Last month the Government Accountability Office weighed in on whether the United States can spot the next pandemic before it spots us. The answer runs to sixty pages. One paragraph tells you most of what you need to know.
In 2024, the federal government created a multi-agency leadership group it called the One Health Coordination Unit, co-led by the CDC, the Department of Agriculture, and the Interior Department. Its purpose was to get the agencies that track disease in people talking to the agencies that track disease in animals. This is important because roughly three out of four emerging infectious diseases originate in animals. When the New World screwworm was spotted crossing over the southern border into Texas, the One Health effort was “paused”.
The screwworm is a real threat and deserves attention. That is not the point. The point is that the team responsible to detect the next pandemic has a bench so thin that a single agricultural pest took it off the field.
That is coordination failure before the disaster even starts.
GAO has had Department of Health and Human Services’ leadership on its High-Risk List since January 2022. It is still there. Eighty-three GAO recommendations on responding to public health emergencies remain unimplemented. HHS did not publish after-action reviews of its COVID-19 or mpox responses. Not surprisingly, the communication failures GAO found during mpox were the same ones it found in COVID-19, in Zika in 2016, and in H1N1 in 2009. These are the failures we are seeing now with the cyclospora outbreak across 47 states. Five outbreaks. One lesson. Never learned.
With her latest book, Annie Jacobsen shines a spotlight on this alarming vulnerability. Biological War takes what is arguably HHS’s most important mission—protecting the nation from catastrophic biological threats—and shows in riveting detail what failure looks like. In her scenario, a genetically modified “super plague” virus outruns the institutions we have built to contain it. The terrifying part is not just the pathogen. It is what happens when government cannot organize itself fast enough to get ahead of it.
The GAO report says our early warning system relies on the “astute clinician” — a doctor who sees something strange and picks up the phone to call the health department. That call still works. What happens after it is the problem.
Everything downstream of that call is a coordination issue. Who convenes? Who decides? Who can direct another agency to share its data, and on whose authority? GAO’s panel of eighteen experts identified exactly this gap and recommended the creation of a leadership coordination unit to close it.
Except that we already know what to do. The doctrine of unified command exists precisely so agencies with different missions and different authorities can act together without surrendering those authorities. It is taught and practiced throughout American emergency management every day of the week. It is not a theory. It is a way of operating. What we lack is the habit of applying that discipline early enough
The United States has extraordinary scientific, medical, pharmaceutical and logistical capabilities. But capability is not the same as preparedness. Preparedness is the ability to bring all of those capabilities together before catastrophe overtakes us. There is already a federal agency built to do this—an agency that has been cut, second-guessed and floated for relocation. That is the agency Cameron Hamilton now inherits. His swearing-in this week should end a long stretch of chaos there.
America does not suffer from a shortage of biological preparedness plans. It suffers from a shortage of ownership. We need a FEMA Administrator who will put his agency in the room where biological threats are being tracked — not wait to be invited after the outbreak has a name. Because when the catastrophe comes, our failure will not happen inside any single government agency. It will happen in the spaces between them. Those are the spaces FEMA was built to own.
