Building Resilience Through Simulation: A Statewide Tabletop Exercise to Advance One Health Preparedness

To assess cross-sector preparedness and response capacity for a hypothetical Highly Pathogenic Avian Influenza (HPAI) H5N1 outbreak in Alabama using a statewide tabletop exercise (TTX) and to identify strengths, gaps, and corrective actions to inform future planning.

Basic qualitative design using inductive data analysis of multi-source qualitative data, including participant discussion notes, hotwash debrief, feedback forms, and an After-Action Report/Improvement Plan (AAR/IP).

A 6-hour, in-person statewide TTX held in August 2025, facilitated by the Alabama Department of Public Health (ADPH), Alabama Department of Agriculture and Industries (ADAI), and the University of Alabama at Birmingham (UAB).

Eighty-three representatives from federal, state, and local agencies; and professional associations.

A multi-phase TTX simulating escalating zoonotic threats, from avian cases to human infections and sector-wide disruptions. Scenarios incorporated stakeholder-recorded audio vignettes to enhance realism and foster cross-sector discussion grounded in One Health principles.

Identification of key strengths, areas for improvement, and corrective actions mapped to 6 exercise objectives focused on roles and responsibilities, priority-setting, procedural gaps, communication, resource needs, and interagency coordination.

Participants demonstrated strong interagency relationships, robust surveillance systems, and shared understanding of zoonotic response roles. Key gaps included inconsistent communication and data-sharing protocols, insufficient engagement of local partners, procedural ambiguities (eg, specimen transport), and concerns regarding availability of critical resources, including Strategic National Stockpile assets. Workforce turnover and limited institutional knowledge were recurring barriers. The AAR/IP outlined 6 priority corrective actions, including development of a Multi-Agency Coordination Zoonotic Disease Workgroup.

The Alabama HPAI H5N1 TTX revealed strong existing partnerships and surveillance capacity but highlighted vulnerabilities in communication, coordination, and resource readiness. Implementing corrective actions, strengthening workforce capacity, and expanding stakeholder engagement will enhance statewide preparedness for H5N1 and future zoonotic threats. The exercise materials and findings offer a model for other jurisdictions seeking to refine preparedness plans.