Influenza Pandemic
Opportunities Exist to Clarify Federal Leadership Roles and Improve Pandemic Planning Gao ID: GAO-07-1257T September 26, 2007An influenza pandemic is a real and significant potential threat facing the United States and the world. Pandemics are unlike other emergencies because they are not a singular event nor discretely bounded in space and time. This testimony addresses (1) federal leadership roles and responsibilities for preparing for and responding to a pandemic, (2) our assessment of the Strategy and Plan, and (3) opportunities to increase clarity of federal leadership roles and responsibilities and improve pandemic planning. GAO used its characteristics of an effective national strategy to assess the Strategy and Plan. The issues discussed in the testimony are based primarily on the GAO report, Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer Federal Leadership Roles and an Effective National Strategy (GAO-07-781). In this report, GAO recommended that (1) The Secretaries of Homeland Security and Health and Human Services develop rigorous testing, training, and exercises for pandemic influenza to ensure that federal leadership roles and responsibilities are clearly defined, understood and work effectively and (2) HSC set a time frame to update the Plan, involve key stakeholders, and more fully address the characteristics of an effective national strategy. The Departments of Homeland Security and Health and Human Services concurred. The HSC did not comment.
The administration has taken an active approach to this potential disaster by, among other things, issuing a National Strategy for Pandemic Influenza (Strategy) in November 2005, and a National Strategy for Pandemic Influenza Implementation Plan (Plan) in May 2006. However, much more needs to be done to ensure that the Strategy and Plan are viable and can be effectively implemented in the event of an influenza pandemic. Key federal 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. Most of these leadership roles involve shared responsibilities and it is unclear how they will work in practice. 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, multi-sector pandemic-related exercise has been held, and that was prior to issuance of the Plan. The Strategy and Plan do not fully address the characteristics of an effective national strategy and contain gaps that could hinder the ability of key stakeholders to effectively execute their responsibilities. Specifically, some of the gaps include (1) The Strategy and Plan do not address resources, investments, and risk management and consequently do not provide a picture of priorities or how adjustments might be made in view of limited resources. (2) State and local jurisdictions were not directly involved in developing the Plan, even though they would be on the front lines in a pandemic. (3) Relationships and priorities among action items are not always clear. (4) Performance measures are focused on activities that are not always linked to results. (5) The linkage of the Strategy and Plan with other key plans is unclear. (6) The Plan does not contain a process for monitoring and reporting on progress. (7) The Plan does not describe an overall framework for accountability and oversight and does not clarify how responsible officials would share leadership responsibilities. (8) Procedures and time frames for updating and revising the Plan were not established. These gaps can affect the usefulness of these planning documents for those with key roles to play. Also, the lack of mechanisms for future updates or progress assessments limit opportunities for congressional decision makers and the public to assess the extent of progress being made or to consider what areas or actions may be need additional attention. Although the Homeland Security Council (HSC) publicly reported on the status of action items in December 2006 and July 2007, it is unclear when the next report will be issued or how much information will be released.
GAO-07-1257T, Influenza Pandemic: Opportunities Exist to Clarify Federal Leadership Roles and Improve Pandemic Planning
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United States Government Accountability Office:
GAO:
Testimony:
Before the Subcommittee on Emerging Threats, Cybersecurity, and Science
and Technology, Committee on Homeland Security, House of
Representatives:
For Release on Delivery:
Expected at 10:00 a.m. EDT:
Wednesday, September 26, 2007:
Influenza Pandemic:
Opportunities Exist to Clarify Federal Leadership Roles and Improve
Pandemic Planning:
Statement of Bernice Steinhardt:
Director:
Strategic Issues:
GAO-07-1257T:
GAO Highlights:
Highlights of GAO-07-1257T, a testimony to the Subcommittee on Emerging
Threats, Cybersecurity, and Science and Technology, Committee on
Homeland Security, House of Representatives.
