Management Issue 6: Public Health Emergency Preparedness and ResponseTopics on this page:
Recent events, such as the terrorist attacks of September 11, 2001; the 2005 Gulf Coast hurricanes; and the potential for future public health emergencies, such as the threat of pandemic influenza, continue to underscore the importance of having a comprehensive national public health infra structure that is prepared to rapidly respond to public health emergencies. OIG work in this area has focused on assessing how well HHS programs and their grantees plan for, recognize, and respond to outside health threats; the security of HHS and grantee laboratory facilities; the management of these grant programs and funds by the Department and grantees; and the readiness and capacity of responders at all levels of Government to protect the public’s health. Recent OIG work has shown that, although some progress had been made, the States and localities are still generally under prepared. Bioterrorism Preparedness The security of internal HHS and Department-funded laboratories, including those using select agents, and the security of assets and materials to be used to respond to emergencies continue to be concerns of OIG. In 2002 and 2003, OIG reviewed Departmental and external (non-Federal) laboratories for compliance with laws and regulations governing select agents and found that many laboratories did not adequately safeguard the agents against theft or loss. Soon afterward, when legal requirements for the possession and use of select agents became more strict, OIG initiated audits of non-Federal entities with select agents from November 2003 to November 2004 and found that, contrary to the revised regulations, laboratories had problems with maintaining accurate inventory and access records, controlling access, security planning, and other areas. In 2006, OIG also completed a number of physical security and environmental control audits of the Strategic National Stockpile managed by the Centers for Disease Control and Prevention (CDC) to provide ready access to drugs and medical supplies during medical emergencies. OIG identified methods to increase the sites’ protection against theft, tampering, destruction, or other loss. Additionally, OIG has recently commenced work at Federal laboratories with select agents and begun two related reviews: an audit of select agent transfers and a follow-up audit on CDC’s management of the select agent program. As follow up to earlier work, in December 2006, OIG issued a report that determined that at the close of the CDC Bioterrorism Program in August 2005, about $996 million, or 15.8 percent, of the program funds awarded to States and major health departments remained unobligated. Many awardees did not fully execute their expenditure plans or submit timely financial status reports, so CDC did not always receive the information needed to encourage the expenditure of funds and minimize unobligated balances. Under its new Public Health Emergency Preparedness Program, which began in August 2005, CDC strengthened its guidance and established additional oversight controls. OIG is currently performing additional reviews of CDC’s oversight of Preparedness and Response for Bioterrorism and Public Emergency Program Funds. Disaster Response Since 2005, OIG has worked with the President’s Council on Integrity and Efficiency (PCIE) Homeland Security Roundtable and Disaster Relief Working Group, as well as with other Federal, State, and local partners, to assess the overall effectiveness of the Department’s deployment and recovery activities in response to Hurricanes Katrina and Rita. As part of a coordinated oversight effort, OIG assessed Departmental procurements and associated management controls, beneficiary protections, and the delivery of critical health care services. In a 2006 report, OIG reviewed the emergency preparedness and response of a selection of nursing homes in five Gulf Coast States and found that all experienced problems during the 2004 and 2005 hurricanes, whether evacuating or sheltering in place. OIG recommended that CMS consider strengthening Federal certification standards for nursing home emergency plans. At the same time, OIG reviewed the U.S. Public Health Service Commissioned Corps response to Hurricanes Katrina and Rita. In this 2007 report, OIG found that although the Corps provided valuable support to the States, more officers were needed. Many of the officers lacked the necessary experience and effective training, and many experienced logistical difficulties in deployment. OIG recommended improved training for officers, a streamlined travel system, and staggered deployments for continuity of operations. OIG also evaluated the use of Government purchase cards in support of the Department’s response operations for the Gulf Coast hurricanes. Based on the findings of this 2007 report, OIG recommended that the Assistant Secretary for Administration and Management (ASAM) provide additional written guidance when cards are issued to employees to reduce the probability of misuse, deliberate or otherwise, and conduct annual training using mock scenarios to improve purchasing approvals. To enhance controls, OIG also recommended that ASAM develop a tracking system to monitor Government card purchases during emergency situations. Additionally, OIG recently issued several reports on its review of the procurement process for pharmaceuticals and other relief-related products and services associated with the HHS response to the Gulf Coast hurricanes. OIG audited 51 contracting actions and procurements with a total value of $79.6 million and found that procurement officials generally complied with the Federal Acquisition Regulations in awarding the contracts. OIG is reviewing CDC’s Bioterrorism Preparedness Program and ASPR’s Hospital Preparedness Program (formerly administered by HRSA) in the Gulf Coast States and will determine whether grantees are spending the funds on costs that are reasonable and allowable under the terms of the grant. OIG will continue to identify and monitor areas of critical importance to ensure that the Department is ready to respond to future public health emergencies. For example, OIG is working in collaboration with ASPR to develop a cross-disciplinary initiative to build upon OIG’s array of emergency preparedness and response work. States and localities are making progress in strengthening their bioterrorism preparedness programs. However, OIG findings still demonstrate the need for significant improvements for local health departments to be fully prepared to detect and respond to bioterrorism and, by extension, naturally occurring disasters. Federal, State, and local health departments are striving to work cooperatively to ensure that potential bioterrorist attacks are detected early and responded to appropriately. CDC has taken steps to improve its capacity to detect and respond to harmful agents and to expand the availability of pharmaceuticals needed in the event of chem ical, biological, or radiological attacks. Both CDC and HRSA have updated their Public Health and Hospital Preparedness Cooperative Agreements to incorporate stronger performance measures and clearer guidance for grant recipients. For example, recent CDC guidance now requires States to establish electronic systems that can effectively detect and report disease outbreaks and other public health emergencies. CDC also plans to implement automated data entry in laboratories, establish a forum for information sharing, as well as identify additional technical resources to increase State and local capacity to respond to a potential terrorist threat. In the aftermath of Hurricanes Katrina and Rita in 2005, the Department placed new emphasis on preparedness outside the realm of terrorism and adopted an “all-hazards” approach to State and local emergency preparedness. This approach incorporates comprehensive preparedness plans that include more definitive and accurate performance measures to prepare stakeholders for a wide array of natural or terrorist threats on multiple scales. The Department will focus more efforts toward monitoring preparedness at the local level, including the testing of local preparedness plans to evaluate how governments perform when plans are put into action. The 2006 Pandemic and All-Hazards Preparedness Act (PAHPA) provides the Department with additional authority, resources, and responsibility to carry out its mission, including the creation of the Office of the Assistant Secretary for Preparedness and Response. The PAHPA, among other things, authorizes the creation of a Biomedical Advanced Research and Development Authority, the transfer of the National Disaster Medical System from the Department of Homeland Security to HHS, and the expansion of the Medical Reserve Corps and other volunteer health professional registries. The 2005 hurricanes underscored the need for a comprehensive Federal plan to respond quickly and effectively to a mass public health emergency event that also requires a seamless integration with responses at the State and local levels. In response to our 2006 nursing home emergency response and preparedness report, CMS is exploring ways to strengthen Federal certification standards for nursing home emergency preparedness and to promote better coordination among Federal, State, and local emergency management entities. The Office of the Surgeon General, Office of Public Health and Science, is implementing many of OIG’s recommendations related to the Commissioned Corps, including identifying, rostering, training, and equipping designated response teams of Commissioned Corps officers. And, in response to OIG’s report on the use of purchase cards in responding to the 2005 hurricanes, ASAM has issued revised guidelines to improve the Department’s purchase card program.
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