Strengthening Emergency Preparedness and Response
HHS faces challenges in strengthening preparedness for responding to public health emergencies resulting from pandemics like the one caused by the 2009 HINI influenza virus, natural disasters like Hurricane Katrina, and potential bioterrorism. Although HHS plays a key role responding to these public health threats, it shares leadership responsibilities with the Department of Homeland Security (DHS) and others to coordinate the federal response and, often must work with states and localities to ensure adequate preparedness and response.
Highlights of GAO-10-381T
Potential terrorist attacks and the possibility of naturally occurring disasters have raised concerns about the "surge capacity" of the nation's health care systems to respond to mass casualty events, that is, the ability to adequately care for a large number of patients or patients with unusual medical needs. The federal government has provided funding, guidance, and other assistance to help states prepare for medical surge in a mass casualty event. Many states have made efforts to increase hospital capacity, plan for alternate care sites, and develop electronic medical volunteer registries, but fewer states have planned for altered standards of care. State officials in GAO's 20-state review reported that they faced challenges relating to all four key components in preparing for medical surge.
GAO's work has pointed out that although the previous administration had taken a number of actions to plan for an influenza pandemic, including developing a national strategy and implementation plan, many issues need to be addressed. Specifically,
- leadership roles and responsibilities need to be clarified, tested, and exercised, and existing mechanisms could be better utilized to address challenges in coordination between the federal, state, and local governments, and the private sector,
- efforts are underway to improve the surveillance and detection of pandemic-related threats, but targeting assistance to countries at the greatest risk has been based on incomplete information,
- the United States and other countries, as well as states and localities, have developed influenza pandemic plans, but planning gaps remain—for example, HHS found many major gaps in states' pandemic plans,
- an outbreak will require additional capacity in many areas, including the procurement of additional patient treatment space and the acquisition and distribution of medical and other critical supplies, such as antivirals and vaccines for an influenza pandemic,
- federal agencies have provided considerable guidance and pandemic-related information to state and local governments, but could augment their efforts with additional information on vaccine distribution and other topics,
- performance monitoring and accountability for pandemic preparedness needs strengthening—such as greater agency accountability to protect federal workers in a pandemic, and
Highlights of GAO-09-909T (PDF), Highlights of GAO-09-334 (PDF)
- monitoring and assessing the status of the national pandemic implementation plan needs improvement.
Highlights of GAO-10-73 (PDF)
The Centers for Disease Control and Prevention (CDC), an agency within HHS, continues to face challenges in developing data systems that help federal, state, and local health officials respond to public health events. For example, CDC took steps to redesign BioSense, an electronic syndromic surveillance system that uses health-related data to identify patterns of disease symptoms prior to specific diagnoses, in order to improve collaboration and address management weaknesses. However, CDC's draft plan for its redesign does not have reliable cost estimates and timelines and the agency has not developed outcome-based performance measures to monitor the program
Highlights of GAO-09-100 (PDF)
^ Back to topWhat Needs to Be Done
HHS should make the following improvements for pandemic preparedness, including:
- Work with DHS to clarify their respective roles and responsibilities through testing, training, and exercising, and ensure that these roles are clearly understood by state, local, and tribal governments; the private and nonprofit sectors; and the international community,
- Finalize guidance to assist state and local jurisdictions to determine how to effectively use limited supplies of antivirals and pre-pandemic vaccine in a pandemic, and
- Coordinate with DHS and other federal agencies to assist states in address identified gaps in their plans. (GAO-09-909T).
CDC should develop reliable cost and timeline estimates and outcome-based performance measures for implementing the redesigned BioSense program.
Highlights of GAO-09-100 (PDF)
The Administration’s Homeland Security Council should make the following improvements to monitoring and assessing the status of the national pandemic implementation plan, including:
- Develop a monitoring and reporting process for action items intended for nonfederal entities,
- Identify the types of information needed to carry out the response-related action items, and
- Improve how completion is assessed.
Highlights of GAO-10-73 (PDF)
^ Back to topKey Reports
- Emergency Preparedness: State Efforts to Plan for Medical Surge Could Benefit from Shared Guidance for Allocating Scarce Medical Resources
- GAO-10-381T, January 25, 2010
- Summary (HTML) Highlights Page (PDF) Full Report (PDF, 20 pages) Accessible Text
- Influenza Pandemic: Monitoring and Assessing the Status of the National Pandemic Implementation Plan Needs Improvement
- GAO-10-73, November 24, 2009
- Summary (HTML) Highlights Page (PDF) Full Report (PDF, 53 pages) Accessible Text Recommendations (HTML)
- Influenza Pandemic: Gaps in Pandemic Planning and Preparedness Need to Be Addressed
- GAO-09-909T, July 29, 2009
- Summary (HTML) Highlights Page (PDF) Full Report (PDF, 30 pages) Accessible Text
- Influenza Pandemic: Sustaining Focus on the Nation's Planning and Preparedness Efforts
- GAO-09-334, February 26, 2009
- Summary (HTML) Highlights Page (PDF) Full Report (PDF, 58 pages) Accessible Text
