Engaging local governments in epidemic preparedness will strengthen global health security by ensuring better coordination between local and national authorities. Writing in PLOS Global Public Health, Resolve to Save Lives and partners explore local-level involvement in epidemic preparedness before the COVID-19 pandemic. The research, based on responses from 33 cities in the Partnership for Healthy Cities, shows that while national governments played a dominant role in preparedness, many cities conducted vital risk assessments and developed response plans. By incorporating local governments more actively in future preparedness efforts, we can better coordinate responses for stronger overall health security.