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This chapter examines one of the many war games-like exercises carried out beginning in the 1990s to test the reaction of government officials to a hypothetical bioterrorist attack. In this exercise, smallpox virus is released simultaneously at three sites across America. Experienced government officials played the roles of the president, his cabinet, and members of the National Security Council in formulating responses to information fed them by exercise planners. As the players stumble through their roles, the situation rapidly spins out of control, and hundreds of thousands of hypothetical deaths occur. This exercise contributed to a sense of panic among government officials, and contributed to the commitments of enormous sums of money to try to remedy perceived shortcomings in our ability to respond to a real bioterrorist attack.

Who is running the show in a nation-wide health crisis? The federal government? Individual states? Preservation of the public health is a power granted to individual states, as an exercise of their constitutionally guaranteed policing powers. But recent legislation (and funding) have put a huge number of resources into the federal government's hands. Lines of fiscal and administrative authority must be worked out in advance of any real crisis. One of the most important powers needed in catastrophic health crises concerns coercive powers: mandatory medical examinations and treatment of at-risk individuals, for example, or compulsory isolation or quarantining of infected persons, or even confiscation of contaminated property or human remains. To deal with these and other critical issues, a Model State Emergency Health Powers Act was drafted in 2001. This chapter looks at this Act, and the numerous issues it has tried to address.

This chapter explores how reinforcing and amplifying emergency preparedness could blunt the trauma that climate impacts spread. The COVID-19 pandemic serves as a warning that catastrophic risks do not honor geopolitical or jurisdictional boundaries. Thus, current approaches for disaster response require an overhaul to address climate change. Four crucial steps can help countries prepare for a future of concurrent, consecutive, and compounding disasters. First, acting before disaster strikes lessens damage and allows communities to bounce back faster. Second, protecting supply chains avoids panic and economic loss. Third, stockpiling acts as an extra level of insurance when compounding events occur. Fourth, bolstering emergency response capabilities to ensure that aid arrives earlier can lead to speedier recoveries. In addition, treating every disaster as a “no more” moment drives continuous improvement in disaster recovery capabilities. Taking these steps offers better protection for communities, including thwarting criminality that may take root when disaster response fails.