Amanda Reiling

2026 marks 20 years since Congress passed the Pandemic and All-Hazards Preparedness Act (PAHPA)—now titled the Protecting Americans from All Hazards Preparedness Act—landmark legislation to strengthen the nation’s public health emergency preparedness and response capabilities. PAHPA was reauthorized in 2013 and 2019, but its authorization lapsed at the end of 2023, leaving many authorities dependent on temporary extensions advanced through appropriations bills and continuing resolutions (CRs). As a result, key policies and structures guiding the US government’s pandemic playbook predate a generation-defining pandemic, underscoring the urgency of reauthorizing this legislation to integrate lessons learned and ensure the United States is better equipped against current and future threats.Efforts to reauthorize PAHPA have proved challenging in a post-COVID-19 political environment. The Senate advanced in mid-2023 a largely clean PAHPA bill with some additional provisions addressing drug pricing, drug shortages, and related issues. However, differences between House proposals stalled further progress, ultimately leading House Republicans and Democrats to introduce separate proposals. A potential breakthrough emerged in late 2024, when a bipartisan health care package containing PAHPA gained traction as part of an end-of-year continuing resolution. The broader health package ultimately fell apart, leaving PAHPA reauthorization unresolved.PAHPA originally amended the Public Health Service Act to establish two cornerstone institutions: the Administration for Strategic Preparedness and Response (ASPR) to lead the nation’s public health emergency response, and under it—and most notably for global health R&D—the Biomedical Advanced Research and Development Authority (BARDA) to accelerate the development of medical countermeasures (MCMs) against emerging infectious diseases (EIDs), antimicrobial resistance (AMR), and pandemic influenza. Together, these entities transformed how the United States invests in, coordinates, and implements medical preparedness and response capabilities. Reauthorization now offers a critical opportunity to renew and strengthen these authorities for future threats.Reauthorization is not simply procedural—it is essential to restoring and enhancing the authorities that enable BARDA and partners to advance lifesaving MCMs. Done thoughtfully, PAHPA renewal could reinforce accountability, transparency, and coordination while safeguarding the United States’ position as a global biomedical innovation leader. Stable, modernized authorities ensure scientists and innovators have the support needed to develop and scale up next-generation technologies that protect Americans and strengthen health security worldwide.GHTC’s vision for PAHPAPrompted by a request for information shared by Representatives Neal Dunn (R-FL) and Lori Trahan (D-MA), GHTC has identified clear opportunities through reauthorization to maintain the strong momentum PAHPA has driven and build an even more proactive, innovative preparedness architecture that keeps us one step ahead of emerging pathogens. From reactive to readyBARDA and external partners estimate that $775 million is needed to successfully advance an EID MCM portfolio at the agency. While a dedicated Influenza and Emerging Infectious Disease (IEID) Division exists, predictable, dedicated funding for this work does not. Historically, investments for EID MCM development have come primarily through emergency supplemental funding bills passed in the wake of public health crises like Ebola, Zika, and COVID-19, reinforcing a reactive rather than proactive posture. To address this gap in preparedness, PAHPA should establish dedicated funding for BARDA's IEID Division to ensure sustainability and readiness.To reinforce BARDA’s critical efforts against AMR, Congress should advance complementary legislation—including the newly reintroduced Pioneering Antimicrobial Subscriptions to End Upsurging Resistance Act and the Saving Us from Pandemic Era Resistance by Building a Unified Global Strategy Act (introduced in the 118th Congress)—to strengthen the pipeline of new tools for antimicrobial-resistant pathogens and support pull incentives that accelerate AMR R&D.MRNA is a critical platform technology for advancing next-generation vaccines and therapeutics. Sustained investment in mRNA research will