Homeland Security
New Department Could Improve Coordination but Transferring Control of Certain Public Health Programs Raises Concerns Gao ID: GAO-02-954T July 16, 2002Federal, state, and local governments share responsibility for terrorist attacks. However, local government, including police and fire departments, emergency medical personnel, and public health agencies, is typically the first responder to an incident. The federal government historically has provided leadership, training, and funding assistance. In the aftermath of September 11, for instance, one-quarter of the $40 billion Emergency Response Fund was earmarked for homeland security, including enhancing state and local government preparedness. Because the national security threat is diffuse and the challenge is highly intergovernmental, national policymakers must formulate strategies with a firm understanding of the interests, capacity, and challenges facing those governments. The development of a national strategy will improve national preparedness and enhance partnerships between federal, state, and local governments. The creation of the Office of Homeland Security is an important and potentially significant first step. The Office of Homeland Security's strategic plan should (1) define and clarify the appropriate roles and responsibilities of federal, state, and local entities; (2) establish goals and performance measures to guide the nation's preparedness efforts; and (3) carefully choose the most appropriate tools of government to implement the national strategy and achieve national goals. The President's proposed Homeland Security Act of 2002 would bring many federal agencies with homeland security responsibilities--including public health preparedness and response--into one department to mobilize and focus assets and resources at all levels of government. GAO believes that the proposed reorganization has the potential to repair fragmentation in the coordination of public health preparedness and response programs at the federal, state, and local levels. The proposal would institutionalize the responsibility for homeland security in federal statute. In addition to improving overall coordination, the transfer of programs from multiple agencies to the new department could reduce overlap among programs and facilitate response in times of disaster. There are concerns about the proposed transfer of control of public health assistance programs that have both public health and homeland security functions from Health and Human Services to the new department. Transferring control of these programs, including priority setting, to the new department has the potential to disrupt some programs that are critical to basic public health responsibilities. GAO does not believe that the President's proposal is sufficiently clear on how both the homeland security and public health objectives would be accomplished.
GAO-02-954T, Homeland Security: New Department Could Improve Coordination but Transferring Control of Certain Public Health Programs Raises Concerns
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United States General Accounting Office:
GAO:
Testimony:
Before the Committee on Health, Education, Labor, and Pensions, U.S.
Senate:
For Release on Delivery:
Expected at 10:00 a.m.
Tuesday, July 16, 2002:
Homeland Security:
New Department Could Improve Coordination but Transferring Control of
Certain Public Health Programs Raises Concerns:
Statement for the Record by Janet Heinrich:
Director, Health Care”Public Health Issues:
GAO-02-954T:
Mr. Chairman and Members of the Committee:
I appreciate the opportunity to submit this statement for the record on
the proposed creation of the Department of Homeland Security. Since the
terrorist attacks of September 11, 2001, and the subsequent anthrax
incidents, there has been concern about the ability of the federal
government to prepare for and coordinate an effective public health
response to such events, given the broad distribution of responsibility
for that task at the federal level. Our earlier work found, for
example, that more than 20 federal departments and agencies carry some
responsibility for bioterrorism preparedness and response and that
these efforts are fragmented. [Footnote 1] Emergency response is
further complicated by the need to coordinate actions with agencies at
the state and local level, where much of the response activity would
occur.
The President‘s proposed Homeland Security Act of 2002 [Footnote 2]
would bring many of these federal entities with homeland security
responsibilities”including public health preparedness and response”into
one department, in an effort to mobilize and focus assets and resources
at all levels of government. The aspects of the proposal concerned with
public health preparedness and response would involve two primary
changes to the current system, which are found in Title V of the
proposed legislation. First, the proposal would transfer certain
emergency preparedness and response programs from multiple agencies to
the new department. Second, it would transfer the control over, but not
the operation of, other public health preparedness assistance programs,
such as providing emergency preparedness planning assistance to state
and local governments, from the Department of Health and Human Services
(HHS) to the new department. [Footnote 3] Title III of the proposed
legislation would also transfer responsibility for certain chemical,
biological, radiological, and nuclear research and development programs
and activities to the new department. [Footnote 4]
In order to assist the Committee in its consideration of this extensive
reorganization of our government, this statement focuses on Titles III
and V of the President‘s proposal and the implications of (1) the
proposed transfer of specific public health preparedness and response
programs currently housed in HHS into the new department, (2) the
proposed transfer of control over certain other public health
preparedness assistance programs from HHS to the new department, and
(3) the proposed transfer of responsibility for research and
development on chemical, biological, radiological, and nuclear threats
to the new department. The statement is based largely on our previous
and ongoing work on homeland security, [Footnote 5] as well as a review
of the proposed legislation.
