Pandemic and All-Hazards Preparedness Act: An Overview

Pandemic and All-Hazards Preparedness Act: An Overview

June 6, 2024
Pandemic and All-Hazards Preparedness Act: An Overview
In 2006, Congress enacted the Pandemic and All-Hazards
PAHPA: An Overview
Preparedness Act (PAHPA; P.L. 109-417), which
Though PAHPA has changed throughout its history, the law
authorized a suite of programs and authorities within the
has generally focused on a set of policy categories. The
Department of Health and Human Services (HHS) to focus
following highlights some key provisions within each
on public health emergency preparedness and response.
category:
Congress has reauthorized PAHPA twice, in 2013 and in
2019, both times with changes prompted by preceding
Leadership, strategy, and planning. In 2006, PAHPA
public health emergencies. Many existing PAHPA
statutorily established that HHS is to lead federal public
provisions were set to expire in September 2023. Congress
health and medical response under the NRF. The law also
has temporarily extended several provisions until December
reauthorized and renamed the position of the Assistant
31, 2024 (P.L. 118-42) and continues to deliberate a
Secretary for Preparedness and Response to serve as
multiyear reauthorization.
principal advisor for HHS emergency response. PAHPA
required the quadrennial publication of the National Health
The Coronavirus Disease 2019 pandemic (COVID-19)
Secretary Strategy (NHSS), where HHS anticipates public
provided a critical test of the nation’s public health
health emergency challenges and the department’s planned
emergency management infrastructure, including the
approach.
programs and authorities enacted in PAHPA. This In Focus
provides an overview of PAHPA, including its context,
SLTT emergency capacity. PAHPA has reauthorized two
areas of focus, history, and current reauthorization status.
grant programs focused on supporting SLTT public health
and medical emergency response capacity: (1) the Centers
What Is Public Health Emergency
for Disease Control and Prevention’s (CDC’s) Public
Management?
Health Emergency Preparedness (PHEP) cooperative
Many types of emergencies involve a public health and
agreement and (2) the Administration for Strategic
medical response component. To illustrate, during a natural
Preparedness and Response’s (ASPR’s) Hospital
disaster, public health agencies might monitor associated
Preparedness Program (HPP). In addition, PAHPA has
health effects while medical responders coordinate
included related authorities. For example, the 2013 law
emergency medical services. Alternately, some types of
(P.L. 113-5) amended the public health emergency (PHE)
emergencies, such as emerging infectious disease outbreaks
declaration authority (Public Health Service Act, PHSA
or bioterrorism events, have a primary impact on human
§319) to allow for temporary assignment of some state and
health. Public health emergency management involves a set
local personnel during PHEs.
of specific capabilities tailored to health threats, for
example, detection capabilities to identify and monitor new
Medical countermeasures. PAHPA has included a suite of
health threats; systems to rapidly develop, regulate, and
programs and authorities aimed at enabling the
distribute medical products to address health threats (e.g.,
development, regulation, availability, and distribution of
vaccines, treatments); policies and systems to manage
medical countermeasures (MCMs). MCMs are medical
surges in demand for medical care and supplies; potential
products that may be used to treat, prevent, or diagnose
use of quarantine and isolation authorities; and leadership
conditions associated with emerging infectious diseases or
and communication functions focused on health.
chemical, biological, radiological, or nuclear (CBRN)
agents. For example, the 2006 law established the
Under the National Response Framework (NRF), HHS
Biomedical Advanced Research and Development
coordinates the public health and medical aspects of federal
Authority (BARDA) to focus on MCM late-stage
emergency response. As with U.S. emergency management
development, manufacturing, and purchase. PAHPA
generally, state, local, tribal, and territorial (SLTT)
reauthorizations have also included provisions for U.S.
governments are to lead public health emergency
Food and Drug Administration (FDA) authorities and
preparedness and response efforts in their communities.
activities related to MCMs, especially beginning with the
Federal agencies generally assist when SLTT communities
2013 reauthorization that included a title focused on FDA.
are overwhelmed, need additional expertise and/or federal
assets, or when an emergency spans many jurisdictions and
Medical response programs. PAHPA authorizes several
prompts a coordinated, federally led response. In addition,
medical response programs, such as the National Disaster
HHS agencies have programs and authorities tailored to the
Medical System, which provides medical personnel,
unique needs and challenges posed by public health
equipment, and other support when requested by states. In
emergencies—many authorized in PAHPA.
addition, the Strategic National Stockpile (SNS) consists of
medical products and ancillary supplies that can be
deployed to SLTT jurisdictions. The SNS includes products
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Pandemic and All-Hazards Preparedness Act: An Overview
tailored to specific health threats (e.g., smallpox vaccines)
public health emergency preparedness and capacity. These
as well as general medical supplies (e.g., personal
assessments generally found that SLTT public health
protective equipment).
departments were unprepared to quickly detect and respond