be critical to maintaining US scientific leadership. Congress should explicitly authorize BARDA to invest in mRNA technology and prioritize its investment via report language directives to ensure the United States sustains the necessary capabilities for a rapid response. Protect the gainsWith the current BARDA Strategic Plan set to end in 2026, a new plan is needed to articulate its goals for the next five years, incorporating lessons learned from the last five. To strengthen the effectiveness and credibility of this plan and ensure it is informed by the best available science and aligned with real-world preparedness needs, BARDA should look to scientific experts, product developers, and other external stakeholders to inform the 2027-2031 strategy via an open, consultative process. Congress should direct BARDA to complete this plan.PAHPA should also mandate BARDA to regularly and publicly report on its MCM research and product-level investments to ensure consistent reporting, regardless of future leadership changes at the department. BARDA's improved efforts on reporting have already been instrumental in a host of ways, so codifying this practice is essential to strengthening transparency and accountability.In an effort to further support national preparedness, BARDA should be directed to run a feasibility study on the creation of a loan authority program to better enable the agency to finance large-scale, capital-intensive projects such as innovative biomanufacturing facilities like those for microneedle patch vaccines. Too often, constrained health workforce and laboratory capacity can hinder the deployment of MCMs in low-resource settings, both in the United States and globally. To ensure this issue does not persist, PAHPA should direct ASPR to study barriers to MCM deployment in low-resource communities and authorize national and global engagement activities during MCM development to ensure products are usable and effective in these settings. Keep what worksAn authority established by the 21st Century Cures Act, the Medical Countermeasure Innovation Partnership, which uses venture-capital-style investment from BARDA to advance MCMs, will expire at the end of fiscal year 2028 under current PAHPA legislation. Given the program’s successful track record—advancing at least eight promising innovations—Congress should eliminate the sunset clause to preserve this productive mechanism. BARDA’s commitment to combatting AMR remains more pertinent than ever. Bacterial AMR was directly responsible for an estimated 1.14 million deaths in 2021 and associated with a total of 4.71 million deaths. Without action, annual deaths attributable to AMR could increase by almost 70 percent, totaling 10 million by 2050, with significant deaths among children and newborns. The pipeline of new antimicrobials and other tools remains insufficient. The critical support BARDA has provided for the development of AMR products must be maintained to meet this escalating threat.See the formal letter that GHTC submitted to Reps. Dunn and Trahan detailing each of these recommendations in full here.The future of R&D preparedness Reauthorizing and modernizing PAHPA is not just about restoring an expired statute; it is about defining the kind of biosecurity leader the United States intends to be in the decades ahead. PAHPA occupies a unique position in the health security landscape. It provides not only the authority to respond effectively during public health emergencies, but also the framework to make proactive, forward-looking investments that keep us one step ahead of emerging biological threats. There is growing bipartisan recognition of the urgency behind many of PAHPA’s core provisions, particularly as the global health and biomedical innovation landscape has shifted dramatically in recent years. Through thoughtful policy refinements, Congress can help shape a future that catalyzes more inclusive innovation, builds stronger public-private partnerships, and ensures the benefits of MCM development are fully realized, saving more lives in the United States and around the world.  At a moment when the cost of being unprepared is painfully clear, the choices made around PAHPA reauthorization will reverberate far beyond US borders and for years to come, helping determine how the world anticipates, confronts, and ultimately mitigates the next generation of health emergencies.

