Pandemic Exercises: Lessons for a New Era in Pandemic Preparedness.

We led the last large-scale exercise conducted by the Johns Hopkins Center for Health Security before the COVID-19 pandemic. Despite COVID-19, pandemic exercises are more necessary than ever to prevent the loss of hard-fought gains achieved during COVID-19, keep policymakers from assuming all pandemics will be like COVID-19, and encourage continued engagement from policymakers in strengthening health resilience rather than returning to a cycle of panic and neglect. Pandemic exercises can also advance new solutions necessary to effectively meet the challenge of a future pandemic. Over 2 decades, the Johns Hopkins Center for Health Security has developed and conducted 6 large-scale, high-level tabletop pandemic exercises. These exercises and others were designed to increase policy focus on the most critical needs in pandemic preparedness and heighten the urgency for making these changes in the near future. Pandemic experts and policymakers alike have highlighted the importance of exercises to ensure that all key actors involved in pandemic response-including the government, healthcare, public health, emergency response, and private business and industry sectors-understand both the best practices and policies to pursue before a pandemic and what to do once a pandemic occurs. These advance efforts can enhance planning, resource allocation, and coordination ahead of time and identify unique gaps and barriers. This commentary describes the approach we have developed to create and conduct such exercises and highlights key considerations that were important to successful outcomes.