Members of the U.S. House Energy and Commerce Subcommittee on Health on Wednesday considered proposed updates to the nation’s law on preparing for and responding to national and global public health emergencies resulting from any chemical, biological, radiological, or nuclear (CBRN) agent, toxin, disaster, threat or attack — be it naturally occurring, unintentional or deliberate.
Both chambers of Congress now are working to fast track revamps to the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA), first reauthorized in 2013, and which is now due to expire Sept. 30.
During the June 6 hearing examining PAHPA, U.S. Rep. Michael Burgess (R-TX), chairman of the House Energy and Commerce Health Subcommittee, noted that the creation of the Assistant Secretary of Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS) under the original law has allowed the United States to make “monumental strides” in preparedness, coordination and response.
Equally vital in making this progress, he added, has been the close collaboration between the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration, and the nation’s state, local, tribal, and territorial public health departments.
“But as we consider this legislation, we must remember that there is more to be done to bolster America’s public health security,” Rep. Burgess said.
In preparation for the hearing, health subcommittee members reviewed the bipartisan discussion draft authored by Rep. Susan Brooks (R-IN) and Rep. Anna Eshoo (D-CA) entitled the Pandemic and All-Hazards Preparedness Reauthorization Act of 2018.
The discussion draft, which Rep. Brooks said she hopes is ready for introduction later this month, would be the House version to reauthorize PAHPA. The U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee on May 23 approved 22-1 its version, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018, S.2852, which U.S. Sen. Richard Burr (R-NC) introduced on May 15. Senate HELP Committee Chairman Lamar Alexander (R-TN) wants markup action to take place on June 20 for S. 2852, as well as for a slew of other Senate proposals.
In the House, the Brooks-Eshoo discussion draft most notably addresses the control shift of the Strategic National Stockpile (SNS) from the CDC to the ASPR. Such language isn’t included in the Senate bill regarding the federal government’s $7-billion storehouse of drugs, supplies and vaccines that are on standby for deployment in the event of a pandemic, infectious disease outbreak, bioterror attack, or chemical accident — whatever large-scale public health emergency that might affect massive numbers of people.
“The discussion draft codifies moving SNS from CDC to ASPR, but really it’s more of an appropriate realignment of the responsibilities,” Brooks said during the hearing. “And it’s a move the administration is already making so it seems as members of Congress we provide oversight and guardrails for any moves or any changes.”
The control shift was first announced in the February release of President Donald Trump’s Fiscal Year 2019 budget proposal, which underscores the move as an enhancement of emergency preparedness and health security that consolidates the necessary strategic decision-making around the development and procurement of medical countermeasures. The move is designed to streamline and create a cohesive leadership structure that will provide swifter responses to public health emergencies.
Brooks, who supported the president’s SNS control shift change, made it a point during the hearing to clarify for her subcommittee colleagues that the discussion draft simply sets out the guideposts for the CDC-to-ASPR change, and she said she thought that was an important aspect for the House bill to contain.
The discussion draft also would fund SNS with $610 million a year “in order to keep the authorized level consistent with what we’ve currently appropriated,” the congresswoman said.
Dr. Robert Kadlec, who serves as Assistant Secretary for Preparedness and Response, testified that the control shift is already under way and extensive work has been ongoing between his office and the CDC. For instance, working groups have been established to deal with topics such as contracts and how they’ll be administered, and regarding replenishment of the stockpile, he testified. Other working groups are handling matters involving personnel issues, such as negotiating the numbers of people being transferred to ASPR from CDC who are working at the local level, Kadlec said.
Brooks asked if there have been any problems in the control shift as the offices work with state and local officials.
Rear Admiral Upper Half Stephen Redd, director of the CDC’s Public Health Preparedness and Response, testified that “the areas that are critical we have clarity on — the medical countermeasures structure is completely under ASPR.”
“Integration is key here,” said Rep. Brooks, referring to the role each office will play and how that information is relayed to state and local health officials. “So both will work with the ASPR?”
“Yes, that’s my understanding,” Kadlec said.
Rep. Frank Pallone (D-NJ), ranking member of the full House Energy and Commerce Committee, voiced concern with the inclusion of the SNS control shift item in the discussion draft, though he said generally he was supportive of the overall document.