Why GAO Did This Study:
An influenza pandemic is a real and significant potential threat facing
the United States and the world. Pandemics are unlike other emergencies
because they are not a singular event nor discretely bounded in space
and time.
This testimony addresses (1) federal leadership roles and
responsibilities for preparing for and responding to a pandemic, (2)
our assessment of the Strategy and Plan, and (3) opportunities to
increase clarity of federal leadership roles and responsibilities and
improve pandemic planning. GAO used its characteristics of an effective
national strategy to assess the Strategy and Plan.
The issues discussed in the testimony are based primarily on the GAO
report, Influenza Pandemic: Further Efforts Are Needed to Ensure
Clearer Federal Leadership Roles and an Effective National Strategy
(GAO-07-781). In this report, GAO recommended that (1) The Secretaries
of Homeland Security and Health and Human Services develop rigorous
testing, training, and exercises for pandemic influenza to ensure that
federal leadership roles and responsibilities are clearly defined,
understood and work effectively and (2) HSC set a time frame to update
the Plan, involve key stakeholders, and more fully address the
characteristics of an effective national strategy. The Departments of
Homeland Security and Health and Human Services concurred. The HSC did
not comment.
What GAO Found:
The administration has taken an active approach to this potential
disaster by, among other things, issuing a National Strategy for
Pandemic Influenza (Strategy) in November 2005, and a National Strategy
for Pandemic Influenza Implementation Plan (Plan) in May 2006. However,
much more needs to be done to ensure that the Strategy and Plan are
viable and can be effectively implemented in the event of an influenza
pandemic.
Key federal 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. Most of these leadership
roles involve shared responsibilities and it is unclear how they will
work in practice. 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, multi-sector pandemic-related exercise has been held, and
that was prior to issuance of the Plan.
The Strategy and Plan do not fully address the characteristics of an
effective national strategy and contain gaps that could hinder the
ability of key stakeholders to effectively execute their
responsibilities. Specifically, some of the gaps include:
& The Strategy and Plan do not address resources, investments, and risk
management and consequently do not provide a picture of priorities or
how adjustments might be made in view of limited resources.
* State and local jurisdictions were not directly involved in
developing the Plan, even though they would be on the front lines in a
pandemic.
* Relationships and priorities among action items are not always clear.
* Performance measures are focused on activities that are not always
linked to results.
* The linkage of the Strategy and Plan with other key plans is unclear.
* The Plan does not contain a process for monitoring and reporting on
progress.
* The Plan does not describe an overall framework for accountability
and oversight and does not clarify how responsible officials would
share leadership responsibilities.
* Procedures and time frames for updating and revising the Plan were
not established.
These gaps can affect the usefulness of these planning documents for
those with key roles to play. Also, the lack of mechanisms for future
updates or progress assessments limit opportunities for congressional
decision makers and the public to assess the extent of progress being
made or to consider what areas or actions may be need additional
attention. Although the Homeland Security Council (HSC) publicly
reported on the status of action items in December 2006 and July 2007,
it is unclear when the next report will be issued or how much
information will be released.
To view the full product, including the scope and methodology, click on
[hyperlink, http://GAO-07-1257T]. For more information, contact Bernice
Steinhardt at (202) 512-6806 or steinhardtb@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to appear here today to discuss the federal government's
efforts to prepare for and respond to a possible influenza pandemic. An
influenza pandemic is a real and significant threat facing the United
States and the world. Although the timing and severity of the next
pandemic is unpredictable, there is widespread agreement that a
pandemic will occur at some point. Unlike incidents that are discretely
bounded in space or time (such as a storm or a terrorist attack), a
pandemic is not a singular event, but is likely to come in waves, each
lasting weeks or months, and could pass through communities of all
sizes across the nation and the world simultaneously.
