pandemic and all-hazards preparedness and advancing innovation act pandemic and all-hazards preparedness and advancing innovation act the pandemic and all-hazards preparedness and advancing innovation act (pahpai) is legislation introduced and passed by the u.s. congress in 2019 that aims to improve the nation's preparation and response to public health threats, including both natural threats and deliberate man-made threats. pandemic and all-hazards preparedness and advancing innovation act of 2019long titlean act to reauthorize certain programs under the public health service act and the federal food, drug, and cosmetic act with respect to public health security and all-hazards preparedness and response, and for other purposes.enacted bythe 116th united states congresscitationspublic law116-22legislative historyintroduced in the senate as s. 1379 by richard burr (r–nc) on may 8, 2019committee consideration by united states senate committee on health, education, labor, and pensionssigned into law by president donald trump on june 24, 2019 a previous bill (with a near-identical name), the pandemic and all-hazards preparedness act (pahpa), was signed into law in 2006 and reauthorized in 2013 in order to create a system that prepares for, and responds to, public health threats that could turn into emergencies. the 2019 bill (pahpai) was introduced by u.s. senators richard burr (r-nc), bob casey (d-pa), lamar alexander (r-tn), and patty murray (d-wa). congress passed the bill and sent it to president trump for his signature in june 2019. (the bill number is s. 1379). background after the september 11, 2001 terrorist attacks and the anthrax attacks that followed, a critical need arose: to develop and stockpile medical countermeasures (certain drugs and vaccines) needed to protect people from chemical, biological, radiological, nuclear (cbrn) and pandemic threats. however, medical countermeasures that address these types of threats, such as anthrax or the plague, have little or no commercial market. therefore, the government needed to incentivize the private market to develop them. to do so, congress passed the project bioshield act in 2004. that law created a federal program called the special reserve fund (srf) to incentivize development of these types of medical countermeasures. the reward poster for the capture and arrest of the perpetrator of the 2001 anthrax attacks. since 9/11, the united states has faced a number of additional sizable public health emergencies. the anthrax attacks of 2001, the destruction caused by hurricane katrina in 2005, and the ebola outbreak in 2014 all raised alarm and concern about how the government should prepare for, and respond to, such events. because of these events, congress has attempted to vastly improve the federal government's ability to address these threats. in 2006, passage of the pandemic and all-hazards preparedness act (pahpa), among other things, created the biomedical advanced research and development authority (barda) to provide companies with money and technical assistance in the advanced research and development of medical countermeasures. several key existing laws give authorities, budgets and policies and procedures to several government agencies tasked with responding to public health emergencies. the public health service act (phs) created a streamlined federal response to public health emergencies by giving the united states public health service the job of preventing the spread of infectious diseases from foreign countries into the united states. the public health security and bioterrorism preparedness act of 2002 gave funding to hospitals and health systems to augment the work of phs. in 2004, the project bioshield act allowed the government to give incentives to the private sector to create drugs that could protect people from biological weapons and naturally-occurring biological threats. when disasters such as wildfires, hurricanes, and disease outbreaks strike, many sectors (public health, healthcare, and the private sector) play a role in saving lives. according to the american hospital association, pahpa is “the backbone of our nation’s health security” by giving the u.s. department of health and human services (hhs) the authority to respond to disasters. after implementing the 2013 pahpa reauthorization, congress recognized certain federal programs, policies and procedures that needed improvement. the purpose of the 2019 pahpai bill is to implement these improvements. bioterrorism and antimicrobial resistance pahpai focuses on a variety of threats, but pays special attention to two specific threats: bioterrorism and “antimicrobial resistance.” bioterrorism occurs when a person or group of people intentionally release germs that can cause serious illness or death. depending on the type of germ (also known as a “biological agent”), sometimes bioterrorism attacks can go almost completely undetected by technology because the biological agents are so microscopic in size. another emerging public health threat that is causing concern is the increase in “microbial resistance” among infectious diseases. microbial resistance occurs when a person who has an infectious disease is given a countermeasure, such as an antibiotic medicine, and it does nothing to help the person get better. therefore, one of the goals of the pahpai law is to develop new therapies that are effective at treating infectious diseases. provisions of the legislation nuclear, biological and chemical (nbc) disposal technicians taking part in a training exercise an “authorization” bill in congress is legislation that creates, or continues, the existence of federal agencies and programs. authorization bills also define the terms and conditions under which the agencies and programs operate, authorize congress to appropriate funds to those programs, and spell out how the programs must use their funds. therefore, a “reauthorization” bill is legislation that redefines these specifics for federal agencies and programs. pahpai reauthorizes federal government programs that were established in the past by the public health service act and the federal food, drug, and cosmetic act. the law makes significant changes and improvements to the agencies and programs under those two laws, in order to make the federal government more effective at preventing and responding to public health security threats such as bioterrorism attacks or disease outbreaks. pahpai focuses on making changes in the law in order to improve the government's response to a number of public health threats, including: biological attacks (such as anthrax) multidrug-resistant pathogens natural disasters (such as wildfires, hurricanes and flooding) other deliberate attacks (such as nuclear weapons) pandemics (such as outbreaks of infectious diseases such as zika, ebola, measles, and flu) the legislation is divided among seven titles which are described below. title i - strengthening the national health security strategy title i