How a reorganized HHS can improve pandemic readiness

The Secretary of Health and Human Services recently announced an important reorganization that can help the federal government prevent future pandemics and be better prepared for other health emergencies. HHS changed the Office of the Assistant Secretary for Preparedness and Response from a “staff division” to an “operating division” and renamed it the Administration for Strategic Preparedness and Response (ASPR).

While this organizational change sounds bureaucratic, it also reflects lessons learned from the COVID-19 pandemic and recognizes the need to improve the ability of ASPR to execute its national health security mission of leading efforts to prepare for, respond to, recover from and mitigate the health security threats that can affect our population. 

It is a good first step, but three additional elements are needed to ensure success: funding, staff and leadership.

ASPR was originally a staff division in the office of the secretary of HHS. This designation carried with it the responsibility for developing policy for the secretary, providing oversight to HHS agencies and managing certain secretarial activities.

This designation did not confer operational responsibility for the delivery of programs nor include independent administrative authorities and functions that facilitate active response. This significantly hampered the flexibility and nimbleness of ASPR, thereby making it harder to meet its mission in support of state, tribal and local governments under a national preparedness and response plan. It also constrained ASPR’s role in the development, stockpiling and fielding of new medical countermeasures the nation needs.

Under the Pandemic and All Hazards Preparedness Act, passed by Congress in 2006, and its following reauthorizations, ASPR is authorized to be the principal advisor to the secretary on health security matters and to coordinate the associated functions of the department. The law also requires ASPR to manage certain programs, staff and funding to address all hazards that may have national health security impacts.

For example, ASPR deploys personnel to support localities through the National Disaster Medical System and awards grant funding for hospital preparedness to support state and local preparedness. In addition, the Biomedical Advanced Research and Development Authority (BARDA) within ASPR develops diagnostics, therapeutics and vaccines for a variety of health security threats. ASPR also manages the Strategic National Stockpile and was tasked during the COVID-19 response to strengthen the emergency medical supply chain. 

As we have seen during the pandemic, these functions are not just about policy, coordination and oversight. ASPR must be an action agent to be the robust entity needed to act in concert with its HHS colleagues at the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration, as well as other federal partners such as FEMA and the Department of Defense. ASPR must have the authority and funding of an operational unit to meet the mission assigned to it by Congress. This reorganization will enhance ASPR’s capabilities for focus and mission effect. 

Infectious disease outbreaks, hurricanes, and other natural disasters and deliberate attacks on our country are all health security threats the country must be better equipped to face. Three additional things are necessary for this reorganization to achieve success.  

First, Congress must appropriate adequate and stable funding to ASPR for it to meet the responsibilities that Congress has assigned. The history of funding for ASPR has shown that intermittent “emergency” funding does not allow for the development of consistent capabilities and ASPR is often staring at a bare or thin cupboard when crises happen. 

Second, ASPR needs to recruit and hire additional quality federal staff. For example, as COVID-19 has shown, medical supply chain specialists who understand the pathway from raw materials to last mile distribution are not yet embedded in the organization to anticipate needs and respond well.

Lastly, leadership at the most senior levels of the White House, HHS, CDC and elsewhere in the federal government need to recognize the importance of the ASPR mission and support it with vigor. This reorganization will work best if its partner agencies are also strengthened in response to recent lessons learned. For example, without a strong and trusted CDC as a partner, the goal of a unified health response that capitalizes on both population health and clinical health care working as one will be difficult. 

This HHS reorganization is an important, positive step forward. With adequate funding, staff and leadership support, ASPR can be a more robust and effective operational agency in protecting the nation’s health security. The U.S. cannot thrive if we are unwilling to learn from our mistakes and make changes to improve. With these changes, ASPR is demonstrating a willingness to act.  

W. Craig Vanderwagen, MD, was the founding assistant secretary for Preparedness and Response from 2006 to 2009; he is now an instructor at Harvard Chan School of Public Health and a senior advisor at East West Resources investment company. Jennifer B. Alton, MPP, previously worked for the Senate Committee on Health, Education, Labor and Pensions and drafted the Pandemic and All-Hazards Preparedness Act; she is now president of Pathway Policy Group and a center affiliate at the Georgetown University Center for Global Health Science and Security.