Today, I will discuss (1) federal leadership roles and responsibilities
for preparing for and responding to a pandemic, (2) our assessment of
the National Strategy for a Pandemic Influenza (Strategy) and the
Implementation Plan for the National Strategy for a Pandemic Influenza
(Plan), and (3) opportunities to increase the clarity of federal
leadership roles and responsibilities and improve pandemic planning.
This statement is based on our August 14, 2007, report, requested by
the Ranking Member, Senate Budget Committee; the Chairman and Ranking
Member, House Committee on Oversight and Government Reform; and the
Chairman, House Committee on Homeland Security.[Footnote 1] Our
objectives in that report were to address the extent to which (1)
federal leadership roles and responsibilities for preparing for and
responding to a pandemic are clearly defined and documented and (2) the
Strategy and the Plan address the characteristics of an effective
national strategy; we conducted our work in accordance with generally
accepted government auditing standards. We analyzed relevant documents,
interviewed cognizant federal officials, and assessed the Strategy and
Plan to determine the extent to which they jointly addressed the six
desirable characteristics of an effective national strategy that we
developed and used in previous work.[Footnote 2] While national
strategies necessarily vary in content, the six characteristics we
identified apply to all such planning documents and can help ensure
that they are effective management tools.
In summary, although the administration has taken an active approach to
this potential disaster by developing a Strategy and Plan, and has
undertaken a number of other efforts, much more needs to be done to
ensure that the Plan is more viable and can be effectively implemented
in the event of an influenza pandemic.
* Key federal 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. Most of these leadership
roles involve shared responsibilities, and it is not clear how these
would work in practice. 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 issuance of the Plan.
* The Strategy and Plan do not fully address the characteristics of an
effective national strategy and contain gaps that could hinder the
ability of key stakeholders to effectively execute their
responsibilities. In addition to the fact that the Strategy and Plan do
not clarify how responsible officials will share leadership
responsibilities, they do not include a description of the resources
required to implement the Plan, and consequently do not provide a
picture of priorities or how adjustments might be made in view of
resource constraints. Additionally, 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, and the linkage of
the Strategy and Plan with other key plans is unclear.
The gaps in the Strategy and Plan are particularly troubling because
they can affect the usefulness of these planning documents for those
with key roles to play and, with no mechanisms for future updates or
progress assessments, limit opportunities for congressional decision
makers and the public to assess the extent of progress being made or to
consider what areas or actions may need additional attention.
We made two recommendations in our August 2007 report to address these
concerns.
* We recommended that the Secretaries of Homeland Security and Health
and Human Services work together to develop and conduct rigorous
testing, training, and exercises for pandemic influenza to ensure that
the federal leadership roles are clearly defined and understood and
that leaders are able to effectively execute shared responsibilities to
address emerging challenges. 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 and responsibilities are clearly understood by nonfederal
partners.
* Our report also recommended that the Homeland Security Council (HSC)
establish a specific process and time frame for updating the Plan. This
process should involve key nonfederal stakeholders and incorporate
lessons learned from exercises and other sources. The next update of
the Plan could be improved by addressing the gaps we identified.
The Department of Health and Human Services (HHS) and the Department of
Homeland Security (DHS) concurred with the first recommendation. The
HSC did not comment on the draft report or our recommendation.
Background:
To address the potential threat of an influenza pandemic, the President
and his HSC issued two planning documents. The Strategy was issued in
November 2005 and is intended to provide a high-level overview of the
approach that the federal government will take to prepare for and
respond to an influenza pandemic. It also articulates expectations for
nonfederal entities--including state, local, and tribal governments;
the private sector; international partners; and individuals--to prepare
themselves and their communities.
The Plan was issued in May 2006 and is intended to lay out broad
implementation requirements and responsibilities among the appropriate
federal agencies and clearly define expectations for nonfederal
entities. The Plan includes 324 action items related to these
requirements, responsibilities, and expectations and most of them are
to be completed before or by May 2009. It is intended to support the
broad framework and goals articulated in the Strategy by outlining
specific steps that federal departments and agencies should take to
achieve these goals. It also describes expectations regarding
preparedness and response efforts of state and local governments,
tribal entities, the private sector, global partners, and individuals.