In summary, we believe that the proposed reorganization has the
potential to repair the fragmentation we have noted in the coordination
of public health preparedness and response programs at the federal,
state, and local levels. As we have recommended, the proposal would
institutionalize the responsibility for homeland security in federal
statute. We expect that, in addition to improving overall coordination,
the transfer of programs from multiple agencies to the new department
could reduce overlap among programs and facilitate response in times of
disaster. However, we have concerns about the proposed transfer of
control of public health assistance programs that have both basic
public health and homeland security functions from HHS to the new
department. These dual-purpose programs have important synergies that
we believe should be maintained. We are concerned that transferring
control over these programs, including priority setting, to the new
department has the potential to disrupt some programs that are critical
to basic public health responsibilities. We do not believe that the
President‘s proposal is sufficiently clear on how both the homeland
security and the public health objectives would be accomplished. The
proposed Department of Homeland Security would also be tasked with
developing national policy for and coordination of the federal
government‘s civilian research and development efforts to counter
chemical, biological, radiological, and nuclear threats. However, we are
concerned that the proposed transfer of control and priority setting for
research from the organizations where the research would be conducted
could also be disruptive to dual-purpose programs.
Background:
In response to global challenges the government faces in the coming
years, we have a unique opportunity to create an extremely effective and
performance-based organization that can strengthen the nation‘s ability
to protect its borders and citizens against terrorism. There is likely
to be considerable benefit over time from restructuring some of the
homeland security functions, including reducing risk and improving the
economy, efficiency, and effectiveness of these consolidated agencies
and programs. Realistically, however, in the short term, the magnitude
of the challenges that the new department faces will clearly require
substantial time and effort, and will take additional resources to make
it fully effective.
The Comptroller General has testified that the Congress should consider
several very specific criteria in its evaluation of whether individual
agencies or programs should be included or excluded from the proposed
department. [Footnote 6] Those criteria include the following:
* Mission Relevancy: Is homeland security a major part of the agency or
program mission? Is it the primary mission of the agency or program?
* Similar Goals and Objectives: Does the agency or program being
considered for the new department share primary goals and objectives
with the other agencies or programs being consolidated?
* Leverage Effectiveness: Does the agency or program being considered
for the new department promote synergy and help to leverage the
effectiveness of other agencies and programs or the new department as a
whole? In other words, is the whole greater than the sum of the parts?
* Gains Through Consolidation: Does the agency or program being
considered for the new department improve the efficiency and
effectiveness of homeland security missions through eliminating
duplications and overlaps, closing gaps, and aligning or merging
common roles and responsibilities?
* Integrated Information Sharing/Coordination: Does the agency or
program being considered for the new department contribute to or
leverage the ability of the new department to enhance the sharing of
critical information or otherwise improve the coordination of missions
and activities related to homeland security?
* Compatible Cultures: Can the organizational culture of the agency or
program being considered for the new department effectively meld with
the other entities that will be consolidated? Field structures and
approaches to achieving missions vary considerably between agencies.
* Impact on Excluded Agencies: What is the impact on departments losing
components to the new department? What is the impact on agencies with
homeland security missions left out of the new department?
Federal, state, and local government agencies have differing roles with
regard to public health emergency preparedness and response. The federal
government conducts a variety of activities, including developing
interagency response plans, increasing state and local response
capabilities, developing and deploying federal response teams,
increasing the availability of medical treatments, participating in and
sponsoring exercises, planning for victim aid, and providing support in
times of disaster and during special events such as the Olympic games.
One of its main functions is to provide support for the primary
responders at the state and local level, including emergency medical
service personnel, public health officials, doctors, and nurses. This
support is critical because the burden of response falls initially on
state and local emergency response agencies.
The President‘s proposal would transfer the Laboratory Registration/
Select Agent Transfer Program”which controls biological agents with the
potential for use in bioterrorism”from HHS to the new department.
Currently administered by the Centers for Disease Control and Prevention
(CDC), the program‘s mission is the security of those biologic agents
that have the potential for use by terrorists. The proposal provides
for the new department to consult with appropriate agencies, which
would include HHS, in maintaining the select agent list.
In addition, the President‘s proposal transfers control over many of the
programs that provide preparedness and response support for the state
and local governments to a new Department of Homeland Security. Among
other changes, the proposed legislation transfers HHS‘s Office of the
Assistant Secretary for Public Health Emergency Preparedness to the new
department. Included in this transfer is the Office of Emergency
Preparedness (OEP), which currently leads the National Disaster Medical
System (NDMS) [Footnote 7] in conjunction with several other agencies
and the Metropolitan Medical Response System (MMRS). [Footnote 8] The
Strategic National Stockpile, [Footnote 9] currently administered by
CDC, would also be transferred, although the Secretary of HHS would
still manage the stockpile and continue to determine its contents.
