What the FY2026-2029 ASPR Strategic Plan signals for preparedness, response, and health access

Read the plan: ASPR Strategic Plan FY2026-2029

The Assistant Secretary for Preparedness and Response (ASPR) FY2026-2029 Strategic Plan reads like more than a routine refresh. It signals a shift in posture, incentives, and how the federal government intends to define preparedness and manage response. I have not reviewed the prior ASPR strategic plan line-by-line, so I am not claiming a formal delta. But compared to how federal health security strategies have typically been framed over the past decade, this document reflects a meaningful pivot in emphasis and execution.

It also arrives amid structural uncertainty inside HHS. As of January 12, 2026, ASPR remains a distinct HHS operating division (not formally placed under the Centers for Disease Control and Prevention, CDC). HHS announced a 2025 reorganization plan that proposed moving ASPR under CDC, and multiple states challenged that plan in court. A federal judge later issued an injunction that halted key elements of the restructuring, leaving the proposed move unresolved.

That uncertainty matters for interpretation, and it is not an inside-baseball detail. If the proposed shift ultimately proceeds, the center of gravity would likely move toward CDC’s data, surveillance, and outbreak-response machinery, changing how priorities are set, measured, and resourced. If it does not, the plan still signals a stronger performance orientation, but implementation may look more like prior ASPR operating models, with familiar seams between public health and medical response left to local practice to bridge.

For clinics and communities, the stakes are straightforward: will these shifts reduce care disruptions during emergencies, or will they add new burdens that make continuity harder to sustain when systems are already strained?

Here are the shifts that matter most for health access in emergencies, along with the risks to watch as these ideas move from paper to practice.

Where ASPR sits inside HHS could reshape implementation

One gap this debate can obscure is the one patients feel first: continuity of primary care and outpatient services (including FQHCs, free clinics, dialysis, and pharmacy access) when disasters push demand onto hospitals.

ASPR has historically operated as a distinct HHS division with a clear mandate to drive medical preparedness and response across the federal enterprise. The 2025 HHS reorganization proposal would place ASPR under CDC. If implemented, preparedness and response may become more tightly integrated with public health operations. Done well, that could reduce seams, speed decisions, and improve how information moves from detection to action.

But integration has tradeoffs. A CDC-centered model can pull priorities toward infectious disease and epidemiologic response, even when disasters are driven by power loss, flooding, heat, or displacement and the core challenge is continuity of clinical care. It also raises governance questions about how authorities and budgets remain clear across CDC emergency functions and ASPR’s roles in medical logistics, deployments, and countermeasures.

If the reorganization remains stalled, the tensions are different: less risk of mission dilution inside CDC, but more risk that persistent seams across public health and medical response remain unresolved and managed unevenly across states and regions.

Preparedness is being reframed as measurable performance and stewardship

The plan centers transparency, discipline, measurable outcomes, and responsible stewardship.

That shift matters because when outcomes become the headline, programs and partners are evaluated less on activity and more on proof. For clinics, NGOs, and private-sector partners, the bar for “prepared” may become more concrete and more audited.

The risk is that metrics become the mission. If readiness is defined narrowly or measured with easy-to-count proxies, partners will optimize for the score, not the outcome. That can drive paperwork, training theatre, and compliance behavior that does not improve continuity of care.

State and local primacy is no longer implied, it is the backbone

The plan is explicitly organized around strengthening preparedness through state, local, tribal, and territorial partners (SLTT) resiliency, tied to an executive order focused on efficiency through state and local preparedness.

Read plainly: readiness is framed as something built and sustained closest to the ground. If ASPR is ultimately placed under CDC, grant-driven levers and state-facing interfaces may become even more central to how this strategy is executed.

The risk is uneven capacity turning into a national vulnerability. Centering SLTT primacy only works if resources and workforce are there. Otherwise, it can widen gaps between well-resourced regions and places already struggling with staffing, rural access, and fragile clinic networks.

Signature preparedness programs are being repositioned around readiness metrics, not inputs

The plan calls to re-scope major preparedness programs by setting measurable readiness performance measures and tracking outcomes.

That is a big deal. It suggests a future where dollars, technical assistance, and expectations are tied to demonstrated readiness, not just participation or narrative reporting.

The risk is a heavier compliance burden without clearer impact. Performance measures can improve accountability, but only if they are validated, kept lightweight, and aligned to patient-centered outcomes. If not, they can add reporting friction, incentivize box-checking, and penalize partners for structural underfunding rather than operational choices.

Federal response is being tuned for speed and clearer authority

The plan leans into rapid, efficient response, calls for clear lines of authority, and emphasizes standardized after-action reviews shared with SLTT and private-sector partners.

If the goal is speed, then role clarity has to be explicit before the next crisis, not improvised during it, especially if ASPR is ultimately placed under CDC.

The upside is faster decisions. The downside is that speed can become synonymous with top-down control. If the model over-corrects, it can squeeze out NGOs and private-sector partners who often solve last-mile access problems faster than government can.

There is also tension with transparency. Public-facing after-action products are valuable, but if partners expect scrutiny without context, candor drops and lessons get watered down.

Supply chain is treated as national security, with onshoring as strategy

The plan is blunt about concentrated foreign sourcing of critical medicines and the need to bolster domestic manufacturing to reduce dependency, framed as a resilience and security imperative.