The Plan's chapters cover categories of actions that are intended to
address major considerations raised by a pandemic, including protecting
human and animal health; transportation and borders; and international,
security, and institutional considerations.
Federal Leadership Roles Are Unclear, Evolving, and Untested:
Several federal leadership roles involve shared responsibilities for
preparing for and responding to an influenza pandemic, including the
Secretaries of Health and Human Services and Homeland Security, the
Administrator of the Federal Emergency Management Agency (FEMA), a
national Principal Federal Official (PFO), and regional PFOs and
Federal Coordinating Officers (FCO). Many of these leadership roles and
responsibilities have not been tested under pandemic scenarios, leaving
unclear how all of these new and developing relationships would work.
Federal Leadership Roles and Responsibilities Are Unclear and Evolving:
The Strategy and Plan do not clarify the specific leadership roles and
responsibilities for a pandemic. Instead, they restate the existing
leadership roles and responsibilities, particularly for the Secretaries
of Homeland Security and Health and Human Services, prescribed in the
National Response Plan (NRP)--an all-hazards plan for emergencies
ranging from hurricanes to wildfires to terrorist attacks. However, the
leadership roles and responsibilities prescribed under the NRP need to
operate somewhat differently because of the characteristics of a
pandemic that distinguish it from other emergency incidents. For
example, because a pandemic influenza is likely to occur in successive
waves, planning has to consider how to sustain response mechanisms for
several months to over a year--issues that are not clearly addressed in
the Plan.
In addition, the distributed nature of a pandemic, as well as the sheer
burden of disease across the nation, means that the support states,
localities, and tribal entities can expect from the federal government
would be limited in comparison to the aid it mobilizes for
geographically and temporarily bounded disasters like earthquakes and
hurricanes. Consequently, legal authorities, roles and
responsibilities, and lines of authority at all levels of government
must be clearly defined, effectively communicated, and well understood
to facilitate rapid and effective decision making. This is also
important for public and private sector organizations and international
partners so everyone can better understand what is expected of them
before and during a pandemic.
The Strategy and Plan state that the Secretary of Health and Human
Services is responsible for leading the medical response in a pandemic,
while the Secretary of Homeland Security is responsible for overall
domestic incident management and federal coordination. However, since a
pandemic extends well beyond health and medical boundaries, to include
sustaining critical infrastructure, private sector activities, the
movement of goods and services across the nation and the globe, and
economic and security considerations, it is not clear when, in a
pandemic, the Secretary of Health and Human Services would be in the
lead and when the Secretary of Homeland Security would lead.
A pandemic could threaten our critical infrastructure, such as the
capability to deliver electricity or food, by removing essential
personnel from the workplace for weeks or months. The extent to which
this would be considered a medical response with the Secretary of
Health and Human Services in the lead, or when it would be under the
Secretary of Homeland Security's leadership as part of his/her
responsibility for ensuring that critical infrastructure is protected,
is unclear. According to HHS officials we interviewed, resolving this
ambiguity will depend on several factors, including how the outbreak
occurs and the severity of the pandemic. Although DHS and HHS officials
emphasize that they are working together on a frequent basis, these
roles and responsibilities have not been thoroughly tested and
exercised.
Moreover, under the Post-Katrina Emergency Management Reform Act of
2006 (referred to as the Post-Katrina Reform Act in this testimony),
the FEMA Administrator was designated the principal domestic emergency
management advisor to the President, the HSC, and the Secretary of
Homeland Security, adding further complexity to the leadership
structure in the case of a pandemic.[Footnote 3] The act also gives the
Administrator responsibility for carrying out a national exercise
program to test and evaluate national preparedness for responding to
all-hazards, including an influenza pandemic.
Other evolving federal leadership roles include those of PFOs and FCOs.
