In an increasingly interconnected world, infectious disease threats do not stop at borders. Preparing to safely move patients with highly dangerous infections—while protecting health care workers, responders, and the public—is a critical part of national health security. That challenge was the focus of the 2025 Tranquil Passport Full-Scale Exercise, a national preparedness effort led by the Administration for Strategic Preparedness and Response (ASPR), a division of the U.S. Department of Health and Human Services (HHS).

What Was the Tranquil Passport Exercise About?

Tranquil Passport, conducted June 24–27, 2025, tested the nation’s ability to safely transport multiple patients with high-consequence infectious diseases (HCIDs) from outside the U.S. to specialized treatment centers within the country.

This exercise marked the first operational deployment of HHS’s new Portable Biocontainment Unit (PBCU), a specially designed system that allows patients with dangerous infectious pathogens to be transported while minimizing risk to responders and the public. The PBCU’s patient care area can be configured to hold either two patients on stretchers or up to ten seated patients, making it a powerful new tool for outbreak response.

The scenario simulated a cluster of adult and pediatric patients being moved from Canada to multiple U.S. Regional Emerging Special Pathogen Treatment Centers, putting infectious disease patient transport plans, coordination processes, and logistics to the test.

Loading the PBCU on a Boeing 747 at Dulles International Airport

Who Participated?

The exercise brought together an unprecedented network of partners. More than 60 organizations took part, representing:

• Federal agencies, including HHS, U.S. Department of State, U.S. Department of Transportation, U.S. Department of Justice, and the U.S. Department of War

• The National Emerging Special Pathogens Training and Education Center (NETEC), the coordinating body for the National Special Pathogen System

• Hospitals and emergency medical services agencies

• State and local public health, emergency management, and law enforcement agencies

• Airport emergency managers and aviation service providers

• International partners in Canada

Exercise activities took place across six cities—Washington, District of Columbia; Baltimore, Maryland; New York City, New York; Raleigh, North Carolina; Atlanta, Georgia; and Toronto, Canada—at airports, hospitals, and emergency operations centers. This wide geographic footprint reflected the complexity of real-world responses that often span jurisdictions, regions, and national borders.

Mock patients and care team members onboard the PBCU enroute from Canada to the United States

Why Was This Exercise Important?

Past outbreaks—such as Ebola, Marburg, and Sudan virus disease—have shown that the ability to rapidly and safely transport infected patients can save lives and prevent further spread of disease. While earlier exercises validated international transport into the U.S., Tranquil Passport addressed a critical gap: domestic transport of multiple high-risk patients over long distances.

By exercising newly developed plans and equipment, the nation was able to:

• Validate a first-of-its-kind federal capability for domestic HCID transport

• Test decision-making and coordination during a complex, multi-patient mission

• Identify strengths and gaps before a real emergency occurs

Exercises like Tranquil Passport help ensure that when a real outbreak happens, systems are already in place—and people are prepared to act.

A mock pediatric patient is transferred by an EMS team

What Impact Did the Exercise Have?

The exercise demonstrated that patient care teams could successfully treat and monitor patients inside the PBCU during transport, while maintaining strong safety practices. It also produced valuable insights that will strengthen future preparedness, including opportunities to:

• Expand and train specialized transport teams

• Enhance health and safety protections for responders

• Improve coordination and communication across agencies and regions

• Clarify roles, responsibilities, and decision-making processes

• Optimize patient care, including support for children and other high-risk patients

These lessons will directly inform improvements to national plans, training programs, and operational procedures.

Looking Ahead

The Tranquil Passport exercise showed what is possible when agencies and partners work together toward a shared goal: protecting lives during the most challenging public health emergencies. By testing capabilities before they are needed, HHS and its partners are strengthening the nation’s readiness to respond swiftly, safely, and effectively to future infectious disease threats.

ASPR’s Office of Medical Reserve Corps (OMRC) and Technical Resources, Assistance Center, and Information Exchange (TRACIE) are collaborating on a one-stop knowledge center that strengthens State and local resilience. This new hub will host resources that Medical Reserve Corps (MRC) unit leaders and volunteers can use as they work to fill gaps in their community’s emergency preparedness, response, and recovery operations.

Under Executive Order 14239, “Achieving Efficiency through State and Local Preparedness,” the Administration for Strategic Preparedness and Response (ASPR) is evaluating existing programs and resources to ensure State and local partners are resilient in the face of disasters. Response starts locally; communities understand their specific needs and can react immediately to emerging threats.

