By W. Craig Vanderwagen and Jennifer B. Alton
June 16, 2026
As the nation navigates an increasingly complex global threat landscape, the infrastructure underpinning America’s health security has never been more critical. The Trump administration has recently taken decisive steps to bolster this foundation by preserving the Administration for Strategic Preparedness and Response (ASPR) within the Department of Health and Human Services (HHS) and nominating new leadership to guide the agency.
However, structural preservation is only the first step. For the United States to remain resilient against biological threats, natural disasters, and unforeseen emergencies, Congress must now act with urgency to confirm the administration’s nominees and reauthorize the foundational legislation that empowers the nation’s emergency response apparatus: the Pandemic and All-Hazards Preparedness Act (PAHPA).
The Invisible Shield: Understanding ASPR
To the average American, the acronym "ASPR" remains largely unfamiliar. Yet, this agency functions as the federal government’s primary engine for coordinating medical and public health responses during crises. Positioned at the critical nexus of national security, specialized health care, and emergency management, ASPR is the entity tasked with ensuring that when the worst-case scenario occurs, the nation is not caught flat-footed.
As the founding assistant secretary for preparedness and response (Vanderwagen) and a lead Senate staffer on the original PAHPA legislation (Alton), we witnessed the birth of this agency. It was designed to bridge the gap between reactive emergency management and proactive medical strategy. Today, that mission is more vital than ever, as the agency manages everything from the repatriation of citizens exposed to hantavirus to the deployment of the Regional Emerging Special Pathogen Treatment Centers—a network meticulously built in the wake of the 2014 Ebola outbreak to ensure that patients receive gold-standard care in high-consequence environments.
Chronology of Preparedness: From PAHPA to the Modern Era
The story of American health security is defined by a series of legislative and operational milestones that have incrementally built our current resilience:
- 2006: The enactment of the Pandemic and All-Hazards Preparedness Act (PAHPA), which formally established ASPR and created a coherent statutory framework for the nation’s preparedness and response capabilities.
- 2006–2009: The formative years of ASPR, where the agency’s core mission of medical countermeasure development and operational readiness was solidified.
- 2014: The Ebola outbreak, which exposed gaps in specialized care capacity, leading to the creation of the Regional Emerging Special Pathogen Treatment Centers.
- 2020–2023: The Covid-19 pandemic, which served as a brutal stress test for global supply chains and domestic medical manufacturing.
- 2023: The expiration of key PAHPA authorities, necessitating the use of stopgap, temporary extensions that have left the agency in a state of statutory limbo.
- 2026: The Trump administration moves to preserve ASPR’s structure and nominates new leadership, signaling a renewed commitment to health security as the nation prepares for high-profile events like the 2026 FIFA World Cup.
Supporting Data: The Cost of Complacency
The argument for robust, permanent authorization is not merely administrative; it is grounded in the harsh reality of modern risk. The Biomedical Advanced Research and Development Authority (BARDA), a vital component of ASPR, is currently funding critical medical countermeasures. Current initiatives include, but are not limited to, the development of vaccine candidates for the Bundibugyo ebolavirus.
The economic and human costs of failing to prepare are immense. The Covid-19 pandemic revealed that relying on fragile, globalized supply chains for essential medicines and PPE is a significant national security vulnerability. Executive orders currently being implemented by the administration aim to repatriate the manufacturing of critical medical supplies. Reducing this dependence is not just a matter of industrial policy; it is a fundamental pillar of national defense.
Furthermore, the agency is currently preparing for a "demanding summer." Beyond seasonal concerns like hurricanes, the 2026 FIFA World Cup and the nation’s upcoming 250th-anniversary celebrations represent massive logistical challenges. These events require seamless coordination across all levels of government—federal, state, territorial, tribal, and local—as well as deep engagement with the private sector.
Official Responses and the Leadership Vacuum
Despite the necessity of the mission, the federal health apparatus faces a significant leadership crisis. The Centers for Disease Control and Prevention (CDC) has functioned without a Senate-confirmed director for nearly a year. Simultaneously, the vacancy at the head of ASPR has only recently been addressed through the administration’s nomination process.
Effective leadership is not a luxury; it is the prerequisite for interagency coordination. When the federal government lacks confirmed heads for its primary health security agencies, the ability to anticipate and respond to threats is severely hamstrung. Congress must move past partisan gridlock and prioritize the swift confirmation of these individuals.
Implications: The Necessity of Legislative Action
The failure to reauthorize PAHPA is a profound oversight that leaves the nation vulnerable. While stopgap measures have kept the lights on, they do not provide the long-term statutory certainty required for complex, multi-year initiatives like the Regional Disaster Health Response System (RDHRS) or the National Disaster Medical System (NDMS).
Allowing these authorities to lapse permanently would effectively erode the foundations laid over the last two decades. It would signal a retreat from the lessons learned at such great cost during the pandemic. To avoid this, the legislative agenda must include:
- Permanent Reauthorization of PAHPA: Providing a robust, modernized statutory framework that incorporates the lessons of the last seven years.
- Strategic Investment in the Public Health Emergency Fund: Ensuring that when a crisis strikes, the financial resources are pre-positioned and ready for deployment without the need for emergency, reactive appropriations.
- Deepening Inter-Governmental Collaboration: Strengthening the ties between ASPR and local health authorities to ensure that national strategy translates into frontline readiness.
- Institutionalizing Supply Chain Resilience: Making the current executive orders on medical manufacturing a permanent feature of national health policy to prevent future shortages of essential medicines.
Conclusion: Preparing for the Unseen
The lesson of the last decade is undeniable: Preparedness cannot be built in the heat of an emergency. It is a slow, methodical process that requires sustained investment, clear statutory authority, and unwavering political will.
America’s next health emergency is not a question of "if," but "when." Whether it is a naturally occurring outbreak, a geopolitical conflict involving biological threats, or a catastrophic industrial accident, the nation’s readiness depends entirely on the systems we choose to support today.
The Trump administration has taken the necessary first steps toward stability. It is now up to Congress to complete the task. By confirming the nominees to lead our health security agencies and passing a comprehensive, long-term reauthorization of PAHPA, lawmakers can ensure that the United States is not just reactive, but resilient—ready to face whatever the future holds with the full strength of a prepared nation.
W. Craig Vanderwagen, M.D., was the founding assistant secretary for preparedness and response from 2006 to 2009; he is now an instructor at Harvard T.H. Chan School of Public Health and co-chair of the National Academies Forum on Medical and Public Health Preparedness. Jennifer B. Alton, M.P.P., previously worked for the Senate Committee on Health, Education, Labor and Pensions and drafted the Pandemic and All-Hazards Preparedness Act; she is now president of Pathway Policy Group.