To assist in planning and coordinating efforts to respond to a
pandemic, in December 2006 the Secretary of Homeland Security
predesignated a national PFO and established five pandemic regions each
with a regional PFO and FCO. PFOs are responsible for facilitating
federal domestic incident planning and coordination, and FCOs are
responsible for coordinating federal resources support in a
presidentially declared major disaster or emergency. However, the
relationship of these roles to each other as well as with other
leadership roles in a pandemic is unclear.
U.S. Coast Guard and FEMA officials we met with recognized that
planning for and responding to a pandemic would require different
operational leadership roles and responsibilities than for most other
emergencies. For example, a FEMA official said that given the number of
people who would be involved in responding to a pandemic, collaboration
between HHS, DHS, and FEMA would need to be greater than for any other
past emergencies. Officials are starting to build on these
relationships. For example, some of the federal officials with
leadership roles for an influenza pandemic met during the week of March
19, 2007, to continue to identify issues and begin developing
solutions. One of the participants told us that although additional
coordination meetings are needed, it may be challenging since there is
no dedicated funding for the staff working on pandemic issues to
participate in these and other related meetings.
It is also unclear whether the newly established national and regional
positions for a pandemic will further clarify leadership roles in light
of existing and newly emerging plans and issues. For example, in 2006,
DHS made revisions to the NRP and released a Supplement to the
Catastrophic Incident Annex--both designed to further clarify federal
roles and responsibilities and relationships among federal, state, and
local governments and responders. However, we reported in February 2007
that these revisions had not been tested and there was little
information available on the extent to which these and other actions
DHS was taking to improve readiness were operational.[Footnote 4] We
also reported in May 2007 that FEMA has predesignated five teams of
FCOs and PFOs in the Gulf Coast and eastern seaboard states at risk of
hurricanes. However, there is still some question among state and local
first responders about the need for both positions and how they will
work together in disaster response.[Footnote 5]
More recently, DHS reviewed the NRP and its supplemental documents. One
of the issues this review intended to address was clarifying roles and
responsibilities of key structures, positions, and levels of
government, including the role of the PFO and that position's current
lack of operational authority over the FCO during an emergency. On
September 10, 2007, DHS released a draft National Response Framework to
replace the NRP, for public comment. Comments on the framework are due
October 11, 2007, and comments on the supplemental documents, such as
revised Emergency Support Function specifications, are due by November
9, 2007.
Exercising and Testing of Plans Is Crucial in Ensuring Capacity:
Disaster planning, including for a pandemic influenza, needs to be
tested and refined with a rigorous and robust exercise program to
expose weaknesses in plans and allow planners to refine them.
Exercises--particularly for the type and magnitude of emergency
incidents such as a severe influenza pandemic for which there is little
actual experience--are essential for developing skills and identifying
what works well and what needs further improvement. Our prior work
examining the preparation for and response to Hurricane Katrina
highlighted the importance of realistic exercises to test and refine
assumptions, capabilities, and operational procedures, and build upon
strengths.[Footnote 6]
While pandemic influenza scenarios have been used to exercise specific
response elements, such as the distribution of stockpiled medications
at specific locations or jurisdictions, no national exercises have
tested the new federal leadership structure for pandemic
influenza.[Footnote 7] The only national multisector pandemic exercise
to date was a tabletop simulation conducted by members of the cabinet
in December 2005. This tabletop exercise was prior to the release of
the Plan in May 2006, the establishment of a national PFO and regional
PFO and FCO positions for a pandemic, and enactment of the Post-Katrina
Reform Act.
Gaps in the National Strategy and Plan Limit Their Usefulness:
Our work found that the Strategy and Plan do not address all of the
characteristics of an effective national strategy as identified in our
prior work. While national strategies necessarily vary in content, the
six characteristics we identified apply to all such planning documents
and can help ensure that they are effective management tools. Gaps and
deficiencies in these documents are particularly troubling in that a
pandemic represents a complex challenge that will require the full
understanding and collaboration of a multitude of entities and
individuals. The extent to which these documents, that are to provide
an overall framework to ensure preparedness and response to a pandemic
influenza, fail to adequately address key areas could have critical
impact on whether the public and key stakeholders have a clear
understanding and can effectively execute their roles and
responsibilities.
