Summary
An influenza pandemic is a real and significant potential threat facing the United States and the world. Pandemics occur when a novel virus emerges that can easily be transmitted among humans who have little immunity. In 2005, the Homeland Security Council (HSC) issued a National Strategy for Pandemic Influenza and, in 2006, an Implementation Plan. Congress and others are concerned about the federal government's preparedness to lead a response to an influenza pandemic. This report assesses how clearly federal leadership roles and responsibilities are defined and the extent to which the Strategy and Plan address six characteristics of an effective national strategy. To do this, GAO analyzed key emergency and pandemic-specific plans, interviewed agency officials, and compared the Strategy and Plan with the six characteristics GAO identified.
The executive branch has taken an active approach to help address this potential threat, including establishing an online information clearinghouse, developing planning guidance and checklists, awarding grants to accelerate development and production of new technologies for influenza vaccines within the United States, and assisting state and local government pandemic planning efforts. However, federal government leadership 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 the many leadership positions are well understood. The Strategy and Plan do not specify how the leadership roles and responsibilities will work in addressing the unique characteristics of an influenza pandemic, which could occur simultaneously in multiple locations and over a long period. A pandemic could extend well beyond health and medical boundaries, affecting critical infrastructure, the movement of goods and services across the nation and the globe, and economic and security considerations. Although the Department of Health and Human Services' (HHS) Secretary is to lead the public health and medical response and the Department of Homeland Security's (DHS) Secretary is to lead overall nonmedical support and response actions, the Plan does not clearly address these simultaneous responsibilities or how these roles are to work together, particularly over an extended period and at multiple locations across the country. In addition, the Secretary of DHS has designated a national Principal Federal Official (PFO) to facilitate pandemic coordination as well as five regional PFOs and five regional Federal Coordinating Officers. Most of these leadership roles and responsibilities have not been tested under pandemic scenarios, leaving it unclear how they will work. Because initial actions may help limit the spread of an influenza virus, the effective exercise of shared leadership roles and responsibilities could have substantial consequences. However, only one national multisector pandemic-related exercise has been held and that was prior to the issuance of the Plan. While the Strategy and Plan are an important first step in guiding national preparedness, they do not fully address all six characteristics of an effective national strategy. Specifically, they fully address only one of the six characteristics, by reflecting a clear description and understanding of problems to be addressed, and do not address one characteristic because the documents do not describe the financial resources needed to implement actions. Although the other characteristics are partially addressed, important gaps exist that could hinder the ability of key stakeholders to effectively execute their responsibilities, including state and local jurisdictions that will play crucial roles in preparing for and responding to a pandemic were not directly involved in developing the Plan, relationships and priorities among actions were not clearly described, performance measures focused on activities that are not always linked to results; insufficient information is provided about how the documents are integrated with other key related plans, and no process is provided for monitoring and reporting on progress.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
Director:
Team:
Phone:
Bernice Steinhardt
Government Accountability Office: Strategic Issues
(202) 512-6543
Recommendations for Executive Action
Recommendation: To enhance preparedness efforts for a possible pandemic, the Secretaries of Homeland Security and Health and Human Services 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.
Agency Affected: Department of Homeland Security
Status: In process
Comments: According to a December 2007 letter from DHS, DHS continues to work with HHS and other interagency partners to develop a series of coordinated interagency pandemic exercises that will include all levels of government (federal, state, local), tribal and territorial governments, and the private and nonprofit sectors (volunteer and faith-based organizations), and the international community.
Agency Affected: Department of Health and Human Services
Status: In process
Comments: According to May 2008 letter from HHS, HHS in concert with DHS, continues to develop and conduct rigorous testing, training, and exercises for a pandemic influenza response. HHS stated that in November 2007, it conducted a pandemic influenza exercise, with the support of DHS, to help clarify the leadership roles and responsibilities throughout HHS. In addition, HHS noted that a Principle Level Exercise (PLE 1-08) was scheduled for February 2008, and that this exercise will allow further definition and clarification of the leadership roles at each level and assist in broadening the understanding of these roles by state, local and tribal governments; the private and nonprofit sectors; and the international community. We have asked FEMA and the Homeland Security Council to provide us with documentation of the February 2008 Principle Level Exercise for pandemic influenza to see if it addresses our recommendation. We received information from FEMA but not from the HSC, which would tell us who participated in the exercise and lessons learned.
Recommendation: To enhance preparedness efforts for a possible pandemic, once the leadership roles have been clarified through testing, training, and exercising, the Secretaries of Homeland Security and Health and Human Services should ensure that these roles are clearly understood by state, local, and tribal governments; the private and nonprofit sectors; and the international community.
Agency Affected: Department of Homeland Security
Status: In process
Comments: DHS and HHS stated that they plan to work together to develop and conduct rigorous testing, training, and exercises for pandemic influenza to test their leadership roles, in order to ensure that these roles are clearly understood by state, local, and tribal governments, the private and nonprofit sector, and the international community.
Agency Affected: Department of Health and Human Services
Status: In process
Comments: DHS and HHS stated that they plan to work together to develop and conduct rigorous testing, training, and exercises for pandemic influenza to test their leadership roles, in order to ensure that these roles are clearly understood by state, local, and tribal governments, the private and nonprofit sector, and the international community.
Recommendation: The Homeland Security Council should establish a specific process and time frame for updating the Implementation Plan for the National Strategy for Pandemic Influenza. The process for updating the Plan should involve key nonfederal stakeholders and incorporate lessons learned from exercises and other sources. The Plan should also be improved by including the following information in the next update: (1) the cost, sources, and types of resources and investments needed to complete the action items and where they should be targeted; (2) a process and schedule for monitoring and publicly reporting on progress made on completing the actions; (3) clearer linkages with other strategies and plans; and (4) clearer descriptions of relationships or priorities among action items and greater use of outcome-focused performance measures.
Agency Affected: Executive Office of the President: Homeland Security Council
Status: In process
Comments: The Homeland Security Council has not published a final status update of the action items in the Implementation Plan for the National Strategy for Pandemic Influenza and, to the best of our knowledge, has not established a plan for an update.
