At the time of this writing, there is no consensus about how COVID started.
My colleagues and I tried to harness that uncertainty as a strength. Rather than waiting for certainty to arrive, we began acting in its absence. Not knowing the origins of COVID meant we were forced — as we readied the country and world for future unknown threats — to make ourselves safer from all potential causes: natural spillovers, lab accidents, and biological weapons. Through the fall 2022 and into 2023, we worked with more than 16 federal agencies, including the Departments of Defense and State, the USDA, CDC, and HHS, and intelligence agencies to develop and execute the White House’s pandemic prevention plan.
Our plans were designed not just for the last crisis, but for the next one. They didn’t assume the next threat would be familiar and accounted for naturally occurring pandemics, laboratory accidents, and deliberate biological attacks. Different causes with different pathways, but the same reality: We may not know what’s coming, when it will arrive, or what form it will take.
We invested in policies, plans, funds, and institutions that work across many scenarios. We scaled up genomic surveillance in our wastewater plants and in our airports. We created a pandemic radar to forecast the spread of infectious disease threats by establishing the CDC’s Center for Forecasting and Outbreak Analytics (CFA). We secured hundreds of millions of dollars to accelerate efforts to use mRNA technology that had powered COVID vaccines to bring us closer to our goal of developing a vaccine for pandemic influenza within 100 days. We invested over $3.2 billion to hire epidemiologists, data specialists, and contact tracers in state and local health departments across all 50 states.
We worked with Congress and President Biden to pass the 2022 PREVENT Pandemics Act and the Global Health Security and International Pandemic Prevention, Preparedness and Response Act. These bipartisan laws established a permanent White House office for pandemic preparedness and response policy, which we had negotiated with Democratic Senator Patty Murray and Republican Senator Richard Burr. They created the position of a permanent U.S. global health security coordinator and a new State Department bureau on global health security and diplomacy, and authorized billions in funding to scale bilateral partnerships and the new Pandemic Fund at the World Bank.
We negotiated a new treaty, the Pandemic Agreement, through the World Health Organization; worked with other nations to uphold the U.N. Biological Weapons Convention and the International Health Regulations; and convened a triennial U.N. summit of heads of state to take action to make us safer.
And we leveraged the power of markets. My team proposed to President Biden that he rally his G7 leaders to unlock a line of credit that would empower low-income countries to put in purchase orders with pharmaceutical companies on “day zero” of a pandemic emergency. This could increase competition, ensure more orders for manufacturers, and expand access to vaccines and medicines.
These actions were focused on helping the world quickly detect and respond to biological crises. We soon faced an unprecedented bird flu (or avian influenza) outbreak due to the H5N1 strain, leading to the death of millions of birds across American farms, spreading to dairy cows and threatening our milk supply, and causing infections and deaths — harbingers of the next pandemic. Mpox continued to rage in parts of Africa, and outbreaks of Ebola and Marburg (from the same filovirus family as Ebola) had occurred in Rwanda, Democratic Republic of Congo, and Ethiopia.
Then, during the second Trump administration, the White House — again — dismantled the pandemic-preparedness team I had led and proposed the steepest cuts to science and public health funding in modern U.S. history. The CDC made sudden, sweeping changes to vaccine practices, cutting the number of vaccines routinely recommended to protect children from diseases, including influenza and hepatitis B, a chronic infection that can cause liver cancer. These changes were driven not by scientific breakthroughs, but by leaders of a movement that promoted false claims and misinformation.
For many, the instinctive response to moments like this is avoidance: to disengage, to despair, or to cling rigidly to a belief that if we just wait long enough, things will return to “normal.” But uncertainty rarely resolves on its own. The lesson we’ve learned repeatedly in public health crises is that we are not defined by the conditions we face but how we respond to them.
When federal capacity weakened, states and communities did not remain passive recipients of risk. The nonpartisan Governors Public Health Alliance, which I have advised, worked to strengthen public health protections at the state and local levels. The Bipartisan Commission on Biodefense, where I have served as a commissioner alongside former Republican and Democratic public officials, released a National Blueprint with many recommendations Congress can codify into law — building on legislation we had worked with President Biden and bipartisan leadership from Congress to pass in 2022 like the PREVENT Pandemics Act and the Global Health Security and International Pandemic Preparedness Act. When enshrined into law, these protections endure regardless of who occupies the executive branch.
In the face of shifting federal guidance and eroding trust, many experts and community leaders embraced uncertainty as a call to action rather than a reason to retreat. Expert-led groups like the Vaccine Integrity Project, Your Local Epidemiologist, and the Common Health Coalition stepped forward to help reconnect with reliable information. As misinformation reshaped federal vaccine guidance, they encouraged providers, patients, and families to critically examine scientific facts with three questions when guidance suddenly changes.
The lesson we’ve learned repeatedly in public health crises is that we are not defined by the conditions we face but how we respond to them.
First: Is the recommendation supported by a broad, consistent body of evidence?
When the CDC’s Advisory Committee on Immunization Practices (ACIP) reversed measles vaccination guidance in 2025 — despite active outbreaks in dozens of states — experts reminded the public that decades of large, high-quality studies had consistently shown MMR (measles, mumps, rubella) and MMRV (measles, mumps, rubella, varicella) vaccines to be safe and highly effective. No new evidence had emerged to justify the reversal.
Second: Has the recommendation been reviewed independently and peer-validated?
After ACIP voted to end universal newborn hepatitis B vaccination, experts highlighted that the decision was not grounded in new peer-reviewed evidence. The scientific literature continues to show that hepatitis B infection in newborns is often silent but can lead to lifelong disease, including liver cancer. Leaders at the American Academy of Pediatrics (AAP) publicly reaffirmed the birth dose, offering families a stable reference point when official guidance wavered.
Third: Who benefits from this recommendation, and are conflicts of interest transparent?
In the wake of ACIP’s controversial votes, including its January 2026 decision to cut the number of recommended vaccines for children from 17 to 11, concerns emerged that political pressure and public skepticism, rather than science, had influenced them. By contrast, organizations like AAP and the Vaccine Integrity Project publish transparent conflict-of-interest disclosures and rely on independent experts whose primary responsibility is children’s health. In uncertain environments, choosing guidance from institutions that minimize hidden incentives helps anchor decisions in evidence rather than ideology.
Ultimately, what these groups did was to accept uncertainty and use that to shift control — from federal to state and local officials; from partisan politicians to experts.
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