Specifically, we found that the documents fully address only one of the
six characteristics of an effective national strategy--problem
definition and risk assessment--because they identified the potential
problems associated with a pandemic as well as potential threats,
challenges, and vulnerabilities. The Strategy and Plan did not address
one characteristic--resources, investments, and risk management--
because they did not discuss the financial resources and investments
needed to implement the actions called for and therefore, do not
provide a picture of priorities or how adjustments might be made in
view of resource constraints. They partially addressed the four
remaining characteristics, as shown in table 1.
Table 1: Extent to Which the Strategy and Plan Address GAO's Desirable
Characteristics of an Effective National Strategy:
Desirable characteristic: Clear purpose, scope, and methodology;
Addresses: [Empty];
Partially addresses: [Check];
Does not address: [Empty].
Desirable characteristic: Problem definition and risk assessment;
Addresses: [Check];
Partially addresses: [Empty];
Does not address: [Empty].
Desirable characteristic: Goals, subordinate objectives, activities,
and performance measures;
Addresses: [Empty];
Partially addresses: [Check];
Does not address: [Empty].
Desirable characteristic: Resources, investments, and risk management;
Addresses: [Empty];
Partially addresses: [Empty];
Does not address: [Check].
Desirable characteristic: Organizational roles, responsibilities, and
coordination;
Addresses: [Empty];
Partially addresses: [Check];
Does not address: [Empty].
Desirable characteristic: Integration and implementation;
Addresses: [Empty];
Partially addresses: [Check];
Does not address: [Empty].
Source: GAO analysis of the National Strategy for Pandemic Influenza
and Implementation Plan for the National Strategy for Pandemic
Influenza.
[End of table]
More specifically, the following are highlights of some of the gaps in
the Strategy and Plan.
* The Strategy and Plan do not address resources, investments, and risk
management. Developing and sustaining the capabilities stipulated in
the Plan would require the effective use of federal, state, and local
funds. Given that funding needs may not be readily addressed through
existing mechanisms and could stress existing government and private
resources, it is critical for the Plan to lay out funding requirements.
For example, one of the primary objectives of domestic vaccine
production capacity is for manufacturers to produce enough vaccine for
the entire U.S. population within 6 months. However, the Plan states
that production capacity would depend on the availability of future
appropriations. Despite the fact that the production of enough vaccine
for the population would be critical if a pandemic were to occur, the
Plan does not provide even a rough estimate of how much the vaccine
could cost for consideration in future appropriations.
* State and local jurisdictions were not directly involved in
developing the Strategy and Plan. Neither the Strategy nor Plan
described the involvement of key stakeholders, such as state, local,
and tribal entities, in their development, even though these
stakeholders would be on the front lines in a pandemic and the Plan
identifies actions they should complete. Officials told us that state,
local, and tribal entities were not directly involved in reviewing and
commenting on the Plan, but the drafters of the Plan were generally
aware of their concerns.
* Relationships and priorities among action items are not always clear.
While some action items depend on other action items, these linkages
are not always apparent in the Plan. An HHS official who helped draft
the Plan acknowledged that while an effort was made to ensure linkages
among action items, there may be gaps in the linkages among
interdependent action items within and across the Plan's chapters that
focused on such issues as human health, animal health, and
transportation and borders considerations.
In addition, we found that the Plan does not establish priorities among
its 324 action items, which becomes especially important as agencies
and other parties strive to effectively manage scarce resources and
ensure that the most important steps are accomplished.
