News and Insights

Failing the fire drill

June 9, 2025

Normalizing ineffective disease outbreak response creates excusable incompetence

There’s a reason we simulate worst-case scenarios. Without taking the time to rehearse what we will do when an emergency hits, we usually panic and scatter. It’s why offices practice fire drills, American schools now prepare children for active shooters and militaries run complex exercises. Preparation saves lives and reveals where we can improve. Effective communication is a keystone. And when we repeatedly fail these kinds of simulations, those in charge are held accountable. That’s the expectation at least, even if it’s not the reality.

Just look at the state of public health today in the United States for an example of the sort of routine failing of the fire drill that we have allowed to persist. Covid scrambled the playbook for responding to both new and preventable disease outbreaks, with the lingering repercussions of bungled communications during the pandemic serving as a primary driver of our ham-handed approach to public health communications in the current measles and avian influenza threats. It underscores our chronic inability to evolve basic public health messaging to meet the reality of our current, highly fragmented environment.  The result is muddled guidance that cascades from national and local government agencies to the rest of society.

Public health requires homogeneity, structure, clarity and top-down leadership – essentially many of the criteria that are in short supply right now in our current efforts to mitigate chronic and infectious diseases. We would never accept alternative or fringe ideas to established protocols in other areas of public life – building codes that prevent prisons from being built next to elementary schools, for example, or the laws of physics that underpin the construction of bridges, tunnels and skyscrapers. The proven orthodoxy that keeps us safe in countless aspects of daily life are reinforced by their track record of success and reevaluated in very rare instances of calamitous failure.

The same can be said of public health – up until now. For most of history, it has stood as an invisible sentry keeping Americans safe from preventable diseases and helping to prevent horrible instances where we fly through windshields at terminal speed (thanks, seatbelts), die prematurely from cancerous carcinogens (thanks, smoking bans) or have our children stolen from us by an easily preventable disease (thanks, vaccines for too many diseases to count).

Who benefits from weakening our public health system? Certainly our geopolitical adversaries, as well as quack operators peddling fake remedies and conflict entrepreneurs who thrive on stoking America’s culture wars. Their playbook has become all too familiar by this point: downplay risks to an outbreak; encourage confusing messaging; sow misinformation and distrust in health authorities; hobble coordination between government agencies; and encourage people to scatter in search of health information that reinforces their own personal viewpoints.

We’re seeing this play out with the current U.S. response to the measles outbreak in southwestern states and it could serve as a proxy for how American public health authorities respond to worse disease outbreaks, especially in light of what we are lacking. Currently, any cooperation between American health authorities and the World Health Organization to share information that identifies and rapidly sequences new pathogens will disappear at the end of this year.

Within U.S. agencies, the National One Health Plan was created to foster greater coordination between the Department of Agriculture, Centers for Disease Control and Prevention, and other agencies under Health and Human Services to combat zoonotic diseases. The U.S. has been criticized for its lumbering approach to containing avian influenza, so it’s fair to ask if widespread staff cuts in HHS agencies have weakened our ability to overcome silos and improve coordination within the U.S. government, especially given the threat of H5N1.

I bet they have and it won’t take long for the signs to become notable. What’s happening right now in Texas is a case in point. In the vacuum that is a clear, unified messaging structure for the measles outbreak, fringe therapies and snake oil medicine have entered the fray. Meanwhile, we have taken a chainsaw to America’s biomedical research capacity, severely undercutting the next generation of scientists who can help us stay one step ahead of disease.

The danger in normalizing incompetence is that we make it chronically excusable and are destined to repeat easily avoidable failures. If measles is our canary in the infectious disease coalmine, we should be taking steps to heed the lessons of minimizing public health threats and look at pragmatic changes that we can introduce to make the systems stronger. In other words, treat the outbreak in Texas as a real-life fire drill and learn from it.

One easy first move is to include communications experts early and meaningfully at different levels of the new public health structure in the U.S. federal government. For example, even in its evolving incarnation, the CDC’s Advisory Committee on Immunization Practices (ACIP) is composed primarily of medical leaders and communications professionals are not fully represented. Broadening ACIP membership to include public health communications specialists could be transformative.

Similarly, given the impact we have seen from public health crises on businesses and local communities in recent years, integrating communications experts who understand how to clearly convey health-related messaging and build trust into corporate boards and city councils can help us avoid unnecessary business and societal interruptions.

We don’t need to wait for the siren to blare before we act. If we respect the process of preparing for the worst and actually heed the lessons available to us from public health fire drills, the U.S. and the world will be healthier and safer as a result.