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Dear Friends and Colleagues,                    Columbia, U.S. territories, and nations like India, China, and
                                                                Kenya.
                We are pleased to present the 2018–20 Council of State and
                Territorial Epidemiologists (CSTE) Annual Report. The global   CSTE continued progress on the pillars of the 2018-2020
                COVID-19 pandemic has dramatically altered our daily lives   Strategic Plan with its central challenge, “Strengthen the Role
                and the resultant public health crisis continues to be the   of Applied Epidemiology to Drive Public Health and Policy
                biggest challenge we have ever faced. Since the U.S. response   Actions.” As we implemented our Strategic Plan, we worked to
                began in January 2020, CSTE members have done remarkable   meet the organizational priorities central to CSTE. We have also
                work, effectively heightening the profile of epidemiologists   worked collaboratively on the new 2021 CSTE Strategic Impact
                to the national stage. As COVID-19 redefines public health,   Plan. Diversity, equity, and inclusion are a significant focus of
                we are inspired daily by the resilience and calm courage of   this plan, brought to the forefront by the health inequities that
                our members. They have worked grueling hours in the face   have emerged during the COVID-19 pandemic.
                of turmoil, infrastructure challenges, and even threats to the
                delivery of data that informs public health action and produces   Prior to the pandemic, CSTE launched the Data: Elemental to
                epidemiologically sound guidance. You can learn more about   Health campaign, a first-of-its-kind advocacy effort to secure
                CSTE’s COVID-19 response with federal, state, local, territorial,   meaningful, sustained funding for public health surveillance.
                and industry partners on pages 9–11 of this report.  However, COVID-19 exposed the critical core need for a strong
                                                                public health surveillance system capable of detecting and
                While applied epidemiologists combat the pandemic, another   facilitating the immediate response to and containment of
                long-standing challenge has been brought to the forefront: the   emerging health threats. Alongside several key partners, CSTE
                disproportionate effect of disease on communities of color. As   secured nearly $1 billion in new federal appropriations for data
                we move forward in this ‘new normal’ era, it has become clear   modernization efforts for public health.
                that public health must redouble its commitment to protect
                the health of all Americans. Addressing structural racism and   Applied epidemiologists responded to a wide range of disease
                health disparities must be reinforced as a key component of   threats during this time—acute, chronic, and emerging alike.
                good epidemiological science, informing policies that reverse   The 2019 E-cigarette, or Vaping, Product Use-Associated Lung
                inequity and disparate approaches to public health.  Injury (EVALI) epidemic response was CSTE’s first-ever activation
                                                                of its Concept of Operations (ConOps) Plan for emergency
                Due to the COVID-19 pandemic, the 2020 CSTE Annual   response, one in which CSTE staff and members led federal and
                Conference scheduled for Seattle, WA was canceled—the first   state partners via regular calls, technical assistance, and critical
                Conference cancellation in CSTE’s 70-year history. The 2019   communications. Both the COVID-19 and EVALI responses
                CSTE Annual Conference was held in Raleigh, NC. Despite   highlight CSTE’s unique and crucial role in mobilizing public
                several jurisdictions having travel restrictions in place, we   health while serving as a conduit between federal, state, and
                hosted over 1,600 attendees from all 50 states, the District of   local responses. CSTE also continued to address the U.S. opioid
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