to potentially deadly infectious disease outbreaks.
Infectious disease and biothreat programs. PAHPA has
formally authorized biosurveillance and laboratory
As noted, PAHPA was reauthorized twice with incident-
capabilities to detect and monitor health threats, as well as a
related modifications: in 2013, as the Pandemic and All-
national situational awareness network to integrate data on
Hazards Preparedness Reauthorization Act (PAHPRA; P.L.
health threats and emergencies from state-level systems. In
113-5) and in 2019, as the Pandemic and All-Hazards
addition, PAHPA has reauthorized several CDC infectious
Preparedness and Advancing Innovation Act (PAHPAIA;
disease programs, such as the Epidemiology and Laboratory
P.L. 116-22). PAHPRA was preceded by the H1N1
Capacity grant program.
influenza pandemic in 2010, which primarily affected
children. The law therefore included several new provisions
Support for at at-risk populations. PAHPA has included
aimed at meeting pediatric medical needs during
provisions aimed at protecting at-risk individuals during
emergencies, among other changes. PAHPAIA was
PHEs, for example, authorizations for national advisory
preceded by outbreaks of Ebola virus (2014-2015, before
committees focused on protecting children, seniors, and
and after) and Zika virus (2015-17), and thus included
individuals with disabilities respectively.
several provisions aimed at infectious disease threats,
including newly incorporated reauthorizations of several
Most, but not all, provisions in PAHPA amend the Public
CDC infectious disease programs.
Health Service Act (PHSA), especially PHSA Titles III and
XXVIII. Several of the FDA provisions amend the Federal
Reauthorization in the 118th Congress
Food, Drug, and Cosmetic Act (FFDCA).
Prior to this Congress, in December 2022, the PREVENT
Pandemics Act, enacted as part of the Consolidated
Expiring and Expired Provisions
Appropriations 2023 (P.L. 117-328), included several
Many provisions from the last reauthorization (P.L. 116-22)
amendments to provisions typically included in PAHPA
expired in September 2023 or earlier. For the most part,
reauthorizations. Among other provisions, the PREVENT
these were authorizations of discretionary appropriations.
Pandemics Act established a new White House Office of
Congress has continued to fund several of these programs
Pandemic Preparedness and Response Policy to coordinate
(e.g., PHEP, HPP) in FY2024 (P.L. 118-47).
federal pandemic preparedness and response activities.
Some PAHPA provisions effectively expire at certain
In addition, both CDC and ASPR have undertaken recent
sunset dates. These include, for example, the authority for
internal changes and reforms. Internal changes to both
temporary reassignment of certain state and local personnel
agencies reflected new and expanded programs and roles
during declared PHEs and authorizations for several
during the COVID-19 pandemic. For example, the Office of
national advisory committees for at-risk populations. P.L.
the Assistant Secretary for Preparedness and Response
118-42 temporarily extended seven provisions with sunset
became the Administration for Strategic Preparedness and
dates until December 31, 2024, in Section 103—creating a
Response and was elevated to an operating division within
new deadline for congressional action on PAHPA.
HHS, finalized in February 2023 (88 FR 10125).
Brief Legislative History
Committees have considered PAHPA reauthorization in this
Congress and the executive branch established public health
context. In September 2023, the Senate Committee on
emergency authorities and programs prior to PAHPA. For
Health, Education, Labor, and Pensions (HELP) reported S.
example, the federal PHE declaration authority in PHSA
2333. In July 2023, the House Energy and Commerce
Section 319 dates back to 1983 (P.L. 98-49). As another
(E&C) ordered to be reported both H.R. 4420 and H.R.
example, CDC was established administratively in 1946 as
4421, supported mostly by majority votes. House E&C
the Communicable Disease Center. Thus, when PAHPA
minority members introduced a separate bill (H.R. 4697).
was enacted in 2006, HHS already had many existing
public health emergency programs and authorities.
A key point of debate has been, What issues are in scope
for PAHPA? For example, House E&C majority leaders did
PAHPA built upon two earlier laws that addressed HHS
not consider FDA drug shortage issues in scope during the
public health emergency policy and programs in 2000 (P.L.
bills’ markup (though included some ASPR supply chain
106-505) and 2002 (P.L. 107-188). Several developments
provisions in H.R. 4421). On the Senate side, S. 2333
led to the 2006 law (summarized in S.Rept. 109-319). First,
includes an entire drug shortages title focused on FDA.
the entire federal homeland security and emergency
These and other questions remain as Congress continues to
management system saw transformations following the 9/11
consider PAHPA reauthorization as new potential threats
terrorist attacks and 2005 hurricane season. Key reforms
arise, such as H5N1 influenza and clade I mpox.
included the establishment of the Department of Homeland
Security and the NRF to better centralize and coordinate
Kavya Sekar, Analyst in Health Policy
federal emergency response. PAHPA helped formalize
Hassan Z. Sheikh, Analyst in Health Policy
HHS’s role within this broader federal response framework.
Second, concerns about a potential avian influenza
IF12683
pandemic in 2005 prompted many assessments of U.S.
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Pandemic and All-Hazards Preparedness Act: An Overview

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