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.

In emergency response, success depends on teamwork long before the sirens sound. When firefighters arrive at a burning building, they rely on dispatchers, emergency medical personnel, emergency managers, and countless others who work together for a shared purpose.

The same is true for medical countermeasures (MCMs). The diagnostics, therapeutics, vaccines, and other medical countermeasures used during and following a public health emergency don’t appear overnight and don’t result from any individual effort.

The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) was established by the U.S. Department of Health and Human Services (HHS) in 2006 and codified by Congress in 2019 as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA). PAHPAIA formalized this interagency body and granted authorities that established a robust pipeline to review and propose investments for MCMs.

Today the PHEMCE serves as the federal government’s central coordinating body for end-to-end medical countermeasure preparedness. Its purpose is straightforward but essential: ensuring that the right partners are working together effectively to identify the nation’s medical countermeasure needs, establish priorities, and move promising products from concept to capability.

How the PHEMCE Advances Readiness and Promotes Coordination

The PHEMCE’s interagency senior leaders meet regularly to ensure agencies’ MCM-related missions operate within a single enterprise, with a shared strategy and objective. Its focus is on medical countermeasure preparedness, helping the nation develop a portfolio of medical countermeasures that address chemical, biological, radiological and nuclear threats, including emerging infectious diseases. It promotes coordination across the federal government that spans the entire medical countermeasure lifecycle.

This coordination extends well beyond the federal government. Medical countermeasure development depends on partnerships with biotechnology companies, pharmaceutical manufacturers, academic researchers, healthcare systems, and many others. These partners make significant investments in research, development, manufacturing capacity, and innovation. They also benefit from understanding the government’s long-term preparedness priorities.

Preparedness Goes Beyond the Science

MCM development starts with understanding potential health threats. The PHEMCE mission focuses on being prepared for highly unlikely events. However, in the world of possible threats, how do we narrow the list to what is most likely? The Department of Homeland Security works with intelligence community partners to best understand our adversaries and the deliberate threat space, while our One Health partners consider how and where a novel pathogen could emerge. This input is coupled with information to estimate the potential to cause a public health emergency. The threats that pose the greatest risk to national security are designated PHEMCE priority threats.

Focusing on the priority threats, multiple federal agencies partner to ensure there are countermeasures in the pipeline to address the greatest threats to public health. Each agency brings unique authorities and expertise, but none is sufficient to bring a countermeasure through the pipeline alone. The National Institutes of Health supports foundational research that advances scientific discovery. The Biomedical Advanced Research and Development Authority (BARDA) partners with industry primarily to support more advanced development and, in some cases, procurement of MCMs that can be used to protect the nation. The Food and Drug Administration provides regulatory oversight to help ensure products are safe and effective. The Centers for Disease Control and Prevention supports public health planning and guidance for the deployment, distribution, and use of MCMs. The Strategic National Stockpile maintains supplies of certain critical medical countermeasures for deployment in an emergency. Beyond HHS, interagency partners, including DOW, VA, USDA, and others, support MCM development efforts through shared expertise, resources, and collaboration.

Without deliberate coordination across those stages, even promising medical countermeasures can stall before reaching the people they are intended to protect. PHEMCE helps prevent gaps by bringing agencies together to evaluate threats, identify capability needs, coordinate investments, and align planning across the entire enterprise.

The PHEMCE Aligns Partners

Two of PHEMCE’s most important tools for providing that shared understanding are the PHEMCE Strategy and Implementation plan (SIP) and the Multiyear Budget (MYB).

By aligning planning across agencies and communicating those priorities publicly, the SIP and the MYB also help our partners better anticipate future needs and support more informed investment decisions. The SIP highlights our long-term goals and our short-term objectives. More than a budget document, the MYB offers a coordinated view of the federal government's priorities and projected investments across the medical countermeasure enterprise. It reflects the professional judgment of every major federal agency working in this space — looking at priority threats and what's feasible for R&D, manufacturing, storage, and deployment.

Our current approach stretches every taxpayer dollar provided, balancing multi-threat technologies that can address a broader range of threats with more targeted approaches.

However, even when we focus on efficiency, a robust, sustainable countermeasure enterprise depends on diverse, continuous investment at every stage, and appropriated funding hasn't kept pace with the full cost of R&D and stockpiling across the priority threat list. PHEMCE estimates that $66.9 billion is needed over five years to build a well-developed preparedness portfolio across all priority threats; if funding stays flat at FY 26 levels, that gap is projected at $33.5 billion over the same period. When the “worst day” does come — and we know it one day inevitably will — difficult conversations around this funding shortfall will inevitably follow.

Progress Towards the Emergency of Tomorrow Can Help Americans Today

The investments we’ve made have protected the health of Americans. Dedicated funding for H5N1 influenza supported diagnostics that could catch human transmission early, helped monitor how the disease was spreading across animal populations, and made sure existing antivirals were ready the moment they were needed. Past investments in research and procurement of diagnostics, vaccines, and therapeutics supported the response to the 2025 Ebola outbreaks in the Democratic Republic of Congo and the Marburg virus outbreak in Ethiopia, keeping both diseases from ever reaching the U.S. and advancing our MCM capabilities for domestic use should we ever need them.

How PAHPA Reauthorization Can Strengthen PHEMCE

The kind of long-term coordination PHEMCE enables has become increasingly important as potential health security threats continue to evolve. The reality is that moving an MCM from advanced research and development to the hands of the people who need it most is often a marathon, not a sprint. Investments in MCM portfolios must be sustained and require collaboration across organizations over years, not months. ASPR recognized that reality when it established the PHEMCE body nearly two decades ago.

As Congress considers reauthorization of PAHPA, we have an opportunity to build on that successful model. The Trump Administration has proposed several targeted improvements that would strengthen PHEMCE’s coordinating role, including better aligning the timing of the Multiyear Budget with the President's Budget, ensuring transparency and mission success.

Preparedness is ultimately a team effort. It requires different parties with different kinds of expertise to work together over the long term. Congress recognized that no single agency can accomplish this work alone. Through the PHEMCE, it established an enterprise that brings together the right partners to ensure the nation is better prepared for whatever public health emergencies lie ahead.