BlueDot Impact Guide to the Clade X Tabletop Exercise

Context

The Clade X tabletop exercise was originally designed by the Johns Hopkins Center for Health Security, and was run with senior US Government officials, lawyers and public health professionals in Washington DC in May 2018. The exercise simulated a series of National Security Council–convened meetings of 10 US government leaders in response to an emerging pandemic outbreak. More details about the context and participants can be found here, but don’t dig too deep into the linked documents – part of the value of the exercise itself is responding to new information about the progression of the outbreak without knowing in advance what’s going to happen.

We’ve slightly adapted the original Clade X exercise to fit this course. The original exercise took roughly 6 hours, so we have removed some of the sections in the interests of time. We have tried to preserve the sections that are broadly relevant to pandemic response in all countries, and remove the sections that were most specific to US internal politics and diplomatic relations. Although this exercise involves all players playing the roles of US Government officials, many Governments across the world have positions with similar divisions of responsibilities and stakeholder interests.

It’s useful to note that this exercise was designed and run pre-COVID, and some of the assumptions and responses might differ now given what we’ve learned since 2018. We are keen for you to utilise the information we know now, rather than pretending the year is still 2018. We’re especially keen for you to reference and discuss the kinds of interventions that you’ve learned about in the previous few weeks of the course.

Goals of the tabletop exercise

The goal of this session is to illustrate the potential consequences of a pandemic, think about the challenges that would pose and also consider some of the policies that would improve those outcomes. The scenario is fictional but well-researched, and based on epidemiological modelling, public health principles and an assessment of past outbreaks. The model and all of the assumptions can be found on the Clade X webpage.

During the exercise, we ask you not to focus so much on whether you agree with those assumptions, but to focus on the bigger picture of what’s going on and think about the policy implications for health security. The exercise is explicitly non-partisan, and is meant to be a generic representation of senior levels of the US government. The President and the administration are not meant to represent any specific administration, past or present. 

We acknowledge that setting this exercise in the US context means that some of the discussion and policies will be specific to the US and/or more developed economies in the Global North. After the exercise, it would be worth reflecting on the ways in which decisions made could have differed if you were playing the role of other Governments.

The scenario

A series of meetings have been called to advise the US President on an ongoing outbreak of a novel infectious disease, called ‘Clade X’. Members of this committee are members of the US National Security Council and a few additional members that the President thought were necessary, including the Senate Majority Leader and US Public Health leaders. This is not dissimilar to the White House Coronavirus Task Force and the White House COVID-19 Response Team set up by the Trump and Biden administrations respectively.

At the beginning of each meeting, members of the committee will receive a video briefing to update them on the latest information about Clade X, before being asked to discuss a series of questions and make recommendations to the President about how they should respond.

The President is outside this exercise and will only be interacting with the participants through the National Security Advisor (played by the facilitator). At the end of each meeting, the group creates a central list of recommendations given to the National Security Advisor to pass on to the President.

Preparation

The only preparation we ask you to do for this exercise is to spend 30-60 mins researching your role, their powers and responsibilities. Tabletop exercises (TTXs) work best when each of the characters are acting realistically within the bounds of their role, as this brings to the surface any shortcomings of the system or real-life stakeholder tensions. TTXs are often run with people with actual experience in the role they are playing, and lawyers in the room to step in when people are overstepping their legal powers. We have included brief character guides below to get you started.

Character guides

As mentioned above, the context for this TTX is that you are enacting the US Government response and will be playing the roles of US Government officials. That said, many Governments across the world have analogous roles with similar divisions of responsibilities and stakeholder interests.

The following roles are listed in priority order to ensure that, even in small groups, a range of different responsibilities are best represented.

For example, in a group of 3 you would have:

• Secretary of Health and Human Services
• Secretary of Homeland Security
• Senate Majority Leader

The roles represent public health, national security, and constituents’ interests respectively. In a group of 8, all the roles would be represented

We have included a bit more information about each of these roles below. We encourage you to use this as a starting point for researching your role.