* Performance measures are focused on activities that are not always
linked to results. Most of the Plan's performance measures are focused
on activities such as disseminating guidance, but the measures are not
always clearly linked with intended results. This lack of linkages to
outcomes and results makes it difficult to ascertain whether progress
has in fact been made toward achieving the national goals and
objectives described in the Strategy and Plan.
* The linkage of the Strategy and Plan with other key plans is unclear.
Although the Strategy states that it is consistent with the National
Security Strategy and the National Strategy for Homeland Security, it
does not state how it is consistent or describe the relationships with
these two strategies. In addition, the Plan does not specifically
address how the Strategy, Plan, or other related pandemic plans should
be integrated with the goals, objectives, and activities of the
national initiatives already in place, such as the interim National
Preparedness Goal.
Further, the Strategy and Plan do not provide sufficient detail about
how the Strategy, action items in the Plan, and a proposed set of
agency plans are to be integrated with other national strategies and
frameworks. For example, the Plan contains 39 action items that are
response related (i.e., specific actions are to be taken within a
prescribed number of hours or days after an outbreak). However, these
action items are interspersed among the 324 action items, and the Plan
does not describe the linkages of these response-related action items
with the NRP or other response related plans.
* The Plan does not contain a process for monitoring and reporting on
progress. While most of the action items have deadlines for completion,
ranging from 3 months to 3 years, the Plan does not identify a process
to monitor and report on the progress of the action items nor does it
include a schedule for reporting progress. According to agency
officials, the HSC is monitoring executive branch agencies' efforts to
complete the action items. However, there is no specific documentation
describing this process or institutionalizing it. This is important
since some of the action items are not expected to be completed during
this administration. Also, a similar monitoring process for those
actions items for which nonfederal entities have the lead
responsibility does not appear to exist. Additionally, there is no
explicit timeline for the HSC to report on the overall progress and
thus, when progress is reported is left to the HSC's discretion.
* The Plan does not describe an overall framework for accountability
and oversight. While the plan contains broad information on roles and
responsibilities and describes coordination mechanisms for responding
to a pandemic, it does not, as noted earlier, clarify how responsible
officials would share leadership responsibilities. In addition, it does
not describe an overall accountability and oversight framework. Agency
officials told us that they had identified individuals to act as
overall coordinators to monitor the action items for which their
agencies have lead responsibility and provide periodic progress reports
to the HSC. However, we could not identify a similar oversight
mechanism for the action items that fall to state and local governments
or the private sector. This is a concern since some action items,
particularly those that are to be completed by state, local, and tribal
governments or the private sector, do not identify an entity
accountable for carrying out the action.
* Procedures and time frames for updating and revising the Plan were
not established. The Plan does not describe a mechanism for updating it
to reflect policy decisions, such as clarifications in leadership roles
and responsibilities and other lessons learned from exercises, or to
incorporate other needed changes. Although the Plan was developed as
initial guidance and was intended to be updated and expanded over time,
officials in several agencies told us that specific processes or time
frames for updating and revising it have not been established.
Opportunities Exist To Clarify Federal Leadership Roles and Improve
Pandemic Planning:
A pandemic poses some unique challenges and would be unlike other
emergencies given the likelihood of its duration and geographic
coverage. Initial actions may help limit the spread of an influenza
virus, reflecting the importance of a swift and effective response.
Therefore, the effective exercise of shared leadership roles and
implementation of pandemic plans could have substantial consequences,
both in the short and long term.
Since no national pandemic exercises of federal leadership roles and
responsibilities have been conducted since the release of the Plan in
May 2006, and key leadership roles continue to evolve, rigorous
testing, training, and exercising is needed. Exercises test whether
leadership roles and responsibilities, as well as procedures and
processes, are clear and well-understood by key stakeholders.
