The Pandemic and All-Hazards Preparedness Act (PAHPA) has been a cornerstone of U.S. public health emergency preparedness since its original passage in 2006. Designed to equip the nation with the tools, authorities, and coordination mechanisms necessary to respond effectively to health crises, PAHPA has evolved in response to pandemics, bioterrorism risks, and natural disasters. As key provisions approach expiration in September 2025, policymakers, practitioners, and stakeholders face critical decisions about how to adapt and strengthen these capabilities in an era of increasing global health threats.
Legislative Background and Evolution
PAHPA was enacted following a period of intense focus on national preparedness, shaped by the aftermath of the 9/11 terrorist attacks, the 2005 hurricane season, and fears of a potential avian influenza pandemic. Building on prior public health emergency authorities, the law codified the Department of Health and Human Services’ (HHS) leadership role under the National Response Framework and established the Assistant Secretary for Preparedness and Response (ASPR) as the principal advisor on health emergencies.
Reauthorizations in 2013 and 2019 introduced targeted reforms based on real-world crises. The 2013 update incorporated lessons from the H1N1 influenza pandemic, with a focus on pediatric needs, while the 2019 law addressed emerging infectious diseases such as Ebola and Zika, strengthening biosurveillance and laboratory networks. More recently, the PREVENT Pandemics Act of 2022—enacted in the wake of COVID-19—codified innovations in outbreak forecasting and supply chain management.
What’s At Risk? Core Provisions and Capabilities
PAHPA encompasses multiple program categories central to U.S. health security:
- Leadership, Strategy, and Planning: Mandates a National Health Security Strategy updated every four years, ensuring preparedness priorities are current and evidence-based.
- State and Local Capacity: Funds the CDC’s Public Health Emergency Preparedness cooperative agreements and ASPR’s Hospital Preparedness Program, enhancing local surge capacity and coordination.
- Medical Countermeasures (MCMs): Supports the Biomedical Advanced Research and Development Authority (BARDA) and FDA authorities to accelerate development and deployment of vaccines, treatments, and diagnostics for chemical, biological, radiological, and nuclear (CBRN) threats.
- Medical Response Infrastructure: Maintains the National Disaster Medical System and the Strategic National Stockpile to rapidly deploy personnel, supplies, and specialized medical products.
- Biosurveillance and Laboratory Systems: Expands national situational awareness and strengthens laboratory capacity to detect and monitor public health threats.
- Support for At-Risk Populations: Establishes advisory bodies focused on the needs of children, seniors, and individuals with disabilities during emergencies
Why It Matters for Public Health and National Security
When preparedness falters, outbreaks spread unchecked, hospitals overflow, and critical services collapse. COVID-19 proved how delay multiplies harm—costing hundreds of thousands of lives and trillions in economic damage. From a national security standpoint, biodefense gaps are as dangerous as leaving military bases unmanned, offering openings for both natural and intentional threats. PAHPA’s programs serve as the backbone of federal, state, and local preparedness.
A Call for Immediate Action
The scientific, medical, and security communities are united in warning that the current limbo is untenable. Congress must reauthorize PAHPA for a full multi-year term, preserve its core programs, and modernize its provisions to meet today’s more complex risk environment.
Preparedness is not a luxury to revisit at political convenience—it is a standing obligation to protect lives, preserve economic stability, and defend national security. The longer lawmakers delay, the more they gamble with the nation’s resilience against the next inevitable crisis.
Sources and Further Reading:
Congressional Research Service: Pandemic and All-Hazards Preparedness Act: An Overview
Global Biodefense: Congress Moves to Reauthorize Key Public Health Workforce Bill
Johns Hopkins University Center for Health Security: More Than 110 Organizations Call on Congress to Reauthorize PAHPA Before End of Year
Journal of General Internal Medicine: Reauthorization of the Pandemic and All-Hazards Preparedness Act: a COVID Mandate