GAO finds gaps in federal pandemic planning

Sep 11, 2007 (CIDRAP News) – In an analysis of the US government's pandemic influenza preparedness plan, the Government Accountability Office (GAO) yesterday called on federal agencies to clarify their leadership responsibilities and recommended interagency testing and training exercises to improve preparedness.

Feedback from the GAO is primarily aimed at the Homeland Security Council (HSC), the White House group that authored the federal government's two pandemic planning documents: the National Strategy for Pandemic Influenza, released in November 2005, and the Implementation Plan for the strategy, published in May 2006.

The GAO, Congress's investigative agency, based its conclusions on a review of federal emergency and response plans, interviews with agency officials, and a comparison of the strategy and plan with six strategic effectiveness characteristics the agency has identified.

Report offers support, criticism
The 52-page report acknowledges the work federal officials have done to prepare for a flu pandemic, such as establishing an information clearinghouse, developing planning checklists for government agencies and other groups, and building the Strategic National Stockpile of drugs and medical supplies. However, federal plans do not adequately address leadership roles and responsibilities, the report says. For example, the plans don't outline how the secretaries of the departments of Health and Human Services (HHS) and Homeland Security (DHS) would share leadership in a pandemic.

Recent legislation designating the Federal Emergency Management Agency administrator as the president's principal domestic emergency management advisor has also clouded the leadership structure, the report asserts.

Most of the leadership roles and responsibilities have not been tested in pandemic simulation exercises, the GAO found. "Without rigorous testing, training, and exercising, the administration lacks information to determine whether current and evolving leadership roles and responsibilities are clear and clearly understood or if more changes are needed to ensure clarity," the report states.

Rep. Henry Waxman, D-Calif., chairman of the House Committee on Oversight and Government Reform, was one of a group of lawmakers who requested the report, the Associated Press (AP) reported yesterday.

"It is vital to resolve questions of turf, responsibility, and performance in advance, rather than in the heat of an actual pandemic," Waxman told the AP.

Of six desirable characteristics that the GAO uses to gauge the effectiveness of various federal strategies, investigators found that the national pandemic strategy and plan address only one: defining problems and assessing risks. The documents partially address four of the GAO's criteria: having a clear purpose, scope, and methodology; defining goals, objectives, activities, and performance measures; outlining organizational roles, responsibilities, and coordination; and addressing integration and implementation.

The GAO analysis asserts that the pandemic plan lacks mechanisms for monitoring and reporting progress and strongly criticizes the HSC's December 2006 status report. The report was intended to cover actions that were to have been completed within 6 months. "However, some of the actions the HSC reported as complete were still underway, and other actions that were supposed to be completed were omitted from the report," the GAO states.

In assessing the final criterion—addressing resources—investigators say the HSC did not project how much the strategy would cost or detail how resources would be used. "Whereas the plan does not allocate funds to specific action items, our analysis of budget documents indicates that the funds were allocated primarily toward those action items related to vaccines and antivirals," the GAO reports.

Recommendations aim to close gaps
The GAO makes two recommendations to enhance federal preparedness efforts. One is for the HHS and DHS secretaries to work together to conduct testing and training exercises. The other is for the HSC to establish a process and time frame for updating the pandemic implementation plan. The GAO advises the HSC to include the following information in its next plan update:

  • Cost, resources, and allocations needed to complete the action items in the plan
  • A process for monitoring and publicly reporting on the plan's progress
  • Clearer linkages with the pandemic strategies and plans of other government agencies
  • Straightforward descriptions of priorities and relationships among action items and greater use of outcome-oriented performance measures

The GAO says it sent a draft of the report to HHS, DHS, and HSC. HHS responded that it had no comments and concurred with the report. DHS said it agreed with the GAO's first recommendation—to work with HHS on training and exercises—but was already taking action on many of the shortcomings identified in the report. The HSC did not comment on the report.

See also:

GAO report on influenza pandemic planning

National Strategy for Pandemic Influenza

National Strategy for Pandemic Influenza: Implementation Plan

Dec 29, 2006 CIDRAP News story "Feds detail progress on pandemic preparedness"

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