It also points to incentives, barrier reduction for industry, and better visibility into vulnerabilities and dependencies.

If you care about continuity of care during disasters, this matters. Supply chain resilience is not abstract. It is whether insulin arrives, whether dialysis disposables are available, and whether clinics can operate on day 4, not just day 1.

The risk is assuming onshoring solves near-term fragility. Domestic production is a long game and can be expensive. Timelines, workforce constraints, and market dynamics do not change on strategic-plan schedules. If policy leans heavily on onshoring without near-term mitigation, patients remain exposed during the transition.

“Gold standard science” is paired with trust restoration and selective use of AI

The plan is direct about transparency, reproducibility, integrity standards, conflict-of-interest management, and restoring public trust. It also calls for integrating digital health and AI where proven effective.

For communities that already experience access barriers, trust is not a communications problem. It is an operational requirement. If the science and guidance are not trusted, uptake drops and the system fractures faster in a crisis.

The risk is widening gaps through technology choices. Proof in controlled settings is not the same as usability during disaster conditions, especially for low-connectivity areas, under-resourced clinics, and communities with language and access barriers. Digital tools and AI also raise privacy, security, and governance questions that have to be addressed before a crisis, not during one.

What this means for health access in emergencies

The plan’s throughline is that preparedness and response will be judged by results, not intent. That direction can be constructive, but only if implementation avoids the traps above. Done well, it pushes the ecosystem toward a few practical needs:

• Shared readiness definitions. A common language for “ready” across clinics, clinicians, public health, NGOs, suppliers, and jurisdictions, measured without creating reporting theatre.

• Faster, cleaner information exchange. Decision-grade data that moves quickly while protecting privacy and sensitive operational details.

• Pre-incident partnering. Roles, expectations, and data pathways built before a disaster so community capacity stays inside the tent.

• Supply chain visibility at the edge. Earlier shortage signals and realistic mitigation while longer-term manufacturing shifts play out.

On the ground: what changes for clinics and clinicians

If the plan’s logic is implemented, clinics and clinicians should expect a more performance-driven preparedness environment and more direct expectations to demonstrate continuity of care under stress.

• More readiness evidence, fewer check-the-box deliverables. Clearer expectations, with higher documentation risk if measures are not simple.

• A sharper focus on continuity of essential services. Can you stay open, communicate, and route patients when staffing, power, and supplies are constrained?

• More structured supply chain monitoring. Stronger expectations to track critical items and document substitutions and conservation strategies.

• Potentially shifting support pathways. If ASPR is ultimately placed under CDC, the “front door” for guidance, technical assistance, and emergency support could change. Without local role clarity, clinics will feel the confusion first.

• Digital readiness becomes part of readiness. Practical ways to share minimum essential data during incidents without taking on heavy new platforms.

On the ground: what changes for public health preparedness leaders

For preparedness leaders, the plan points toward tighter performance management, stronger SLTT levers, and pressure to integrate medical response and public health operations more tightly. If the proposed reorganization proceeds, that integration would occur inside a CDC-centered structure. If it does not, leaders will still be pushed to reduce seams across agencies and partners through existing operating division boundaries.

• Readiness measures become central. Pressure to define outcomes that can be compared across jurisdictions and defended as meaningful and equitable.

• More pre-incident governance work. Document who decides what, how partners plug in, and how to avoid sidelining community capacity.

• After-action products travel farther. Faster learning, but only if incentives protect candor and context.

• Supply chain becomes a standing agenda item. Dependencies, mitigation, vendor relationships, and realistic planning while onshoring timelines lag.

• A higher bar for trust and communications. Transparency, credibility, and guardrails for digital tools as core preparedness functions.

On the ground: what changes for private sector partners

For manufacturers, distributors, wholesalers, pharmacies, payers, health tech vendors, and other private sector partners, the plan points toward clearer expectations, more data-driven coordination, and higher accountability for continuity and transparency.

• More structured engagement with response leadership. Stronger expectations for pre-incident planning, exercises, and incident information-sharing, with clearer roles during response.

• Greater demand for supply chain visibility. Earlier shortage signals, dependency mapping, and mitigation strategies that protect community-level continuity of care.

• More scrutiny of performance and outcomes. Greater pressure to demonstrate reliability, surge capability, and service continuity, not just commitments.

• Tighter governance around data sharing. Clear guardrails to protect proprietary information, privacy, and security while enabling situational awareness.

• A longer runway for manufacturing shifts, with near-term expectations. Onshoring may accelerate investment, but near-term fragility still requires substitution plans, conservation guidance, and coordinated allocation during disruptions.

What HRA will do next

This strategic direction reinforces why HRA exists. If the future is performance, speed, and visibility, then clinics, public health agencies, NGOs, and private-sector partners need practical ways to plug in before the next event.

In 2026, HRA will focus on:

• Helping partners define and report readiness in ways that are lightweight, comparable, and useful during operations

• Facilitating communication between clinics, NGOs, and private-sector partners so needs and offers match quickly and responsibly

• Building visibility tools that prioritize decision-grade information, not more noise, so response leaders can move fast without losing the community-level picture

If you are a clinic leader, a public health preparedness lead, or a private-sector partner, I would welcome a short conversation about what continuity looks like in your context and what data, workflows, or agreements would make it easier to protect access to care during the next disruption.