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Fiscal Year 2020 Budget-In-Brief

Public Health and Social Services Emergency Fund

Great strides have been made in public health emergency management since 9/11 and Hurricane Katrina. In 2006, the Office of the Assistant Secretary for Preparedness and Response (ASPR) was created within the U.S. Department of Health and Human Services (HHS) under the Pandemic and All Hazards Preparedness Act. ASPR leads the nation in preventing, preparing for, responding to, and recovering from the health effects of disasters and public health emergencies. ASPR focuses on preparedness planning, response, and recovery; building emergency operational capabilities; medical countermeasures (MCM) research and advanced development; and, providing resources to support health care systems, hospitals, and providers.

ASPR’s mission is to save lives and protect Americans from 21st century health security threats. On behalf of the Secretary of HHS, ASPR leads public health and medical preparedness and response in accordance with the National Response Framework and health and social services recovery under the National Recovery Framework. ASPR coordinates across HHS and the federal government to support state, local, territorial, and tribal partners in preparing for, responding to, and recovering from public health emergencies and disasters. ASPR enhances medical surge capacity by organizing, training, equipping, and deploying federal public health and medical personnel while providing logistical support for federal responses during public health emergencies.

ASPR is funded through appropriations to the Public Health and Social Services Emergency Fund. The Fiscal Year (FY) 2020 budget request is $2.6 billion, which is $26 million above the FY 2019 enacted budget. This funding level supports the launch of a new pediatric disaster care initiative to enhance care to infants and children during emergencies; coordination of the National Biodefense Strategy (NBS); support for emergency operations planning and response; and, advanced development of MCMs through procurement, storage, and deployment. These investments ensure that ASPR can fulfill its unique role in protecting Americans from the impact of natural disasters, terrorist threats, and emerging infectious diseases. The request provides:

  • $1.6 billion for the Biomedical Advanced Research and Development Authority (BARDA), including $322 million for Advanced Research and Development (ARD); $180 million for Combating Antibiotic Resistant Bacteria (CARB); $735 million for Project BioShield (PBS); and, $256 million for pandemic influenza (PI).
  • $620 million for the Strategic National Stockpile (SNS) to manage and deliver life-saving MCMs during a public health emergency.
  • $258 million for the Hospital Preparedness Program (HPP) to support cooperative agreements and other programs and initiatives that improve surge capacity and enhance health care readiness.
  • $106 million for Preparedness and Emergency Operations (PEO), the National Disaster Medical System (NDMS), and the Civilian Volunteer Medical Reserve Corps (MRC) to support federal staff and local volunteers in preparing for and responding to public health emergencies and disasters, including training, modernization of equipment, and creation of a pediatric disaster care pilot initiative.
  • $51 million for ASPR’s policy, planning, acquisitions, grants, financial management, business operations, and executive leadership.

To accomplish its mission, ASPR has four key goals:

  • Advance an Innovative MCM Enterprise;
  • Develop a Regional Disaster Health Response System;
  • Sustain Robust and Reliable Public Health Security Capabilities; and
  • Foster Strong Leadership.

To address the potential catastrophic consequences of 21st century threats, a regional approach is needed to improve national health care readiness and medical surge capacity. Supporting regional disaster health response capabilities requires collaboration among local health care coalitions, trauma centers, public and private health care facilities, and emergency medical services. This is accomplished by integrating preparedness within the health care delivery infrastructure across the public and private sectors and also by increasing coordination with non-government entities, including private sector hospitals and providers. Ultimately, this approach better supports state, local, tribal, and territorial disaster risk reduction, preparedness, mitigation, response, and recovery efforts.

During 2018, Ebola reemerged in the Democratic Republic of the Congo (DRC), with two outbreaks of Ebola virus disease occurring. The first outbreak, in western DRC, was contained quickly. However, the second outbreak, in eastern DRC, is prolonged due to the volatile security situation in that region. The second outbreak has become the second largest Ebola outbreak since the virus was discovered in 1976, surpassed only by the 2014–2016 outbreak in West Africa. This outbreak is unlikely to be the world’s last. Ebola and other highly infectious diseases cross borders. In order to protect the American people, ASPR partners with the Centers for Disease Control and Prevention (CDC) and others to monitor and support domestic preparation. During April 2018, ASPR led a historic exercise, Tranquil Terminus, to review notification processes, coordinate decisions, provide access to the resources needed, and test the movement of patients with highly infectious diseases by both air and ground. The exercise revealed strengths as well as gaps that ASPR is addressing.


