Preparedness Starts with Ready Jurisdictions: How PAHPA Strengthens America’s Medical Countermeasure System

For more than 25 years, I have had the privilege of serving with the Strategic National Stockpile (SNS) and watching our nation’s public health preparedness system evolve through acts of terrorism, hurricanes, pandemics, emerging infectious diseases, and countless other emergencies.

Throughout that time, one lesson has remained constant: Preparedness is strongest when complementary capabilities exist at all levels of government. Preparedness certainly includes hospitals and the broader care delivery systems as well as countless non-governmental partners in many roles, but the various levels of government have a shared statutory role serving as the foundation of preparedness.

We know every public health emergency begins in a community. State, local, tribal, and territorial governments are on the frontline, and they understand their local risks, patient populations, healthcare infrastructure, and the unique needs of the people they serve better than anyone else. Their ability to rapidly access lifesaving medical countermeasures can make a critical difference when every minute counts.

National preparedness is strongest when those local capabilities are supported by a coordinated federal preparedness system. As we begin National Preparedness Month 2026, I urge our jurisdictional partners to take some time to plan to both strengthen the capabilities in the communities they serve and partner with us to strengthen preparedness. For nearly two decades, the Pandemic and All-Hazards Preparedness Act (PAHPA) has provided much of the statutory foundation for that system. Since its enactment in 2006, PAHPA has strengthened HHS authorities and programs that support public health emergency preparedness and response, including medical countermeasure development, hospital preparedness, public health emergency planning, and the Strategic National Stockpile. Together, these authorities have helped build a more coordinated preparedness enterprise capable of responding to a wide range of public health threats.

While PAHPA provides the statutory foundation for the nation's public health preparedness enterprise, preparedness ultimately succeeds through strong partnerships that empower jurisdictions while leveraging the unique capabilities of the federal government.

Today, that enduring framework is complemented by renewed emphasis on strengthening state, local, tribal, and territorial readiness. The nationwide Jurisdictional Stockpile Program reflects that vision by helping jurisdictions build and expand sustainable medical countermeasure capabilities while reinforcing a coordinated national preparedness system.

One Preparedness System. Complementary Roles.

Since its establishment in 1999, the SNS has served as a cornerstone of the nation’s public health emergency preparedness system. The SNS maintains specialized medicines, vaccines, antidotes, antitoxins, medical supplies, and other emergency medical countermeasures needed to respond to chemical, biological, radiological, and nuclear threats, as well as emerging infectious diseases.

As the SNS continues to focus on its core mission, it prioritizes specialized medical countermeasures and national response capabilities for high-consequence public health emergencies. Many of these specialized medical countermeasures are not readily available through commercial supply chains, making the SNS an essential national resource. In some instances, the SNS may be the only source of certain lifesaving medical countermeasures. The SNS serves as the nation's safety net when jurisdictional resources are overwhelmed or commercial supply chains cannot meet emergency demand.

But today’s SNS is more than a federal stockpile. It is also a trusted preparedness partner.

Every day, the SNS works alongside public health agencies, emergency management organizations, healthcare systems, tribal nations, U.S. territories, federal partners, and private industry to strengthen preparedness through planning, technical assistance, training, exercises, and operational support.

One of the most important lessons we’ve learned over the past 25 years is that preparedness starts with ready jurisdictions. Jurisdictional stockpiles — established by states, directly funded localities, federally recognized Tribal Nations, U.S. territories, or regional collaborations — are intended to serve as the primary, first-line source of commercially available medical countermeasures during public health emergencies. Designed around local risks and operational needs, they position lifesaving resources closer to the point of need, assuring rapid response times and strengthening community resilience. Some jurisdictions, like North Dakota, already have robust stockpiles that improve readiness and enhance emergency response capabilities.

Jurisdictional stockpiles are not intended to replace the SNS. Instead, they are designed to complement the SNS by serving as the frontline source of commercially available products and providing rapid access to supplies needed during the earliest stages of an emergency. The SNS maintains specialized medical countermeasures and provides national surge capability when incidents exceed jurisdictional resources or require unique federal assets. Together, they create a layered preparedness system that ensures lifesaving medical countermeasures are available when and where they are needed most.

Building Preparedness Through Partnership

Preparedness is built through partnerships.

The success of the SNS depends not only on maintaining specialized federal capabilities, but also on helping our partners strengthen their own capabilities before emergencies occur.

Over the past year, we have expanded listening sessions, strengthened partnerships with public health agencies, healthcare coalitions, emergency management organizations, federal agencies, and private industry, and developed practical guidance informed by what we’ve learned from our partners.

Our commitment extends beyond planning and technical assistance. The SNS is also helping jurisdictions strengthen their own stockpiling capabilities by making selected medical supplies and equipment available to support local preparedness. These efforts provide practical opportunities for jurisdictions to expand local capabilities while contributing to a more resilient, responsive, and integrated national preparedness system.

Building sustainable preparedness also requires continued collaboration and investment. While there is currently no dedicated federal funding for jurisdictions to establish or maintain their own stockpiles, many have chosen to invest in these capabilities because they recognize the importance of positioning lifesaving resources closer to their communities.

Stronger Together

Over the past quarter century, I have seen one truth reaffirmed time and again: no single organization can prepare for every emergency alone. Preparedness is a shared responsibility.

PAHPA provides an enduring statutory foundation for our nation’s preparedness enterprise. Building on that foundation, the SNS remains committed to serving as both the nation’s repository of specialized medical countermeasures and a trusted preparedness partner, working alongside jurisdictions across the country to help them build and sustain their stockpiling capabilities. This partnership contributes to a more resilient, responsive, and integrated national system for medical countermeasure readiness.

I remain optimistic about the future of our nation’s preparedness system because I see dedicated professionals across every level of government working together every day to strengthen readiness and protect their communities.

Together, by sharing expertise, strengthening partnerships, and building preparedness where it begins — in our communities — we can create a stronger, more resilient, and more integrated medical countermeasure system that ensures lifesaving resources are available when and where they are needed most. We encourage all of our partners to build these partnerships during National Preparedness Month and beyond to strengthen our nation’s preparedness system and, ultimately, national health security.