A Government Accountability Office (GAO) report released yesterday details persistent problems at the US Department of Health and Human Services (HHS) that impaired the country's ability to respond to the COVID-19 pandemic and other public health crises and extreme weather events.
The 13-page document summarizes key findings from its January 2022 report characterizing HHS leadership and coordination of public health emergencies as high-risk and a related 2023 document. HHS includes the Centers for Disease Control and Prevention (CDC), the Administration for Strategic Preparedness and Response (ASPR), and the Food and Drug Administration (FDA) among its 12 operating divisions.
"For over a decade, GAO has identified deficiencies at HHS that have hindered the nation's response to the COVID-19 pandemic and to a variety of past emergencies, including other infectious diseases," the report said. "This includes the H1N1 influenza pandemic, Zika, and Ebola—and extreme weather events, such as hurricanes."
91 of 155 recommendations not implemented
As of April 2023, 91 of the 155 GAO recommendations to HHS since 2007 are still outstanding. According to the new report, the HHS has not:
- Developed clear roles and responsibilities. For instance, when the HHS helped repatriate US citizens from abroad and quarantined them domestically, "significant confusion ensued. As a result, HHS put repatriates, its own personnel, and nearby communities at risk due to a lack of clarity as to which HHS agency was in charge."
- Created an interoperable network of systems for near real-time public health situational awareness, required by statute since 2006. In June 2022, the GAO recommended this action and 11 others, but none have been implemented, even though HHS agreed with 10 of them and was reviewing the remaining 2.
- Provided clear, consistent communication about disease outbreaks such as information on COVID-19 testing. In January 2021, the GAO recommended that HHS develop and publicize testing information, and while HHS partially concurred, nothing has been done.
- Been transparent when disseminating crisis information, such as the scientific reasoning for changes to COVID-19 testing guidelines. "COVID-19 testing guidelines changed several times over the course of the pandemic with little scientific explanation of the rationale behind the changes, thereby confusing providers and public health stakeholder groups implementing the guidelines, and risking the erosion of trust in the federal government," the authors wrote.
- Undertaken key workforce planning to meet its emergency planning and response mission and goals. "ASPR relies on other response partners, but does not have a complete understanding of the capabilities and limitations of those partners, which creates a vulnerability. Furthermore, we have concerns that ASPR lacks the capability to fully execute its own responsibilities," the report said. While the federal government has made some improvements, the GAO said more needs to be done.
Waiting 'not an option'
The executive branch and Congress must provide leadership and attention to ensure that the nation is prepared for managing multiple simultaneous threats, mitigating their economic impact, and aiding in recovery.
For over a decade, GAO has identified deficiencies at HHS that have hindered the nation's response to the COVID-19 pandemic and to a variety of past emergencies, including other infectious diseases.
"A whole-of-nation multidisciplinary approach to preparedness and response is essential," the GAO wrote. "HHS partnership and engagement with nonfederal entities, including state, local, tribal, and territorial governments, and the private sector are key elements of this approach."
The time to act is now, the GAO said: "Waiting to address the deficiencies we have identified is not an option—it is not possible to know precisely when the next threat will occur; only that it will come."
