GAO: States want more pandemic planning guidance

Jul 29, 2008 (CIDRAP News) – Despite a wide range of pandemic planning guidance documents from federal and private groups, states say they still need more information from federal officials, particularly on community mitigation measures, fatality management, and supporting medical surge efforts, the Government Accountability Office (GAO) reported recently.

The GAO released its findings on Jul 19 in a 52-page report posted on its Web site. Members of Congress had asked the GAO to describe how states and localities were preparing for a pandemic, along with how they handled their pandemic exercises, what they learned from them, and how the federal government can better assist state and local officials with pandemic planning.

The GAO based its findings on visits to the five most populous states, California, Florida, Illinois, New York, and Texas, and ten localities within them. The localities included five urban areas—Los Angeles County, Miami, Chicago, New York City, and Dallas—and five rural counties: Stanislaus County, California; Taylor County, Florida; Peoria County, Illinois; Washington County, New York; and Angelina County, Texas. Taken together, the areas include a third of the US population and account for a third of federal funds for pandemic planning exercises, and they also are border areas or international travel hubs. All 15 of the sites had developed pandemic plans.

Spotty preparations
One of the findings was that states and localities have had little involvement with federal pandemic planning efforts, despite the fact that, according to the National Pandemic Implementation Plan, they must lead 17 of it 324 action items and are involved in 64 other tasks. "Stakeholder involvement during the planning process is important to ensure that the federal government's and nonfederal entities' responsibilities and resource requirements are clearly understood and agreed on," the GAO reported.

In 2007 the US Department of Health and Human Services (HHS) reviewed states' pandemic plans. The agency found many major gaps in 16 of 22 priority areas and a few major gaps in six other areas. HHS officials told GAO investigators that states have generally done well planning public health measures such as mass vaccination and antiviral distribution, but were less adept in other areas such school closures and maintaining critical infrastructure.

"We found the areas in which state and local officials were looking for additional federal guidance were often the same areas that were rated by HHS as having 'many major gaps' in planning," the investigators wrote.

Federal officials issued a pandemic planning guide for the states in March 2008; the states are required to submit updated plans for review by the end of July.

All the states and all but two of the localities in the GAO study had conducted a pandemic exercise to test their plans. All said they had incorporated lessons learned during the exercises into their pandemic planning. For example, officials in New York City learned they might experience a ventilator shortage and purchased 70 additional units. And officials in Stanislaus County, California, learned they needed to train their staff on how to use the National Incident Management System, a nationwide public-private system that prepares for and responds to domestic emergencies.

Lots of resources, but not enough
The GAO detailed myriad resources for states, including checklists, planning documents, and Webinars from the federal government as well as the private sector. Federal officials have also hosted five regional workshops on pandemic planning. However, investigators found that states and localities still would like more guidance on specific topics, including some—such as community mitigation measures—that have already been addressed. "The existing guidance may not have reached state and local officials or may not address the particular concerns or circumstances of the state and local officials we interviewed," the auditors wrote.

Other areas on which nonfederal officials said they wanted more guidance included fatality management, how to support medical surge capacity, mass vaccination, antiviral drug distribution, how to plan quarantine stations, how to handle school closures, and how to maintain critical infrastructure.

In some instances, states are developing their own guidance, the GAO reported. For example, California is developing medical surge guidelines for healthcare professionals, and Texas has developed an antiviral prioritization plan.

GAO calls for more regional workshops
The GAO recommended that federal officials hold more regional pandemic planning sessions for states to address some of the topics and address gaps in planning. However, a senior official in the Department of Homeland Security (DHS) told investigators that no more workshops were planned.

HHS generally agreed with the GAO's recommendation and said it might consider holding more regional planning workshops after its staff finishes reviewing state pandemic plan revisions. DHS said in a letter accompanying the report that it also agreed with the GAO's recommendation.

See also:

Jul 19 GAO report on state pandemic planning

Mar 14 CIDRAP News story "HHS issues pandemic planning guide for states"

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