“I have yet to hear a strong argument for moving the [SNS] from the [CDC] to the ASPR under statute,” Congressman Pallone said. “The Secretary of HHS can and has already started the process of moving the SNS under existing law and I see no reason to codify this move before we know the consequences. We must make certain that placing the SNS in ASPR instead of the CDC does not weaken our current preparedness and response capabilities before making such a move permanent.”
In his opinion, lawmakers would be “trading some debatable improvements in procurement efficiency on the front end for the ability to more effectively reach communities and individuals with the materials they need in case of a public health emergency,” said Pallone.
Guaranteeing that life-saving drugs and medical supplies get into their hands during such events “should be our top priority,” Rep. Pallone said, adding that a move really isn’t necessary because “CDC has the relationships and expertise that make the most sense for managing and operationalizing the stockpile, as well as a record of successful stewardship of the SNS.”
Among other provisions included in the discussion draft, according to a summary provided by Rep. Brooks, are those that would clarify the use of the Public Health Emergency Fund; codify the Public Health Emergency Medical Countermeasures Enterprise; improve the ability of the HHS Secretary to fill intermittent federal employee vacancies in National Disaster Medical System; prioritize preparing for and responding to cyber threats; and would authorize resources for the development of medical countermeasures for pandemic influenza and emerging infectious diseases within the Biomedical Advanced Research and Development Authority (BARDA).
SECURE Act unveiled
U.S. Rep. Jan Schakowsky (D-IL) during the hearing announced that she had introduced the Securing Experts to Control, Understand, and Respond to Emergencies (SECURE) Act, H.R. 5998, which she hopes to get included in the PAHPA reauthorization.
H.R. 5998, according to the congressional record, would amend the Public Health Service Act to reauthorize a loan repayment program under which health professionals agree to conduct prevention activities, as employees of the CDC and the Agency for Toxic Substances and Disease Registry, in consideration of the federal government agreeing to make payments on the principal and interest of their educational loans, among other purposes.
“This bill would actually simply reauthorize the Epidemic Intelligence Service, or EIS program under CDC,” the congresswoman said, which is aimed at helping the nation build a robust preparedness and response workforce. “I’m hopeful this program can be reauthorized and make it a part of the underlying bill.”
EIS is a two-year fellowship program within CDC first created in the 1950s in response to the threat of bioterror during the Korean War, providing on-the-job training to equip physicians and other health professionals in responding to public health emergencies.
In recent years, such professionals have responded to the Sept. 11, 2001 terror attacks, the anthrax attacks, the 2014-2015 Ebola outbreak, and the spread of the Zika virus in West Africa, among other public health emergencies.
And while the need for more of these professionals has grown, the congresswoman said, the response capacity of the program has steadily diminished compared to the capacity of the 1980s, with physicians comprising just 30 percent of the current class.
At the same time, medical school debt remains one of the most consistent barriers to choosing EIS service over more highly paid career options, she said.
“We need more of these boots-on-the-ground disaster detectives,” Schakowsky said.
In fact, the CDC’s Redd testified that the EIS is a major vehicle for recruiting health professionals, in particular, medical physicians such as himself. “It would be an incentive” for more to join if their student loans were being paid, he told Schakowsky. “I hope it becomes part of the bill.”
Training at EIS also is a great lead in to public service, Redd said, a comment backed by Schakowsky, who said 85 percent of EIS grads enter the public workforce, “so it acts as a pipeline for the next generation of public health professionals,” she said.
“I wouldn’t be sitting here testifying today without it,” Redd said.
The Infectious Diseases Society of America, which has worked to inform policy makers of the critical need to build up the network of physicians equipped to detect, prevent and respond to disease outbreaks, and which helped develop H.R. 5998, also wants it included in the PAHPA reauthorization.
“The SECURE Act addresses the need for a public health workforce that is trained, ready and sufficient to respond to large-scale infectious disease outbreaks, and other threats to our health security,” the society said in a June 5 statement.
Inclusion of H.R. 5998 in the PAHPA reauthorization, the society said, “will help to ensure our country sustains the public health leadership needed for successful responses to bioterror attacks, infectious diseases outbreaks, and other public health emergencies.”
H.R. 5998 has been referred to the U.S. House Energy and Commerce Committee for consideration.