Public Health Infrastructure and Pandemic Preparedness Provisions in the Build Back Better Act

The Build Back Better Act, originally introduced in Congress on September 27, 2021, is a broad funding and programmatic package supported by President Biden. The bill, as first introduced by the House, was estimated to total $3.5 trillion. A more recent version now under consideration in the House is estimated to total significantly less, at $1.75 trillion, due to pressures to reduce the bill’s cost.

Among the provisions in the bill are several designed to strengthen the public health infrastructure, including the workforce, and to support pandemic preparedness. While the original version of the bill provided $51.8 billion for these purposes (with $36 billion directed toward improving the public health infrastructure and $15.8 billion toward pandemic preparedness), the new version of the bill provides 63% less, or $19.2 billion, including $16.2 billion for public health infrastructure and $3 billion for pandemic preparedness.  Almost all public health and preparedness areas in the original bill saw reductions, and several were eliminated.

The following table identifies the provisions of the bill related to public health infrastructure and pandemic preparedness, their specific funding amounts, and activities supported.1 Unless otherwise specified, all funding would be made available until expended, and, if ultimately enacted, would build on funding provided in previous emergency spending bills passed by Congress to respond to the COVID-19 pandemic.

Area/Provision Amount Activities
HEALTH CARE INFRASTRUCTURE AND WORKFORCE $16,160,000,000
SEC. 31001. FUNDING TO SUPPORT CORE PUBLIC HEALTH INFRASTRUCTURE FOR STATE, TERRITORIAL, LOCAL, AND TRIBAL HEALTH DEPARTMENTS AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION $7,000,000,000 (provided between 2022-2026) Funding to support core public health infrastructure activities to strengthen the public health system and expand and improve activities of the Centers for Disease Control and Prevention (CDC). Activities include: health equity activities; workforce capacity and competency; all hazards public health and preparedness; testing capacity, including test platforms, mobile testing units, and personnel; health information, health information systems, and health information analysis (including data analytics); epidemiology and disease surveillance; contact tracing; policy and communications; financing; community partnership development; and relevant components of organizational capacity.

Funding Allocation: To support core public health infrastructure activities throughout the U.S.

  • Population-Based Grants: $3,500,000,000 provided to each State or territorial health department, and to local health departments that serve counties with a population of at least 2,000,000 or cities with a population of at least 400,000 people. Formula must consider population size and the Social Vulnerability Index.
  • Competitive Grants: $1,750,000,000 provided through competitive grants to State, territorial, local, or Tribal health departments.
  • NOTE: Of the grant funding provided to State health departments through formula and competitive awards, at least 25% must be reallocated to local health departments.
  • CDC: $1,750,000,000 to expand and improve core public health infrastructure and activities at the CDC.
SEC. 31002. FUNDING FOR HEALTH CENTER CAPITAL GRANTS $2,000,000,000 Funding to be awarded through grants and cooperative agreements to support community health centers for capital improvement projects.
SEC. 31003. FUNDING FOR TEACHING HEALTH CENTER GRADUATE MEDICAL EDUCATION $3,370,000,000 Funding for direct payments and awards to support the establishment of new as well as the maintenance and expansion of existing graduate medical residency training programs.
SEC. 31004. FUNDING FOR CHILDREN’S HOSPITALS THAT OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS $200,000,000 Funding to support children’s hospitals that operate graduate medical education programs.
SEC. 31005. FUNDING FOR NATIONAL HEALTH SERVICE CORPS $2,000,000,000 Funding to support the National Health Service Corps.
SEC. 31006. FUNDING FOR THE NURSE CORPS $500,000,000 Funding to support the Nurse Corps.
SEC. 31007. FUNDING FOR SCHOOLS OF MEDICINE IN UNDERSERVED AREAS $500,000,000 Funding to be awarded to support the establishment, improvement, or expansion of an allopathic or osteopathic school of medicine, with priority given to minority-serving institutions, and taking into consideration equitable distribution of awards among the geographical regions of the United States (including rural populations) in order to reach disadvantaged, rural, underserved, underrepresented, and low-income individuals.

Among other things, supported activities include: recruiting, enrolling, and retaining students; curricula development, implementation, expansion, and modernization; facilities construction, modernization, or expansion; accreditation; and the hiring of faculty and staff.

SEC. 31008. FUNDING FOR SCHOOLS OF NURSING IN UNDERSERVED AREAS $500,000,000 Funding to be awarded to support schools of nursing to enhance and modernize nursing education programs and increase the number of faculty and students at such schools, taking into consideration equitable distribution of awards among the geographical regions of the United States, the capacity of a school of nursing to provide care in underserved areas, and with priority to reach disadvantaged, rural, underserved, underrepresented, and low-income individuals.

Among other things, supported activities include: recruiting, enrolling, and retaining students; creating, modernizing, enhancing, or expanding curricula and programs; hiring and retention of faculty; modernizing school infrastructure; and establishing partnerships with healthcare providers as well as interdisciplinary programs to further educational opportunities.