Under the President‘s proposal, the new department would also be
responsible for all current HHS public health emergency preparedness
activities carried out to assist state and local governments or private
organizations to plan, prepare for, prevent, identify, and respond to
biological, chemical, radiological, and nuclear events and public health
emergencies. Although not specifically named in the proposal, this would
include CDC‘s Bioterrorism Preparedness and Response program and the
Health Resources and Services Administration‘s (HRSA) Bioterrorism
Hospital Preparedness Program. These programs provide grants to states
and cities to develop plans and build capacity for communication,
disease surveillance, epidemiology, hospital planning, laboratory
analysis, and other basic public health functions. Except as otherwise
directed by the President, the Secretary of Homeland Security would
carry out these activities through HHS under agreements to be
negotiated with the Secretary of HHS. Further, the Secretary of
Homeland Security would be authorized to set the priorities for these
preparedness and response activities.
The new Department of Homeland Security would also be responsible for
conducting a national scientific research and development program,
including developing national policy and coordinating the federal
government‘s civilian efforts to counter chemical, biological,
radiological, and nuclear weapons or other emerging terrorist threats.
Its responsibilities would also include establishing priorities and
directing and supporting national research and development and
procurement of technology and systems for detecting, preventing,
protecting against, and responding to terrorist acts using chemical,
biological, radiological, or nuclear weapons. Portions of the
Departments of Agriculture, Defense, and Energy that conduct research
would be transferred to the new Department of Homeland Security. The
Department of Homeland Security would carry out its civilian health-
related biological, biomedical, and infectious disease defense research
and development through agreements with HHS, unless otherwise directed
by the President. As part of this responsibility, the new department
would establish priorities and direction for programs of basic and
applied research on the detection, treatment, and prevention of
infectious diseases such as those conducted by the National Institutes
of Health (NIH).
Transfer of Certain Public Health Programs Has Potential to Improve
Coordination:
The transfer of federal assets and resources in the President‘s proposed
legislation has the potential to improve coordination of public health
preparedness and response activities at the federal, state, and local
levels. Our past work has detailed a lack of coordination in the
programs that house these activities, which are currently dispersed
across numerous federal agencies. In addition, we have discussed the
need for an institutionalized responsibility for homeland security in
federal statute. [Footnote 10]
The proposal would transfer the Laboratory Registration/Select Agent
Transfer Program from HHS to the new department. The select agent
program, recently revised and expanded by the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002, [Footnote 11]
generally requires the registration of persons and laboratory
facilities possessing specific biologic agents and toxins”called select
agents”that have the potential to pose a serious threat to public
health and safety. Select agents include approximately 40 viruses,
bacteria, rickettsia, fungi, and toxins. Examples include Ebola,
anthrax, botulinum, and ricin. The 2002 act expanded the program to
cover facilities that possess the agents as well as the facilities
that transfer the agents.
The mission of the select agent program appears to be closely aligned
with homeland security. As stated earlier, one key consideration in
evaluating whether individual agencies or programs should be included
or excluded from the proposed department is the extent to which
homeland security is a major part of the agency or program mission. By
these criteria, the transfer of the select agent program would enhance
efficiency and accountability.
The President‘s proposal also provides the potential to consolidate
programs, thereby reducing the number of points of contact with which
state and local officials have to contend. However, coordination would
still be required with multiple agencies across departments. Many of the
agencies involved in these programs have differing perspectives and
priorities, and the proposal does not sufficiently clarify the lines of
authority of different parties in the event of an emergency, such as
between the Federal Bureau of Investigation (FBI) and public health
officials investigating a suspected bioterrorist incident.
We have reported that many state and local officials have expressed
concerns about the coordination of federal public health preparedness
and response efforts. [Footnote 12] Officials from state public health
agencies and state emergency management agencies have told us that
federal programs for improving state and local preparedness are not
carefully coordinated or well organized. For example, federal programs
managed by the Federal Emergency Management Agency (FEMA), Department
of Justice (DOJ), OEP, and CDC all currently provide funds to assist
state and local governments. Each program conditions the receipt of
funds on the completion of a plan, but officials have told us that the
preparation of multiple, generally overlapping plans can be an
inefficient process. [Footnote 13] In addition, state and local
officials told us that having so many federal entities involved in
preparedness and response has led to confusion, making it difficult for
them to identify available federal preparedness resources and
effectively partner with the federal government.
The proposed transfer of numerous federal response teams and assets to
the new department would enhance efficiency and accountability for these
activities. This would involve a number of separate federal programs for
emergency preparedness and response, whose missions are closely
aligned with homeland security, including FEMA; certain units of DOJ;
and HHS‘s Office of the Assistant Secretary for Public Health Emergency
Preparedness, including OEP and its NDMS and MMRS programs, along
with the Strategic National Stockpile. In our previous work, we found
that in spite of numerous efforts to improve coordination of the
separate federal programs, problems remained, and we recommended
consolidating the FEMA and DOJ programs to improve the coordination.
[Footnote 14] The proposal places these programs under the control of
the Under Secretary for Emergency Preparedness and Response, who could
potentially reduce overlap and improve coordination. This change would
make one individual accountable for these programs and would provide a
central source for federal assistance.