Women’s health remains one of the most underfunded and under-explored areas in health research, despite its profound importance to the lives of women and health outcomes across populations. Today, only about 5 percent of health research and development (R&D) funding worldwide is dedicated to women’s health, and less than one percent of that share supports non-cancer-related conditions, leaving vast gaps in our understanding of conditions that disproportionately or uniquely affect women. These gaps persist globally, including within the United States, where the National Institutes of Health (NIH) plays a central role in shaping biomedical research priorities. While these disparities remain clear today, meaningful progress has been made in women’s health—particularly in expanding women’s inclusion in research and establishing foundational policies that prioritize sex and gender in science. This March, in recognition of Women’s History Month, we look back at key milestones at NIH that have advanced women’s health research. These achievements not only highlight how far the field has come but also help guide where we need to go next. For decades, women were systematically excluded from clinical research, leading to critical gaps in the knowledge needed to adequately understand, diagnose, and treat diseases and other health challenges faced by women. Women’s symptoms were misunderstood, their risks underestimated, and their health needs too often treated as a secondary, niche issue rather than a scientific imperative.  The women’s rights movement of the 1960s ignited a parallel women’s health movement that forced policymakers and scientists to confront systemic disparities. A pivotal turning point came in 1983, when the Public Health Service Task Force on Women’s Health Issues—established by Assistant Secretary for Health Edward Brandt Jr.—became the first federal initiative focused on increasing women’s inclusion in NIH-funded clinical trials. The Congressional Caucus for Women’s Issues echoed that call to action. These were not symbolic gestures, but structural interventions that began reshaping the research enterprise. By 1990, sustained advocacy led to a major advancement: the creation of the NIH Office of Research on Women’s Health (ORWH). For the first time, NIH had a dedicated mechanism and leadership to strengthen, coordinate, and champion women’s health research across the agency. Congress codified and strengthened this progress with the 1993 NIH Revitalization Act, which formally established the ORWH into law and, importantly, mandated that women and minorities be included in all NIH-funded clinical research. The latter change was spurred by a group of female members of Congress who recognized deficiencies in NIH’s prior 1986 internal guidelines that urged but did not require that women be included. These landmark policy changes helped transform women’s health from a peripheral cause into a core component of biomedical science, propelling meaningful scientific progress. With the ORWH fully in force, NIH launched additional efforts to improve women’s health research, including the Specialized Centers of Research on Sex Differences. This initiative aimed to accelerate the translation of discoveries about sex differences from basic science into clinical applications, bridging gaps between laboratory research and women’s clinical care. In 2018, the effort evolved into the Specialized Centers of Research Excellence on Sex Difference—a network of research centers dedicated to advancing translational research on the role of sex differences in the health of women. The 2006 NIH Reform Act, further strengthened ORWH by elevating it into the NIH Office of the Director. This shift gave ORWH greater authority to coordinate across institutes and centers, influence research priorities, and ensure women’s health considerations were integrated at the highest levels of decision-making and across the entire R&D continuum. After two decades of building a scientific and policy foundation for better inclusion, NIH took another pivotal step that reshaped the research enterprise: the NIH Policy on Sex as a Biological Variable (SABV). Implemented in 2016, the policy required researchers to factor sex into the design, analysis, and reporting of basic, preclinical, and clinical studies. For years, basic science relied heavily on male cells and male animal models, embedding blind spots at the earliest stages of discovery. By requiring scientists to examine how sex influences health and disease from the outset, NIH strengthened the rigor, reproducibility, and translational value of federally funded research. The policy helps ensure that differences in disease progression, drug metabolism, immune response, and treatment efficacy are identified early before they become costly failures or missed opportunities in product development. By institutionalizing sex-informed research design, SABV signaled a clear shift in practice. Inclusion is not just about who participates in research, but also about how science is conducted.  In parallel, Congress also passed the 2016 21st Century Cure Act that affirmed and enhanced compliance requirements around SABV and required that people of all ages be included in clinical research unless valid scientific reasons existed for exclusion. The policy also established a task force to advance recommendations, knowledge, and guidance around the safe inclusion of pregnant and lactating individuals in clinical trials.  