The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 Signed Into Law: NEHA's Journey to Get Environmental Health to the Table.
PAHPA was signed into law by President George W. Bush on December 19, 2006. Hurricane Katrina in 2005 highlighted the need to enhance coordination among federal, state, local, tribal, and territorial entities to prevent, detect, and respond to outbreaks of plant or animal disease that could compromise national security, international adulteration of food, or other public health threats directly related to public health emergency preparedness and response capabilities. The purpose of PAPHA was to improve the nation's public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural.
PAHPA had broad implications for the preparedness and response activities of the U.S. Department of Health and Human Services. Among other things, PAHPA amended the Public Health Service Act to establish within the department a new Assistant Secretary for Preparedness and Response. It also provided new authorities for a number of programs, including the advanced development and acquisition of medical countermeasures. The law was reauthorized by Congress in 2013 with a new reauthorization date set for 2018. In an oversight, however, the original law and subsequent reauthorization omitted explicit mention of environmental health agencies or professionals. The result of this omission was that environmental health professionals were generally absent from emergency preparedness exercises and planning.
After that meeting I began my quest to change the language in the bill. Research was conducted on when the bill required reauthorization (by September 30, 2018) and who the influencers would be on the bill. I joined both formal and informal coalitions of organizations that included many of NEHA's regular partners and several other organizations that NEHA had never worked with before, such as those in the biodefense arena.
I sat down with Christine Ortiz Gumina, NEHA's Program and Partnership Development staff member who had worked in a local health department in Virginia and had seen firsthand the problems that arise when environmental health professionals are not part of emergency preparedness. She and I reviewed the law and found critical places to insert environmental health agencies and professionals into the legislative text.
As the new bill was drafted, I met with many staffers, senators, and representatives on Capitol Hill to explain the importance of including the language Christine and I had drafted. Throughout these meetings I emphasized over and over that environmental health professionals are second responders and save more lives in the days and weeks after a disaster than are usually lost during the initial event.
To further our cause I attended many coalition meetings, trying to get support from other organizations on our language and explaining time and time again the need to add environmental health language to this legislation. Individual meetings were scheduled with coalition members to help them understand the need for this language. Considerable resistance was encountered from partner organizations who wanted to focus only on the money in the bill and did not believe that environmental health needed to be included in the bill.
In 2017 NEHA held its first Annual Hill Day--a day in which NEHA board members and staff meet with senators, representatives, and their staff from both political parties to ensure that the environmental health profession has a voice in major policy decisions. We held our Third Annual Hill Day on May 1, 2019. During these events, our board members and staff were encouraged to emphasize the need for environmental health to be included in PAHPA.
It was my goal every time NEHA was represented on Capitol Hill that there was a constant drumbeat and reminder of the need to include the environmental health profession in national emergency preparedness initiatives. Week after week, hours of phone calls, and numerous arranged meeting with congressional staff members were conducted to stress the importance of this language. And finally, our efforts were rewarded when our language became part of the U.S. Senate bill. The text remained there as the bill went through the U.S. Senate Health, Education, Labor, and Pensions Committee. It was extremely gratifying to see the bill gain momentum with our priorities included.
As representatives and their staff from the U.S. House of Representatives began to focus on the bill, I had to renew my efforts to emphasize the importance of our environmental health language, even though that groundwork had been laid earlier with them. Once they began to focus on the writing of the legislation, specific conversations on their version of the bill were held. I explained each time the role of environmental health professionals in emergency situations as second responders.
At that point the "politics side" of the process had begun. I worked to make sure that anyone who was concerned with the overall bill, and not necessarily our piece, heard how important this legislation was and why it was needed in the grand scheme of protecting people's lives when natural or man-made disasters occurred.
The end result of all of this work was that we finally had a U.S. Senate and U.S. House of Representatives bill that contained identical environmental health provisions. Even better, the bill was moving through the U.S. House of Representatives and in fall 2018, they passed PAHPA. It was encouraging that the U.S. Senate was poised to do the same; however, the bill got held up for political reasons that had nothing to do with the bill.
