Strategies Don’t Save Lives. Follow-Through Does.

Last week I spoke at the 11th annual Texas A&M Scowcroft Pandemic Policy Conference, where the agenda focused on three goals: finding the gaps in systems, infrastructure, and workforce that block sustained readiness; sharing lessons from past responses to biological incidents; and developing concrete policy and investment recommendations.

One theme surfaced in various panels and across side conversations: strategies are just words on paper. Preparedness and readiness for the next biological threat come from exercising, operationalizing, and implementing them.

Four takeaways stood out.

We don’t need another strategy.

We have biodefense and pandemic preparedness strategies going back decades. I know because I helped write a few of them. Writing another one isn’t progress. Every biodefense and pandemic preparedness strategy is similar. We need to act to move forward.

The White House should use the existing strategies, pick a few key priority items, and push the U.S. Congress to resource them. With strong community and cross-branch agreement growing, biodeterrence and biosurveillance are strong candidates to be prioritized, resourced, and implemented; the building blocks are already in motion.

Deterring actors from deliberately misusing biology is essential, as the norm against biological weapons continually seems to be challenged. On biodeterrence, the Department of War (DOW) is out front. In March, unveiled a framework built on denying adversaries the benefits of a biological attack, attributing attacks, and holding perpetrators accountable.

On biosurveillance, the U.S. CDC and the DOW are moving forward to better protect the public. Biosurveillance is critical to response and preparedness, acting as an early warning data stream. NTI’s Global Health Security Index shows why it matters: in the 2021 Index, countries averaged just 32 out of 100 on detection and reporting.

A White House prioritization on both these efforts is critical to maintaining focus and coordination across the government.

We need to mean what we say.

Our strategies continue to mention “One Health,” or a similar term. This phrase rolls off the tongue, but implementing it is the hard part. One Health is the concept that the health of people, animals, plants, and environment are closely linked. The concept is valuable, yet stovepipes persist because mandates, budgets, and incentives pull in different directions.

Closing that gap means understanding what motivates counterparts in human health, animal health, agriculture, environment, defense, and intelligence. Then operate and exercise together, continuously, not once before a rollout. A crisis is a terrible time to exchange business cards.

Congress should create a budget line, overseen by the White House or the Department of Homeland Security that provides resources for cross-departmental efforts, modeled after interdepartmental funding seen throughout academia.

Relationships matter.

We need to build, rebuild, and foster relationships at every level: across federal, state, local, tribal, and territorial governments; across departments and agencies; across borders; and between the public and public officials. We live in a world of mistrust and distrust, and long-standing relationships have been tested and, at times, eroded.

Readiness isn’t just stockpiles, sensors, and statutes. We can’t be ready for the next biological incident if trust hasn’t been rebuilt first. Relationships and non-traditional public-private partnerships are critical. In 2021, the Shots at the Shop initiative enlisted Black-owned barbershops and salons to share COVID-19 vaccine information in communities where vaccination rates lagged. This is the model.

Congress needs to pass PAHPA, and the next Congress is the moment.

The Pandemic and All-Hazards Preparedness Act is the legislative backbone of U.S. public health security. Congress has improved national preparedness through it for nearly two decades, yet it has been overdue for reauthorization since September 2023. It was included in an end-of-year funding package in 2024, then pulled when concerns were raised about the size and scope of the legislation. Similar to the farm bill, since then, it has limped along on short-term extensions.

That’s no way to run a preparedness system. Short-term extensions leave state and local health departments, hospitals, and countermeasure developers—the backbone of our response system—planning around uncertainty, which is the opposite of readiness.

There are reasons for optimism. Reps. Neal Dunn (R-FL) and Lori Trahan (D-MA) issued a request for information in January 2026, seeking input on what’s working, where programs overlap, and what should be modernized. That’s a bipartisan signal. With the midterms barely behind us and a new Congress convening in January, there’s a real window.

My ask: make PAHPA an early priority, not an afterthought attached to the last must-pass bill of the year.

PAHPA is where many of the three lessons above become law. It forces prioritization, authorizes funding for follow-through, and gives state, local, and federal partners stable ground to build trust.

Focus, follow-through, and trust.  We need all three because none works alone.