Nationwide
January 10, 2025 

In June 2026, when North America hosted the largest Federation Internationale de Football Association (FIFA) World Cup, it wasn’t just the athletes and fans making history. With 48 nations competing in 104 matches across 16 cities in three countries, the event's size and global attendance also created distinct health care and public health challenges.

Behind the roar of the crowds, the United States has an unprecedented opportunity to test and strengthen its defenses against special pathogens. Special pathogens are high consequence infectious diseases (HCIDs) that, if contracted, can make people severely ill, have high mortality rates, and for which there are limited medical countermeasures or treatments. With increased global travel and large crowds expected during the 2026 World Cup, special pathogens may spread more quickly and pose a risk to national health security.

Anticipating these challenges, the Administration for Strategic Preparedness and Response (ASPR) funded Coordinating Body of the NSPS, the National Emerging Special Pathogens Training and Education Center (NETEC), organized a first-of-its-kind national tabletop exercise focused on a World Cup scenario to test and improve special pathogen readiness across the nation.

The NSPS prepares the health care delivery system to protect communities and the health care workforce and respond to special pathogen events nationwide. NETEC supports the NSPS by coordinating high-quality special pathogen care through a tiered network of health care entities across the United States, including 13 NSPS Level 1 or Regional Emerging Special Pathogen Treatment Centers (RESPTCs) and public health and EMS organizations.

In October 2024, NETEC assembled a planning committee for the World Cup exercise, which included representatives from all Regional Emerging Special Pathogen Treatment Centers. The planning committee provided the Regional Emerging Special Pathogen Treatment Centers with the flexibility to address local needs through and the ability to test their own plans and regional capabilities against a standard scenario. The committee met biweekly to coordinate logistics and resources, identify partners for outreach, and design an exercise based on the Middle East Respiratory Syndrome (MERS).¹

On January 10, 2025, more than 515 participants from all 13 Regional Emerging Special Pathogen Treatment Centers, as well as federal, state, and local health care organizations and public health departments, emergency medical services, and health care coalitions, came together to conduct the exercise. NETEC created 11 separate breakout groups — one for each Department of Health and Human Services region and one for national-level coordination—each navigating a scenario involving a patient with a suspected MERS case near a World Cup site. Each region completed three modules:

• Module 1: Early symptoms and laboratory testing

• Module 2: Safe transport of infected patients, particularly at-risk populations such as children and older adults

• Module 3: Coordination with other components of the NSPS and engagement with the media and the public.

Through these modules, participants practiced their roles, collaborated with the appropriate partners, tested their plans for strengths and weaknesses, and identified solutions to strengthen their collective response.

After the exercise, participants collectively debriefed to identify strengths and areas for improvement. For many regions, the exercise revealed gaps in laboratory capacity, highlighting the need for increased testing capabilities to provide timely diagnosis, treatment, and infection control. To mitigate this gap, numerous regions have convened laboratory working groups, collaborating with regional partners to improve testing capacity and coordination.

The exercise brought together partners across health care, emergency response, and public health for a rare collaborative effort. With all 10 Health and Human Services regions testing their special pathogen plans simultaneously, regional leaders exchanged challenges and promising practices to enhance nationwide preparedness. Participants shared expertise, formed new relationships, clarified roles, and coordinated response strategies—benefits extending beyond special pathogen events to any emergency. Like soccer, effective defense against pathogens relies on practice, teamwork, coordination, and communication.

 Learn more about the National Special Pathogen System 2026 World Cup Tabletop Exercise.
 

^1. Citation-Khan S, El Morabet R, Khan RA, Bindajam A, Alqadhi S, Alsubih M, Khan NA. Where we missed? Middle East Respiratory Syndrome (MERS-CoV) epidemiology in Saudi Arabia; 2012-2019. Sci Total Environ. 2020 Dec 10;747:141369. doi: 10.1016/j.scitotenv.2020.141369. Epub 2020 Aug 3. PMID: 32791417; PMCID: PMC7398055
 

Richmond, Virginia
January 5, 2025  

On Sunday, January 5, 2025, local and national news channels began reporting on the potential for a blizzard to hit the greater Richmond area. While residents rushed to the grocery store to grab last-minute necessities, the Central Virginia Healthcare Coalition (CVHC) began monitoring weather reports and preparing for the snow’s potential impacts on health care in the area. The Greater Richmond area, inclusive of Henrico and Chesterfield counties, typically experiences minimal snowfall, averaging a total of three to seven inches annually. However, meteorologists predicted an unusual six to eight inches in just one day. 

CVHC is a health care coalition funded by ASPR’s Hospital Preparedness Program (HPP). CVHC leadership works with its members to conduct annual emergency preparedness and response exercises, establishing systems, protocols, and key relationships ahead of an emergency response. CVHC’s 203 member organizations include local emergency services, public health, fire departments, long-term care facilities, and acute care hospitals. As the storm approached, the CVHC maintained close contact with its members, sharing weather and situational awareness updates to stay ahead of any potential emergencies. 

By Monday, January 6, nearly six inches of snow had fallen, setting off a series of cascading consequences that resulted in widespread water contamination and issues with distribution in and around the greater Richmond area. By Monday afternoon, the CVHC team began receiving texts and calls from several of its members, informing Coalition leadership of the impending water crisis. Soon after, the CVHC received the first of what would be many hotline calls, warning that the city would be out of water by approximately 5:00 PM that day. The Coalition immediately jumped into response mode. 

