Expanding Contracting Authorities Across the Department of Health and Human Services Family of Agencies to Address Critical Public Health Needs

The US Centers for Disease Control and Prevention Increasing Community Access to Testing (ICATT) program rapidly expanded no-cost COVID-19 testing through commercial pharmacies in 2021, prioritizing rural and high Social Vulnerability Index (SVI) communities. Using public health emergency (PHE) authorities and Federal Acquisition Regulation (FAR) waivers, ICATT achieved its initial goal of 10,000 sites. However, a subsequent shift to FAR-based competitive contracting without waivers limited participation by key retail vendors, leading to the discontinuation of over 1,700 testing sites and constraining further expansion to a 20,000-site target. This case highlights structural limitations in Department of Health and Human Services (HHS) contracting authorities that hinder rapid scaling of medical countermeasure (MCM) services during emergencies. Specifically, limited statutory access to Other Transaction Authorities (OTAs)-flexible contracting mechanisms exempt from standard federal procurement requirements-restricted ICATT's ability to engage nontraditional vendors with extensive community reach. Existing OTA authorities within HHS are largely confined to product development (eg, vaccines, therapeutics) and do not adequately encompass service delivery models such as diagnostic testing. Expanding OTA authority across HHS agencies and broadening its scope to include MCM services could address these gaps. Drawing on precedents from the US Department of Defense, enhanced OTA use would enable more agile partnerships, reduce administrative barriers, and support rapid prototyping and scale-up of public health interventions. Key policy recommendations include congressional action to extend OTA applicability across HHS and to explicitly authorize their use for service-based public health responses, alongside investments in workforce capacity and acquisition policy development. Strengthening HHS contracting flexibility is critical to ensuring equitable access to essential services and improving responsiveness in future public health emergencies.