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PAHPA prospects still murky

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Jan 16, 2024
Illustration of a stop sign shaped like a covid particle.

Illustration: Brendan Lynch/Axios

The latest stopgap spending bill calls for extending certain provisions of the the Pandemic and All-Hazards Preparedness Act. But prospects for a full pandemic preparedness reform package remain in limbo.

Why it matters: Renewing PAHPA would give Congress an opportunity to apply the lessons from COVID-19 to the pandemic preparedness system.

  • But disagreements over issues like how to address drug shortages, combined with rolling government funding deadlines, has made it difficult to envision what a final deal might look like.

What they're saying: "We're looking at all of our options," Senate HELP Chair Bernie Sanders said last week when asked about the status of negotiations.

  • He said his panel was working on getting "the strongest possible primary care bill" passed and working with top HELP Republicans and Senate leadership.
  • Sanders also said that "discussions are ongoing" with the House Energy and Commerce Committee on PAHPA.
  • A GOP aide with E&C previously told Axios that reauthorizing PAHPA was one of the committee's priorities this year.

Yes, but: There's still the sensitive issue of whether to expand the FDA's authority to address drug shortages, which split House Republicans and Democrats last summer.

  • Republicans are skeptical of the agency coming out of the pandemic and not eager to give it more authority. Democrats insist the issue is germane to PAHPA.
  • "We're still working on the policy on PAHPA. It's really more the drug shortage issue, which we're all concerned about. Does that fit in PAHPA or not? So that's kept us from getting Democrat votes for PAHPA," Rep. Brett Guthrie, chair of the Energy and Commerce health subcommittee told Axios on Friday.
  • But Guthrie acknowledged that Republicans may have to accommodate some Democratic policy priorities to get anything done: "It's difficult to pass anything without Democrat support. So we've got to figure out how to get that Democrat support."
  • Guthrie said the bigger issue is finding a legislative vehicle for PAHPA and continued uncertainty about a government funding bill.

Meanwhile, there's also the possibility that House Freedom Caucus members such as Rep. Chip Roy could continue to oppose the legislation unless certain demands are met.

  • Roy told reporters in November that renewing the program as-is is, "concerning for me with respect to how we handled COVID and the distribution of vaccines and the sort of empowerment of the federal government in engagement and push of vaccines."
  • Roy previously led Freedom Caucus members in urging then-Speaker Kevin McCarthy not to bring a PAHPA reauthorization to the House floor without cutting funding levels, establishing a vaccine liability commission and making certain COVID-related data transparent.

Zoom in: The CR text released by Senate Majority Leader Chuck Schumer and House Speaker Mike Johnson on Sunday includes PAHPA provisions that were extended in the previous stopgap, though the fate of a priority review voucher program is still up in the air.

  • Extended through March 8 are national health security authorities that include:
  • "The Assistant Secretary for Preparedness and Response's direct hire authority for the National Disaster Medical System, the ability for States and Tribes to request temporary reassignment of federally funded personnel, three national advisory committees related to preparedness and response, and certain authorities related to public-private partnerships under the Biomedical Advanced Research and Development Authority," per a section-by-section summary released by the Senate Appropriations Committee.
  • The priority review voucher program gives an incentive to drugmakers to develop drugs for rare or tropical diseases by getting streamlined FDA product evaluations.
  • With opposition from Sanders, which we wrote about previously, the future of the measure is still uncertain, though medical countermeasure groups are still pushing for it.

What we're watching: If the CR passes this week, that will give lawmakers more time to potentially come together on a deal.

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