The Public Health and Medical Response to Disasters: Federal Authority and Funding

Publication Date: August 2008

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

Type:

Abstract:

When catastrophes overwhelm the response capability of state and local authorities, the President can provide certain assets and personnel to aid stricken communities, and can provide funding to individuals, government and not-for-profit entities to assist them in response and recovery. Aid is provided under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act), upon a presidential declaration of an emergency (providing a lower level of assistance) or a major disaster (providing a higher level of assistance). The Secretary of Health and Human Services (HHS) also has both standing and emergency authorities to assist state and local governments, not-for-profit entities, and others in response to public health and medical emergencies.

The flawed response to Hurricane Katrina and preparedness efforts for an influenza ("flu") pandemic have each raised concerns about existing federal response mechanisms for incidents in which there are overwhelming public health and medical needs. In addition, some concerns have been expressed about federal leadership and delegations of responsibility for the public health and medical response to incidents, as carried out according to the National Response Plan (NRP).

While there is precedent for presidential authority to declare an infectious disease threat an emergency, pursuant to the Stafford Act, there is not corresponding precedent for the authority to declare such a threat a major disaster. Many of the needs likely to result from a flu pandemic could not be met with the types of assistance provided pursuant to the Stafford Act, even if a major disaster declaration applied. For example, in a severe pandemic, the healthcare system may have to provide care for seriously ill victims who are uninsured or underinsured, or sustain the loss of revenue if more lucrative but non-essential procedures are postponed during a pandemic. In addition, potential adverse economic impacts of a flu pandemic, such as losses in trade, travel and tourism, are not generally eligible for Stafford Act assistance. In the course of the public health and medical response to Hurricane Katrina, numerous federal aid mechanisms in addition to those in the Stafford Act assistance were developed administratively or in statute. Some of these mechanisms may be applicable during a flu pandemic.

This report examines: (1) the statutory authorities and coordinating mechanisms of the President (acting through the Secretary of Homeland Security) and the Secretary of HHS in providing routine assistance, and in providing assistance pursuant to emergency or major disaster declarations and/or public health emergency determinations; (2) mechanisms to assure a coordinated federal response to public health and medical emergencies, and overlaps or gaps in agency responsibilities; and (3) existing mechanisms and potential gaps in financing the costs of a response to public health and medical emergencies. A listing of federal public health emergency authorities is provided in the Appendix.