The House Energy and Commerce Committee (E&C) June 6 held a hearing on draft legislation authored by Reps. Susan Brooks (R-Ind.) and Anna Eshoo (D-Calif.) that would reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) for five years.
The legislation considered by E&C differs from the bill advanced by the Senate, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (PAHPAI; S. 2852) [see Washington Highlights, May 25]. The House draft would reauthorize the Hospital Preparedness Program (HPP) at a much lower level ($264.6 million for each fiscal year 2019 through 2023) than the Senate bill ($385 million for each fiscal year 2019 through 2023). In a group letter sent May 22 to HELP committee leadership, several public health and medical groups cautioned that even the authorization levels proposed in the Senate bill should be higher to adequately support HPP and other federal preparedness programs.
The House draft also would broaden the types of partnerships eligible to receive HPP funding to include those with health systems, state hospital associations, and health care coalitions, rather than exclusively partnerships with states or political subdivisions.
Additionally, the House draft recognizes ‘cybersecurity’ on the list of potential threats facing the nation, adding preparedness and response to cybersecurity threats to several programs – including HPP – without authorizing specific funding to support the additional responsibility.
While both bills would reauthorize the Strategic National Stockpile (SNS), the nation’s stockpile of antibiotics, vaccines and other medical equipment and supplies, the House draft would shift administration of the stockpile from the Centers for Disease Control and Prevention (CDC) to the Assistant Secretary for Preparedness and Response (ASPR). Both bills also would revise an existing Public Health Emergency Fund, though the House bill would fund the account through a tap of up to 1 percent on any discretionary appropriations at the discretion of the Secretary of Health and Human Services. The secretary also would have the authority to activate the fund for additional purposes, including “to develop and procure medical countermeasures” for a variety of threats.
Unlike the House bill, the Senate bill also requires the ASPR to develop, with input from stakeholders, guidelines to inform regional systems of health care facilities on appropriate patient care in public health emergencies. The Senate legislation would also provide for a demonstration project for these regional health care preparedness and response systems, although no separate authorization level is specified in the legislation.
Witnesses at the hearing were Robert Kadlec, MD, ASPR, Department of Health and Human Services (HHS); Anna Abram, Deputy Commissioner for Policy, Planning, Legislation, and Analysis, U.S. Food and Drug Administration (FDA); Rear Admiral Upper Half Stephen Redd, MD, Director, Office of Public Health Preparedness and Response, CDC; M. Michelle Berrey, MD, MPH, President and CEO, Chimerix, Inc.; Erik Decker, Chief Security and Privacy Officer, University of Chicago Medicine; and Umair Shah, MD, Executive Director, Harris County Public Health in Houston, Tex.
As an expert in cybersecurity, Mr. Decker commented on the potential of a cyber-attack during his remarks, “We can no longer think of preparedness relative only to natural disasters or pandemics; it’s imperative that we acknowledge the criticality of cybersecurity threats levied against the nation’s healthcare system…for ASPR to be successful in preparedness and response that specific cybersecurity expertise will be necessary, as well as the supporting financial resources.”
Concern over appropriate funding levels was also expressed by Ranking Member Frank Pallone (D-N.J.) In his opening remarks, Rep. Pallone stated, “Federal funding and support for local, state, and tribal public health activities is critical to saving lives... Unfortunately, our public health capacity and infrastructure is not as strong as it could be. Public dollars have been depleted and the workforce has shrunk.”
Dr. Shah echoed this sentiment, stating, “Passion and dedication aside, it is clear that without resources from the CDC and the ASPR during Hurricane Harvey, our preparedness, response, and recovery efforts and impacts would have been far less robust.” He went on to note that the response to Harvey reflected years of investment to support planning and preparations, emphasizing, “In order to meet preparedness and response needs of communities such as ours, CDC and ASPR must have adequate support and authorization levels along with commensurate funding to ensure local health departments are equipped to prepare and respond to the variety of local disasters.”
Next steps to reauthorize PAHPA are unclear. HELP Committee Chair Lamar Alexander (R-Tenn.) had indicated he hoped to have the full Senate consider PAHPAI by June 20.