Strengthening Preparedness for Large-Scale Public Health Emergencies

Recent natural disasters, the spread of severe acute respiratory syndrome (SARS) from China in 2002 and the persistent threat of an 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. Some efforts have already been made at the federal level to develop systematic planning guidance. For example, the administration issued a National Strategy for Pandemic Influenza in 2005 to guide federal efforts to prepare and respond to a possible pandemic, as well as an Implementation Plan for the National Strategy for Pandemic Influenza in 2006 that describes the responsibilities of federal agencies and the expectations of nonfederal entities in pandemic preparedness and response. Additionally, the Congress has appropriated more than $6 billion since 2002 to support activities to strengthen state and local governments’ emergency preparedness capabilities.  HHS has distributed these funds annually to the states, territories, and four large municipalities through a CDC grant program for public health preparedness and a separate hospital preparedness program.  CDC’s program provides both funds and guidance to help state and local entities improve public health systems’ abilities to respond to bioterrorism and other public health emergencies, such as providing mass vaccinations or antibiotics.  Many states have used the hospital preparedness funds in their efforts to improve the surge capacity of the nation’s health care systems by increasing hospital capacity, setting up registries of volunteer health professionals, planning for alternative care sites, and, to a lesser extent, developing guidelines for allocating scarce medical resources in the event of mass casualties.  Federal agencies, however, continue to face challenges in working with one another and with state and local governments, private organizations, and international partners to

• establish clearer federal leadership roles;

  Highlights of GAO-07-781 (PDF)

• coordinate response efforts to identify and assess the magnitude of threats;

  Highlights of GAO-06-618 (PDF)

• develop effective countermeasures, such as vaccines;

  Highlights of GAO-08-671 (PDF), Highlights of GAO-08-92 (PDF)

• marshal the resources required for an effective public health response, such as developing health system surge capacity to handle large numbers of casualties; and

  Highlights of GAO-08-668 (PDF)

• provide for increased interaction between the federal government and other partners over which groups will play important roles in response to public health emergencies.

  Highlights of GAO-08-36 (PDF)

^ Back to topWhat Needs to Be Done

• DHS and HHS should work together to develop and conduct rigorous testing, training, and exercises for pandemic influenza to ensure that federal leadership roles are clearly defined and understood and that leaders are able to effectively execute shared responsibilities to address emerging challenges, and then ensure that these roles are clearly understood by state, local, and tribal governments; the private and nonprofit sectors, and the international community.

  Highlights of GAO-07-781 (PDF)

• The Homeland Security Council needs to establish a specific process and time frame for updating the national pandemic implementation plan that will involve key nonfederal stakeholders and incorporate lessons learned from exercises and other sources.

  Highlights of GAO-07-781 (PDF)

• HHS should expeditiously finalize guidance to assist state and local jurisdictions to determine how to effectively use limited supplies of antivirals and prepandemic vaccines in an influenza pandemic, including prioritizing target groups for prepandemic vaccines.

  Highlights of GAO-08-671 (PDF)

• HHS should further assist states in determining how they will allocate scarce medical resources in a mass casualty event by serving as a clearinghouse for sharing among the states altered standards of care guidelines that have been developed by individual states or medical experts.

  Highlights of GAO-08-668 (PDF)

• While a system of coordinating councils was created to facilitate planning between government and the private sector for critical infrastructure protection, DHS should use these mechanisms more fully to help in planning for a pandemic influenza.

  Highlights of GAO-08-36 (PDF)

• HHS should develop a departmental-level plan to deal with the health effects that responders may experience by incorporating lessons identified from the World Trade Center health programs.

  Highlights of GAO-08-610 (PDF)

• DHS needs to address gaps identified by federal and state officials in the federal government's ability to help states respond to the psychological consequences of catastrophic disasters.

  Highlights of GAO-08-22 (PDF)

• In coordination with other federal partners such as DOD, HHS, and VA, DHS should address limitations in how the federal government provides assistance with the evacuation of nursing home facilities.

  Highlights of GAO-06-826 (PDF)

• HHS and DHS, in coordination with other federal agencies, should convene additional meetings of the states in the five federal influenza pandemic regions to help them address identified gaps in their pandemic planning.

  Highlights of GAO-08-539 (PDF)

^ Back to topKey Reports

Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer Federal Leadership Roles and an Effective National Strategy

GAO-07-781, August 14, 2007

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 56 pages)   Accessible Text   Recommendations (HTML)

Influenza Pandemic: Efforts Under Way to Address Constraints on Using Antivirals and Vaccines to Forestall a Pandemic

GAO-08-92, December 21, 2007

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 76 pages)   Accessible Text

Catastrophic Disasters: Federal Efforts Help States Prepare for and Respond to Psychological Consequences, but FEMA's Crisis Counseling Program Needs Improvements

GAO-08-22, February 29, 2008

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 61 pages)   Accessible Text   Recommendations (HTML)

Disaster Preparedness: Limitations in Federal Evacuation Assistance for Health Facilities Should be Addressed

GAO-06-826, July 20, 2006

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 57 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)

Influenza Pandemic: Federal Agencies Should Continue to Assist States to Address Gaps in Pandemic Planning

GAO-08-539, June 19, 2008

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 52 pages)   Accessible Text   Recommendations (HTML)

September 11: HHS Needs to Develop a Plan That Incorporates Lessons from the Responder Health Programs

GAO-08-610, May 30, 2008

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 37 pages)   Accessible Text   Recommendations (HTML)

Influenza Pandemic: Opportunities Exist to Address Critical Infrastructure Protection Challenges That Require Federal and Private Sector Coordination

GAO-08-36, October 31, 2007

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 51 pages)   Accessible Text   Recommendations (HTML)

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)