SEC. 31009. FUNDING FOR PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING $25,000,000 Funding to be awarded through grants and contracts to support the training of health professionals in palliative and hospice care as well as foster patient and family engagement, integration of palliative and hospice care with primary care and other appropriate specialties, and collaboration with community partners to address gaps in health care for individuals in need of palliative or hospice care with priority given to rural, medically underserved populations and communities, Indian Tribes or Tribal Organizations, or Urban Indian organizations.
SEC. 31010. FUNDING FOR PALLIATIVE MEDICINE PHYSICIAN TRAINING $20,000,000 Funding to be awarded through grants and contracts to accredited schools of medicine, schools of osteopathic medicine, teaching hospitals, and graduate medical education programs for the purpose of providing support for projects that fund the training of physicians or specialists who plan to teach or practice palliative medicine.
SEC. 31011. FUNDING FOR PALLIATIVE CARE AND HOSPICE ACADEMIC CAREER AWARDS  $20,000,000 Funding to be awarded to accredited schools of medicine, osteopathic medicine, nursing, social work, psychology, allied health, dentistry, or chaplaincy applying on behalf of board-certified or board-eligible individuals to promote the academic career development as hospice and palliative care specialists.
SEC. 31012. FUNDING FOR HOSPICE AND PALLIATIVE NURSING $20,000,000 Funding to be awarded as grants and contracts to accredited schools of nursing, health care facilities, programs leading to certification as a certified nurse assistant, or partnerships of such schools and facilities to develop and implement programs and initiatives to train and educate individuals in providing interprofessional, interdisciplinary, team-based palliative care in health-related educational, hospital, hospice, home, or long-term care settings.
SEC. 31013. FUNDING FOR DISSEMINATION OF PALLIATIVE CARE INFORMATION $5,000,000 Funding to be provided through the award of grants or contracts to public and nonprofit private entities to disseminate information to inform patients, families, caregivers, direct care workers, and health professionals about the benefits of palliative care throughout the continuum of care for patients with serious or life-threatening illness.
PANDEMIC PREPAREDNESS $3,000,000,000
SEC. 31021. FUNDING FOR LABORATORY ACTIVITIES AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION $1,400,000,000 Acting through the Director of the Centers for Disease Control and Prevention, funding shall be used to renovate, improve, expand, and modernize State and local public health laboratory infrastructure as well as CDC laboratories. Activities supported include improving and enhancing: testing and response capacity; the Laboratory Response Network for rapid outbreak detection; genomic sequencing capabilities to detect emerging diseases and variant strains; and biosafety and biosecurity capacity.

Funding may also be used to enhance the ability of the Centers for Disease Control and Prevention to monitor and exercise oversight over biosafety and biosecurity of State and local public health laboratories.

SEC. 31022. FUNDING FOR PUBLIC HEALTH AND PREPAREDNESS RESEARCH, DEVELOPMENT, AND COUNTERMEASURE CAPACITY $1,300,000,000 Acting through the Assistant Secretary for Preparedness and Response Activities, funding shall be used to support:

  • Surge capacity, including through construction, expansion, or modernization of facilities, to respond to a public health emergency, for procurement and domestic manufacture of drugs, active pharmaceutical ingredients, vaccines and other biological products, diagnostic technologies and products, personal protective equipment, medical devices, vials, syringes, needles, and other components or supplies for the Strategic National Stockpile
  • Expanded global and domestic vaccine production capacity, including by developing or acquiring new technology and expanding manufacturing capacity through construction, expansion, or modernization of facilities
  • Activities to mitigate supply chain risks and enhance supply chain elasticity and resilience for critical drugs, active pharmaceutical ingredients, and supplies (including essential medicines, medical countermeasures, and supplies in shortage or at risk of shortage), drug and vaccine raw materials, and other supplies through the construction, expansion, or modernization of facilities, adoption of advanced manufacturing processes, and other activities to support domestic manufacturing of such supplies
  • Activities conducted by the Biomedical Advanced Research and Development Authority for advanced research, standards development, and domestic manufacturing capacity for drugs, including essential medicines, diagnostics, vaccines, therapeutics, and personal protective equipment
  • Increased biosafety and biosecurity in research on infectious diseases, including by modernization or improvement of facilities.
SEC. 31023. FUNDING FOR INFRASTRUCTURE MODERNIZATION AND INNOVATION AT THE FOOD AND DRUG ADMINISTRATION $300,000,000 Funding provided to improve and modernize infrastructure at the Food and Drug Administration and to enhance food and medical product safety as follows:

  • $150,000,000 for improving technological infrastructure, including through developing integrated systems, and improving the interoperability of information technology systems.
  • $150,000,000 for modernizing laboratory infrastructure of, or used by, the Food and Drug Administration, including modernization of facilities related to, and supporting, such laboratory infrastructure, including through planning for, and the construction, repair, improvement, extension, alteration, demolition, and purchase of, fixed equipment or facilities.

 

Endnotes
  1. Only funding amounts listed under “Subtitle I - Public Health” in the “Build Back Better Act” (H.R. 5376) are included. Funding that may support public health activities provided under other subtitles is not included.

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