Reauthorizing the Nation's Preparedness

Most professionals in the U.S. public health emergency preparedness community are, in varying degrees, aware of and reasonably familiar with the Pandemic and All-Hazards Preparedness Act (PAHPA) and/or have had their own preparedness efforts, and their response operations, directly affected by it. The U.S. Congress passed and then-President George W. Bush signed the original law, which had broad implications for the Department of Health and Human Services’ (HHS) preparedness and response activities, in December 2006.

The PAHPA, also known as Public Law No. 109-417, was enacted specifically “to improve the nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural.” The initial act, passed in the wake of Hurricane Katrina, which struck the Gulf Coast in 2005, also was intended to help the federal government support communities in various aspects of preparing for, responding to, and recovering from the adverse health effects of all public health emergencies and disasters, both natural and manmade.

Among other things, the Act: (a) amended the Public Health Service Act to establish the post of Assistant Secretary for Preparedness and Response (ASPR) within HHS; (b) provided new authorities for a number of programs, including the advanced development and acquisition of medical countermeasures systems and devices; and (c) called for the establishment and periodic updating of a quadrennial National Health Security Strategy. On a larger scale, PAHPA also has bolstered the ability of HHS to ensure that federal, state, and local governments are prepared to respond more effectively to a broad array of public health emergencies associated with both natural disasters and intentional attacks.

Authorizing Funds & Protecting Populations

On 13 March 2013, President Obama signed into law the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, which reauthorizes provisions of the Project Bioshield Act of 2004, as well as the aforementioned PAHPA of 2006, for an additional five years.

The PAHPA reauthorization will, among other things, provide $2.8 billion – spread over five years – for the procurement of such necessary medical countermeasures as the vaccines needed to counter anthrax and smallpox. To ensure that those funds are not depleted, the reauthorization includes a provision requiring that HHS alert Congress when the funds remaining dip below $1.5 billion.  One additional element of the Reauthorization Act is that it grants new authorities to state health departments that will permit greater flexibility in dedicating resources to meet critical community needs during a declared disaster.

In order to meet immediate urgent needs, the reauthorization recognized the realities of responding to large-scale public health emergencies in times of fiscal austerity and allows states to temporarily utilize federally funded state personnel whose day-to-day jobs are not related directly to emergencies. Clearly, in times of a public health emergency, the ability to use an “all hands on deck” approach that makes the best use of all staff involved is obviously a major step forward.

Another element of the new Act is a mandate to plan more effectively for “at-risk populations,” which is of critical importance to those directly involved. Unlike the original law, PAHPA requires the ASPR secretary to consider the public health and medical needs of at-risk individuals during future public health emergencies. Moreover, to ensure there are no misunderstandings or misinterpretations, HHS officially defines “at-risk” as “those individuals specifically recognized as at-risk in the statute, i.e., children, senior citizens, and pregnant women, as well as those individuals who may need additional response assistance.”

Included in the latter group are not only persons with physical or mental disabilities but also those with limited English proficiency. ASPR must consider the needs of at-risk individuals in the guidance policies given to recipients of state and local public health grants as well as in the acquisition, stockpiling, and distribution of the vaccines, pharmaceuticals, and other material resources contained in the Strategic National Stockpile. In addition, ASPR is required to: (a) oversee an advisory committee on at-risk persons; and (b) disseminate novel and best practices on outreach to and care of the nation’s at-risk populations before, during, and after public health emergencies.

Cooperation, Coordination & Long-Range Planning

Other key points of the reauthorization include:

  • The reauthorization of programs including the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Program, the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP), the Medical Reserve Corps, and the Hospital Preparedness Program (HPP);
  • New emphasis on the need to clarify and explain the roles and responsibilities of the ASPR in providing policy coordination, streamlining, and strategic direction;
  • A requirement that the ASPR submit a plan that will be independently assessed by the Government Accountability Office and prepare an annual and internally coordinated five-year budget plan of medical countermeasure priorities; and
  • A requirement for more robust interaction between the U.S. Food and Drug Administration and medical countermeasure sponsors, including “regulatory management plans” for each countermeasure that receives an investigational use application.

It is important to note that one of the more significant elements of PAHPA are the previously mentioned grants/funding streams the legislation will provide to thousands of state and local public health agencies and organizations as well as hospitals. These funds call for, among other things, improved communications and collaboration between and among these entities. That requirement should translate directly into a much improved understanding of capabilities and capacities as well as the better overall planning needed to respond to sudden disasters.  There have already been some successes – coping with the 2009-2010 H1N1 pandemic, for example, and the successful evacuation of healthcare facilities after such major weather events as the 2011 tornado that devastated Joplin, Missouri, and Superstorm Sandy, which caused significant damage in New Jersey in 2012 – in this regard and this act will no doubt build upon those.

The original PAHPA will undoubtedly go down in history as one of the most important laws ever enacted to improve the nation’s public health emergency preparedness capabilities. The 2013 reauthorization means that the numerous victories and advances achieved in the world of public health emergency preparedness over the past decade will continue far into the future – certainly more than the five years specifically mandated.

Raphael M. Barishansky

Raphael M. Barishansky, DrPH, is a public health and emergency medical services (EMS) leader with more than 30 years of experience in a variety of systems and agencies in positions of increasing responsibility. Currently, he is a consultant providing his unique perspective and multi-faceted public health and EMS expertise to various organizations. His most recent position prior to this was as the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health, a role he recently left after several years. Mr. Barishansky recently completed a Doctorate in Public Health (DrPH) at the Fairbanks School of Public Health at Indiana University. He holds a Bachelor of Arts degree from Touro College, a Master of Public Health degree from New York Medical College, and a Master of Science in Homeland Security Studies from Long Island University. His publications have appeared in various trade and academic journals, and he is a frequent presenter at various state, national, and international conferences.



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