Strengthening Preparedness for Large-Scale Public Health Emergencies

Why Area is Important

The federal government 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. Recent natural disasters, the current influenza pandemic, and the 2001 attack on the World Trade Center all highlight the need to plan for a coordinated response to large-scale public health emergencies. They also underscore the importance of the federal role in planning how to protect the American public, the nation's critical infrastructure, and the disaster responders involved in rescue, recovery, and cleanup activities. The Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS) working with other federal agencies, share leadership responsibilities to coordinate the federal response. In addition to federal coordination, HHS, DHS, and other federal agencies must work with states and localities to ensure adequate preparedness and response.

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, and Congress has appropriated funds to help states and localities, 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, and
• performance monitoring and accountability for pandemic preparedness needs strengthening.
  Full report of GAO-09-909T (PDF), Highlights of GAO-09-334 (PDF)

HHS and several of its agencies face challenges ensuring preparedness due to existing shortages of workers in the public health care sector at the national, state, and local levels. Given these shortages, HHS has proposed strategies such as encouraging the cross-training of people in key positions, including laboratory personnel, and creating a voluntary program that enables the sharing of health care professionals across state lines. However, these strategies continue to draw upon the same small pool of professionals.

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.

^ Back to topWhat Needs to Be Done

HHS and DHS should make the following improvements for pandemic preparedness, including:

• Work together 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, and
• Coordinate with DHS and other federal agencies to assist states in address identified gaps in their plans.

In addition, HHS should 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

CDC should develop reliable cost and timeline estimates and outcome-based performance measures for implementing the redesigned BioSense program

^ Back to topKey Reports

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

Influenza Pandemic: HHS Needs to Continue Its Actions and Finalize Guidance for Pharmaceutical Interventions

GAO-08-671, September 30, 2008

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 77 pages)   Accessible Text   Recommendations (HTML)

Emergency Preparedness: States Are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources

GAO-08-668, June 13, 2008

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 59 pages)   Accessible Text   Recommendations (HTML)

More Reports