Emergency exercises serve as a reminder that readiness is not just a plan, it’s an ongoing practice. With a large and high-density population and millions of visitors from across the globe, New York City (NYC) sits at the front line of public health preparedness in the United States.  

Over the past year, the NYC Department of Health and Mental Hygiene (referred to as the NYC Health Department) participated in Tranquil Passport, a full-scale federally led international exercise designed to test national and local capacity to respond to high-consequence infectious disease outbreaks. The scenario imagined an outbreak of a viral hemorrhagic fever during the upcoming 2026 FIFA World Cup, requiring the transport of patients for care, underscoring how international events can become flashpoints for global health emergencies. 

With a population of approximately 8.5 million, NYC is the largest, most densely populated, and most diverse city in the U.S. [1] Approximately half of the population speaks a language other than English at home and 37 percent of the population was born in a different country [2]. The city is also an international destination for business, media, and tourism, and welcomes more than 100 million passengers annually, travelling through its international airports. Consequently, NYC faces a high risk of both intentional and naturally occurring hazards. A biological attack or large-scale infectious disease outbreak in NYC significantly impacts the health, security, and economy of both the city and the country.  Given this, close and productive relationships with state, federal, and international health authorities are essential elements for public health preparedness in NYC.   

What lessons or innovations emerged from this exercise that could inform preparedness efforts, especially ahead of high-profile events like the 2026 World Cup?  

The response to an outbreak of VHF is complex and requires unique actions that deviate from our routine outbreak response activities. Participating in this full-scale exercise underscored the many moving pieces and decision points requiring coordination during the initial response. It is particularly important to engage subject matter experts and key external stakeholders early in the response, provide enhanced training to responding staff on their roles, and institute clear, pre-established protocols for communication and coordination among stakeholders.  

What partnerships and resources were essential to the success of this initiative, and what would be needed to sustain or expand this type of work in the future?  

Highly effective coordination among key state and local partners—including FDNY EMS, the NYC Health Department, NYCEM, NYC Health + Hospitals/Bellevue, and the New York State Department of Health—was essential to the success of this exercise.  

The ability of these partners to coordinate effectively is made possible in part by over two decades of collaborative planning, exercising, and resolving gaps in local and regional preparedness that has been funded by key federal programs, including CDC’s Public Health Emergency Preparedness (PHEP) grant, ASPR’s Hospital Preparedness Program (HPP), as well as the ASPR-supported National Emerging Special Pathogens Training and Education Center (NETEC) and RESPTC programs. Federal investment in these programs needs to be increased and consistent to sustain and build on the capabilities demonstrated in the Tranquil Passport exercise and other real-world events. 

It’s also important to highlight that the patients in the exercise were already known to have a VHF. While safe transport and treatment for these patients is an important capability, the early identification and isolation of patients suspected to have a VHF when they initially present for care is critical. There is currently no source of federal funding to train providers at front-line hospitals—the facilities most likely to first encounter these patients—to recognize a disease like a VHF and quickly prevent its spread. Greater investment is essential to help the country be ready to respond when the risk of health threats is high, such as during the 2026 FIFA World Cup. 

What risks does NYC Health anticipate, regionally and beyond, if programs like PHEP and HPP and funding for RESPTCs, NETEC, and other critical elements of the National Special Pathogen System are not maintained due to reductions in federal funding?  

If federal preparedness funding were decreased or eliminated, the ability of major cities like NYC—which are hubs of commerce, media and travel—to prevent, detect, respond to, and mitigate health threats such as infectious disease outbreaks would be severely diminished. 

In the Tranquil Passport exercise scenario, without the PHEP and HPP programs, NYC Health would not have staff to receive and coordinate patient transport requests and to develop emergency protocols that help first responders and healthcare providers safely transfer and treat patients. We would also have diminished public health laboratory capacity, reducing our ability to rapidly identify infectious threats. The lack of these resources would lead to disruption and confusion among responders, delays in patient care, and increased exposure risks for first responders and healthcare providers, and ultimately, preventable loss of life.   

Without RESPTC funding, NYC would lack a biocontainment unit and the highly trained staff to safely treat patients who have a VHF, further placing healthcare providers, other hospital staff, and patients at greater risk of exposure. The consequences of these gaps would extend far beyond NYC; in a global travel hub, even one undetected case could seed additional outbreaks across the U.S. as exposed individuals travel to other cities, making containment far more challenging.  

The Tranquil Passport exercise focused only on the earliest stages of what would be a massive international response required to contain an outbreak of VHF. Visitors attending FIFA World Cup games are highly mobile; therefore, state and local health departments would be critical in identifying, tracking and containing disease spread, conducting laboratory testing, and ensuring healthcare systems are prepared and coordinating with federal partners. Without PHEP and HPP funding, health departments would not have the trained workforce or infrastructure necessary to carry out these life-saving activities.