The Future of PAHPA and National Public Health Preparedness

February 16, 2026 | Catherine Murphy

Among the policies that impact public health’s readiness and response capacity at the national, state, and local levels, the Pandemic and All-Hazards Preparedness Act (PAHPA) is a significant contributor. Originally passed in 2006, with subsequent reauthorizations in 2013 and 2019, the legislation authorized key programs for public health preparedness. Among PAHPA’s provisions are programs and authorities for public health emergencies, medical countermeasures (MCM), medical response (e.g., the National Disaster Medical System and Strategic National Stockpile), infectious disease and biothreats, and protecting vulnerable populations — children, seniors, and people with disabilities.

PAHPA has been overdue for reauthorization since 2023, but progress has been slow due to the sheer size of the bill — the legislation encompasses several programs, and it has fallen by the wayside among other Congressional priorities, namely funding for the government. Authorization for many of PAHPA’s programs has been cobbled together through continuing resolutions. In 2024, as Congress sought to pass a continuing resolution before the holiday recess, PAHPA reauthorization was included in an end-of-year funding package. Congress ultimately removed PAHPA from the bill, along with many other provisions, after members of President-elect Trump’s transition team raised concerns about the size and scope of the legislation.

This spring, discussions on Capitol Hill have breathed new life into the prospects for reauthorization. Congressman Neal Dunn (R-FL) is taking over the bill, which will be co-led by Congresswoman Lori Trahan (D-MA). They have opened a Request for Information for stakeholders to provide input and are expected to release bill text sometime in 2026. ASTHO will provide comments on how PAHPA can best support state and territorial health agencies.

The Trump Administration is expected to include priorities for the PAHPA reauthorization in the FY27 President’s Budget Request. At a recent panel hosted by the Johns Hopkins Center for Health Security, John Knox, Principal Deputy Assistant Secretary for Preparedness and Response, highlighted the Administration for Strategic Preparedness and Response's (ASPR) strategic plan for fiscal years 2026-29, which includes an emphasis on streamlining processes and communication across the agency. Knox also shared ASPR’s priorities in implementing Executive Order (EO) 14239, which shifts the nation’s response framework and disaster planning from federal government to state and local entities. This change has created some buzz, as the EO proposed states be responsible for evaluating and managing their own readiness, including supplies such as personal protective equipment (PPE) and MCM. Also included is a shift away from an all-hazards approach to a “risk-informed” approach that prioritizes “resilience and action.”

In addition to Assistant Secretary Knox, the Johns Hopkins panel featured preparedness thought leaders across sectors, who shared perspectives on PAHPA:

• Julie Gerberding, Co-Chair of CSIS Bipartisan Alliance on Global Health Security and former Director of CDC.
  • Highlighted the uptick in public health infrastructure post-COVID and noted the ongoing threats to biosecurity and, therefore, the importance of modernization and investment for emergency preparedness and response. “Boom and bust” funding cycles are detrimental to readiness and response infrastructure.
• Phyllis Arthur, Executive Vice President and Head of Healthcare Policy and Programs at the Biotechnology Innovation Organization.
  • Framed the importance of PAHPA and emergency preparedness in language similar to that used for robust defense spending — we must be ready for anything that comes our way.
  • Highlighted the Biomedical Advanced Research and Development Authority and BioShield, which signal to industry that there is a partnership with continuous, sustained funding that provides a reduction in risk. This powers development for MCMs, vaccines, diagnostics, drugs, and more.
  • Noted that federal agencies provide not only authorities but also direction for private industry to create and scale these resources.
• Andy Pickett, Director, Bureau of Emergency Preparedness and Response, Pennsylvania Department of Health.
  • Underscored the necessity of flexible, sustained funding for the Public Health Emergency Preparedness program and the Hospital Preparedness Program.
  • Highlighted space for collaboration with ASPR to set clear expectations for stockpiling, as well as the necessity of time for states to make these changes. State, local, tribal, and territorial departments turn federal policy and funding into real-world responses.
  • Discussed the Public Health Emergency Medical Countermeasures Enterprise, which has existed without a voice or vote for the end user, who should have a voice at the federal level, especially considering the paradigm shift created by EO 14239 shifting more responsibility to states.
• Tom Inglesby, Director, Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.
  • Emphasized the lack of PAHPA reauthorization, which creates uncertainty.
  • Brought up the importance of balancing stockpile vs. domestic manufacturing and supply chains for state stockpiles. 
  • Talked about expensive and hard-to-supply PPE — COVID showed us errors in our supply chain for respirators and other products.
• Congressman Andy Harris (R-MD)
  • Discussed the importance of PAHPA reauthorization and noted the current biological defense budget for chemical, biological, and radiological events is not adequate.

Two PAHPA-authorized programs fund a significant portion of state, local, and territorial-level public health preparedness: the ASPR Hospital Preparedness Program and CDC Public Health Emergency Preparedness programs. Both programs support cooperative agreements between health departments and the federal government. These critical programs bolster preparedness and coordination efforts for health departments and health care systems, and provide guidance and technical assistance to strengthen state, local, and territorial readiness and response. In his comments during the panel, Andy Pickett shared the importance of collaboration between federal and state agencies as response capabilities potentially shift to states.

PAHPA remains a significant part of our nation’s preparedness and response framework. ASTHO remains hopeful and supportive of this crucial legislation and continues to communicate with stakeholders and federal partners to underscore PAHPA’s importance to state and territorial readiness. PAHPA reauthorization, along with sustained and robust funding for emergency preparedness and response, ensures capacity for state, local, territorial, and tribal response to emergencies.