Now is the time to resource the Public Health Emergency Fund
As America is once again faced with the reality of a new pandemic, decision-makers are scrambling to figure out how to pay for the response.
While working to mitigate the spread of COVID-19 within the United States, the Department of Health and Human Services is currently being forced to shift money from other activities. Congress will surely provide emergency supplemental funding now that the administration has requested additional resources.
The good news is that Congress authorized a Public Health Emergency Fund for exactly this purpose—in 1983. The account is still in existence, and just last year, Congress updated its authorizing statute with enhanced criteria outlining when and how the fund should be used, and embedding it with oversight mechanisms to ensure it meets congressional intent. It was tailor-made for exactly the situation in which we now find ourselves.
Unfortunately, the last infusion of funds into the account was 20 years ago.
The dormancy of the fund is difficult to explain. Since at least the West Africa Ebola outbreak, both the executive and legislative branches have expressed bipartisan support for better funding models. The parties may disagree on the amount, but representatives from both sides have agreed that, in addition to supporting preparedness between crises, setting aside a ready-made emergency response fund is the responsible course of action to avoid the necessity of emergency supplementals that were needed for both the Ebola and Zika responses.
Appropriators created a new Infectious Diseases Rapid Response Reserve Fund in the Fiscal Year 2019 funding law for use by the Centers for Disease Control and Prevention. For the past two funding cycles, Congress has appropriated modest funding ($50 million and $85 million) via the annual appropriations bills into this account; the president’s FY2021 budget requests an additional $50 million.
The Reserve Fund is designed for use by the CDC; whereas the COVID-19 response has called on the CDC, as well as the National Institutes of Health, the assistant secretary for Preparedness and Response, and other agencies of the Department of Health and Human Services. The long-standing but empty Public Health Emergency Fund, on the other hand, can be used HHS-wide once the secretary declares an emergency.
This fund also requires long-term oversight in the form of reporting requirements from HHS to Congress and a Government Accountability Office review.
We do not need to reinvent the wheel by creating new funds—we simply need to rectify the disconnect between authorization and appropriations and use the tools already at our disposal.
New funds appropriated for the coronavirus emergency response should be put into the Public Health Emergency Fund. The fund provides no-year money that can be carried over if it is not needed right away; enables HHS to make grants, enter into contracts, and conduct investigations pertaining to public health emergencies; can be used to strengthen biosurveillance and laboratory capacity, including paying for the development of diagnostic tests; can fund the development of emergency medical countermeasures like vaccines and treatments; and can support deployment of response personnel.
The fund has much more detailed criteria for use than the CDC Reserve Fund and better mobilization of funds to the various agencies that need to respond. Six bipartisan senators recently re-introduced legislation to create an automatic funding formula for the fund; however, appropriators can resource it right away.
The regularity of public health events that warrant the use of the Public Health Emergency Fund should be a signal that its premise is as sound today as it was in 1983. The 2019 update to the fund was an important step toward assuring that federal resources could be quickly mobilized to enable outbreak response while building in additional oversight mechanisms to ensure the money is spent with the public interest in mind.
When Congress appropriates emergency supplemental funding for COVID-19, it should put the money into the Public Health Emergency Fund. Any leftover money after the outbreak could be used as seed funding for responding to future outbreaks, obviating the need for future emergency supplementals.
Jennifer B. Alton, MPP is president of Pathway Policy Group and a Center Affiliate at the Georgetown University Center for Global Health Science and Security. Ellen P. Carlin, DVM is assistant research professor at the Georgetown University Center for Global Health Science and Security and director of Georgetown’s Global Infectious Disease graduate program.
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