The Coalition activated pre-developed plans and systems to coordinate a virtual response, keeping its members and partners connected despite unsafe road conditions and limited access to water in the CVHC office. Without these pre-developed plans and systems, the CVHC team would not have been able to safely coordinate the response, allowing the crisis to grow to the point of needing to evacuate affected facilities and patients. Together, the team quickly worked with its members to procure urgent supplies (e.g., heaters, blankets, bottled water, handwashing stations, non-potable water tankers), establish daily coordination calls, and provide 24/7 support to all affected facilities. 

For example, one of the community’s most immediate needs was to secure alternative water sources, both to maintain facility operations (e.g., heating, plumbing) and to continue patient care. The CVHC coordinated with the Emergency Support Function #8 at the Virginia Emergency Operations Center to identify and distribute 36 tanker trucks to provide non-potable water to the 21 affected facilities, including 11 hospitals and freestanding emergency departments and 10 long-term care facilities. The CVHC team also set up hand-washing stations and coordinated the distribution of bottled water to facilities to ensure patients stayed hydrated, ate, and took their medications. As a result of CVHC’s efforts, none of the 21 affected facilities had to evacuate.

Throughout the week, CVHC staff worked tirelessly, often without breaks, to manage the crisis and support all affected facilities. The team maintained situational awareness by leading daily coordination calls with partners, tracking and updating facility availability in the Virginia Healthcare Alerting and Status System, and maintaining consistent communication with all affected facilities. The Coalition worked closely with one of its key partners, the Office of Drinking Water, receiving timely and relevant status updates throughout the response. These updates helped CVHC staff plan resource allocation, staffing efforts, and potential next steps for patient movement. 

One of the most remarkable aspects of the response was the sense of community and collaboration across Coalition members. As the Coalition worked with affected facilities to plan for potential patient relocation, its goal was to keep patients as close to their original facilities as possible. Despite being competitors, Coalition members unaffected by the water crisis stepped up to assist affected facilities, sharing resources and offering available bed space in case affected facilities needed to evacuate patients. Strong inter-facility collaboration showcased the value of the relationships and overall community built by the CVHC over the years. 

By Friday, January 10, the city temporarily repaired the water plant, restoring water pressure and water safety. In all, the Coalition received and responded to 28 resource requests submitted through the Virginia Healthcare Alerting and Status System and the Coalition’s hotline. 

In Fiscal Year 2024, CVHC received and addressed 38 total hotline requests for assistance the whole year. During the week of the water crisis, the CVHC received and addressed 35 total hotline requests for assistance, preventing all affected facilities from evacuating. 

As CVHC team members reflected on the week, they shared a sense of pride in their collaboration and care for their community throughout the response. The Coalition was key to the success of this response, providing value through its:

• Extensive member network that includes non-traditional partners like the Office of Drinking Water,

• Flexible response structure that allowed the team to coordinate an effective response remotely, and

• Community-centered approach to patient care that enabled prompt identification, sourcing, and delivery of critical resources to affected facilities.
   

Community means knowing who to call when you need help. When disaster struck, health care entities throughout the greater Richmond area called on the CVHC and its members to help maintain continuity of care for all patients. Funded by HPP, the CVHC was prepared to answer its community’s call for help, coordinating a timely, well-informed, and effective response.  

Learn more about how HPP encourages community-centered health care coalition membership by accessing the Membership section (page 17) of the HPP Fiscal Year 2024-2028 Notice of Funding Opportunity.

In a scene from every parent's nightmare, Brandon Pitman's 12-year-old son Gabriel needed specialized compound medicine to treat his seizures. But the local compounding pharmacy was closed following Hurricane Helene, and no other pharmacy in the area could produce the medication needed.

To make things worse, Brandon's cell phone had no service, so he couldn't call pharmacies outside the area for help. Even if he could find a pharmacy to fulfill the medication, due to storm damage delivery to his home was not an option.

Fortunately, ASPR's responders were ready to help. Brandon brought his child with special needs, Gabriel, to ASPR's Base of Operations (BoO) at Blue Ridge Memorial Hospital in Spruce Pine, North Carolina, for help in securing the life-saving medication.

Two pharmacists from the National Disaster Medical System's Disaster Medical Assistance Team RI-1, Megan McCaskill and Jennifer Sawicky, and the Incident Management Team (IMT) pharmacist lead, Maya Leiva, collaborated to ensure Gabriel received his medication. First, they worked with the prescribing physician to determine the correct medications and dosages. Next, they located an open compounding pharmacy in Durham, NC - approximately 200 miles away - to prepare the medication.

Sometimes, a drug isn't right for a patient as it is usually dispensed. In these cases, the product may need to be compounded. For example, if the FDA-approved medication contains a dye the patient is allergic to, a compounding pharmacy can prepare a version of the drug that does not include that dye. The compounding pharmacy can prepare a liquid formulation if the patient can't swallow a tablet. A licensed pharmacist or physician combines, mixes, or alters the ingredients of a drug to create a tailored medicine that meets the specific needs of the patient.

The compounding pharmacy agreed to waive shipping and copayment fees, ensuring the Pitmans didn't incur any expenses. The pharmacists then focused on getting the medication to the Pitmans as quickly as possible. They arranged for the compounding pharmacy ship the medicine to the IMT in Charlotte and the ASPR logistics team delivered the medicine to the BoO in Spruce Pine.

The Pittman family had the medication in hand within 28 hours of coming to NDMS for help.

The NDMS is activated at a state's request when health resources are overwhelmed by disasters, such as a hurricanes, earthquakes, pandemics, or terrorist attacks.

A BoO is a modularly designed facility that allows NDMS to deploy assets to meet the needs of responders in the field. These assets can include hospital beds, medical equipment, and pharmaceuticals.