I suspect many of the changes have to be legislative.
I don't think most of those organizations can simply restructure themselves at will to deal with a potential small pox attack.
That doesn't occur in some sort of "oligarchy" as you describe it.
It seems like the state spent vast time and effort to "find weaknesses" but didn't, say, correct the frickin' weaknesses.
Bureaucrats with so much latitude they can spend their entire budget on entertaining war games rather, say, emergency medical supplies.