Facilitator

• National Security Advisor
• Attorney General

Participants

1. Secretary of Health and Human Services (HHS)
2. Secretary of Homeland Security
3. Senate Majority Leader 
4. CDC Director
5. Secretary of State  
6. CIA Director
7. Secretary of Defense
8. Member of U.S. House of Representatives

 

Organisational Structure of the US Federal Government

The chart below gives an overview of how these departments and roles relate to each other.[1]

Source: Adapted from Simple Legal Guides

Facilitator

Overall, you have two main roles in the exercise:

• [As the National Security Advisor] To chair the meeting, solicit advice from your committee of ‘experts’ and ensure that it is written up into a clear list of recommendations for the President at the end of each discussion. 
• [As the Attorney General] To step in if you think any of the members of the committee are overstepping their legal powers or are offering suggestions outside of their area of expertise (e.g. if the Secretary of State starts offering public health advice).

In reality, these would never be the same person, however it makes most sense for the facilitator to play both of these roles for this exercise.

[Facilitator] National Security Advisor

Responsibilities

• Coordinates national security policy across all government agencies.
• Provides direct advice to the President on national security and foreign policy matters.
• Manages the National Security Council staff and chairs NSC meetings.

Powers

• Has direct access to the President and can influence key policy decisions.
• Can convene meetings of the NSC and other high-level government officials.
• Coordinates the implementation of national security policies across different agencies.

Goals/Incentives

• Ensure the safety and security of the United States and its interests.
• Balance domestic and international concerns in crisis management.
• Maintain cohesion and effective communication among various government agencies.

[Facilitator] Attorney General

We have built an Attorney General GPT to offer advice on whether participants’ actions are legal/constitutional. Note that this is experimental and may hallucinate, but could be useful if you want to query something quickly mid-session.

Responsibilities

• Serves as the chief law enforcement officer and lawyer of the U.S. government.
• Provides legal advice to the President and heads of executive departments.
• Oversees federal law enforcement agencies, including the FBI.

Powers

• Can issue legal opinions on the constitutionality and legality of government actions.
• Has the authority to initiate or intervene in legal proceedings on behalf of the U.S.
• Can prioritise law enforcement efforts and allocate Department of Justice resources.

Goals/Incentives

• Ensure that government actions during the crisis are within legal and constitutional bounds.
• Maintain public order and enforce laws relevant to the pandemic response.
• Balance civil liberties with necessary emergency measures.

Key relationships

With HHS Secretary: They both want to implement legally sound public health measures to combat the pandemic. The Attorney General may be more cautious about curtailing civil liberties, while the HHS Secretary might push for more extensive emergency powers to combat the pandemic.

With Secretary of Homeland Security: They would work together to enforce pandemic-related laws and executive orders. The Attorney General might advocate for more restrained law enforcement measures, while the Secretary of Homeland Security could push for increased surveillance and stricter enforcement during the crisis.

 

(1) Secretary of Health and Human Services (HHS)

[Role wiki, Dept. wiki, Dept. website]

Responsibilities

• Oversees all aspects of public health, including disease prevention and control.
• Manages federal health agencies like the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Food and Drug Administration (FDA).
• Coordinates with state and local health departments on national health issues.

Powers

• Can declare a public health emergency, unlocking additional resources and authorities.
• Has the ability to mobilise health resources and personnel across the country.
• Can issue federal guidelines and recommendations for public health measures.

Goals/Incentives

• Protect the health and well-being of the American public during the pandemic.
• Ensure efficient distribution of medical resources and implementation of health measures.
• Balance immediate crisis response with long-term public health considerations.

Key relationships

With CDC Director: They collaborate closely to implement effective public health strategies based on scientific evidence. However, the HHS Secretary may face political pressures that conflict with the CDC Director's scientific recommendations.

With Senate Majority Leader and House Representative: They work together to secure necessary funding for health initiatives and pandemic response. The HHS Secretary may push for rapid action, while legislators may insist on greater oversight and debate.