In 2019, NIH published its first comprehensive strategy to advance the health of women, which outlined the agency’s activities and objectives from 2019 through 2023. Though an updated strategy has since been released, this first plan marked an important first step in translating ORWH’s mission into a unified NIH vision with a structured path forward. With input from technical experts and civil society, NIH published its second women’s health strategy. The current plan prioritizes advancing research on women’s health disparities and underscores the importance of basic and translational research in biomedical discovery and innovation. While it addresses other issues, including actions related to the inclusion of women and girls in clinical trials, much of its focus is on early-stage research. As the strategy concludes in 2028, there is an opportunity to build on this foundation by strengthening support for later-stage R&D and addressing priority gaps in health innovations for women. As we mark International Women’s Day, the question is no longer whether women should be included in research, but whether research is delivering the health products that women need. NIH has built the policy architecture to enhance representation, inclusion, coordination, and strategic priority-setting across the research continuum, correcting historical blind spots and reshaping the research enterprise.  Yet inclusion alone does not guarantee innovation. As we look ahead to the future of women’s health research at NIH, continued collaboration will be essential. We encourage NIH to sustain and deepen its engagement with academia, researchers, industry, and civil society as it shapes the next iteration of its women’s health strategy. Building on this dialogue will help ensure priorities reflect both scientific opportunity and real-world need.  GHTC stands ready to partner in shaping what comes next. NIH has made meaningful progress over the past several decades—now is the moment to build on that momentum and work together to drive even greater impact on women’s health in the years ahead. Beyond this strategy, GHTC wants to continue working with Congress to ensure that the progress made at NIH through various avenues is codified into law. By advancing strong, bipartisan policies that strengthen and sustain women’s health research, Congress can protect recent gains and help ensure they deliver lasting impact for patients and communities around the world. As the agency sets its course, we urge decision makers to maintain a strong commitment to women’s health research, including research that advances the development of new priority health technologies for women. The current strategy’s emphasis on foundational and basic science lays critical groundwork for breakthrough products, but translational and later-stage research are equally vital to move promising discoveries across the finish line and into the hands of patients.  This month, and every month, offers an opportunity to reflect on the progress made, the gaps that remain, and the shared responsibility to accelerate a future where investing in and supporting women’s health research is not the exception, but the standard. 

Over the past century, partnerships between the US government and scientists have led to major breakthroughs in global health research and development (R&D). Consistent US government funding, combined with the nation’s strong research universities and entrepreneurial spirit, has positioned America as a world leader. This investment has paid off in both health and economic gains. However, that foundation has recently weakened, as US government actions have sharply reduced research spending and limited global health research collaborations. These changes risk driving US researchers abroad and eroding the very strengths that made the United States such a scientific powerhouse. The result could be fewer breakthroughs, fewer economic benefits, and a costly brain drain for our nation. How we got here America’s global health research leadership is built on the backbone of decades of government investment by agencies like the National Institutes of Health (NIH), the Biomedical Advanced Research and Development Authority (BARDA), the Centers for Disease Control and Prevention, and the US Agency for International Development (USAID). This support built a top-tier talent pool at home and drew innovators from abroad—giving the United States a strong competitive advantage. That advantage is now in jeopardy. Recent policy and budget decisions have led to the termination of thousands of NIH grants, the wind-down of BARDA’s mRNA vaccine work, the closure of USAID and near-total cancellation of its health R&D awards, and the loss of more than 20,000 jobs at the Department of Health and Human Services. More cuts and restructuring are proposed.New federal rules are also disrupting universities—the backbone of US biomedical research. To stay eligible for federal funding, institutions must meet shifting requirements, adding costs and uncertainty. At the same time, new NIH policies have restricted international partnerships and broadly limited "dangerous gain-of-function research,” including studies that leading experts consider to be safe. Research on infectious diseases like tuberculosis has been disrupted as a result.  Funding for training young scientists is also falling. NIH’s main program for supporting early-career researchers saw its grant spending drop from $2.2 billion in 2024 to $1.7 billion in 2025. Without reliable support, many students and junior researchers may take their talents abroad—or abandon their field altogether. The international response In the wake of these changes, other countries are moving quickly to recruit US researchers.  