requests (56 percent) to redirect funds were associated with unanticipated costs in initial work plans and budgets. The use of administrative partners, planning tools, dedicated staff, streamlined procedures, eg, contracts, and cost sharing facilitated PHI recovery. The most common hindrance to PHI recovery were delays in procurement and shipping. In summary, investments in dedicated funding to upgrade, repair, or replace critical structures and systems for infectious disease surveillance, laboratory capacity, vector control, environmental health inspections, and vaccine storage and administration in Puerto Rico and the US Virgin Islands after Hurricanes Irma and Maria contributed to their recovery capacity. These findings may inform funding and resource allocation considerations for PHI recovery in the US territories.


Author Biographies

S. Carolina Luna-Pinto, MPH

Centers for Disease Control and Prevention/Office of Minority Health & Health Equity, Atlanta, Georgia

Jessica Irizarry Ramos, MS, PhD

Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia

Yanelis Gonzalez, MPH

Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia

Nairimer Berrios Cartagena, MS

Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia

Samuel Taveras, MEd, MPH

Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia


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How to Cite

Luna-Pinto, S. C., J. I. Ramos, Y. Gonzalez, N. B. Cartagena, and S. Taveras. “Factors That Support Public Health Infrastructure Recovery in Puerto Rico and US Virgin Islands After Hurricanes Irma and Maria”. Journal of Emergency Management, vol. 22, no. 2, Apr. 2024, pp. 129-38, doi:10.5055/jem.0841.