 

(2) Secretary of Homeland Security

[Role wiki, Dept. wiki, Dept. website]

Responsibilities

• Coordinates domestic security efforts and protects against threats on US soil.
• Oversees agencies like Federal Emergency Management Agency (FEMA), Transportation Security Administration (TSA), and U.S. Customs and Border Protection (CBP).
• Manages federal response to domestic emergencies and disasters.

Powers

• Can implement travel restrictions and border control measures.
• Has authority to coordinate with state and local governments on crisis response.
• Can deploy Homeland Security personnel and resources for emergency management.

Goals/Incentives

• Maintain domestic security and mitigate potential threats related to the pandemic.
• Ensure effective coordination between federal, state, and local emergency responses.

Key relationships

With HHS Secretary: They coordinate efforts to manage the domestic pandemic response effectively. They may disagree on the extent to prioritise health outcomes or national security measures in certain scenarios.

With Secretary of Defense: They collaborate on domestic crisis management, particularly when civilian resources are overwhelmed. The Secretary of Homeland Security may request extensive military support for domestic operations, while the Secretary of Defense may resist overcommitting military resources to domestic issues.

 

(3) Senate Majority Leader

[Role wiki, Dept. wiki, Dept. website]

For the sake of this exercise, imagine that the Senate Majority Leader is from the same political party as the President[2], but the opposite political party to the Member of the House of Representatives (if you have one).

Responsibilities

• Leads the majority party in the Senate and shapes the legislative agenda.
• Works with committee chairs to schedule and prioritise legislation.
• Acts as a key negotiator between the Senate, House of Representatives, and Executive branch.

Powers

• Can influence the passage of emergency funding and legislation related to the pandemic.
• Has significant control over which bills come to the Senate floor for a vote.
• Can rally party members to support or oppose specific measures.

Goals/Incentives

• Represent the interests of their party and constituents during the crisis.
• Balance the need for swift action with proper legislative oversight.
• Position their party favourably for upcoming elections while addressing the national emergency.

Key relationships

With the Member of the House of Representatives: They work together to pass crucial pandemic-related legislation and secure necessary funding. They may have partisan differences in their approach to the pandemic response or compete for influence over the legislation.

With HHS Secretary: They collaborate to provide necessary resources and authority for effective pandemic response. The Senate Majority Leader may insist on legislative oversight and input, while the HHS Secretary may push for more executive freedom to act quickly.

 

(4) CDC Director

[Role wiki, Dept. wiki, Dept. website]

Responsibilities

• Leads the primary federal agency for public health and disease control.
• Oversees disease surveillance, research, and prevention efforts nationwide.
• Provides scientific expertise and guidance on public health matters.

Powers

• Can issue public health guidelines and recommendations at a national level.
• Has the authority to direct CDC resources for research, surveillance, and response efforts.
• Can deploy CDC personnel to affected areas for investigation and support.

Goals/Incentives

• Control the spread of the disease through evidence-based measures.
• Provide accurate, timely information to government officials and the public.
• Maintain public trust in health institutions while navigating scientific uncertainties.

Key relationships

With HHS Secretary: They work closely to implement science-based public health strategies to combat the pandemic. The CDC Director may face pressure to adjust scientific recommendations to align with political or economic considerations from the HHS Secretary.

With Secretary of State: They collaborate on international health coordination efforts to address the global nature of the pandemic. They may disagree on how to balance domestic public health priorities with international health needs and obligations.

 

(5) Secretary of State

[Role wiki, Dept. wiki, Dept. website]

Responsibilities

• Serves as the President's chief foreign affairs adviser.
• Conducts U.S. foreign policy through diplomatic efforts.
• Oversees U.S. embassies and consulates worldwide.

Powers

• Can negotiate with foreign governments on behalf of the U.S.
• Has the authority to issue travel advisories and warnings for U.S. citizens.
• Can coordinate international aid and cooperation efforts.

Goals/Incentives

• Maintain positive international relations during a global crisis.
• Protect U.S. citizens abroad and manage their potential return during the pandemic.
• Secure international cooperation for global pandemic response efforts.

Key relationships 

With CIA Director: They work together to gather and interpret crucial international information about the pandemic. The Secretary may prioritise maintaining positive diplomatic relations, while the CIA Director could push for more aggressive intelligence gathering.