In May, the European Union pledged $567 million over three years to “make Europe a magnet for researchers.” Similarly, the Netherlands launched a new fund to attract top international scientists, and Norway unveiled a £7.2 million program to recruit researchers. The head of Norway’s Research Council pointed to the pressure US researchers are facing on academic freedom as part of its rationale.  Individual universities are also joining in. Aix-Marseille University in France launched its Safe Place for Science program to attract US scientists who may “feel threatened or hindered in their research.” The Free University Brussels created a dedicated point of contact for US researchers interesting in continuing their work in Belgium. The message from abroad is clear: America’s loss can be their gain. So what?As the US retreats, the center of gravity for biomedical research may shift overseas. Data from Nature’s jobs board shows that in the first few months of the current administration, US job-seekers applying abroad rose sharply: 41 percent more to Canada, 32 percent to Europe, 20 percent to China, and 39 percent to other Asian countries compared to the same period in 2024.  Early-career researchers are being hit hardest. At the most innovative and impactful stage of their careers, opportunities are disappearing. Many have been left jobless or unsure if they have a future in their field. The US economy is also at stake. In 2024, NIH-funded research supported more than 400,000 jobs across all 50 states and generated $94.60 billion in economic activity—a return of $2.56 for every dollar spent. Reductions in US spending could shift those economic benefits to other countries. And since no other nation has the resources to fully replace the US’s historic role, we could see fewer medical breakthroughs for the world overall. Without strong and predictable federal research support, the United States risks losing its place as a top engine of global biomedical progress. Young researchers see more uncertainty than opportunity, and other nations are investing heavily to take the lead, accelerating a US brain drain. If US policymakers do not act to restore the foundational factors that rooted American scientific leadership, the future of science may unfold elsewhere—and the next generation of discoveries may not be American-led.  

For decades, strong US government investment in biomedical innovation has fueled the development of new vaccines, treatments, and other breakthrough global health technologies that have saved and improved millions of lives around the world and here at home. Unfortunately, in recent months, we have seen these investments decline significantly, as the US government has shrunk its foreign assistance footprint and ended hundreds of medical research grants. With the majority of global health research programs at the US Agency for International Development (USAID) and many other key US agency programs facing an uncertain future, past progress and future gains in global health innovation are now at risk. These disruptions threaten to undermine the United States’ longstanding role as a global leader in biomedical innovation, compromise the return on previous investments, and heighten health risks for people in the United States and around the world.The current US administration has signaled its priority to make America safer, stronger, and more prosperous—a goal which is directly aligned with the outcomes of global health research and development (R&D). By embracing ongoing commitments and continuing to invest in global health R&D, US policymakers can safeguard the well-being, resilience, and economic prosperity of the American people—advancing the agenda of the US administration while simultaneously saving and improving lives around the world. Global health R&D protects Americans from disease threats and promotes international stabilityDisease threats know no borders. Americans are increasingly at risk of emerging and neglected diseases, as underscored by the recent domestic outbreaks of H5N1, measles, mpox, and tuberculosis. Right now, health technologies developed with US funding are protecting Americans and ensuring that the United States is equipped with the proper tools to mitigate disease threats. The 2025 outbreak of Sudan virus, which can cause Ebola disease in humans, in Uganda was the latest Ebola outbreak that endangered the well-being of citizens worldwide. In addition to providing critical monetary and technical assistance contributions to Uganda to combat this outbreak, the US government also donated courses of an experimental monoclonal antibody treatment that was developed with US funding and 500 rapid detection test kits to support ongoing surveillance and prevention of future outbreaks. Additionally, other global partners launched two major clinical trials testing an experimental vaccine and therapeutics, including the monoclonal antibody therapy and an antiviral treatment, all of which were developed with past US government support. Collectively, these interventions and the rapid response effort helped stop the virus from spreading beyond Ugandan borders, ultimately protecting lives around the world and quelling the potential threat to Americans. Thanks to sustained US investment in Ebola research and