How PAHPA Strengthened State and Local Resilience Through Workforce Flexibility

As we look at the 20th anniversary of the Pandemic and All Hazards Preparedness Act (PAHPA), it’s easy to recognize some of the most tangible results that benefited State and local communities: new medicines, cutting-edge diagnostic tools, stockpiles filled with medical countermeasures, and ultimately, lives saved.

PAHPA's legacy extends beyond what we can see and touch. It extends beyond the programs, plans, and training we have built because of the authorities it granted. At its core, PAHPA gave us something even more fundamental: the legal authority to act when it matters most.

Because of PAHPA’s cycle for reauthorization, there are times when we can all collectively examine best practices and identify gaps in authorities to ensure we continue to move forward in providing the best support to those in need.

One example is when we had an outbreak of H1N1 in 2009. States and territories requested permission to use federally funded personnel to augment their response efforts. Unfortunately, our hands were tied. There was no authority to permit the use of those personnel for duties outside their original funding purposes. This was a technical gap in the baseline authorities — there was no emergency use clause or other consideration for flexible surge.

Expanding PAHPA’s Authorities

The 2013 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) amended the Public Health Service Act (PHSA) to add much needed flexibility. Under this amendment, governors and tribal leaders could request temporary reassignment of federally funded public health personnel when a public health emergency was declared. In simple terms, upon request from a governor, tribal leader, or their designee, federally funded state and local personnel can be temporarily reassigned to immediately address emergency needs. 

The impact has been measurable.

Most states and U.S. territories have used this authority since 2020. Across jurisdictions, over 65,000 full-time equivalents have been reassigned to support disaster response operations. During declared public health emergencies, these personnel directly contributed to State and local resilience. Personnel disseminated vital communications to communities, connected health care systems with data, guidance, and medical supplies and equipment, enhanced coordination among public health, emergency management, and healthcare partners, staffed public hotlines, and performed many other duties to mitigate gaps in health care and community health needs.

Temporary reassignment does not create new positions. It allows jurisdictions to pivot the existing staff who are currently funded under the PHSA to the mission that matters most. It turns hands tied into helping hands within communities across the nation.

It also reduced reliance on the federal government. Communities best know their needs and this authority directly supports such efforts at low to no cost. Staff are already on the ground and have demonstrated the ability to quickly pivot under this authority to mitigate the impact of a public health emergency.

Congress included clear guardrails for use of this authority, and we appreciate the check and balance. For example, reassignments must be voluntary. They must occur within the geographic footprint of the declared emergency. Any reassignment beyond 30 days must be reauthorized. And importantly, the HHS Secretary must provide notice to Congress upon approval of an initial request or any extension. Flexibility and accountability exist side by side.

Streamlining Disaster Response

The expansion of PAHPA’s authorities reflects a broader principle that the Trump Administration has emphasized: disaster response works best when states are empowered to act. The threats facing state and local partners are not diminishing. Healthcare systems continue to operate under strain. Emerging biological threats require rapid coordination across jurisdictions. In that environment, workforce flexibility is not a luxury: It’s a necessity.

Over time, we’ve strengthened PAHPA to guarantee the authorities we need to respond proportionately in an emergency. We’ve used these authorities to empower state and local leaders so they can pivot their workforce quickly when conditions change.

Congress included a sunset date of September 2023 for this authority in the 2019 PAHPA reauthorization. The goal was to determine utilization of the authority. Every year since September 2023, the authority has been extended incrementally via funding bills.

Bottom line, temporary reassignment of personnel during disasters will give states the much-needed flexibility to move quickly and save lives when the next disaster strikes. History tells us that this authority is lifesaving. This is just one critical authority that ensures states have the flexibility they need to save more lives in the future.