The proposed transfer of MMRS, a collection of local response systems
funded by HHS in metropolitan areas, has the potential to enhance its
communication and coordination. Officials from one state told us that
their state has MMRSs in multiple cities but there is no mechanism in
place to allow communication and coordination among them. Although
the proposed department has the potential to facilitate the
coordination of this program, this example highlights the need for
greater regional coordination, an issue on which the proposal is
silent.
Because the new department would not include all agencies with public
health responsibilities related to homeland security, coordination
across departments would still be required for some programs. For
example, NDMS functions as a partnership among HHS, the Department of
Defense (DOD), the Department of Veterans Affairs (VA), FEMA, state and
local governments, and the private sector. However, as the DOD and VA
programs are not included in the proposal, only some of these federal
organizations would be brought under the umbrella of the Department of
Homeland Security. Similarly, the Strategic National Stockpile
currently involves multiple agencies. It is administered by CDC, which
contracts with VA to purchase and store pharmaceutical and medical
supplies that could be used in the event of a terrorist incident.
Recently expanded and reorganized, the program will now include
management of the nation‘s inventory of smallpox vaccine. Under the
President‘s proposal, CDC‘s responsibilities for the stockpile would be
transferred to the new department, but VA and HHS involvement would be
retained, as well as continuing review by experts of the contents of
the stockpile to ensure that emerging threats, advanced technologies,
and new countermeasures are adequately considered.
Although the proposed department has the potential to improve emergency
response functions, its success depends on several factors. In addition
to facilitating coordination and maintaining key relationships with
other departments, these factors include merging the perspectives of
the various programs that would be integrated under the proposal and
clarifying the lines of authority of different parties in the event of
an emergency. As an example, in the recent anthrax events, local
officials complained about differing priorities between the FBI and the
public health officials in handling suspicious specimens. According to
the public health officials, FBI officials insisted on first informing
FBI managers of any test results, which delayed getting test results to
treating physicians. The public health officials viewed contacting
physicians as the first priority in order to ensure that effective
treatment could begin as quickly as possible.
New Department‘s Control of Essential Public Health Capacities Raises
Concern:
The President‘s proposal to shift the responsibility for all programs
assisting state and local agencies in public health emergency
preparedness and response from HHS to the new department raises concern
because of the dual-purpose nature of these activities. These programs
include essential public health functions that, while important for
homeland security, are critical to basic public health core capacities.
[Footnote 15] Therefore, we are concerned about the transfer of control
over the programs, including priority setting, that the proposal would
give to the new department. We recognize the need for coordination of
these activities with other homeland security functions, but the
President‘s proposal is not clear on how the public health and homeland
security objectives would be balanced.
Under the President‘s proposal, responsibility for programs with dual
homeland security and public health purposes would be transferred to the
new department. These include such current HHS assistance programs as
CDC‘s Bioterrorism Preparedness and Response program and HRSA‘s
Bioterrorism Hospital Preparedness Program. Functions funded through
these programs are central to investigations of naturally occurring
infectious disease outbreaks and to regular public health
communications, as well as to identifying and responding to a
bioterrorist event. For example, CDC has used funds from these programs
to help state and local health agencies build an electronic
infrastructure for public health communications to improve the
collection and transmission of information related to both bioterrorist
incidents and other public health events. [Footnote 16] Just as with
the West Nile virus outbreak in New York City, which initially was
feared to be the result of bioterrorism, [Footnote 17] when an unusual
case of disease occurs public health officials must investigate to
determine whether it is naturally occurring or intentionally caused.
Although the origin of the disease may not be clear at the outset, the
same public health resources are needed to investigate, regardless of
the source. States are planning to use funds from these assistance
programs to build the dual-purpose public health infrastructure and
core capacities that the recently enacted Public Health Security and
Bioterrorism Preparedness and Response Act of 2002 stated are needed.
States plan to expand laboratory capacity, enhance their ability to
conduct infectious disease surveillance and epidemiological
investigations, improve communication among public health agencies, and
develop plans for communicating with the public. States also plan to
use these funds to hire and train additional staff in many of these
areas, including epidemiology.
Our concern regarding these dual-purpose programs relates to the
structure provided for in the President‘s proposal. The Secretary of
Homeland Security would be given control over programs to be carried
out by HHS. The proposal also authorizes the President to direct that
these programs no longer be carried out through agreements with HHS,
without addressing the circumstances under which such authority would be
exercised. We are concerned that this approach may disrupt the synergy
that exists in these dual-purpose programs. We are also concerned that
the separation of control over the programs from their operations could
lead to difficulty in balancing priorities. Although the HHS programs
are important for homeland security, they are just as important to the
day-today needs of public health agencies and hospitals, such as
reporting on disease outbreaks and providing alerts to the medical
community. The current proposal does not clearly provide a structure
that ensures that the goals of both homeland security and public health
will be met.
