	Background

Three important principles color the issues in public health and medical preparedness and response. First, preparedness and response are different functions. The 2001 terrorist attacks, the flawed response to Hurricane Katrina, and concerns about an influenza ("flu") pandemic sharpened congressional interest in the nation's ability to track and respond to health threats. The 109 th Congress established or reauthorized relevant programs and activities in the Departments of Health and Human Services (HHS) and Homeland Security (DHS). The 110 th Congress focused on oversight of these activities, in particular (1) the fitness of HHS and DHS—in terms of authority, funding, policies, and workforce—to respond to health emergencies; (2) the effectiveness of federal agency coordination; and (3) the status of major initiatives such as pandemic flu preparedness and disaster planning for at-risk populations. The 111 th Congress is likely to remain engaged in oversight of the nation's readiness for health threats. This report, which will be updated as needed, summarizes key issues in domestic public health and medical preparedness and response, citing other CRS Reports and sources of additional information. Shifts in doctrine or priority in the new Administration, if any, may manifest when key positions are filled, or when the budget proposal for FY2010 is unveiled. Other substantial reorganizations of federal homeland security agencies do not appear to be under debate at this time. HHS Response Capability and Funding Authority

The 111 th Congress may consider the adequacy of permanent authorities of the HHS Secretary for responding to public health threats, including authority to declare a public health emergency and the expanded authorities that flow from it. Although the HHS Secretary has authority for a no-year Public Health Emergency Fund, Congress has not appropriated monies to the fund for many years. Also, it is not clear that a flu pandemic would qualify as a major disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act). Since then there has been an expansion of the federal role through direct procurement and deployment of medical response assets, providing a stronger backstop for state, local, and private-sector response efforts. 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. Congress or the Bush Administration provided special assistance to address this concern three times in response to recent disasters. Communicable Disease Control

The response to communicable disease threats may involve movement restrictions, business and school closures, compulsory treatments, and other constraints. While state and local governments have the primary authority over these domestic containment measures, a comprehensive response to a public health emergency may involve overlapping governmental authorities and attendant legal and economic issues. Finally, health emergencies often involve scarcities of resources, including personnel, equipment, drugs, and vaccines. Development, Procurement, and Use of Countermeasures

			Project BioShield

The 108 th Congress launched Project BioShield to encourage the development of countermeasures that lack commercial markets.
Key recent events—the 2001 terrorist attacks, Hurricane Katrina, and concerns about an influenza ("flu") pandemic, among others—sharpened congressional interest in the nation's systems to track and respond to public health threats. The 109th Congress passed several laws that established, reorganized, or reauthorized key public health and medical preparedness and response programs in the Departments of Health and Human Services (HHS) and Homeland Security (DHS). The 110th Congress was engaged in oversight of the implementation of these laws, focused in particular on such matters as (1) the fitness of HHS and DHS—in terms of authority, funding, policies, and workforce—to respond to health emergencies; (2) the effectiveness of coordination among them and other federal agencies; and (3) the status of major initiatives such as pandemic flu preparedness and disaster planning for at-risk populations. The 111th Congress is likely to remain engaged in oversight of the nation's readiness for health threats.
The Obama Administration may reconsider homeland security objectives and priorities established by the George W. Bush Administration. Shifts in doctrine or priority, if any, may manifest as key positions are filled, or in the budget proposal for FY2010.
The 111th Congress may review HHS's disaster response capabilities, including its authority to declare a public health emergency and the means to fund its response efforts. Among other things, it is not clear that 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 no-year Public Health Emergency Fund, Congress has not appropriated monies to the fund for many years. Finally, since Hurricane Katrina, Congress has urged and HHS has adopted a more aggressive federal role in the response to health emergencies.
Historically, federal assistance to states in dealing with disasters has come mainly as guidance and funding for preparedness and response activities. Since Hurricane Katrina, the federal role has been more direct, involving, for example, more procurement and deployment of medical response assets. Congress may wish to consider whether this trend is appropriate and sustainable.
At this time, there is no federal assistance program designed purposefully to cover the uncompensated or uninsured health care costs for disaster victims. The 111th Congress may reconsider earlier proposals to provide such assistance under certain circumstances.
Health emergencies often involve scarcities of resources (including personnel), movement restrictions, business and school closures, and other constraints. While state and local governments have the primary authority over such measures as quarantine and isolation, a comprehensive response to a public health emergency may involve overlapping governmental authorities and attendant legal and economic issues.
The 108th Congress launched Project BioShield to encourage the development of medical countermeasures. Some concerns remain about the program's ability to attract private-sector developers. Also, the 109th Congress provided a means for liability protection for product developers and others, if countermeasures are used during a health emergency. A program to compensate persons who may be injured by such covered countermeasures has not been funded.
This report summarizes key issues in domestic public health and medical preparedness and response, citing other CRS Reports and sources of additional information.