Preparedness paradox

The preparedness paradox is the tendency for effective prevention to make a danger look less serious because we never experience the crisis that prevention averted.

The investment may look excessive, precisely because it worked. In other words,

The better prevention works, the more wasteful it looks.

CDC laboratory technician Dorothy Roland records data from an AutoAnalyzer, 1964. CDC Public Health Image Library; public domain.

Public health researchers call the resulting pattern the cycle of panic and neglect (National Academies, Exploring Lessons Learned from a Century of Outbreaks, 2019). A crisis makes the value of preparedness obvious, so governments build teams and fund surveillance. Once the crisis fades, successful prevention leaves little visible evidence that the investment worked, and preparedness begins to look wasteful. The next crisis restarts the cycle. Julie Gerberding, quoted in that report, describes it as

“a period of intense focus and attention, investment, planning, collaboration, and coordination that eventually relaxes into a phase of inattention and dispersion.”

The problem is that the payoff hinges on a counterfactual, and counterfactuals are not “real”. A disaster that did not happen is just an ordinary day; it is hard to distinguish “we prevented it” from “there was nothing to prevent”.

Cognitive biases make this worse. Wikipedia lists several: normalcy bias, memory decay between rare events, and the tendency to weigh certain short-term costs against uncertain long-term benefits.

Cyclospora outbreak#

As the 2026 United States cyclosporiasis outbreak unfolds, the CDC’s July 2025 decision to make FoodNet reporting optional for Cyclospora and five other pathogens has taken on new significance. The decision followed budget cuts, but the timing does not establish that it caused the outbreak or delayed the investigation. The CDC says that FoodNet was not designed to detect outbreaks and that other outbreak systems remained unchanged. Still, FoodNet provided another layer of safety: staff actively contacted laboratories, audited reports, and tracked trends. When reporting became optional, food safety officials warned that relying on passive reports could miss cases, slow outbreak detection, and obscure the full picture.

A clean causal chain from one cut to one outbreak is rare. Preparedness erodes by increments. Each cut looks small on its own; together, they leave the system brittle enough that one more cut can become the last straw.

COVID-19#

In May 2018, before the COVID 19 pandemic, the Trump administration disbanded the National Security Council’s Directorate for Global Health Security and Biodefense and folded some of its staff into other units. Disbanding the unit did not cause the virus, and we cannot know whether keeping it would have changed the response. We also cannot observe the outbreaks that such an office might have helped contain.

The JAMA article notes that several previous administrations also dismantled similar offices and later recreated them. The crisis that arrives feels inevitable, while any crisis the office helped prevent never becomes visible enough to justify keeping it.