Transfer of Control and Priority Setting over Dual-Purpose Research and
Development Raises Concern:
The proposed Department of Homeland Security would be tasked with
developing national policy for and coordinating the federal government‘s
civilian research and development efforts to counter chemical,
biological, radiological, and nuclear threats. In addition to
coordination, we believe the role of the new department should include
forging collaborative relationships with programs at all levels of
government and developing a strategic plan for research and
development. However, we have many of the same concerns regarding the
transfer of responsibility for the research and development programs
that we have regarding the transfer of the public health preparedness
programs. We are concerned about the implications of the proposed
transfer of control and priority setting for dual-purpose research. For
example, some research programs have broad missions that are not easily
separated into homeland security research and research for other
purposes. We are concerned that such dual-purpose research activities
may lose the synergy of their current placement in programs. In
addition, we see a potential for duplication of capacity that already
exists in the federal laboratories.
We have previously reported that while federal research and development
programs are coordinated in a variety of ways, coordination is limited,
raising the potential for duplication of efforts among federal
agencies. [Footnote 18] Coordination is limited by the extent of
compartmentalization of efforts because of the sensitivity of the
research and development programs, security classification of research,
and the absence of a single coordinating entity to ensure against
duplication. For example, DOD‘s Defense Advanced Research Projects
Agency was unaware of U.S. Coast Guard plans to develop methods to
detect biological agents on infected cruise ships and, therefore, was
unable to share information on its research to develop biological
detection devices for buildings that could have applicability in this
area.
The new department will need to develop mechanisms to coordinate and
integrate information on research and development being performed
across the government related to chemical, biological, radiological, and
nuclear terrorism, as well as user needs. We reported in 1999 and again
in 2001 that the current formal and informal research and development
coordination mechanisms may not ensure that potential overlaps, gaps,
and opportunities for collaboration are addressed. [Footnote 19] It
should be noted, however, that the President‘s proposal tasks the new
department with coordinating the federal government‘s ’civilian
efforts“ only. We believe the new department will also need to
coordinate with DOD and the intelligence agencies that conduct research
and development efforts designed to detect and respond to weapons of
mass destruction. In addition, the first responders and local
governments possess practical knowledge about their technological needs
and relevant design limitations that should be taken into account in
federal efforts to provide new equipment, such as protective gear and
sensor systems, and help set standards for performance and
interoperability. Therefore, the new department will have to develop
collaborative relationships with these organizations to facilitate
technological improvements and encourage cooperative behavior.
The President‘s proposal could help improve coordination of federal
research and development by giving one person the responsibility for
creating a single national research and development strategy that could
address coordination, reduce potential duplication, and ensure that
important issues are addressed. In 2001, we recommended the creation of
a unified strategy to reduce duplication and leverage resources, and
suggested that the plan be coordinated with federal agencies performing
research as well as state and local authorities. [Footnote 20] The
development of such a plan would help to ensure that research gaps are
filled, unproductive duplication is minimized, and that individual
agency plans are consistent with the overall goals.
The President‘s proposal would also transfer the responsibility for
civilian health-related biological defense research and development
programs to the new department, but the programs would continue to be
carried out through HHS. These programs, now primarily sponsored by
NIH, include a variety of efforts to understand basic biological
mechanisms of infection and to develop and test rapid diagnostic tools,
vaccines, and antibacterial and antiviral drugs. These efforts have
dual-purpose applicability. The scientific research on biologic agents
that could be used by terrorists cannot be readily separated from
research on emerging infectious diseases. For example, NIH-funded
research on a drug to treat cytomegalovirus complications in patients
with HIV is now being investigated as a prototype for developing
antiviral drugs against smallpox. Conversely, research being carried
out on antiviral drugs in the NIH biodefense research program is
expected to be useful in the development of treatments for hepatitis C.
The proposal to transfer responsibility to the new department for
research and development programs that would continue to be carried out
by HHS raises many of the same concerns we have with the structure the
proposal creates for public health preparedness programs. Although
there is a clear need for the new department to have responsibility for
setting policy, developing a strategy, providing leadership, and
overall coordinating of research and development efforts in these
areas, we are concerned that control and priority-setting
responsibility will not be vested in those best positioned to
understand the potential of basic research efforts or the relevance of
research being carried out in other, non-biodefense programs.
In addition, the proposal would allow the new department to direct,
fund, and conduct research related to chemical, biological,
radiological, nuclear, and other emerging terrorist threats on its own.
This raises the potential for duplication of efforts, lack of
efficiency, and an increased need for coordination with other
departments that would continue to carry out relevant research. We are
concerned that the proposal could result in a duplication of capacity
that already exists in the current federal laboratories.
