On May 4, 2023, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing titled “Preparing for the Next Public Health Emergency: Reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA).” PAHPA, which initially became law in 2006 and was last reauthorized in 2019, aims to improve the country’s preparedness for public health emergencies such as pandemics, natural disasters, and bioterrorism. The current authorization of PAHPA is set to expire on September 30, 2023. The hearing focused on reflections from the COVID-19 pandemic and how the country can better prepare for future pandemics and other health emergencies through the next PAHPA bill.

The hearing took place in two parts:

Panel I 
Dawn O’Connell, Assistant Secretary for Preparedness and Response, Administration for Strategic Preparedness and Response (ASPR)
Rochelle Walensky, MD, MPH, Director, Centers for Disease Control and Prevention (CDC)
Robert Califf, MD, Commissioner, Food and Drug Administration (FDA)
  
Panel II 
Reshma Ramachandran, MD, MPP, MHS, Assistant Professor of Medicine, Yale School of Medicine 
Robert Weissman, President, Public Citizen 
Martin Makary, MD, MPH, Professor, Johns Hopkins University  

In his opening remarks, committee Chair Bernie Sanders (I-VT) emphasized the need to reauthorize PAHPA and improve public health infrastructure to prepare for the next pandemic. He acknowledged the hard work of public health workers and healthcare providers but also mentioned how unprepared the country was to respond to COVID-19, discussing overwhelmed hospitals and an initial lack of personal protective equipment (PPE). He also said that schools, businesses, and the economy was shut down “for far too long” due to lack of infrastructure. Addressing workforce shortages and the need for accurate public health data and communications systems are also important to keep people informed and protect vulnerable populations. Ranking Member Bill Cassidy (R-LA) discussed the need for better coordination between the public and private sectors, saying “the public sector hindered the private sector’s ability to act quickly.” Ranking Member Cassidy agreed with Chair Sanders that the country made mistakes during the COVID-19 pandemic, and that there is a need to work together to reflect on lessons learned to “update the playbook” and ensure readiness for future disaster response.

The first panels’ testimony focused on reflections from the COVID-19 pandemic and how the country can better prepare for future pandemics and other public health emergencies. Assistant Secretary Dawn O’Connell of ASPR discussed the agency’s need to procure supplies more quickly, especially PPE, and hire staff more efficiently during large response efforts. In the PAHPA reauthorization, O’Connell requested authority for ASPR to procure tools and supplies more quickly in order to respond to disasters, including acquiring and sustaining access to PPE. She reminded the committee of recent internal changes to the Agency, including how ASPR is now a standalone agency within the Department of Health and Human Services (HHS) and the strategic national stockpile now reports to her as its own office.

CDC Director Dr. Rochelle Walensky said that public health threats are emerging at an increased pace, and that CDC will continue to be response-ready to protect the country. Dr. Walensky emphasized the need to support public health workers with student loan reimbursement, improve data collection and transparency, and maintain infrastructure to administer vaccines. (Note: NACCHO supports the Public Health Workforce Loan Repayment Program, which has been authorized but requires funding to be available in FY2024. NACCHO sent letters to both Senate and House appropriations committees requesting these funds.) Dr. Walensky warned that the end of the public health emergency (PHE) means the CDC will no longer be able to collect certain data and share information with the country. She said CDC should engage in more transparent communication with partners and the American public to increase understanding of methods and recommendations during future pandemics.

FDA Commissioner Dr. Robert Califf highlighted the importance of modernizing FDA to ensure better response to future threats, prevent drug and medical device shortages, and incentivize industries to prepare for and respond during public health emergencies. Regarding supply chains, Dr. Califf emphasized the need for greater transparency to improve resiliency and ensure continued access, as drug and medical device shortages most often impact the most vulnerable. He asked for additional authorities to allow FDA oversight authority to conduct remote regulatory assessments and records requests.

During questioning, Chair Sanders raised concerns about development of vaccines and treatment, workforce infrastructure, and overall preparedness. O’Connell stressed the need for research funding into the seven viral families most likely to cause the next pandemic, while Walensky discussed the toll on public health workers and her concerns about medical and public health workers leaving the profession. Senator Patty Murray (D-WA) discussed the Prevent Pandemics Act that includes directives to ASPR to help local public health agencies access the strategic national stockpile. Senator Mitt Romney (R-UT) discussed false impressions of public health agency ineffectiveness and asked what he and his colleagues could do to help improve public perceptions. Also of note, Senator Tim Kaine (D-VA) discussed a bill he introduced to modernize public health data infrastructure, noting that some provisions were included in the FY2023 omnibus spending bill, but there is more to do.

Questioning of the second panel was much more brief. This section of the hearing focused on prescription drug and vaccine pricing, covering lessons learned during the pandemic and equity considerations for the future. The second panel of witnesses shared their experiences and insights on the challenges and successes of responding to public health emergencies with a focus on drug pricing and innovation both during and after the public health emergency.