The budget requests $77 million for NDMS, which is $20 million above the FY 2019 enacted level. The request supports logistics and the regional emergency coordination needed to prepare for and respond to public health emergencies and disasters. Funding will be used for medical response assets, including training for NDMS teams and modernized equipment sets. An increase of $20 million in the request for NDMS will address existing shortfalls in pediatric disaster care. Children represent 25 percent of the U.S. population and face specialized issues. A Pediatric Disaster Care program is being developed jointly by NDMS and HPP to address appropriate planning and response capabilities for those specific needs, such as pediatric triage, decontamination considerations, and mass sheltering. Funds will support regional preparedness cooperative agreements for pediatric disaster care, response assets including training NDMS deployable teams, and medical equipment to assist with the special needs of children.


emPOWER provides public health agencies and their partners with Medicare datasets, mapping tools, training, and technical assistance to protect the health of more than 4.1 million individuals who live independently and rely on life-maintaining electricity-dependent equipment (including ventilators) and healthcare services (such as dialysis and oxygen). Over 53,500 individuals have used the public HHS emPOWER Map to help communities address electricity-dependency needs. emPOWER’s planning and just-in-time emergency datasets have helped responders to anticipate, plan for, respond to, and conduct life-saving outreach in over 100 local to federal emergencies. emPOWER also provides voluntary training to states and territories to help them develop state Medicaid datasets to protect at-risk children and adults.


The FY 2020 budget request for HPP is $258 million, which is $7 million below the FY 2019 enacted level. As the only source of federal funding for health care delivery system readiness, HPP focuses on health care provider coordination that enables an effective response to save lives and mitigate negative health outcomes for those impacted by public health and medical emergencies. HPP supports regional health care system readiness through health care coalitions (HCC). HCCs are groups of health care and response organizations that play a critical role in ensuring that each member has what is needed to respond to emergencies and planned events. Preparedness includes addressing medical surge capabilities, access to real-time information and communication systems, and disaster-specific education and training for health care personnel. HPP provides formula‑based cooperative agreements to states, territories, freely associated states, the District of Columbia, and three high-risk subdivisions.

SPOTLIGHT on the Technical Resources, Assistance Center, and Information Exchange (TRACIE)

TRACIE provides technical assistance to support health care emergency preparedness to local, state, regional, tribal, territorial, and federal staff, health care associations, health care entities, and other stakeholders. Through TRACIE’s online tools (, health and emergency management professionals can access the best peer-reviewed resources and experts to call for help. ASPR TRACIE has responded to almost 4,600 requests for technical assistance. TRACIE has over 5,000 (and growing) resources available for download in its resource database and provides access to more than 650 subject matter experts who can advise on a wide-range of topics related to emergency management, public health, disaster clinical medicine, and health care system preparedness, response, and recovery.


The FY 2020 budget includes $25 million in budget authority for PEO activities, which is equal to the FY 2019 enacted level. The request includes $5 million in three-year funding to prepare for and respond to National Special Security Events, public health emergencies, and other events that are not eligible for assistance under the Stafford Act. Preparedness and response to public health and medical emergencies requires a robust and continuous training and exercise program. HHS has deemed ongoing exercises to be critical to preparing for effective responses during emergencies. Also essential is the operation and maintenance of the Secretary’s Operation Center to ensure that clear and timely information is available to support rapid response to disasters and public health emergencies.


The FY 2020 budget requests $4 million for MRC, which is $2 million below the FY 2019 enacted level. The funding will support technical assistance to MRC units. The assistance includes identifying and sharing training courses and other resources for developing unit capabilities for responding and deploying during disasters and emergencies as well as other topics specific to MRC, such as volunteer recruitment and retention.