Concluding Observations:
Many aspects of the proposed consolidation of response activities are in
line with our previous recommendations to consolidate programs,
coordinate functions, and provide a statutory basis for leadership of
homeland security. The transfer of the HHS medical response programs
has the potential to reduce overlap among programs and facilitate
response in times of disaster. However, we are concerned that the
proposal does not provide the clear delineation of roles and
responsibilities that is needed. We are also concerned about the broad
control the proposal grants to the new department for research and
development and public health preparedness programs. Although there is
a need to coordinate these activities with the other homeland security
preparedness and response programs that would be brought into the new
department, there is also a need to maintain the priorities for basic
public health capacities that are currently funded through these dual-
purpose programs. We do not believe that the President‘s proposal
adequately addresses how to accomplish both objectives. We are also
concerned that the proposal would transfer the control and priority
setting over dual-purpose research and has the potential to create an
unnecessary duplication of federal research capacity.
Contact and Acknowledgments:
For further information about this statement, please contact me at (202)
512-7118. Robert Copeland, Marcia Crosse, Greg Ferrante, and Deborah
Miller also made key contributions to this statement.
[End of section]
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Homeland Security: Intergovernmental Coordination and Partnership Will
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Homeland Security: Proposal for Cabinet Agency Has Merit, but
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Homeland Security: New Department Could Improve Coordination but May
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Homeland Security: Key Elements to Unify Efforts Are Underway but
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Homeland Security: Responsibility and Accountability for Achieving
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Homeland Security: Progress Made; More Direction and Partnership
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Homeland Security: Challenges and Strategies in Addressing Short- and
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Homeland Security: A Risk Management Approach Can Guide Preparedness
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Homeland Security: Need to Consider VA‘s Role in Strengthening Federal
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Homeland Security: Key Elements of a Risk Management Approach. GAO-02-
150T. Washington, D.C.: October 12, 2001.
Homeland Security: A Framework for Addressing the Nation‘s Efforts.
GAO-01-1158T. Washington, D.C.: September 21, 2001.
Public Health:
Bioterrorism: The Centers for Disease Control and Prevention‘s Role in
Public Health Protection. GAO-02-235T. Washington, D.C.: November 15,
2001.
Bioterrorism: Review of Public Health Preparedness Programs. GAO-02-
149T. Washington, D.C.: October 10, 2001.
Bioterrorism: Public Health and Medical Preparedness. GAO-02-141T.
Washington, D.C.: October 9, 2001.
Bioterrorism: Coordination and Preparedness. GAO-02-129T. Washington,
D.C.: October 5, 2001.
Bioterrorism: Federal Research and Preparedness Activities. GAO-01-
915. Washington, D.C.: September 28, 2001.
Chemical and Biological Defense: Improved Risk Assessment and Inventory
Management Are Needed. GAO-01-667. Washington, D.C.: September 28,
2001.
West Nile Virus Outbreak: Lessons for Public Health Preparedness.
GAO/HEHS-00-180. Washington, D.C.: September 11, 2000.
Chemical and Biological Defense: Program Planning and Evaluation Should
Follow Results Act Framework. GAO/NSIAD-99-159. Washington, D.C.:
August 16, 1999.
Combating Terrorism: Observations on Biological Terrorism and Public
Health Initiatives. GAO/T-NSIAD-99-112. Washington, D.C.: March 16,
1999.
Combating Terrorism:
National Preparedness: Technologies to Secure Federal Buildings. GAO-
02-687T. Washington, D.C.: April 25, 2002.
National Preparedness: Integration of Federal, State, Local, and Private
Sector Efforts Is Critical to an Effective National Strategy for
Homeland Security. GAO-02-621T. Washington, D.C.: April 11, 2002.
Combating Terrorism: Intergovernmental Cooperation in the Development
of a National Strategy to Enhance State and Local Preparedness. GAO-02-
550T. Washington, D.C.: April 2, 2002.
Combating Terrorism: Enhancing Partnerships Through a National
Preparedness Strategy. GAO-02-549T. Washington, D.C.: March 28, 2002.
Combating Terrorism: Critical Components of a National Strategy to
Enhance State and Local Preparedness. GAO-02-548T. Washington, D.C.:
March 25, 2002.
Combating Terrorism: Intergovernmental Partnership in a National
Strategy to Enhance State and Local Preparedness. GAO-02-547T.
Washington, D.C.: March 22, 2002.
Combating Terrorism: Key Aspects of a National Strategy to Enhance
State and Local Preparedness. GAO-02-473T. Washington, D.C.: March 1,
2002.
Chemical and Biological Defense: DOD Should Clarify Expectations for
Medical Readiness. GAO-02-219T. Washington, D.C.: November 7, 2001.
Anthrax Vaccine: Changes to the Manufacturing Process. GAO-02-181T.
Washington, D.C.: October 23, 2001.
Chemical and Biological Defense: DOD Needs to Clarify Expectations for
Medical Readiness. GAO-02-38. Washington, D.C.: October 19, 2001.
Combating Terrorism: Considerations for Investing Resources in Chemical
and Biological Preparedness. GAO-02-162T. Washington, D.C.: October 17,
2001.
Combating Terrorism: Selected Challenges and Related Recommendations.
GAO-01-822. Washington, D.C.: September 20, 2001.
