A bipartisan opportunity to strengthen America’s pandemic security

READDI board member Richard Burr and co-author Julie L. Gerberding make the case for reauthorizing — and strengthening — the landmark Pandemic and All Hazards Preparedness Act.

By Richard Burr and Julie L. Gerberding, August, 28, 2023 — In 2006, when many Americans had barely heard the word “coronavirus,” Congress passed the Pandemic and All Hazards Preparedness Act (PAHPA), a landmark, bipartisan legislative framework that has successfully steered our nation’s biosecurity policy ever since.

Before and during the worst of Covid, PAHPA’s authorities and programs served as the backbone of the country’s public health response, enabling the acceleration of medical countermeasure development via public-private partnerships; a swift regulatory process to make tests, treatments and vaccines available to Americans; and a strategic distribution and deployment of such medical products and supplies based on need. The PAHPA framework depends on a good-faith partnership between the federal government, states, public health officials and the private sector.

Its current authorization expires at the end of September, and congressional action to reauthorize it is imperative. As we cope with the post-emergency phase of the Covid-19 pandemic, we must heed the painful lessons we’ve learned during this global crisis and build even stronger defenses against the future infectious disease and other threats that we will inevitably face.

PAHPA authorizes the critical institutions and infrastructure that we now know are indispensable in defending against dangerous outbreaks and other biological threats with pandemic potential: the Administration for Strategic Preparedness and Response, the Biomedical Advanced Research and Development Authority, and the Strategic National Stockpile. Through PAHPA, Congress can also further refine the U.S. biosecurity strategy and improve collaboration across the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and other U.S agencies responsible for protecting the health and safety of the American people.

A successful reauthorization is within reach but will require discipline and realism. While some have called for significant changes to the framework or new funding for PAHPA’s programs, the current fiscal, political and scheduling constraints in Congress are not conducive to major new financial commitments or programmatic and policy changes that would be divisive or require extensive study and deliberation. Only a “lean” PAHPA that includes straightforward reauthorizations for expiring authorities and programs with minimal policy or programmatic changes — and commitment across the aisle and across both chambers of Congress that national biosecurity is an overarching priority — can make PAHPA’s reauthorization a reality in 2023.

The House Energy and Commerce Committee held a hearing in June for PAHPA legislation, which included various proposals ranging from simple reauthorizations to larger reforms. Senate Health, Education, Labor, and Pensions Committee Chair Bernie Sanders (I-Vt.) and Ranking Member Bill Cassidy (R-La.) released a discussion draft including more extensive changes to PAHPA on July 3. While each committee has taken action, there are limited days for the House and Senate to reach an agreement on the critical few bipartisan provisions before PAHPA authorities expire at the end of September.

PAHPA reauthorization should include three essential common-sense reforms that do not require significant new appropriations and can gain support across the political divide.

1. Affirm White House strategic leadership for preparedness strategy, operational planning, exercising and pandemic response coordination.

Just last year, Congress passed legislation creating the Office of Pandemic Preparedness and Response at the White House. Congress should reaffirm and delineate the centrality of the White House responsibilities in overall preparedness planning and emergency pandemic operations leadership.

At the same time, Congress should clarify the preparedness and response roles and responsibilities of the Administration for Strategic Preparedness and Response, the Biomedical Advanced Research and Development Authority, the Strategic National Stockpile, CDC, FDA, NIH, and the newly created Advanced Research Projects Agency for Health (ARPA-H). It should also mandate far more intensive and regular comprehensive operational exercises that engage multi-sector stakeholders including federal, state, local, tribal and territorial government agencies; public health, healthcare and community organizations; biopharmaceutical companies; businesses; and other non-governmental stakeholders.

2. Expand the Administration for Strategic Preparedness and Response authority to ensure the development and deployment of flexible, scalable and accessible countermeasures for future threats.

The Administration for Strategic Preparedness and Response needs to implement existing authorities passed in last year’s PREVENT Pandemics Act to improve acquisition and procurement, construction and industrial base investment, and contracting with private sector partners. Enhancing these authorities will strengthen the countermeasure development pipeline, increase the Strategic National Stockpile capability and transparency, and improve countermeasure scalability and supply chain resilience. In addition, these authorities will allow ASPR to achieve a “warm” base of manufacturing that can be quickly accessed during an emergency, and reduce its dependence on Department of Defense capabilities in future crises.

Congress should also direct the Administration for Strategic Preparedness and Response and the Biomedical Advanced Research and Development Authority to prioritize investments that move countermeasure and diagnostic test development beyond the “one bug, one test, one drug” approach and prioritize research on new platform technologies that are “pathogen agnostic” — that is, they can be used on or quickly adapted to address both new and previously unknown pathogens.

3. Elevate attention to global needs.

By definition, an all-hazards approach to U.S. health security encompasses threats that emerge from any source, anywhere in the world, and demands support for the bio-detection networks, communication exchanges, supply chains and expert practitioners required to respond to them. Whatever tools developed need to work both in the United States and must also be deployable to global partners — at or near the source of danger — if they are to protect Americans at home. Reauthorizing PAHPA provides the opportunity to elevate the global threat detection landscape by strengthening the global surveillance networks and leverage emerging technologies to develop and improve bio-detection capabilities so that we can more quickly identify and respond to threats closer to the source. Strengthening global health security is key to U.S. health security. Congress should build upon and support global partnerships that successfully deliver public health resources, medical countermeasures and other response tools to countries in need around the world.

Though necessary, merely reauthorizing PAHPA is not itself sufficient. The many “lessons learned” from the response to Covid-19 demonstrate that we have several additional important opportunities to strengthen our overall biosecurity capabilities and improve accountability for our government agencies, including those that are underway in Congress to strengthen CDC’s pandemic surge capacity, improve data systems and collaboration with state and local partners, focus on public-private partnerships and bolster overall response capability. We must continue to build support for these and other biosecurity enhancements in hopes that Congress will eventually enact them.

In the meantime, Congress must reauthorize the essential PAHPA framework and enact a disciplined set of sensible reforms now. This is the opportunity for a bipartisan effort in Congress to again use PAHPA as a tool of policy, not politics, to make Americans — and the world — safer in the age of pandemic threats.

READDI Board of Directors member Richard Burr is the principal policy adviser and chair of the Health Policy Strategic Consulting Practice at DLA Piper and a former senator from North Carolina, where he served as the immediate past ranking member on the Senate Committee on Health, Education, Labor, and Pensions. Julie Gerberding is the CEO of the Foundation for the National Institutes of Health and former director of the CDC. Together they serve as co-chairs of the CSIS Bipartisan Alliance for Global Health Security. This opinion piece originally appeared in STAT.