{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:22:10Z","timestamp":1789802530848,"version":"4.0.1"},"reference-count":16,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Security"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>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)\u2014flexible contracting mechanisms exempt from standard federal procurement requirements\u2014restricted ICATT\u2019s 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.<\/jats:p>","DOI":"10.1177\/23265094261464012","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:25:51Z","timestamp":1785475551000},"page":"355-358","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding Contracting Authorities Across the Department of Health and Human Services Family of Agencies to Address Critical Public Health Needs"],"prefix":"10.1177","volume":"24","author":[{"given":"Debra","family":"Zides","sequence":"first","affiliation":[{"name":"Debra Zides, MA, MS, is Principal Program Manager for Rapid and Agile Acquisition, The MITRE Corporation, Burlington, MA. Sutyajeet Soneja, PhD, is an Associate Scientist, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and Center for Outbreak Response and Innovation, Johns Hopkins Center for Health Security; both in Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sutyajeet","family":"Soneja","sequence":"additional","affiliation":[{"name":"Debra Zides, MA, MS, is Principal Program Manager for Rapid and Agile Acquisition, The MITRE Corporation, Burlington, MA. Sutyajeet Soneja, PhD, is an Associate Scientist, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and Center for Outbreak Response and Innovation, Johns Hopkins Center for Health Security; both in Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"1.US Centers for Disease Control and Prevention. Increasing Community Access to Testing (ICATT) for COVID-19. https:\/\/www.cdc.gov\/icatt\/index.html"},{"issue":"5","key":"e_1_3_2_3_1","article-title":"The Increasing Community Access to Testing, Treatment, and Response program \u2014 a model for future public health emergency response","volume":"7","author":"Tsai TC","year":"2026","unstructured":"2.Tsai TC, , Yu E, , Godoshian A, et al. The Increasing Community Access to Testing, Treatment, and Response program \u2014 a model for future public health emergency response. NEJM Catal. 2026;7(5).","journal-title":"NEJM Catal"},{"key":"e_1_3_2_4_1","unstructured":"3.Administration for Strategic Preparedness and Response. Public health emergency declaration. Accessed June 9 2026. https:\/\/aspr.hhs.gov:443\/legal\/PHE\/Pages\/Public-Health-Emergency-Declaration.aspx"},{"key":"e_1_3_2_5_1","unstructured":"4.Public Health Emergencies. 42 USC \u00a7247d. https:\/\/www.govinfo.gov\/content\/pkg\/USCODE-2019-title42\/html\/USCODE-2019-title42-chap6A-subchapII-partB-sec247d.htm"},{"key":"e_1_3_2_6_1","unstructured":"5.US Government Accountability Office (GAO). COVID-19: Continued Attention Needed to Enhance Federal Preparedness Response Service Delivery and Program Integrity. Washington DC: GAO; 2021. Accessed June 9 2026. https:\/\/www.gao.gov\/products\/gao-21-551"},{"key":"e_1_3_2_7_1","unstructured":"6.ARPA-H. Other Transaction Community. Accessed June 9 2026. https:\/\/arpa-h.gov\/engage-and-connect\/other-transaction-community"},{"key":"e_1_3_2_8_1","unstructured":"7.US Government Accountability Office (GAO). COVID-19 Contracting: Actions Needed to Enhance Transparency and Oversight of Selected Awards. Washington DC: GAO; 2021. Accessed June 9 2026. https:\/\/www.gao.gov\/products\/gao-21-501"},{"key":"e_1_3_2_9_1","unstructured":"8.Consolidated Appropriations Act 2023 Pub L No. 117-328. https:\/\/www.govinfo.gov\/app\/details\/PLAW-117publ328"},{"key":"e_1_3_2_10_1","unstructured":"9.Biomedical Advanced Research and Development Authority 42 USC \u00a7247d\u20137e (2024). https:\/\/www.govinfo.gov\/app\/details\/USCODE-2024-title42\/USCODE-2024-title42-chap6A-subchapII-partB-sec247d-7e"},{"key":"e_1_3_2_11_1","unstructured":"10.Advanced Research Projects Agency\u2013Health. 42 USC \u00a7290c (2022). https:\/\/www.govinfo.gov\/content\/pkg\/USCODE-2024-title42\/pdf\/USCODE-2024-title42-chap6A-subchapIII-partJ-sec290c.pdf"},{"key":"e_1_3_2_12_1","unstructured":"11.National Institutes of Health. Other Transactions. Last updated October 1 2024. Accessed June 9 2026. https:\/\/grants.nih.gov\/funding\/funding-categories\/other-transactions"},{"key":"e_1_3_2_13_1","unstructured":"12.Appointment and Authority of the Director of the Centers for Disease Control and Prevention. 42 USC \u00a7242c (2024). https:\/\/www.govinfo.gov\/app\/details\/USCODE-2024-title42\/USCODE-2024-title42-chap6A-subchapII-partA-sec242c"},{"key":"e_1_3_2_14_1","unstructured":"13.US Government Accountability Office. Other Transaction Agreements: DOD can improve planning for consortia awards. Published September 20 2022. Accessed June 9 2026. https:\/\/www.gao.gov\/products\/gao-22-105357"},{"key":"e_1_3_2_15_1","unstructured":"14.Public Health Service. 42 USC Chapter 6A. https:\/\/www.govinfo.gov\/content\/pkg\/USCODE-2014-title42\/pdf\/USCODE-2014-title42-chap6A.pdf"},{"key":"e_1_3_2_16_1","unstructured":"15.Research Projects: Transactions Other than Contracts and Grants (2024). 10 USC \u00a74021. https:\/\/www.govinfo.gov\/app\/details\/USCODE-2024-title10\/USCODE-2024-title10-subtitleA-partV-subpartE-chap301-subchapII-sec4021"},{"key":"e_1_3_2_17_1","unstructured":"16.Authority of the Department of Defense to Carry Out Certain Prototype Projects. 10 USC \u00a74022 (2024). https:\/\/www.govinfo.gov\/content\/pkg\/USCODE-2024-title10\/pdf\/USCODE-2024-title10-subtitleA-partV-subpartE-chap301-subchapII-sec4022.pdf"}],"container-title":["Health Security"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23265094261464012","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23265094261464012","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23265094261464012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:46:11Z","timestamp":1789800371000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23265094261464012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8,1]]}},"alternative-id":["10.1177\/23265094261464012"],"URL":"https:\/\/doi.org\/10.1177\/23265094261464012","relation":{},"ISSN":["2326-5094","2326-5108"],"issn-type":[{"value":"2326-5094","type":"print"},{"value":"2326-5108","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}