Combating Terrorism: Actions Needed to Improve DOD Antiterrorism
Program Implementation and Management. GAO-01-909. Washington, D.C.:
September 19, 2001.
Combating Terrorism: Comments on H.R. 525 to Create a President‘s
Council on Domestic Terrorism Preparedness. GAO-01-555T. Washington,
D.C.: May 9, 2001.
Combating Terrorism: Accountability Over Medical Supplies Needs Further
Improvement. GAO-01-666T. Washington, D.C.: May 1, 2001.
Combating Terrorism: Observations on Options to Improve the Federal
Response. GAO-01-660T. Washington, DC: April 24, 2001.
Combating Terrorism: Accountability Over Medical Supplies Needs Further
Improvement. GAO-01-463. Washington, D.C.: March 30, 2001.
Combating Terrorism: Comments on Counterterrorism Leadership and
National Strategy. GAO-01-556T. Washington, D.C.: March 27, 2001.
Combating Terrorism: FEMA Continues to Make Progress in Coordinating
Preparedness and Response. GAO-01-15. Washington, D.C.: March 20, 2001.
Combating Terrorism: Federal Response Teams Provide Varied
Capabilities; Opportunities Remain to Improve Coordination. GAO-01-
14. Washington, D.C.: November 30, 2000.
Combating Terrorism: Need to Eliminate Duplicate Federal Weapons of
Mass Destruction Training. GAO/NSIAD-00-64. Washington, D.C.: March 21,
2000.
Combating Terrorism: Chemical and Biological Medical Supplies Are
Poorly Managed. GAO/T-HEHS/AIMD-00-59. Washington, D.C.: March 8, 2000.
Combating Terrorism: Chemical and Biological Medical Supplies Are
Poorly Managed. GAO/HEHS/AIMD-00-36. Washington, D.C.: October 29,
1999.
Combating Terrorism: Observations on the Threat of Chemical and
Biological Terrorism. GAO/T-NSIAD-00-50. Washington, D.C.: October 20,
1999.
Combating Terrorism: Need for Comprehensive Threat and Risk Assessments
of Chemical and Biological Attacks. GAO/NSIAD-99-163. Washington, D.C.:
September 14, 1999.
Chemical and Biological Defense: Coordination of Nonmedical Chemical
and Biological R&D Programs. GAO/NSIAD-99-160. Washington, D.C.: August
16, 1999.
Combating Terrorism: Use of National Guard Response Teams Is Unclear.
GAO/T-NSIAD-99-184. Washington, D.C.: June 23, 1999.
Combating Terrorism: Observations on Growth in Federal Programs. GAO/T-
NSIAD-99-181. Washington, D.C.: June 9, 1999.
Combating Terrorism: Analysis of Potential Emergency Response Equipment
and Sustainment Costs. GAO/NSIAD-99-151. Washington, D.C.: June 9,
1999.
Combating Terrorism: Use of National Guard Response Teams Is Unclear.
GAO/NSIAD-99-110. Washington, D.C.: May 21, 1999.
Combating Terrorism: Observations on Federal Spending to Combat
Terrorism. GAO/T-NSIAD/GGD-99-107. Washington, D.C.: March 11, 1999.
Combating Terrorism: Opportunities to Improve Domestic Preparedness
Program Focus and Efficiency. GAO/NSIAD-99-3. Washington, D.C.:
November 12, 1998.
Combating Terrorism: Observations on the Nunn-Lugar-Domenici Domestic
Preparedness Program. GAO/T-NSIAD-99-16. Washington, D.C.: October 2,
1998.
Combating Terrorism: Observations on Crosscutting Issues. GAO/TNSIAD-
98-164. Washington, D.C.: April 23, 1998.
Combating Terrorism: Threat and Risk Assessments Can Help Prioritize
and Target Program Investments. GAO/NSIAD-98-74. Washington, D.C.:
April 9, 1998.
Combating Terrorism: Spending on Governmentwide Programs Requires
Better Management and Coordination. GAO/NSIAD-98-39. Washington, D.C.:
December 1, 1997.
Disaster Assistance:
Disaster Assistance: Improvement Needed in Disaster Declaration
Criteria and Eligibility Assurance Procedures. GAO-01-837. Washington,
D.C.: August 31, 2001.
Chemical Weapons: FEMA and Army Must Be Proactive in Preparing States
for Emergencies. GAO-01-850. Washington, D.C.: August 13, 2001.
Federal Emergency Management Agency: Status of Achieving Key Outcomes
and Addressing Major Management Challenges. GAO-01-832. Washington,
D.C.: July 9, 2001.
Budget and Management:
Budget Issues: Long-Term Fiscal Challenges. GAO-02-467T. Washington,
D.C.: February 27, 2002.
Results-Oriented Budget Practices in Federal Agencies. GAO-01-1084SP.
Washington, D.C.: August 2001.
Managing for Results: Federal Managers‘ Views on Key Management Issues
Vary Widely Across Agencies. GAO-01-592. Washington, D.C.: May 25,
2001.
