Puerto Rico (PR) and the U.S. Virgin Islands (USVI) are historically marginalized and under-resourced areas facing vulnerabilities to geographic isolation, natural disasters, and public health threats. Knowing that effective public health emergency preparedness and response (PHEPR) efforts require a deep understanding of the specific challenges and needs within communities, the Region 2 Center for Public Health Preparedness and Response (R2C) engaged with local communities in PR and USVI to identify key barriers, priorities, and locally developed solutions for enhancing public health preparedness and resilience.
In close collaboration with the Puerto Rico Public Health Institute and Imkada Solutions, R2C held a series of listening sessions in May 2025 in the region. These sessions brought together PR & USVI public health professionals, community leaders, and multi-sector partners to help shape the preparedness, response, and recovery strategies outlined in the five-year regional workplan.
Read on to learn more about what we learned in Puerto Rico and the US Virgin Islands.
Puerto Rico
Listening sessions in San Juan, Ponce, and Mayagüez brought together public health professionals, community leaders, and multi-sector partners to identify key barriers, priorities, and locally developed solutions for strengthening preparedness and resilience across the island.
Strengthening Risk Communication
Across all sites, risk communication emerged as a top priority. Participants emphasized the need for trusted spokespeople, consistent messaging across agencies, and engagement at the community level—an approach proven effective during COVID-19 vaccination efforts.
Advancing Evidence- and Risk-Based Planning
Participants underscored the importance of reliable, validated data to identify vulnerabilities and guide interventions. However, many expressed frustration with repeated data collection that fails to produce visible improvements, urging that research efforts be tied to tangible community benefits and outcomes.
Improving Administrative Preparedness
Administrative preparedness challenges included delays in reporting, fragile electrical infrastructure, and bureaucratic obstacles to accessing emergency funds. Participants highlighted the need for streamlined systems, decentralized decision-making, and improved shelter standards to ensure timely and effective responses.
Elevating Community Leadership and Partnerships
Partnerships and community leadership were recognized as central to resilience. While community leaders often serve as first responders, many shoulder excessive responsibilities without compensation. Participants emphasized strengthening grassroots organizations and formally integrating them into planning and response processes as critical to building sustainable preparedness capacity.
U.S. Virgin Islands
Listening sessions on St. Thomas, St. John, and St. Croix convened local health officials, emergency managers, nonprofit representatives, and community leaders to identify shared cross-cutting challenges and community-driven opportunities for improving preparedness and recovery across the territory.
Enhancing Administrative Preparedness
Administrative preparedness was identified as the greatest barrier to timely response. Participants noted that rigid procurement processes and hiring delays slow operations. They suggested practical improvements such as pre-approved contracts, delegated authority, and flexible emergency protocols to improve response efficiency.
Supporting Long-Term Community Recovery
Community recovery was framed as a long-term process requiring sustained investment. Participants emphasized the importance of supporting mutual aid networks, expanding mental health services, and developing community-based recovery hubs to promote ongoing resilience.
Modernizing Data Systems
Data modernization was a recurring theme. Participants called for interoperable systems and transparent data sharing to enhance situational awareness and coordination. Locally built dashboards that integrate information such as shelter capacity and fuel levels were cited as successful, scalable examples.
Deepening Partnerships
Partnership enhancement was viewed as essential but often shallow in practice. Participants called for sustained collaboration, formal memoranda of understanding (MOUs), and inclusive training initiatives that bring together government, nonprofit, and grassroots networks.
Strengthening Workforce Capacity
Workforce challenges, including low pay, burnout, and limited career pathways, were seen as major barriers to preparedness. Participants highlighted community health worker certification programs as promising models and stressed the need for territory-rooted training, mentorship, and mental health support for responders.
Conclusion
Despite different contexts, both Puerto Rico and the USVI emphasized equity, local leadership, and the scaling of community-driven solutions as the foundation for resilient public health preparedness. By centering community voices, the listening sessions not only identified critical challenges but also uncovered promising solutions, rooted in the realities of those most affected, that can be scaled and sustained.
The R2C is using the findings from Puerto Rico and the U.S. Virgin Islands to help shape a five-year workplan that connects priorities across Region 2, which also includes New York City, New York State, and New Jersey. This work builds on a broader recognition that resilience cannot be imposed from outside but must be cultivated from within communities. Guided by ongoing collaboration with partners across the region, the R2C is strengthening regional systems, relationships, and readiness through coordinated planning, technical assistance, and knowledge sharing to enhance preparedness for future public health threats.
Sign up below to get future updates from the Region 2 Center for Public Health Preparedness and Response.