A new report from the US Government Accountability Office (GAO) finds that two key federal programs designed to bolster the nation’s public health emergency readiness lack formal coordination and do not adequately track whether states and local jurisdictions can respond effectively to public health threats and emergencies.
GAO reviewed US Department of Health and Human Services (HHS) documentation, including notices of funding opportunity, templates, and examples of documents from eight jurisdictions selected to include variation among geographic location, proportion of the population living in rural areas, and public health governance structure. The team also interviewed officials from HHS and the eight jurisdictions.
HHS administers nearly $900 million annually through the Public Health Emergency Preparedness (PHEP) program and the Hospital Preparedness Program (HPP). In 2024, HHS awarded $654 million to states and local jurisdictions through PHEP and $240 million through HPP.
These programs are intended to strengthen the nation’s ability to prepare for and respond to threats ranging from extreme weather and nuclear or chemical events to infectious disease outbreaks.
Data on states’ preparedness not collected
Jurisdictions are required to complete a series of activities as a condition of receiving these funds, including developing preparedness plans, training staff, and conducting exercises.
But GAO found that HHS lacks formal mechanisms—such as joint exercises, written agreements, or working groups—for coordinating PHEP and HPP.
“HHS is missing opportunities to coordinate between these two programs,” the authors wrote. “For example, funding recipients from both programs could be required to conduct joint training and exercises.”
Officials reported holding monthly meetings to discuss due dates and supplemental guidance, but the meetings are informal and undocumented. Earlier efforts aimed at coordination, including joint grant management, interagency work groups, and Centers for Disease Control and Prevention (CDC) site visits, are no longer in place.
Lessons learned from the COVID-19 pandemic have demonstrated the importance of coordination between these systems...if jurisdictions are to be effectively prepared,
The report also found that HHS does not collect or analyze information on whether jurisdictions can meet the 15 public health preparedness capabilities and four health care preparedness capabilities outlined by HHS as necessary to effectively respond to and recover from public health threats. These capabilities include mass medical care and laboratory testing at scale for emerging pathogens.
“Lessons learned from the COVID-19 pandemic have demonstrated the importance of coordination between these systems, such as between state health departments and hospitals, if jurisdictions are to be effectively prepared,” the report said. “Additionally, officials from selected jurisdictions said that greater interagency coordination could help reduce resource inefficiencies associated with implementation of PHEP and HPP.”
Recommendations to improve preparedness
Being able to collect and analyze data on jurisdictions’ ability to meet preparedness capabilities would give HHS a clearer picture of national readiness. Such information is critical not only to guide federal support but also to assess whether PHEP and HPP investments are building preparedness nationwide.
“Effectively preparing for public health threats, such as hurricanes and wildfires, is essential to saving lives during emergencies,” notes the report. Activities such as exercises, assessments, and trainings “build and sustain jurisdictions’ preparedness capabilities through PHEP and HPP. These activities are crucial to support jurisdictions and their health care system partners to prepare for and respond to public health threats.”
GAO made five recommendations to improve preparedness, including that HHS establish a formal mechanism to coordinate PHEP and HPP and develop a process to collect and analyze information on jurisdictions’ preparedness capabilities and related gaps. HHS concurred with the recommendations.