Additionally, they help identify weaknesses and allow for corrective
action to be taken before an actual emergency occurs. Consequently, in
our August 2007 report, we recommended that the Secretaries of Homeland
Security and Health and Human Services work together to develop and
conduct rigorous testing, training, and exercises for pandemic
influenza to ensure that the federal leadership roles are clearly
defined and understood and that leaders are able to effectively execute
shared responsibilities to address emerging challenges. 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 and responsibilities are
clearly understood by state, local, and tribal governments; the private
and nonprofit sectors; and the international community. DHS and HHS
concurred with the recommendation, and DHS stated that it is taking
action on many of the shortfalls identified in the report.
The Strategy and Plan are important because they broadly describe the
federal government's approach and planned actions to prepare for and
respond to a pandemic and also set expectations for states and
communities, the private sector, and global partners. The extent to
which the Strategy and Plan fail to adequately address key areas could
have a critical impact on whether key stakeholders and the public have
a clear understanding of their roles and responsibilities. However,
gaps in the Strategy and Plan limit their usefulness as a management
tool for ensuring accountability and achieving results. The plan is
silent on when information will be reported or when it will be updated.
Although the HSC publicly reported on the status of action items in
December 2006 and July 2007, it is unclear when the next report will be
issued or how much information will be released. This lack of
transparency makes it difficult to inform a national dialogue on the
progress made to date or what further steps are needed. It also
inhibits congressional oversight of strategies, funding priorities, and
critical efforts to enhance the nation's level of preparedness.
Therefore, in our August 2007 report we recommended that the HSC
establish a specific process and time frame for updating the Plan. We
stated that this process should involve key nonfederal stakeholders and
incorporate lessons learned from exercises and other sources. Further,
we stated that the Plan could be improved by including the following
information in the next update: (1) 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 action items, (3) clearer linkages with other
strategies and plans, and (4) clearer descriptions of relationships or
priorities among actions items and greater use of outcome-focused
performance measures. The HSC did not comment on the draft report.
Mr. Chairman and Members of the Subcommittee, this completes my
statement. I would be pleased to respond to any questions that you
might have.
Contacts and Acknowledgments:
For further information on this testimony, please contact Bernice
Steinhardt, Director, Strategic Issues, at (202) 512-6806 or
steinhardtb@gao.gov. Individuals making key contributions to this
testimony include Susan Ragland, Allen Lomax, Catherine Myrick, Susan
Sato, and Jordan Wicker.
[End of section]
Footnotes:
[1] GAO, Influenza Pandemic: Further Efforts Are Needed to Ensure
Clearer Leadership Roles and an Effective National Strategy, GAO-07-781
(Washington, D.C.: Aug. 14, 2007).
[2] See GAO, Combating Terrorism: Evaluation of Selected
Characteristics in National Strategies Related to Terrorism, GAO-04-
408T (Washington, D.C.: Feb. 3, 2004); Rebuilding Iraq: More
Comprehensive National Strategy Needed to Help Achieve U.S. Goals, GAO-
06-788 (Washington, D.C.: July 11, 2006); and Financial Literacy and
Education Commission: Further Progress Needed to Ensure an Effective
National Strategy, GAO-07-100 (Washington, D.C.: Dec. 4, 2006).
[3] Pub. L. No. 109-295, Title VI.
[4] GAO, Homeland Security: Management and Programmatic Challenges
Facing the Department of Homeland Security, GAO-07-398T (Washington,
D.C.: Feb. 6, 2007).
[5] GAO, Homeland Security: Observations on DHS and FEMA Efforts to
Prepare for and Respond to Major and Catastrophic Disasters and Address
Related Recommendations and Legislation, GAO-07-835T (Washington, D.C.:
May 15, 2007).
[6] GAO, Hurricane Katrina: GAO's Preliminary Observations Regarding
Preparedness, Response, and Recovery, GAO-06-442T (Washington, D.C.:
Mar. 8, 2006).
[7] Congressional Research Service, Pandemic Influenza: Domestic
Preparedness Efforts, RL 33145 (Washington, D.C.: Feb. 20, 2007).
[End of section]
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