The PHEMCE Ensures Effective Medical Countermeasure Coordination
In emergency response, success depends on teamwork long before the sirens sound. When firefighters arrive at a burning building, they rely on dispatchers, emergency medical personnel, emergency managers, and countless others who work together for a shared purpose.
The same is true for medical countermeasures (MCMs). The diagnostics, therapeutics, vaccines, and other medical countermeasures used during and following a public health emergency don’t appear overnight and don’t result from any individual effort.
The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) was established by the U.S. Department of Health and Human Services (HHS) in 2006 and codified by Congress in 2019 as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA). PAHPAIA formalized this interagency body and granted authorities that established a robust pipeline to review and propose investments for MCMs.
Today the PHEMCE serves as the federal government’s central coordinating body for end-to-end medical countermeasure preparedness. Its purpose is straightforward but essential: ensuring that the right partners are working together effectively to identify the nation’s medical countermeasure needs, establish priorities, and move promising products from concept to capability.
How the PHEMCE Advances Readiness and Promotes Coordination
The PHEMCE’s interagency senior leaders meet regularly to ensure agencies’ MCM-related missions operate within a single enterprise, with a shared strategy and objective. Its focus is on medical countermeasure preparedness, helping the nation develop a portfolio of medical countermeasures that address chemical, biological, radiological and nuclear threats, including emerging infectious diseases. It promotes coordination across the federal government that spans the entire medical countermeasure lifecycle.
This coordination extends well beyond the federal government. Medical countermeasure development depends on partnerships with biotechnology companies, pharmaceutical manufacturers, academic researchers, healthcare systems, and many others. These partners make significant investments in research, development, manufacturing capacity, and innovation. They also benefit from understanding the government’s long-term preparedness priorities.
Preparedness Goes Beyond the Science
MCM development starts with understanding potential health threats. The PHEMCE mission focuses on being prepared for highly unlikely events. However, in the world of possible threats, how do we narrow the list to what is most likely? The Department of Homeland Security works with intelligence community partners to best understand our adversaries and the deliberate threat space, while our One Health partners consider how and where a novel pathogen could emerge. This input is coupled with information to estimate the potential to cause a public health emergency. The threats that pose the greatest risk to national security are designated PHEMCE priority threats.
Focusing on the priority threats, multiple federal agencies partner to ensure there are countermeasures in the pipeline to address the greatest threats to public health. Each agency brings unique authorities and expertise, but none is sufficient to bring a countermeasure through the pipeline alone. The National Institutes of Health supports foundational research that advances scientific discovery. The Biomedical Advanced Research and Development Authority (BARDA) partners with industry primarily to support more advanced development and, in some cases, procurement of MCMs that can be used to protect the nation. The Food and Drug Administration provides regulatory oversight to help ensure products are safe and effective. The Centers for Disease Control and Prevention supports public health planning and guidance for the deployment, distribution, and use of MCMs. The Strategic National Stockpile maintains supplies of certain critical medical countermeasures for deployment in an emergency. Beyond HHS, interagency partners, including DOW, VA, USDA, and others, support MCM development efforts through shared expertise, resources, and collaboration.
Without deliberate coordination across those stages, even promising medical countermeasures can stall before reaching the people they are intended to protect. PHEMCE helps prevent gaps by bringing agencies together to evaluate threats, identify capability needs, coordinate investments, and align planning across the entire enterprise.
The PHEMCE Aligns Partners
Two of PHEMCE’s most important tools for providing that shared understanding are the PHEMCE Strategy and Implementation plan (SIP) and the Multiyear Budget (MYB).
By aligning planning across agencies and communicating those priorities publicly, the SIP and the MYB also help our partners better anticipate future needs and support more informed investment decisions. The SIP highlights our long-term goals and our short-term objectives. More than a budget document, the MYB offers a coordinated view of the federal government's priorities and projected investments across the medical countermeasure enterprise. It reflects the professional judgment of every major federal agency working in this space — looking at priority threats and what's feasible for R&D, manufacturing, storage, and deployment.
Our current approach stretches every taxpayer dollar provided, balancing multi-threat technologies that can address a broader range of threats with more targeted approaches.
However, even when we focus on efficiency, a robust, sustainable countermeasure enterprise depends on diverse, continuous investment at every stage, and appropriated funding hasn't kept pace with the full cost of R&D and stockpiling across the priority threat list. PHEMCE estimates that $66.9 billion is needed over five years to build a well-developed preparedness portfolio across all priority threats; if funding stays flat at FY 26 levels, that gap is projected at $33.5 billion over the same period. When the “worst day” does come — and we know it one day inevitably will — difficult conversations around this funding shortfall will inevitably follow.
Progress Towards the Emergency of Tomorrow Can Help Americans Today
The investments we’ve made have protected the health of Americans. Dedicated funding for H5N1 influenza supported diagnostics that could catch human transmission early, helped monitor how the disease was spreading across animal populations, and made sure existing antivirals were ready the moment they were needed. Past investments in research and procurement of diagnostics, vaccines, and therapeutics supported the response to the 2025 Ebola outbreaks in the Democratic Republic of Congo and the Marburg virus outbreak in Ethiopia, keeping both diseases from ever reaching the U.S. and advancing our MCM capabilities for domestic use should we ever need them.
How PAHPA Reauthorization Can Strengthen PHEMCE
The kind of long-term coordination PHEMCE enables has become increasingly important as potential health security threats continue to evolve. The reality is that moving an MCM from advanced research and development to the hands of the people who need it most is often a marathon, not a sprint. Investments in MCM portfolios must be sustained and require collaboration across organizations over years, not months. ASPR recognized that reality when it established the PHEMCE body nearly two decades ago.
As Congress considers reauthorization of PAHPA, we have an opportunity to build on that successful model. The Trump Administration has proposed several targeted improvements that would strengthen PHEMCE’s coordinating role, including better aligning the timing of the Multiyear Budget with the President's Budget, ensuring transparency and mission success.
Preparedness is ultimately a team effort. It requires different parties with different kinds of expertise to work together over the long term. Congress recognized that no single agency can accomplish this work alone. Through the PHEMCE, it established an enterprise that brings together the right partners to ensure the nation is better prepared for whatever public health emergencies lie ahead.
