Strengthening our national health security has been an enduring, bipartisan objective of the federal government for many years. Prompted in part by infectious disease threats like Ebola, Zika and this past year’s particularly severe seasonal influenza, Congress has used the reauthorization of a key piece of health security legislation as a moment to take stock. The Oversight and Investigations Subcommittee of the House Committee on Energy and Commerce recently called a hearing on the federal government’s ability to respond to natural and intentional infectious disease threats. The conversation mostly centered around pandemic influenza and the development of medical countermeasures for biological attacks.
There were four expert witnesses representing the primary responding HHS components:
- Dr. Rick Bright – Director of BARDA and Deputy Assistant Secretary of ASPR
- Dr. Anne Schuchat – Principal Deputy Director, CDC
- Dr. Anthony Fauci – Director, NIH NIAID
- Rear Admiral Denise Hinton – Chief Scientist, FDA
There were several important comments and opinions shared during the hearing, but the main takeaways points that I gleaned were as follows:
- There was a significant amount of focus on preparing for an influenza pandemic, particularly in terms of detection and response. There were a lot of questions directed towards the NIH and FDA representatives on this topic. They both emphasized the importance of inter-agency collaboration to speed up the clinical trial process.
- There is bipartisan support for the reauthorization of the Pandemic and all Hazards Preparedness Act (PAHPA), which will provide funding and resources to combat emerging infectious disease threats.
- Concern was expressed by committee members over the transfer of the Strategic National Stockpile (SNS) from the CDC to the Assistant Secretary for Preparedness and Response (ASPR). Representatives from both agencies reassured committee members of ongoing communication efforts to ensure a smooth transition.
The transfer of the SNS was a topic of concern because of the outsized importance of the SNS during public health emergencies. The SNS is a critical component of the U.S. preparedness response efforts. Proper management of the SNS is necessary for the rapid and organized distribution of medical countermeasures to the effected populations. Witnesses from ASPR and CDC reaffirmed the dedication of their respective organizations to ensure a smooth transfer with minimal consequences of new management. Dr. Bright said, “We have several working groups working very close with CDC and ASPR to evaluate various components of the stockpile transfer.” This sentiment was confirmed by Dr. Schuchat who followed up, “We are well on the way to a seamless transition.”
Many questions about the development of medical countermeasures and getting those products rapidly in to the market were directed towards the witnesses from NIAID and the FDA. Dr. Fauci of NIAID made several references to the promising avenue of multiplex point-of-care diagnostic tests that are capable of detecting multiple different viruses in one test with one sample. These tests would revolutionize response efforts to disease outbreaks, particularly in resource-poor settings. Dr. Fauci seemed enthusiastic about the technology, saying that “multiplex is a very important tool of the future now for detecting outbreaks.” Dr. Fauci also discussed Phase II trials for an Ebola vaccine and ongoing work to develop a universal influenza vaccine; although he admitted that such a product is still years away.
Re-authorizing PAHPA would be an important step in increasing the capacity of the United States to protect its own citizens and the global community from infectious disease threats. The original act was signed into law in 2006 and was re-authorized in 2013. A current reauthorization is being undertaken by Congress under the title of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI). PAHPAI will continue to support important preparedness efforts such as funding the development and stockpiling of vaccines, therapeutics and medical devices that will be needed during an emergency and enabling local, state, and federal public health agencies to rapidly respond to infectious disease emergencies. In his opening statements, Chairman Mr. Harper said, “Passage of PAHPA’s reauthorization would not only provide critical certainty for public health agencies and industry partners, it would also bring about some much needed reforms.” In general, committee members appeared supportive of re-authorizing PAHPA.