Determining Performance and Accountability Challenges and High Risks.
GAO-01-159SP. Washington, D.C.: November 2000.
Managing for Results: Using the Results Act to Address Mission
Fragmentation and Program Overlap. GAO-AIMD-97-146. Washington, D.C.:
August 29, 1997.
Government Restructuring: Identifying Potential Duplication in Federal
Missions and Approaches. GAO/T-AIMD-95-161. Washington, D.C.: June 7,
1995.
Government Reorganization: Issues and Principles. GAO/T-GGD/AIMD-95-
166. Washington, D.C.: May 17, 1995.
Grant Design:
Grant Programs: Design Features Shape Flexibility, Accountability, and
Performance Information. GAO/GGD-98-137. Washington, D.C.: June 22,
1998.
Federal Grants: Design Improvements Could Help Federal Resources Go
Further. GAO/AIMD-97-7. Washington, D.C.: December 18, 1996.
Block Grants: Issues in Designing Accountability Provisions. GAO/AIMD-
95-226. Washington, D.C.: September 1, 1995.
[End of section]
Footnotes:
[1] U.S. General Accounting Office, Bioterrorism: Federal Research and
Preparedness Activities, GAO-01-915 (Washington, D.C.: Sept. 28, 2001).
[2] H.R. 5005, 107th Cong. (2002).
[3] These changes are primarily covered by Sections 502 and 505,
respectively, in Title V of the President‘s proposed legislation.
[4] These changes are primarily covered by Sections 301, 302, and 303
of the President‘s proposed legislation.
[5] See Related GAO Products at the end of this testimony.
[6] U.S. General Accounting Office, Homeland Security: Proposal for
Cabinet Agency Has Merit, but Implementation Will Be Pivotal to
Success, GAO-02-886T (Washington, D.C.: June 25, 2002).
[7] In the event of an emergency, NDMS has response teams that can
provide support at the site of a disaster. These include specialized
teams for burn victims, mental health teams, teams for incidents
involving weapons of mass destruction, and mortuary teams that can be
deployed as needed. About 2,000 civilian hospitals have pledged
resources that could be marshaled in any domestic emergency under the
system.
[8] MMRS is a program that provides support for local community
planning and response capabilities for mass casualty and terrorist
incidents in metropolitan areas.
[9] The stockpile, previously called the National Pharmaceutical
Stockpile, consists of two major components. The first component is the
12-Hour Push Packages, which contain pharmaceuticals, antidotes, and
medical supplies and can be delivered to any site in the United States
within 12 hours of a federal decision to deploy assets. The second
component is the Vendor Managed Inventory.
[10] U.S. General Accounting Office, Homeland Security: Responsibility
and Accountability for Achieving National Goals, GAO-02-627T
(Washington, D.C.: Apr. 11, 2002).
[11] Pub. L. No. 107-188, §§ 201-204, 116 Stat. 594, 637-647 (2002).
[12] U.S. General Accounting Office, Bioterrorism: Federal Research and
Preparedness Activities, GAO-01-915 (Washington, D.C.: Sept. 28, 2001).
[13] U.S. General Accounting Office, Combating Terrorism:
Intergovernmental Partnership in a National Strategy to Enhance State
and Local Preparedness, GAO-02-547T (Washington, D.C.: Mar. 22, 2002).
[14] U.S. General Accounting Office, Combating Terrorism: Selected
Challenges and Related Recommendations, GAO-01-822 (Washington, D.C.,
Sept. 20, 2001).
[15] The recently enacted Public Health Security and Bioterrorism
Preparedness and Response Act of 2002 mandated development of a
preparedness plan for state and local governments building on core
public health capacities, to include effective public health
surveillance and reporting mechanisms, appropriate laboratory
readiness, properly trained and equipped public health and medical
personnel, and communications networks that can effectively disseminate
relevant information in a timely and secure manner. Pub. L. No. 107-
188, §101, 116 Stat. 594, 596 (adding section 2801 to the Public Health
Service Act).
[16] These include the Health Alert Network (HAN), a nationwide system
that facilitates the distribution of health alerts, dissemination of
prevention guidelines and other information, distance learning,
national disease surveillance, electronic laboratory reporting, and Epi-
X, a secure Web-based disease surveillance network for federal, state,
and local epidemiologists that provides tools for searching, tracking,
discussing, and reporting on diseases and is therefore a key element in
any disease investigation.
[17] U.S. General Accounting Office, West Nile Virus Outbreak: Lessons
for Public Health Preparedness, GAO/HEHS-00-180 (Washington, D.C.:
Sept. 11, 2000).
[18] GAO-01-822.
[19] U.S. General Accounting Office, Chemical and Biological Defense:
Coordination of Nonmedical Chemical and Biological R&D Programs,
GAO/NSIAD-99-160 (Washington, D.C.: Aug. 16, 1999), and GAO-01-822.
[20] GAO-01-822.
[End of section]
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