Once the new hub launches, users will have easy access to curated tip sheets, operational tools, courses, and exercises. This information will specifically benefit MRC units. The TRACIE Team will expand the existing Resource Library and 58 Topic Collections with new content targeted for unit leaders and volunteers. ASPR TRACIE will also develop a dedicated MRC page with links to original materials, such as planning considerations, guidance documents, and speaker series recordings. This new page will allow registered users to save favorites and select training courses to complete at their own pace.

I encourage MRC volunteers to join the ASPR TRACIE Information Exchange (IE). Membership will allow you to connect with your peers and participate in near-real time conversations about anticipated and ongoing health threats; share plans and other materials; and discuss promising practices. All of the conversations in the IE section take place in a secure, password-protected environment. The IE also offers a private group feature for subgroups of users, allowing them space to discuss sensitive topics and share plans and documents that cannot be shared with the broader IE community. OMRC and ASPR TRACIE will create several private groups for MRC leaders, units, and volunteers, beginning with one for state coordinators.

As always, if your MRC unit needs help, reach out to askasprtracie@hhs.gov and ask the question.

ASPR TRACIE and OMRC have shared goals: to serve, inform, and protect the nation. What will users get when these two programs work together? A powerhouse of partnership, aimed at putting actionable information in the hands of state and local residents, bolstering community resilience. ASPR continues to strengthen State and local capabilities and this hub is just one way to access information and strengthen planning.

As we prepare to launch this new resource this spring, the ASPR TRACIE and OMRC teams continue to collect materials for the new library. If you have a resource that your Medical Reserve Corps unit has used to help you prepare for disasters, respond effectively, or increase resilience, contact askasprtracie@hhs.gov.

About the Medical Reserve Corps

The Medical Reserve Corps (MRC) is a national network of 268,000 dedicated volunteers, organized locally in more than 700 units to improve the health and safety of their communities. The MRC recruits, trains, and activates volunteers to respond to community health and safety needs during emergencies.

In 2024 alone, MRC volunteers dedicated over 300,000 hours of service in the communities they serve, filling critical gaps in local health care systems. For example, MRC volunteers provided CPR training to other MRC volunteers and community members; supported the U.S. Army’s 250th birthday and other National Security Special Events; and responded to emergencies, including the flooding in Washington State, the flooding in Texas, and the Shooting at Brown University. To find out how MRC made a difference in your community, check out the 2024 MRC Activities and Impacts by State or Territory.

About ASPR TRACIE

ASPR TRACIE is a one-stop shop, to support access to information and technical assistance (TA) needs of health care coalitions, and health care entities and providers, emergency managers, public health practitioners, and others working in disaster medicine, health care system preparedness, and public health emergency preparedness. The team responds to TA requests during steady state and during response operations and has developed more than 550 resources to fill emergency preparedness knowledge gaps.

Over the last decade, ASPR TRACIE has become the go-to resource for health care emergency managers across the country. TRACIE assists more than 70,000 CMS providers/suppliers with meeting the requirements of the Emergency Preparedness Rule and accrediting organization standards. During disaster and public health emergencies, ASPR TRACIE serves as a virtual force multiplier, improving information access and minimizing duplication of effort.

This year marks the 20th anniversary of the Pandemic and All-Hazards Preparedness Act (PAHPA). Signed into law in 2006, PAHPA established HHS’s lead role in public health emergencies, created the position of the Assistant Secretary for Preparedness and Response who leads the office now called the Administration for Strategic Preparedness and Response (ASPR), and supported critical programs like the Strategic National Stockpile (SNS) and the Biomedical Advanced Research and Development Authority (BARDA).

For two decades, PAHPA has helped the nation prepare for, respond to, and recover from disasters and public health emergencies.

Since ASPR was established, we have faced many challenges—from the Deepwater Horizon oil spill to infectious disease outbreaks that required rapid development of new medical countermeasures, to natural disasters like hurricanes, wildfires, and tornadoes that affected entire regions.

This anniversary is a time to reflect on how far we’ve come—and to prepare for what’s ahead.

As someone who has spent a career in emergency response, I’m proud to serve as Principal Deputy Assistant Secretary (PDAS) for Preparedness and Response. Time and again, ASPR teams have stepped up during crises to protect lives and support communities during some of their most difficult times.

Why PAHPA Matters

PAHPA was signed into law after Hurricane Katrina exposed major weaknesses in the nation’s healthcare infrastructure. Katrina was not just a storm—it caused long-lasting damage across the entire healthcare infrastructure. Hospitals were destroyed, evacuation routes were flooded, supply chains failed, and communities faced overlapping public health, environmental, energy, and safety crises.

