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GAO Identifies Shortcomings in Coordination of Federal Pandemic Preparedness Efforts

By Jennifer Nuzzo, September 14, 2007

On September 10, 2007, the Government Accountability Office (GAO) released a review of federal pandemic influenza preparedness activities entitled Influenza Pandemic: Further Efforts are Needed to Ensure Clearer Federal Leadership Roles and an Effective National Strategy.1 The report, dated August 14, 2007, was completed by bipartisan Congressional (House) request.

According to the document, the objectives of the review were “to address the extent to which (1) federal leadership roles and responsibilities for preparing and responding to a pandemic are clearly defined and documented and (2) the [National] Strategy [for Pandemic Influenza] and the [Implementation] Plan [for the National Strategy for Pandemic Influenza] address the characteristics of an effective national strategy.”

In its review, the GAO analyzed the federal government’s pandemic plans, interviewed officials from the Departments of Homeland Security (DHS), Health and Human Services (HHS), Agriculture (USDA), Defense (DOD), Transportation (DOT), and State as well as the Vice Commandant of the U.S. Coast Guard “who has been predesignated as the national Principal Federal Official for pandemic influenza.” The GAO also assessed the Strategy and Plan to determine how well they jointly addressed the following “six desirable characteristics of an effective national strategy”:

1. “Purpose, scope, and methodology. Addresses why the strategy was produced, the scope of its coverage, and the process by which it was developed.
2. Problem definition and risk assessment. Addresses the particular national problems and threats the strategy is directed toward.
3. Goals, subordinate objectives, activities, and performance measures. Addresses what the strategy is trying to achieve; steps to achieve those results; as well as the priorities, milestones, and performance measures to gauge results.
4. Resources, investments, and risk management. Addresses what the strategy will cost, the sources and types of resources and investments needed, and where resources and investments should be targeted by balancing risk reductions and costs.
5. Organizational roles, responsibilities, and coordination. Addresses who will be implementing the strategy, what their roles will be compared to others, and mechanisms for them to coordinate their efforts.
6. Integration and implementation. Addresses how a national strategy relates to other strategies’ goals, objectives, and activities—and to subordinate levels of government and their plans to implement the strategy.”

The GAO review found that while the actions the administration has taken in preparing for an influenza pandemic “have been significant, considerably more work needs to be done.” In particular, “federal government leaderships roles and responsibilities for preparing for and responding to a pandemic continue to evolve and will require further clarification and testing before the relationships of many leadership positions are well-understood.” The GAO report points out that key federal pandemic planning documents “do not specify how the leadership roles and responsibilities would work” to address the likely pervasive and protracted effects of a pandemic. Specifically, “it is not clear how, in a pandemic, the Secretaries of Health and Human Services and Homeland Security would share leadership responsibilities in practice.”

The GAO also found that while federal preparedness plans adequately “address one of the desirable characteristics of an effective national strategy”— problem definition and risk assessment of a pandemic (#2)—the plans only partially address four of the characteristics (#1, 3, 5, 6). Furthermore, federal preparedness plans do not address the “financial resources and investments needed to implement the actions called for [in the plans]” (characteristic #4).

The GAO concluded that federal pandemic preparedness efforts may be enhanced if the following conditions are met:

1. The Secretaries of DHS and HHS “work together to develop and conduct rigorous testing, training and exercises for pandemic influenza to ensure that the federal leadership roles are clearly defined and understood and that leaders are able to effectively execute shared responsibilities to address emerging challenges”;
2. the “Homeland Security Council [establishes] a specific process and time frame for updating the Implementation Plan for the National Strategy for Pandemic Influenza.”1

Reference

1. U.S. Government Accountability Office. Influenza pandemic: Further efforts are needed to ensure clearer federal leadership roles and an effective national strategy. August 2007. http://www.gao.gov/new.items/d07781.pdf. Accessed September 13, 2007.