From Ebola to NSPS: A Decade of Building the National Special Pathogen System

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In a recent episode of Transmission Interrupted, host Jill Morgan, RN, sat down with NETEC’s three co-principal investigators — Dr. Aneesh Mehta (Emory University), Dr. Vikram Mukherjee (NYC Health + Hospitals/Bellevue), and Dr. John Lowe (University of Nebraska Medical Center) — to reflect on the past decade of special pathogen preparedness and what lies ahead.

Their conversation traces how NETEC was formed — and how its work has evolved into a broader national system. https://netec.org/transmission-interrupted/netec-leadership-reflects-a-decade-of-special-pathogen-preparedness-in-the-us/Listen to the episode now.

A Wake-Up Call

Before 2014, only a handful of U.S. hospitals operated high-level isolation units. These programs were specialized, lightly resourced, and often viewed as niche capabilities.

Then Ebola arrived.

While several American aid workers were safely repatriated and treated in dedicated biocontainment units, the national conversation shifted when the first travel-associated Ebola case was diagnosed in Dallas.

On September 25, 2014, a traveler from Liberia sought care at a Dallas emergency department but was initially discharged despite reporting recent travel from West Africa. He returned days later with worsening symptoms and, on September 30, became the first laboratory-confirmed Ebola case in the United States. He unfortunately died on October 8.

Within a week, two nurses involved in his care were diagnosed with Ebola. Both were medically evacuated to established high-level isolation units and, fortunately, they both ultimately recovered. But healthcare worker transmission on U.S. soil exposed serious vulnerabilities in our healthcare systems.

The assumption that any hospital could safely manage a high-consequence infectious disease was shaken. The event revealed gaps in training, infection control, and communication. It also shifted the focus from blaming individual “protocol breaches” to confronting systemic shortcomings. The issue was not simply whether clinicians followed rules — it was whether the system had adequately prepared and protected them.

Dallas catalyzed a national shift: away from a decentralized approach and toward a tiered system of specialized centers, designated biocontainment units, mandatory training and drills, enhanced traveler screening, and a renewed emphasis on healthcare worker safety.

Preparedness required more than written protocols. It required structure, expertise, and sustained coordination.

From Crisis Coordination to National Framework

A small group of institutions — including Emory University, the University of Nebraska Medical Center, and NYC Health + Hospitals/Bellevue — had already demonstrated that advanced care for Ebola could be delivered safely in specialized units.

In the months following Dallas, leaders from those centers formalized their collaboration. What began as crisis-driven coordination evolved into a national training and education center designed to standardize best practices and expand readiness nationwide.

NETEC was established in 2015 as the National Ebola Training and Education Center. As the threat landscape evolved beyond a single pathogen, so did the mission — and the name. The organization became the National Emerging Special Pathogens Training and Education Center, reflecting a broader focus on high-consequence infectious diseases.

From Ebola Network to National System

Early national coordination efforts were structured under the Regional Ebola Treatment Network (RETN) — a framework created to identify and support designated Ebola treatment centers.

Over time, it became clear that the country needed more than a network built around one virus. RETN evolved into what is now the National Special Pathogen System (NSPS) — a tiered, permanent system of care designed to address a wide range of high-consequence infectious diseases.

Similarly, the Regional Ebola and other Special Pathogen Treatment Centers were formalized and expanded into today’s Regional Emerging Special Pathogen Treatment Centers (RESPTCs), reflecting both broader scope and sustained capability.

The shift marked a transition from reactive outbreak response to a durable national preparedness infrastructure.

Building a Tiered System of Care

Today, the NSPS defines levels of responsibility across the healthcare landscape. Not every hospital must provide definitive HCID treatment. But every hospital plays a role:

• Rapid identification
• Immediate isolation
• Protection of healthcare workers
• Safe stabilization and transfer

The model mirrors the trauma system: coordinated, tiered, and time sensitive. The goal is clear — any patient, anywhere, anytime can access the appropriate level of care.

Saving Lives — Safely

One of the most profound lessons of the past decade is that advanced care for high-consequence pathogens is possible — and effective.

Patients once thought unlikely to survive have recovered after receiving intensive care support, including dialysis and mechanical ventilation, in high-level isolation settings.

But that capability comes with responsibility.

Unlike trauma or stroke, infectious diseases carry transmission risks. Protecting staff requires rigorous training, PPE discipline, environmental controls, and continuous process improvement.