PAHPA was designed to fix those gaps by creating a unity of command while consolidating federal nonmilitary public health and medical preparedness and response functions. The goal was simple but critical: help the nation do better when disasters threaten our healthcare system and public health.

During the H1N1 response, ASPR utilized existing authorities to lead coordination efforts across HHS and the interagency. HHS more broadly was analyzing the virus, disseminating information to researchers and public health officials, developing and shipping new tests to diagnose infections, and distributing antiviral drugs from the (SNS). While ASPR and HHS mitigated the potential spread, there were gaps. Local and State capabilities were overwhelmed.

Building Stronger Preparedness

PAHPA has been strengthened over time. In 2013, Congress re-authorized and updated the law based on lessons from the H1N1 flu pandemic, which hit children especially hard. These updates helped improve care for children during emergencies. The law was also expanded to better support older adults and people with disabilities.

The 2013 reauthorization also added important flexibility, allowing federally funded healthcare workers employed by states, localities, or tribes—such as nurses and lab staff—to be reassigned to support communities facing surge needs during declared public health emergencies.

Following major hurricanes that impacted Puerto Rico, the U.S. Virgin Islands, and the East Coast, PAHPA was reauthorized a second time focusing on flexibilities for the deployable response force – the National Disaster Medical System and the Medical Reserve Corps.

The 2019 reauthorization also addressed ongoing threats from Ebola and other highly contagious infectious diseases (HCID). ASPR helped establish what is now the National Special Pathogen System, including 13 regional treatment centers for special pathogen readiness. Because of that readiness, the United States has been able to respond to Ebola and other serious diseases—such as Zika, Marburg virus, and mPox— while citizens continue with their daily lives with minimal disruption.

Looking Ahead

This anniversary is not only a time to reflect—it’s a reminder to stay ready. Today’s threats are increasingly complex, from natural disasters and emerging diseases to cyber risks facing healthcare systems. That’s why PAHPA and ASPR’s mission remain so important.

To meet future challenges, ASPR recently released its 2026–2029 Strategic Plan. The plan supports key Trump Administration priorities like increasing state and local resiliency, enhancing government efficiency, and onshoring pharmaceutical manufacturing and production capabilities to Make America Healthy Again.

The lesson of the past 20 years is clear: strong preparedness today enables effective response tomorrow. As Congress considers reauthorizing PAHPA for the third time, we hope lessons learned continue to strengthen ASPR’s authorities—so we can keep protecting health and saving lives across the nation.

During my first year serving in the HHS Administration for Strategic Preparedness and Response, one thing is abundantly clear: uncertainty is not the exception – it's the operating environment. ASPR provided resources and support to communities during a steady stream of challenges: infectious disease outbreaks, natural disasters, fragile medical supply chains, and more.

ASPR has delivered landmark achievements in 2025, and these accomplishments reflect ASPR’s commitment to safeguarding the health of the American people while strengthening national security.

Advancing Medical Countermeasures and Pharmaceutical Supply Chain Resilience

We cannot face tomorrow’s health security challenges with yesterday’s medicines and pharmaceutical supply chains. Our direction from the Trump Administration is clear: innovate so we are better equipped to Make America Healthy again and onshore and strengthen the pharmaceutical manufacturing and production capabilities that our nation relies on.

In support of the Make America Healthy Again initiative, ASPR’s Biomedical Advanced Research and Development Authority achieved 10 new FDA approvals, bringing its cumulative total to 107 medical countermeasure approvals. These life-saving innovations span diagnostics, therapeutics, and vaccines and strengthen preparedness for chemical, biological, radiological, and nuclear (CBRN) threats, pandemic influenza, and emerging infectious diseases.

In alignment with Executive Order 14336 – Ensuring American Pharmaceutical Supply Chain Resilience, ASPR’s Center for Industrial Base Management and Supply Chain (IBMSC) has made major strides to establish pharmaceutical independence for the United States. In 2025, IBMSC began work to support the storage of critical and at-risk drugs identified as vital to national health and security.

To reduce dependence on foreign pharmaceutical supply chains, IBMSC invested over $1 billion in domestic manufacturing capacity with a special emphasis on utilizing new technologies such as on demand, on site production technology using artificial intelligence, machine learning, 3-D printing, and informatics.

