Legislating Preparedness: Reauthorizing a Critical Law to Protect America from 21st Century Health Threats

Legislating Preparedness: Reauthorizing a Critical Law to Protect America from 21st Century Health Threats

August 9, 2018

August 9, 2018 - When it comes to public health preparedness, legislation can be just as important as medication – and we need not look further than the Pandemic and All-Hazards Preparedness Act (PAHPA) to prove it.

The original Pandemic and All-Hazards Preparedness Act was signed into law on December 19, 2006 “to improve the Nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural.” PAHPA underlies, through funding, support, or outright establishment, a number of the capabilities that come to mind when we think of “preparedness” – the Assistant Secretary for Preparedness and Response (ASPR), the National Disaster Medical System, the Strategic National Stockpile, the Biomedical Advanced Research and Development Authority (BARDA), and many others.

Major programs and capabilities authorized, funded, or established by PAHPA

Program or capability


Office of the Assistant Secretary for Preparedness and Response (ASPR)

Established by PAHPA, the Office of the ASPR within the US Department of Health & Human Services (HHS) “leads the nation’s medical and public health preparedness for, response to, and recovery from disasters and public health emergencies.” (Source: US HHS)

National Disaster Medical System (NDMS)

The NDMS is “a cooperative asset-sharing program that augments local medical care when an emergency exceeds the scope of a community’s hospital and healthcare resources. The emergency resources … come from federal, state and local governments, the private sector and civilian volunteers.” (Source: FEMA)

Strategic National Stockpile

The Strategic National Stockpile is “the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.” (Source: Centers for Disease Control and Prevention)

Biomedical Advanced Research and Development Authority (BARDA)

Located within the Office of the ASPR, BARDA “provides an integrated, systematic approach to the development and purchase of the necessary vaccines, drugs, therapies, and diagnostic tools for public health medical emergencies.” (Source: US HHS)

Hospital Preparedness Program (HPP)

The HPP is “the only source of federal funding that supports regional health care system preparedness.” (Source: US HHS)

Public Health Emergency Preparedness (PHEP) Cooperative Agreement

PHEP funds state, local, and territorial public health departments to develop and strengthen emergency preparedness and response capabilities.


Moreover, PAHPA was significant in its unambiguous acknowledgement that all disasters have public health consequences – which has the resulting implication that neglecting to include public health considerations in planning and response makes any kind of disaster preparedness incomplete.

The deadline to pass the most recent reauthorization bill – PAHPAI, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 – and ensure our disaster response capabilities is less than two months away, on September 30, 2018. PAHPAI builds upon the original Act as well as its first reauthorization, PAHPRA (the Pandemic and All-Hazards Preparedness Reauthorization Act). PAHPRA reauthorized funding for invaluable public health programs such as the Hospital Preparedness Program and Public Health Emergency Preparedness (PHEP) Cooperative Agreement. It also enhanced state and local preparedness and response abilities, and those of the U.S. Food and Drug Administration, to support rapid response to public health emergencies.

PAHPA’s investment in holistic preparedness made sense in 2006 in the wake of Hurricane Katrina, as did its reauthorization in 2013. And with numerous and growing 21st century threats to health and security (including the risk of a pandemic, cyber-attacks, and extreme weather events like the hurricanes of the 2017 Atlantic season), reauthorizing and strengthening PAHPAI in 2018 is more important and timely than ever.

PAHPAI, public health, and Healthcare Ready

By weaving together public health and disaster preparedness, the original PAHPA established a critical precedent for preparedness legislation that enables the health and public health (HPH) sector to secure America’s readiness. But another of PAHPA’s important precedents is its encouragement of coordination between components of critical healthcare infrastructure from both the private and public sector. Now, PAHPAI and its additions have the potential to significantly strengthen and codify public-private coordination, which is a moving target and growing need in the field. 

PAHPA and PAHPRA, through the many programs they establish, fund and/or support, underpin much of Healthcare Ready’s work and the work of our partners across – and between – the public and private sectors. Healthcare Ready has provided feedback on how to better integrate healthcare supply chain activities into preparedness planning. Codifying this integration in PAHPAI while also using the Act to establish new programs (like the Pandemic Influenza Program and Emerging Infectious Diseases Program) that leverage industry R&D capabilities stands to be an important measure to improve inter-sector coordination and take us that much closer to comprehensive preparedness. 

The added “I” for Innovation in PAHPAI sets another precedent – an acknowledgement of the need for developing preparedness measures and capabilities that evolve with modern threats. The 2018 reauthorization is an important opportunity to shape resources and programs that not only help us “prepare for the last disaster,” but move the needle significantly on our preparedness for 21st century threats.

PAHPAI’s progress

PAHPAI was advanced by the House Energy and Commerce Committee after a mid-July mark-up (as H.R.6378). It is pending on the Senate Legislative Calendar under General Orders Calendar No. 467 as S. 2852. With the September 30 deadline to pass PAHPAI fast-approaching, Congress must work together to pass this critical legislation to ensure preparedness for future threats and to protect the nation’s health.

Courtney Romolt

Courtney Romolt is a Program Analyst at Healthcare Ready, where she provides research and communications support for a wide variety of programs and initiatives. Before joining Healthcare Ready, Courtney worked with the World Resources Institute’s Initiative 20x20 to promote the business case for landscape restoration in Latin America and the Caribbean. Prior to this, she researched the environmental effects, economic trends, and regulatory framework of enhanced oil recovery as a Graduate Consultant for the NGO Clean Water Action. Courtney holds a Masters of Arts in International Economics and Energy, Resources and the Environment from the Johns Hopkins School of Advanced International Studies, where she also earned a Graduate Certificate in Chinese and American Studies in Nanjing, China. Courtney also holds undergraduate degrees in Integrative Biology and Global Studies from the University of Illinois at Urbana-Champaign.