Preparedness is not static. Skills degrade quickly when rarely used. “Staleness” sets in faster for HCIDs than other specialties because patient volume is (thankfully) low. Maintaining proficiency requires high-fidelity drills, mystery patient exercises, and infrastructure that must be tested even when not actively in use.

Preparedness is not about perfection — it is about continuous improvement.

The Biggest Barrier: The Boom-and-Bust Cycle

Despite a decade of progress, one barrier continues to challenge the U.S. healthcare system: we treat special pathogen readiness as an episodic emergency response rather than a baseline operational standard.

The cycle is familiar — panic and invest during crisis, neglect and defund once headlines fade.

Why is it so difficult to fix?

Misaligned Incentives

In a predominantly private, fee-for-service healthcare system, readiness is a cost center without immediate revenue. Hospitals operate on thin margins and lean staffing models. Without a regulatory mandate or consistent reimbursement structure — like the trauma system — executives struggle to justify sustained investment during “peacetime.”

Operational Complexity

HCID readiness requires continuous training, protected staffing models, and specialized space. Without ongoing use, expertise fades quickly. Maintaining biocontainment capabilities is a constant uphill effort when patient volume is low.

COVID-19 underscored the cost of episodic preparedness. Diagnostic delays, supply chain breakdowns, and workforce strain revealed the consequences of underinvestment.

Sustained readiness is not simply a healthcare priority — it is a national security imperative.

The 3–5 Year Goal: Operationalizing the Network

Over the next several years, the priority is clear: move beyond reliance on 13 Level 1 RESPTCs and fully operationalize a robust network of Level 2 Special Pathogen Treatment Centers (SPTCs).

Today, when a patient presents far from a Level 1 center, the burden on frontline facilities can be significant. The goal is a coordinated referral system in which frontline hospitals can rapidly identify, isolate, and stabilize patients, Level 2 centers can manage them for the duration of illness, and Level 1 RESPTCs can preserve capacity for the most complex cases and research.

Strengthening this middle tier builds regional resilience, distributes expertise more effectively, and keeps patients closer to home whenever possible.

The 10-Year Vision: True System Integration

Looking further ahead, the ambition is even greater: for the NSPS to function as seamlessly as the trauma system.

The vision can be summed up in four words: any patient, anywhere, anytime.

No matter where a patient presents in the United States, the system should be able to identify the risk, isolate appropriately, inform the right partners, and transport the patient to the appropriate level of care within a defined timeframe — ideally mobilizing resources in under two hours.

In this future state, readiness is not a special activation triggered by crisis. It is embedded in the everyday fabric of healthcare operations.

What Must Happen to Get There

Reaching that level of integration will require structural change.

First, sustainable, non-emergency funding must replace cycle-dependent grants. Preparedness cannot hinge on headlines. It requires stable and permanent legislative appropriations — similar to national defense or strategic stockpiles.

Second, regulatory and accreditation standards must reinforce readiness. Integrating HCID readiness into Centers for Medicare & Medicaid Services (CMS) and Joint Commission standards, making participation in the tiered system a recognized quality metric rather than a voluntary effort.

Third, public–private partnerships must continue to expand. Initiatives such as the NSPS Level 2 Special Pathogen Treatment and Network Development (STAND) Award demonstrate how private health systems can sustain readiness when supported through coordinated federal investment.

Preparedness cannot rest solely with a handful of institutions. It must be a shared responsibility across government, healthcare systems, and communities.

Preparedness Makes Us Safer — Every Day

Although high-consequence pathogens are rare, the habits developed through special pathogen readiness improve routine healthcare.

Embedding infectious risk assessment into everyday clinical thinking, standardizing PPE practices, formalizing transfer and handoff protocols, and strengthening communication all enhance patient and provider safety. These measures protect healthcare workers not only from Ebola, but from influenza, norovirus, and other common infectious threats.

Preparedness is not a niche specialty. It is foundational to safe care.

A Decade of Progress — and Work Still to Do

Ten years ago, a small group of institutions came together in response to crisis. Today, NETEC supports a growing national system of care with defined tiers, expanded training, strengthened diagnostics, and increasing regional coordination.

The progress is substantial. But the mission continues.

The next decade will require sustained funding, expanded diagnostic capacity, regulatory alignment, and continued innovation in healthcare worker safety.

Preparedness is not static. It is a commitment — one that must endure long after the immediate crisis fades.

Listen to the full episode of Transmission Interrupted to hear the complete discussion and reflections from NETEC’s principal investigators.