outbreak response since 2011, the United States had the knowledge, infrastructure, and tools needed to respond quickly and effectively to the recent outbreak—minimizing the threat to regional stability and American public health.Beyond Ebola, the US government has also advanced other global health breakthroughs that have directly benefited Americans, including new drug-resistant tuberculosis treatments, long-acting HIV prevention and treatment options, and vaccines for mpox.Global health R&D strengthens US global influence, while also protecting military personnelGlobal health R&D has historically been a powerful diplomatic tool for the United States in strengthening its partnerships and ties around the world. By drawing back its investments, the United States risks ceding leadership in the foreign policy and medical research space to other countries—including its geopolitical rivals—who could step up to fill part of the vacuum left behind. Take China for example: in recent years, it has continued to grow its R&D investments, diminishing the gap between American and Chinese investments. Additionally, at the 2024 Forum on China Africa Cooperation, the Chinese government announced plans to encourage Chinese businesses to invest in the production of medicines and vaccines in Africa as part of its 2025-2027 action plan. As other global actors expand their influence in global health, including through increased investment in medical innovation and manufacturing, the United States must remain engaged to preserve its leadership, uphold its values, and continue delivering lifesaving impact around the world. Diminished leadership in global health innovation could also increase the vulnerability of US military personnel stationed around the world. Infectious diseases are the single largest cause of hospitalizations of US servicemembers during conflicts, representing an average of nearly 60 percent of casualties in recent conflicts. Global health technologies advanced through foreign assistance dollars and non-defense spending have helped keep US warfighters healthy and safe. For example, the US Centers for Disease Control and Prevention helped create a test to ensure US military uniforms treated with malaria-targeting insecticides remain effective, and USAID supported the development of tafenoquine, a single-dose medicine used to treat Plasmodium vivax malaria, as well as the only US Food and Drug Administration-approved treatment for leishmaniasis, a parasitic disease common in the Middle East. Without continued investments in research, challenges like growing antibiotic resistance could put the US military in an increasingly vulnerable position.Global health R&D drives American innovation and prosperityBetween 2007 and 2022, the US government invested just under $46 billion in R&D for neglected diseases, emerging infectious diseases, and sexual and reproductive health issues (To put this amount in context, in 2022 alone, the US government spent $751 billion on defense and $1.34 trillion on Medicare and Medicaid). This relatively modest investment helped contribute to the development of 67 new technologies approved since 1999 for neglected and emerging diseases (excluding COVID-19) and fueled a burgeoning pipeline of 261 promising products in late-stage development, which could further reduce the human and economic toll of these diseases.Beyond its health impact, this investment has also delivered substantial economic benefits to the US economy. Between 2007 and 2022, at least 86 percent of all funding that the US government directed to global health R&D was reinvested in American companies and institutions. This investment has created an estimated 600,000 new American jobs, spurred $104 billion in direct economic activity, and yielded scientific knowledge to inspire further innovations, which will ultimately generate $255 billion in long-term benefits to the American economy.These investments have also proven their potential to create cost savings, by driving down health care costs or preventing costly care down the line. For example, switching all patients with drug-resistant tuberculosis to regimens incorporating a new drug, pretomanid, which was developed with support from USAID and the National Institutes of Health, could generate global cost savings of $740 million annually. Even modest investments in scientific research can yield significant economic returns for the United States. The good we do makes us great Investment in global health R&D makes up just a small portion of the federal budget—around 0.8 percent in fiscal year 2022—but it has a priceless impact on the lives and livelihoods of Americans and people in need around the world. When the United States invests in global health research, we create opportunities and benefit the health of people in our nation and around the world. We fuel innovation at home. We create jobs. We make friends and allies. We make the world safer, and we make our world safer too. It’s the good we do, in part, that makes us great. As the US government reimagines its foreign assistance architecture and makes future research funding decisions, global health R&D efforts must be prioritized to preserve the progress we’ve made and deliver the bold breakthroughs of tomorrow. Sustaining the US government’s commitment to global health R&D will yield strategic and cost-effective benefits, bringing us closer to a safer, stronger, and more prosperous America and world—but only if we are able to meet the moment we are in.