In December 2018, the federal government experience a shutdown and the 115th U.S. Congress ended sine die (i.e., without any future date being designated for resumption) without passing PAHPA. This situation meant that we would have to start over with a new bill in both the U.S. Senate and U.S. House of Representatives because once a Congress ends sine die, all legislation that has not become law must be reintroduced. So, our sights were now set on getting the bill passed by the 116th U.S. Congress.
Many meetings were held to discuss whether a brand-new bill with a new Democrat majority in the U.S. House of Representatives would be needed or if the House could pass what was already agreed upon in fall 2018. Luckily for NEHA, the U.S. House of Representatives agreed to put forward a bill with only one new addition and mostly the exact same language (including the environmental health language) that had passed in fall 2018. The bill was unanimously passed by a voice vote in January 2019.
Once again, PAHPA was stalled in the U.S. Senate due to politics, not policy. Letters of support and many meetings helped us find a way forward, even though the weeks of inaction regarding the bill turned into months. We had to remind everyone of not only the importance of this legislation for the country but also why NEHA was supporting the legislation. We used NEHA's Third Annual Hill Day on May 1, 2019, as a platform to request the passage of PAHPA in the U.S. Senate. NEHA board members and staff held over 50 meetings within one day to plead our case and emphasize the importance of environmental health professionals and PAHPA. Each of these meetings required follow-up and requests to encourage the passing of PAHPA by the U.S. Senate.
As hurricane season approached, a new focus on passing the legislation began to heat up on Capitol Hill. In the end, a deal was brokered: if the U.S. House of Representatives agreed to drop a provision it added to the bill then the U.S. Senate would agree to pass PAHPA. The U.S. House of Representatives agreed that the added provision was not a deal breaker and the U.S. Senate passed PAHPA. A couple of weeks later, the U.S. Senate version of PAHPA was passed in the U.S. House of Representatives. PAHPA was then sent to President Donald Trump to sign. After 9 days where it looked like it would become law on its own, the president signed PAHPA into law on June 24, 2019.
Information from NEHA regarding how environmental health is mentioned in the law can be found online at www.neha.org/ node/60816. In general:
* The law specifically outlines who the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services considers appropriate partners to consult and engage with as it relates to healthcare providers and professionals. The list includes physicians, nurses, first responders, healthcare facilities, pharmacies, emergency medical providers, trauma care providers, environmental health agencies, public health laboratories, poison control centers, blood banks, tissue banks, and other experts that are determined appropriate.
* The law makes changes in reference to laboratories. The reference to "clinical laboratories" has been changed to "clinical laboratories and public environmental health agencies."
* The law has redesignated human health to include "taking into account zoonotic diseases, including gaps in scientific understanding of the interactions between human, animal, and environmental health."
* The law changes the definition of situational awareness and biosurveillance as a national security priority. Specifically, under the Situational Awareness and Biosurveillance as a National Security Priority section, "environmental health agencies" has been inserted after "public health agencies."
* The law directs federal departments to work with state, local, tribal, and territorial public health labs and other biological threat detections to include collaboration regarding the development of a coordinated environmental remediation plan.
* The law directs the reporting on public health preparedness and response capabilities of hospitals, long-term care facilities, and other healthcare facilities to include environmental health.
* The law includes an evaluation of coordination efforts between the recipients of federal funding for programs described in Subparagraph (A) and environmental health agencies with expertise in emergency preparedness and response planning for hospitals, long-term care facilities, and other healthcare facilities.
NEHA is now working on next steps to ensure that environmental health professionals are at the emergency preparedness table. It has been a long journey to include environmental health into PAHPA and to include our profession in the national conversation regarding planning and response to emergency events. Thank you to all involved in this process and for their hard work.
By Joanne Zurcher (firstname.lastname@example.org)
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|Title Annotation:||NEHA NEWS|
|Publication:||Journal of Environmental Health|
|Date:||Aug 20, 2019|
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