	Background

Several events in the past decade sharpened congressional interest in the nation's ability to track and respond to health threats. Key incidents include the airline and anthrax attacks in 2001, Hurricane Katrina in 2005, and the H1N1 influenza ("flu") pandemic in 2009. In 2006, the 109 th Congress established or reauthorized relevant programs and activities, principally in the Departments of Health and Human Services (HHS) and Homeland Security (DHS), responding to problems identified during prior incidents. Given the current budgetary climate, spending for public programs, including emergency management programs, may be significantly constrained. Under the circumstances, Congress may be interested in approaches to improve the efficiency of incident response mechanisms, to enhance the integration of the private sector in planning and response activities, to fully leverage routine capabilities for incident response, and to strengthen program accountability, among other things. This report, which will be updated as needed, summarizes key issues in the preparedness for and response to domestic, civilian public health and medical incidents, citing other CRS reports and additional sources of information. 109-417 ), passed in 2006, established or extended programs for public health emergency preparedness and response activities in HHS, and established the Biomedical Advanced Research and Development Authority (BARDA) to spur the development of medical countermeasures. Appropriations authority for a number of activities last reauthorized in PAHPA has expired, or will expire at the end of FY2011, and the 112 th Congress may consider reauthorization. These include, for example, the authority of the HHS Secretary to declare a public health emergency, and to access a special fund for response purposes; authorities of the HHS Secretary or the Commissioner of the Food and Drug Administration (FDA) to ensure the safety of foods and medical products; and authorities of the President to declare an emergency or a major disaster and provide specified forms of assistance pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act). Issues for Congress

		Government Leadership, Organization, and Capacity

			Federal Leadership and Coordination

For public health and medical preparedness and response, the roles and responsibilities of principals in HHS and DHS have shifted in past years. Also, it is not clear that a flu pandemic or bioterrorism incident would qualify as a major disaster under the Stafford Act. State Grants for Public Health Preparedness and Response

From FY2002 through FY2010, Congress provided about $7.6 billion in cooperative agreement funds to states and territories to strengthen public health preparedness for public health threats (see Figure 1 ). Depending on the circumstances, federal funds may be available from a variety of sources. Since 2001, the federal government has sought to establish this capacity in the private sector, with mixed success. Disaster Victims and Health Care Costs

There is no federal assistance program designed purposefully to cover the uncompensated or uninsured costs of individual health care that may be needed as a result of a disaster. Development, Procurement, and Use of Countermeasures

			Project BioShield82

The 108 th Congress launched Project BioShield to encourage the development of medical countermeasures (such as drugs, vaccines, and diagnostic tests) that lack commercial markets. Each of these matters poses its own set of management challenges in ensuring that the right medical products are available and can be delivered to the right recipients in a timely manner.
Key recent events—the 2001 terrorist attacks, Hurricane Katrina, and the H1N1 influenza ("flu") pandemic, among others—sharpened congressional interest in the nation's ability to respond to health threats. For the response to health emergencies, most authority resides with state and local governments, and most capacity resides in the private sector. The federal government plays a key role, however, providing numerous forms of assistance for planning and preparedness, as well as for response and recovery. Previous Congresses passed a number of laws intended to establish clear federal leadership roles and responsibilities and effective organizational structures, in the Departments of Health and Human Services (HHS) and Homeland Security (DHS) in particular. Nonetheless, challenges persist in coordinating federal preparedness and response efforts.
From FY2002 through FY2010, Congress provided about $11.4 billion in grants to states and territories to strengthen public health and medical system capacity in preparedness for health threats. However, depending on the incident, dedicated funding for the actual response to these threats may or may not be available. For example, it is not clear that infectious disease incidents (such as bioterrorism or a flu pandemic) would qualify for major disaster assistance under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act). Also, although the HHS Secretary has authority for a Public Health Emergency Fund, Congress has not appropriated monies to the fund for many years. Finally, there is no federal assistance program designed purposefully to cover uncompensated or uninsured health care costs for disaster victims.
Another challenge is ensuring that the right medical products are available, and that they can be delivered to those in need in a timely manner. Previous Congresses established Project BioShield and the Biomedical Advanced Research and Development Authority (BARDA) in HHS to encourage private-sector development of medical countermeasures, such as drugs and vaccines, that lack commercial markets. Given the high cost and financial risk inherent in the development of new medical products, debate continues about how to balance these costs and risks between the federal government and product developers.
Given the current budgetary climate, spending for public programs, including emergency management programs, may be significantly constrained. Under the circumstances, the 112th Congress may be interested in approaches that improve community resilience in the face of disasters through better integration of the private sector in planning and response activities and better leveraging of routine capabilities for incident response, among others. The 112th Congress is also likely to remain interested in optimizing coordination, efficiency, and accountability in federal activities. Finally, for a number of health emergency activities authorized by previous Congresses, appropriations authority has expired or will expire at the end of FY2011. If the 112th Congress considers reauthorization, the matter of efficient use of federal resources is likely to be front and center during its deliberations.
This report, which will be updated, summarizes key issues in domestic public health and medical preparedness and response, and discusses selected federal programs, citing other CRS reports and other sources of additional information. Specifically, it discusses issues regarding government leadership, organization, and capacity; health system preparedness and response; the development, procurement, and use of countermeasures; and the defense against specific threats, including foodborne outbreaks and bioterrorism, among others.