This document is part of an effort to strengthen cross-sector coordination in public health emergency preparedness. It was developed during 2007-2008 by the Public Health and Law Enforcement Emergency Preparedness Workgroup (hereinafter, the Workgroup), which was established by the Centers for Disease Control and Prevention (CDC)'s Public Health Law Program in partnership with the U.S. Department of Justice's Bureau of Justice Assistance. The Workgroup's composition included experts from local, state, and national (United States) organisations representing the sectors of public health, law enforcement, corrections, and the judiciary.

This guide for developing a Memorandum of Understanding (MOU) is shaped by the observation that "During a serious influenza pandemic or similar contagious disease threat...[,] decision-making, implementation, and monitoring the impact of...actions (or non-actions) would need to be coordinated across levels of government and across jurisdictional lines....In addition, these responses would engage numerous sectors, including elected officials, public health, law enforcement, the judiciary, corrections, probation, health care providers, schools, businesses, the media, the military, and others. The specific ways that each of these sectors might be influenced by the actions and expectations of the others is the focus of this MOU guidance."

Specifically, the document provides guidance for consideration by state, tribal, local, and other jurisdictions when addressing planning efforts to coordinate cross-sector implementation of community responses (including social distancing) to prevent or limit the spread of a severe, contagious respiratory disease such as pandemic influenza. It covers the set of community measures that would be needed when a contagious disease has already reached the point at which some measures (e.g., involuntary quarantine and isolation) would have limited, if any, indication because of the substantial spread of the disease in question. The particular scenario of a pandemic of severe influenza was chosen as an illustrative one, although the guide also can be applied to other disease-specific scenarios.

This guide is designed to serve as a focus for initiating conversations and then agreements that would specify and clarify the roles each sector would play, the expectations each would have of the others, the legal authorities under which each would act, information requirements, and other gaps that need to be addressed to ensure pre-event preparedness. Depending on the needs of a given jurisdiction, the contents of the guide contained in this document can function as a checklist, a "fill-in-the-blanks" template, and/or an outline for analysing, reviewing, and discussing the status of multi-jurisdictional and cross-sectoral preparedness for use of community response measures.

The Workgroup indicates that decisions to implement public health control measures must be determined by critical factors - explored within the guide - that may vary considerably depending on the specific pathogen. For example, by necessity, decisions regarding the adoption of the generic MOU components provided in this document will vary substantially by jurisdiction to reflect applicable laws and other jurisdiction-specific factors.

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Avian Influenza Surveillance Update from the World Health Organization (WHO) Thailand, September 15 2008.