In the spring of 2009, cases of a previously unidentified strain of influenza began appearing in Mexico and the southwestern U.S. Within just a few months, outbreaks of 2009 Novel H1N1 (commonly referred to as Swine Flu) were so widespread that the World Health Organization declared its first influenza pandemic in over forty years. This case focuses on how state health officials in Texas, which experienced some of the first cases of H1N1, organized a response to the disease in the face of considerable uncertainty regarding its contagiousness, lethality, and geographic spread. The case prompts readers to contemplate the challenges of responding to a rapidly unfolding event featuring a high degree of novelty, the benefits and limitations of pre-event preparedness efforts, and the difficulties of coordinating an effective response among a number of partners and across multiple levels of government.