Changes to the Pandemic and All Hazards Preparedness Act are essential to saving lives in disasters

While the U.S. government is better prepared than ever to respond to health impacts of disasters, Americans must keep pace with the very real, unpredictable, serious threats our nation faces. The reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA), which enables that readiness and response, is currently underway. The Trump Administration’s recommended changes to this legislation will improve our ability to save lives and protect Americans from 21^st century health security threats, whether naturally occurring, such as an influenza pandemic or severe storm, or a deliberate chemical, biological, radiological, or nuclear attack.

Twelve years ago, in the wake of Hurricane Katrina, PAHPA created the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services to lead and coordinate medical and public health emergency preparedness activities and to collaborate across the federal government. This office of Assistant Secretary brings unified medical and public health response capabilities to support state and local authorities during declared emergencies.

To ensure readiness for modern threats, this office must evolve by continually evaluating and incorporating national security threats into its plans and programs. This office achieves this through coordination with the Director of National Intelligence and the Department of Homeland Security to assess changes in the global and domestic threat landscape.

{mosads}Further, we must strengthen the pipeline and domestic stockpile of medical countermeasures, such as medicines, vaccines and diagnostic tests, needed to protect Americans from these threats by ensuring robust funding and a clear government market for these medical countermeasures, which often have no commercial use. Industry will only produce them if a clear, reliable government buyer exists. In particular, Congress should authorize a 10-year advance appropriation for purchasing countermeasures for national security threats through the Project Bioshield Special Reserve Fund. This change would return the program to its original successful construct and incentivize biotechnology and pharmaceutical companies to dedicate their time, talent and resources to developing the products we need in a national security event.

In addition, Congress should authorize funding to ensure readiness for pandemic influenza. Using previous supplemental funding, the Biomedical Advanced Research and Development Authority has made tremendous strides in collaborating with industry to build our domestic vaccine manufacturing capacity, develop better vaccines, antivirals, and ancillary supplies needed for the next pandemic. History is clear: the question is not if another influenza pandemic will occur but when and how severe it will be. Authorizing recurring funding to further improve our readiness for pandemic influenza is essential to achieving domestic preparedness.

Beyond developing and stockpiling products, we must ensure our nation’s healthcare system is ready to care for a large influx of patients in a disaster and medical professionals from throughout the country can be mobilized quickly to respond.

Through this office’s National Disaster Medical System, thousands of medical professionals from across the country came to the aid of communities in Texas, Florida, Puerto Rico and the U.S. Virgin Islands during the historic hurricane season of 2017. Collectively, HHS medical responders provided care to more than 36,000 patients between the three major hurricanes and spent months deployed. We must support the National Disaster Medical System’s intermittent federal employees by providing specific benefits that are commensurate with other federal responders. Further, the National Disaster Medical System is not sufficiently staffed or trained to respond to all current threats, so Congress should add direct hiring authority to quickly increase staffing levels.

Recent emergencies – from train derailments to hurricanes – demonstrated the value of healthcare facilities collaborating before disaster strikes. Healthcare is a multi-trillion-dollar, highly competitive industry. However, using modest funding and guidance from this office’s Hospital Preparedness Program, more than 31,000 local healthcare facilities and services have forged healthcare coalitions across the country to prepare together. We should expand these partnerships, adding trauma centers, burn centers, pediatric hospitals, public health labs, outpatient services, and federal facilities like Veterans Affairs clinics to better meet the health care needs of the public in a disaster.

Using supplemental funding during the Ebola crisis of 2014, this office helped build a tiered, national Ebola treatment center network that is now trained and ready to treat patients with serious infectious diseases, such as Ebola, anywhere in the country. Using a similar tiered model, the office of Assistant Secretary for Preparedness and Response aims to build an interstate “regional disaster health response system” by better leveraging established investments in health care preparedness and trauma systems.  Combating modern threats requires innovative solutions to train, equip, organize, and incentivize our health care systems in ways that make our local communities, and our nation, more resilient.

Paramount to reauthorization is recognition that while our nation is better prepared than in the past for the health effects of disasters, we must continuously update our readiness programs in order to save lives and protect Americans from evolving 21^st century health security threats.

NOTE: This story has been updated from the original to include three paragraphs near the top that were inadvertently left out.

Robert Kadlec, MD, is the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services