Relevant Authorities and Legislation

When response and recovery resource needs surpass the available capabilities of SLTT officials, federal support will be required. Several levels of federal emergency declarations can help support biological incident response and recovery, ranging from a public health emergency declaration by the Secretary of HHS to an emergency or major disaster declaration under the Stafford Act granted by the President upon request from a state governor, tribal leader, or other designated official.

In a biological incident, the following declarations may be issued and may influence incident response and recovery in unique ways. It is important to consider that many prior biological incidents have been addressed without any of the following declarations. Moreover, states or territories can issue their own public health emergency declarations at their discretion, and SLTT declarations are likely to occur with greater frequency than any federal or international declarations. Additionally, the federal and international declarations, reviewed in Table 1 below, will often overlap with SLTT declarations for the same incident as the impacts and support needs expand over time.

Table 1: Relevant Federal and International Declarations

For detailed descriptions of declaration types and more information on federal response and recovery support for a biological incident, readers are directed to the BIA. For additional explanation of funding sources for Stafford and non-Stafford incidents, readers are directed to Appendix C of this document.

In December 2006, Congress passed and the President signed the Pandemic and All-Hazards Preparedness Act (PAHPA), Public Law No. 109-417. Among other things, this act amended the Public Health Service Act to establish within HHS a new Office of the Assistant Secretary for Preparedness and Response, which was elevated to an operational division in 2022 and is now the Administration for Strategic Preparedness and Response. It also provided new authorities for several programs, including the advanced development and acquisitions of medical countermeasures, and called for the establishment of a quadrennial National Health Security Strategy. Subsequently, the Pandemic and All-Hazards Preparedness Reauthorization Act (2013) and the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA, 2019) were signed into law and build on work undertaken to advance national health security. These acts authorized funding for public health and medical preparedness programs, such as the Hospital Preparedness Program (HPP) and the Public Health Emergency Preparedness (PHEP) Cooperative Agreement and amended the Public Health Service Act (PHSA) to grant state health departments greatly needed flexibility in dedicating staff resources to meeting critical community needs in a disaster. Most recently, PAHPAIA also authorized new public health and medical preparedness programs for regional healthcare preparedness and military and civilian partnerships.

Planners are directed to HHS CDC’s PHEP Cooperative Agreement and HHS ASPR’s HPP for more information on how these initiatives can support collaboration between emergency management, public health, and HCCs in SLTT jurisdictions. HPP focuses on building HCCs, which incentivize diverse and often competitive healthcare organizations with differing priorities to work together to prepare for and respond to events that threaten the public’s health. Serving as both coordinating entities and response bodies, HCCs help ensure that their members have the necessary medical equipment and supplies, real-time information, communication systems, and trained personnel to respond to emergencies. Each HCC must include four core member types: acute care hospitals, public health agencies, emergency medical services (EMS), and emergency management agencies.¹⁵