With HHS Secretary: They collaborate on global health cooperation efforts to combat the pandemic internationally. They may disagree on how to balance national interests with international health obligations.

 

(6) CIA Director

[Role wiki, Dept. wiki, Dept. website]

Responsibilities

• Oversees the collection and analysis of foreign intelligence relevant to national security.
• Briefs the President and National Security Council on international developments.
• Manages covert operations and counterintelligence efforts.

Powers

• Can direct intelligence gathering operations related to the pandemic's global impact.
• Has access to classified information from various international sources.
• Can share critical intelligence with other agencies to inform decision-making.

Goals/Incentives

• Gather and provide crucial information on the international aspects of the pandemic.
• Assess potential foreign threats that may arise due to global instability.
• Support U.S. interests abroad through intelligence operations during the crisis.

Key relationships 

With Secretary of State: They work together to provide comprehensive intelligence on the global pandemic situation to inform foreign policy. The CIA Director's push for covert operations may sometimes conflict with the Secretary of State's diplomatic approaches.

With Secretary of Defense: They collaborate to ensure military and intelligence efforts are coordinated in response to the pandemic. The CIA Director might advocate for allocating more resources to intelligence gathering, while the Secretary of Defense may push to maintain resources for traditional military operations.

 

(7) Secretary of Defense

[Role wiki, Dept. wiki, Dept. website]

Responsibilities

• Oversees the Department of Defense and advises on military matters.
• Manages the U.S. Armed Forces and implements national defence policy.
• Coordinates with civilian leadership on military involvement in crisis response.

Powers

• Can mobilise military resources for logistical support, security, or medical assistance.
• Has authority over the deployment of military personnel within legal constraints.
• Can coordinate with other nations' militaries on joint response efforts.

Goals/Incentives

• Maintain military readiness while supporting domestic pandemic response efforts.
• Ensure national security is not compromised during the health crisis.
• Balance military resources between pandemic response and regular defence duties.

Key relationships 

With Secretary of Homeland Security: They coordinate on supporting domestic crisis response efforts when civilian resources are insufficient. The Secretary of Defense may resist committing extensive military resources to domestic pandemic response, while the Secretary of Homeland Security may push for more military support.

With Secretary of State: They work together to coordinate international military cooperation and support during the global pandemic. The Secretary of Defense might prioritise maintaining global military readiness, while the Secretary of State may push for using military resources for international pandemic aid and cooperation.

 

(8) Member of the U.S. House of Representatives

[Role wiki, Dept. wiki, Dept. website]

If you have this role, you can pick whichever district you would like to represent. For the sake of this exercise,  imagine that this member is from the opposite political party to the Senate Majority Leader and the President.

This role is primarily included in the TTX to represent the views of the public, but they may have been invited to this meeting because they sit on a relevant House Subcommittee[3].

Responsibilities

• Represents the interests of their district in the federal government.
• Participates in the legislative process, including drafting and voting on bills.
• Serves on committees that may oversee aspects of pandemic response.

Powers

• Can introduce or co-sponsor legislation related to pandemic response and funding.
• Has a vote on emergency measures and can influence House leadership priorities.
• Can use their platform to advocate for their district's needs during the crisis.

Goals/Incentives

• Address the concerns and needs of their constituents during the pandemic.
• Balance local interests with national emergency requirements.
• Position themselves favourably for re-election while contributing to crisis management.

Key relationships 

Senate Majority Leader: They collaborate to pass necessary pandemic-related legislation and secure appropriate funding. They may have partisan differences in their approach to the pandemic or compete for influence over the shape of the legislation.

HHS Secretary: They work together to address the health concerns of the Representative's constituents during the pandemic. The Representative may push for policies that benefit their specific district, which might conflict with the HHS Secretary's national strategy.

Footnotes

1. I promise this is the simplest diagram I could find.

2. As of July 2024, this is currently the case, but has not always historically been true.

3. One example of this is the Emergency Management and Technology Subcommittee, housed within the Committee on Homeland Security. Republicans and Democrats have separate websites for this committee.