changes the national health security strategy (nhss) so that it includes a detailed description of all public health threats, as well as the processes to respond to each type of threat and emergency. it also adds zoonotic disease and disease outbreaks related to food and agriculture into the national health strategy. the nhss is a vision, set forth by hhs, to responding and managing public health emergencies. according to hhs:the 2019-2022 national health security strategy (nhss) provides a vision to strengthen our nation’s ability to prevent, detect, assess, prepare for, mitigate, respond to, and recover from disasters and emergencies. it describes strategies to improve readiness and adapt operational capabilities to address new and evolving threats. by coordinating a whole-of-government approach that engages external partners and supports public health authorities and health care stakeholders, we can better safeguard the health and well-being of people across the country.the nhss is created every four years by hhs and the office of the assistant secretary for preparedness and response (aspr). title ii - improving preparedness and response title ii is further divided into 10 sections: section 201: improving benchmarks and standards for preparedness and response requires the government to re-evaluate several important metrics of two programs: the public health emergency preparedness (phep) cooperative agreement and the hospital preparedness program (hpp) section 202: amendments to preparedness and response programs reauthorizes the phep cooperative agreement and hpp through 2023 makes some changes to the two programs section 203: regional health care emergency preparedness and response systems requires the federal government to give specific instructions to local hospitals and health systems to be able to respond to a bioterror attack, an emerging infectious disease outbreak, or a pandemic was written with lessons learned from the ebola virus outbreak in 2014 in mind sets up a number of processes to improve coordination between the government and health responders section 204: military and civilian partnership for trauma readiness brings together military trauma teams with civilian trauma centers (such as hospitals) sets up a system for the two to cooperate in case of a national emergency section 205: public health and health care situational awareness and biosurveillance capabilities modernizes and adds more resources to the government's biosurveillance programs expands coordination across government agencies to improve the “situational awareness” that is necessary to monitor, identify, and respond to cbrn threats creates a budget for the government's biosurveillance network reauthorizes biosurveillance and situational awareness programs through 2023 section 206: strengthening and supporting the public health emergency fund clarifies specific incidents and how the public health emergency fund dollars can be spent section 207: improving all-hazards preparedness and response by public health emergency volunteers encourages states to let doctors and other health professionals to cross state lines to do their work during a public health emergency helps states find ways to get more volunteers during public health emergencies section 208: clarifying state liability law for volunteer health care professionals clarifies that in whichever state the disaster occurs, the liability laws for health care professionals from that state are applied section 209: report on adequate national blood supply requires a report with ways to get more blood donors and increase the national blood supply section 210: report on the emergency preparedness and response capabilities and capacities of hospitals, long-term care facilities, and other health care facilities requires a report that shows how prepared and ready to respond health care facilities are title iii - reaching all communities medical reserve corps volunteers look over papers title iii is further divided into six sections: section 301: strengthening and assessing the emergency response workforce recent emergencies have put strain on the emergency response workforce and its capabilities, so this section closes the gaps needed to address these strains reauthorizes the national disaster medical system and medical reserve corps through 2023 section 302: health system infrastructure to improve preparedness and response this section gives federal authorities more flexibility in getting emergency medical supplies and restocking the strategic national stockpile (sns). (the sns is a large supply of medicine and medical supplies to be used in public health emergencies. an example is the anthrax vaccine.) section 303: considerations for at-risk individuals focuses federal efforts on making sure that at-risk individuals (such as pregnant and postpartum women and infants) are taken into consideration when doing emergency planning section 304: improving emergency preparedness and response considerations for children similar to section 303, except focused on children section 305: national advisory committees on disasters reauthorizes the national advisory committee on children and disasters through 2023 creates new advisory committees focused on senior citizens and people with disabilities section 306: guidance for participation in exercises and drills requires the government to finish writing a “guidance” on using public health emergency workers in drills and practice exercises title iv - prioritizing a threat-based approach official logo for the assistant secretary for preparedness and response title iv is further divided into five sections: section 401: assistant secretary for preparedness and response encourages the hhs assistant secretary for preparedness and response (aspr) to work with the intelligence agencies, department of defense, and public health agencies in carrying out his/her mission section 402: public health emergency medical countermeasure enterprise (phemce) makes the existence of the phemce permanent in federal law (the phemce is a council of the heads of several agencies and is in charge of coordinating the federal government in gathering medical countermeasures to prepare for chemical, biological, radiological and nuclear threats (cbrn) and emerging infectious diseases) section 403: strategic national stockpile reauthorizes the sns through 2023 focuses the efforts to replenish and supply the sns based on a “threat-based approach” section 404: preparing for pandemic influenza, antimicrobial resistance, and other significant threats gives more authority to the head of the biomedical advanced research and development authority (barda) to create initiatives to combat threats that are a significant risk to u.s. national security, in order to “accelerate and support advanced research, development, and procurement of countermeasures” to combat such threats (barda is a federal agency that helps companies inventing countermeasures such as vaccines and drugs move from