Enhancing National Emergency Preparedness

Through teamwork, precision, and relentless preparation, ASPR ensured the nation was better prepared to face complex threats to our nation’s health.

ASPR led the Tranquil Passport Full-Scale Exercise, one of the most extensive infectious disease patient movement exercises ever conducted. More than 1,000 personnel from 70+ federal, state, local, international, and non-governmental organizations participated in this exercise to test and validate the nation’s ability to safely and securely transport patients with high-consequence infectious diseases to regional treatment centers, and to demonstrate capabilities of ASPR’s new Portable Biocontainment Unit (PBCU).

ASPR brought together 92% of the nation's directors of public health emergency preparedness (DPHPs) for a groundbreaking event between DPHPs and ASPR regional teams from across the country. The workshop and Open House, featuring 17 ASPR programs, gave participants a clear understanding of ASPR’s mission, resources, and capabilities. The event strengthened collaboration, promoted transparency, and enhanced collective preparedness, laying the foundation for future action-oriented workshops to advance jurisdictional resilience nationwide.

ASPR also manages the Strategic National Stockpile (SNS) to ensure lifesaving medicines and supplies are ready and quickly deliverable to affected communities. In 2025, the SNS began a nationwide effort to place medical countermeasures closer to the communities that depend on them by supporting state, local, tribal, and territorial (SLTT) partners in building and maintaining their own stockpiles. To strengthen readiness, the SNS held listening sessions with 613 SLTT partners and validated 22 SLTT warehouse facilities to ensure they can receive, stage, and store medical countermeasures during emergencies.

In addition, the SNS trained responders from all 10 regions, including 22 states, two territories and one tribal entity, at the SNS Operations Course held at FEMA’s Center for Domestic Preparedness. This past year, the SNS also responded to multiple real-world incidents, deploying mpox treatments, personal protective equipment and antiviral drugs for H5N1, a Federal Medical Station for flooding in Washington State, Marburg, and Ebola Zaire vaccine for laboratory workers, clinicians, emergency responders and other at-risk personnel.

ASPR’s Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) continued to be the backbone of healthcare preparedness, providing more than 13,000 technical assistance responses and supporting over 70 active incidents in 2025. ASPR also trained over 740,000 individuals on how to support electricity-dependent and healthcare-dependent at-risk populations during emergencies.

Driving Effective Response and Recovery Operations

In 2025, ASPR’s mission demanded rapid action on multiple fronts: deploying expert teams of medical responders, supporting communities through disaster recovery, defending critical health systems from cyber threats, and confronting emerging diseases abroad before they impacted national public and medical health.

In 2025, ASPR deployed nearly 1,300 personnel, including medical personal from the National Disaster Medical System, to support emergent crises and high-profile national events. ASPR was activated for nine National Special Security Events (NSSEs) and five disaster incidents, ensuring expert support wherever and whenever it was needed.

Recovery and behavioral health teams were activated for nine missions, with two ongoing concurrently, providing essential mental health and community recovery services.

ASPR continued to advance national cybersecurity in health care—triaging over 1,500 cybersecurity incidents and monitoring more than 780 potential threat events to mitigate risks across the sector.

Notably, a cybersecurity breach occured in St. Croix that significantly disrupted the islands essential clinical systems demonstrated ASPR’s rapid-response capability to cyber threats impacting critical healthcare infrastructure. At the request of local and federal partners, ASPR's Disaster Telemedicine team devised a rapidly deployable solution to support ongoing hospital services and recovery efforts utilizing ASPR’s telemedicine resources. 

In 2025, ASPR supported global response operations, preventing several infectious disease threats from reaching U.S. shores. For example, ASPR:

• Rawanda - Marburg

• Delivered 100 treatment courses of an Ebola therapeutic, along with diagnostic tests and swabs, to the Democratic Republic of Congo (DRC).

• Donated nearly 240,000 doses of monkeypox vaccine to six African nations and deployed over 550 therapeutic drugs to treat symptomatic patients.

• Pledged up to 2,500 doses of an investigational Marburg vaccine and 25 doses of a Marburg therapeutic to Ethiopia in response to the ongoing outbreak.

Looking Ahead

ASPR advanced preparedness for, response to, and recovery from public health and medical disasters throughout 2025. From groundbreaking FDA approvals and supply chain investments to large-scale training initiatives and global countermeasure deployments, ASPR continues to build a resilient health security future for all Americans.

As we prepare to celebrate the 250th anniversary of this great country, whatever challenges we may face in 2026, ASPR will stand ready, move fast, and save lives.