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Open Recommendations (15 total)

Zoonotic Diseases: Federal Actions Needed to Improve Surveillance and Better Assess Human Health Risks Posed by Wildlife

GAO-23-105238
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of CDC, in collaboration with other agencies, as appropriate, should comprehensively assess zoonotic disease risks related to imported wildlife to inform CDC's decisions about regulations. Such an assessment could include identifying high priority categories of wildlife and then conducting risk assessments for those particular categories. (Recommendation 5)
Open
As of February 2024, CDC agreed that qualitative and quantitative public health risk assessments are valuable for informing policy decisions but that comprehensively assessing zoonotic disease risks was too broad. The agency stated that the recommendation implied conducting public health risk assessments for wildlife that are not known to pose a zoonotic disease risk, which would not be a good use of resources. CDC also said the Smithsonian Institution's project to rank the risk of imported wildlife made GAO's recommendation duplicative. GAO continues to believe that CDC could use a risk-based approach--for example, identifying high priority categories of wildlife for risk assessments--to use its resources efficiently and that it could do so in collaboration with other agencies, such as the Smithsonian Institution, as appropriate.

Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited

GAO-22-105276
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of the CDC should expand the scope of its analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to include the prevalence of falls and fall-related injuries among adults under age 65 who may be at higher risk of falls, including adults with disabilities, and, as appropriate, share findings with ACL and other agencies overseeing relevant programmatic efforts. For example:

  • CDC could analyze existing BRFSS data on adults aged 45 to 64 and share findings, as appropriate.
  • CDC could propose asking adults aged 18 to 44 the two BRFSS fall-related questions, as part of the survey update process.

(Recommendation 1)
Open
CDC agreed with this recommendation. As of January 2023, CDC officials said they have begun exploring options to expand the scope of the BRFSS data analysis for adults under age 65. Specifically, CDC is analyzing BRFSS data on falls among adults with disabilities aged 45 to 64. CDC will also consider how best to disseminate these findings, such as through targeted outreach to key partners, publications, and email outreach to those who subscribe to CDC updates on older adult falls prevention.

Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement

GAO-22-105018
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should assess additional opportunities to improve the quality of air passenger information it collects and manages— including opportunities to increase automation by adopting or establishing data exchange standards—and take action, as appropriate, based on this assessment. (Recommendation 2)
Open
In December 2023, CDC told us that they are working on a multiphase project to improve data exchange between CDC and state, local, and territorial health departments. According to CDC officials, CDC is working to build and test a platform that will allow for more secure, automated, and user-friendly data exchange. This effort has not been completed and therefore, this recommendation remains open. GAO will continue to monitor CDC's efforts to implement this recommendation.

Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement

GAO-22-105018
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should re-design QARS or deploy a new data system that would allow CDC to more effectively facilitate contact tracing for air passengers and conduct disease surveillance for air travel. (Recommendation 3)
Open
As of December 2023, CDC officials told us that efforts to modernize the Quarantine Activity Reporting System (QARS) are underway. One module has been converted to a cloud-based platform, while an additional five modules are pending development. GAO will continue to monitor CDC's progress implementing this recommendation.
Centers for Disease Control and Prevention The Director of CDC should implement controls for the entry of data into its Quarantine Activity Reporting System (QARS), including by providing adequate training and standard operating procedures that are documented and institutionalized for system users and by conducting consistent validation checks. (Recommendation 1)
Open
As of December 2023, CDC has taken steps to address this recommendation, according to CDC officials. For example, CDC officials stated that they created an automated system for checking the quality of data entered into QARS allowing CDC staff to monitor critical data entered into the system. Using this system, CDC officials reported that they have been able to review over 100,000 records and address more than 2,000 data entry errors. In addition, CDC officials told us that they have created an online repository of training and onboarding resources related to data quality and are working to update the QARS operations manual. GAO has requested documentation to corroborate these actions and will continue to monitor CDC's efforts to implement this recommendation.

Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference

GAO-22-104613
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The CDC Director should ensure that CDC employees and contractors performing scientific activities are trained on how to report allegations of political interference in scientific decision-making. (Recommendation 2)
Open
As of April 2024, HHS was updating its departmental scientific integrity policy and its operating divisions were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference. Following publication of the updated departmental scientific integrity policy in 2024, HHS will develop scientific integrity training for employees, contractors, and other persons covered by the policy. This training will describe HHS's policies and procedures related to scientific integrity, including how to recognize, avoid, and report potential political interference.

Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference

GAO-22-104613
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The CDC Director should ensure that procedures for reporting and addressing potential political interference in scientific decision-making are developed and documented, including adding a definition of political interference. (Recommendation 1)
Open
As of April 2024, HHS was updating its departmental scientific integrity policy and its operating divisions, including the CDC, were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference. HHS plans to finalize its policy in 2024 and will make the policy publicly available on its website.

COVID-19: HHS Agencies' Planned Reviews of Vaccine Distribution and Communication Efforts Should Include Stakeholder Perspectives

GAO-22-104457
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention As CDC finalizes its plans for an after action review related to its COVID-19 vaccine distribution and communication efforts, the Director of the Centers for Disease Control and Prevention should ensure the agency obtains feedback during the life cycle of the response from key stakeholders, including state and local health officials, and incorporates their perspectives as it conducts its review. (Recommendation 1)
Open
CDC concurred with this recommendation. As of April 2024, HHS/CDC stated that the agency was drafting its after action report, and that the agency would incorporate feedback from state and local stakeholders, as appropriate. We will continue to monitor the agency's actions in this area.

COVID-19: HHS Agencies' Planned Reviews of Vaccine Distribution and Communication Efforts Should Include Stakeholder Perspectives

GAO-22-104457
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should share relevant findings of its after action review related to vaccine distribution and communication with key stakeholders, such as state and local health officials, and other federal agencies, as appropriate. (Recommendation 2)
Open
CDC concurred with this recommendation. As of April 2024, HHS/CDC stated that the agency was drafting its after action report, and that the agency would incorporate feedback from state and local stakeholders, as appropriate. The agency has previously stated that it would share relevant findings with key stakeholders, as appropriate, once it completes its after-action review. We will continue to monitor the agency's actions in this area.

Small Business Research Programs: Agencies Should Further Improve Award Timeliness

GAO-22-104677
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should evaluate the effectiveness of steps taken to improve SBIR award timeliness and take any necessary additional steps in order to consistently meet SBA award timeliness guidelines. (Recommendation 7)
Open – Partially Addressed
HHS agreed with this recommendation. According to an April 2022 HHS letter responding to our report as well as additional information provided by the Centers for Disease Control and Prevention (CDC), the CDC stated its intent to take steps to identify the organizational processes, systems, and policies that may offer opportunities for increased efficiencies. CDC also stated it had modified the roles and responsibilities of staff engaged in the SBIR program and provided documentation of these roles and responsibilities, as of November 2021. In May 2023, CDC reported to GAO that it had changed its SBIR funding process with an aim to increase applicant volume for its SBIR awards, and thereby, to improve award timeliness. CDC also reported that it had conferred with a cross-HHS workgroup resulting in recommendations for process measures to improve timeliness. In December 2023, we obtained and analyzed publicly available CDC award data for FY22. Our analysis indicated that CDC did not meet SBA's award timeliness guidelines in FY22. Further, in combination with prior fiscal years, CDC has not met SBA's timeliness guidelines in at least 3 of the preceding 5 years based on available data. Going forward, we will follow up to obtain data on CDC award timeliness in subsequent fiscal years to determine if actions the agency has taken have resulted in it being able to consistently meet SBA's award timeliness guidelines.
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