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he Energy and Commerce Subcommittee on Oversight and Investigations has been holding hearings on the current state of U.S. public health biopreparedness. Its goal is to improve the country’s ability to respond to biological attacks, pandemics, and outbreaks of emerging infectious diseases. Among the topics for discussion is the reauthorization and funding for an essential piece of legislation, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018.

Aimed at reauthorizing an earlier law, this act would ensure that the U.S. is poised to effectively prevent, detect, and respond to threats that could weaken public health. A key part of this is the infrastructure needed to maintain health care operations during normal times and during a crisis. This infrastructure includes hospitals, pharmacies, nursing homes, and dialysis centers, along with health care distribution centers and manufacturing facilities. The act also provides funding to support partnerships and programs that further strengthen this infrastructure and help communities across the country prepare for and rebound from disasters and disease outbreaks.

To continue building on the progress the U.S. has made in disaster preparedness, we must foster partnerships across government and the private sector that can truly move the needle. These partnerships must recognize that more than 75 percent of the essential health care infrastructure, including health care providers and production facilities, is in the private sector. We cannot have a strong preparedness and response network without input from, and coordination with, the private sector.

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While it is crucial that our emergency management and public health programs are fully funded, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act is about more than funding. It also lays the groundwork for executing our national preparedness and response strategy. The original Pandemic and All-Hazards Preparedness Act, passed in 2006, was transformational legislation in its recognition that all disasters have public health consequences. Its third iteration, the 2018 act, continues to push for a stronger and more resilient public health infrastructure that can respond to emerging and ongoing threats, whether they are natural or man-made.

A recent poll conducted by my organization, Healthcare Ready, found that Americans don’t feel they are as prepared for a disaster as they should be. Many are concerned that a catastrophic event may affect their community in the next five years. If the federal government hasn’t allocated the resources to preparedness, or if communities lack robust response infrastructure, then people across the country will suffer unnecessarily during catastrophic events.

Much of the guiding framework and overall infrastructure for our national health security strategy is federal. Yet all disasters are inherently local, and local and state government will always be in the lead and on site first during catastrophic events. While the federal government definitely has a role in large-scale events, investments in state and local preparedness enable a more efficient local response to small and mid-scale disasters and disease outbreaks.

While much of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act pertains to federal capabilities, such as the emergency response activities of the Office of the Assistant Secretary for Preparedness and Response within the Department of Health and Human Services, it also reauthorizes invaluable programs such as the Hospital Preparedness Program and the Public Health Emergency Preparedness program. These support state and local public health infrastructure and have directly saved lives during countless responses to events such as the 2016 floods in Louisiana, the mass shooting in Las Vegas, and Hurricane Harvey. Without such programs, local authorities affected by crises will be forced to respond without the public health personnel and health care emergency response coalitions we depend on.

Since 2006, the preparedness acts have helped the country respond to natural and man-made disasters and disease outbreaks by building the public health workforce, expanding our health security capacity, and improving the infrastructure for public health emergency responses. Congress needs to continue working in a bipartisan manner to tackle the threats that the Pandemic and All-Hazards Preparedness and Advancing Innovation Act is intended to address.

In recent disease outbreaks, mobilizing a rapid pathway to creating medical countermeasures, such as a vaccine that can prevent death from an Ebola infection or rapid diagnostics to earlier detect flu or other infections, has been possible because of the existence of the Biomedical Advanced Research and Development Authority. That program, and others like it, would cease to exist if the preparedness act is not reauthorized. It is impossible to build a research and development enterprise in the midst of a disaster and expect it to quickly deliver medical countermeasures that can immediately start saving lives. BARDA is essential for supporting the creation of countermeasures for a pandemic caused by a new or emerging infectious disease for which there is otherwise no market and therefore no incentive for companies to pursue development.

In this increasingly connected world, diseases and natural disasters often have no borders. There has never been a more important time to direct funds and attention towards disaster preparedness. As an emergency management professional, I know that it will be nearly impossible to keep pace with evolving global threats without the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018. We need this legislation to build a 21st century public health infrastructure that can effectively respond to today’s threats, and tomorrow’s.

Nicolette Louissaint, Ph.D., is the executive director of Healthcare Ready.

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