Influenza Pandemic:

Federal Agencies Should Continue to Assist States to Address Gaps in Pandemic Planning

GAO-08-539: Published: Jun 19, 2008. Publicly Released: Jul 21, 2008.

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The Implementation Plan for the National Strategy for Pandemic Influenza states that in an influenza pandemic, the primary response will come from states and localities. To assist them with pandemic planning and exercising, Congress has provided $600 million to states and certain localities. The Department of Homeland Security (DHS) established five federal influenza pandemic regions to work with states to coordinate planning and response efforts. GAO was asked to (1) describe how selected states and localities are planning for an influenza pandemic and who they involved, (2) describe the extent to which selected states and localities conducted exercises to test their influenza pandemic planning and incorporated lessons learned as a result, and (3) identify how the federal government can facilitate or help improve state and local efforts to plan and exercise for an influenza pandemic. GAO conducted site visits to five states and 10 localities.

All of the five states and 10 localities reviewed by GAO had developed influenza pandemic plans. In fact, according to officials at the Centers for Disease Control and Prevention (CDC), which administers the federal pandemic funds, all 50 states have developed an influenza pandemic plan, in accordance with federal pandemic funding requirements. At the time of GAO's site visits, officials from the selected states and localities reviewed said that they involved the federal government, other state and local agencies, tribal nations, and nonprofit and private sector organizations in their influenza pandemic planning. Since GAO's site visits, the Department of Health and Human Services (HHS) has provided feedback to the states, territories, and the District of Columbia (hereafter referred to as states) on whether their plans addressed 22 priority areas, such as policy process for school closure and communication. On average the department found that states' plans had "many major gaps" in 16 of the 22 priority areas. In March 2008, HHS, DHS, and other federal agencies issued guidance to states to help them update their pandemic plans, which are due by July 2008, in preparation for another HHS-led review. According to CDC officials, all states and localities that received the federal pandemic funds have met the requirement to conduct an exercise to test their plans. Officials from all of the states and localities reviewed by GAO reported that they had incorporated lessons learned from influenza pandemic exercises into their influenza pandemic planning, such as buying additional medical equipment, providing training, and modifying influenza pandemic plans. For example, as a result of an exercise, officials at the Dallas County Department of Health and Human Services (Texas) reported that they developed an appendix to their influenza pandemic plan on school closures during a pandemic. The federal government has provided influenza pandemic guidance on a variety of topics including an influenza pandemic planning checklist for states and localities and draft guidance on allocating an influenza pandemic vaccine. However, officials of the states and localities reviewed by GAO told GAO that they would welcome additional guidance from the federal government in a number of areas to help them to better plan and exercise for an influenza pandemic, in areas such as community containment (community-level interventions designed to reduce the transmission of a pandemic virus). Three of these areas were also identified as having "many major gaps" in states' plans nationally in the HHS-led review. In January 2008, HHS and DHS, in coordination with other federal agencies, hosted a series of meetings of states in the five federal influenza pandemic regions to discuss the draft guidance on updating their pandemic plans. Although a senior DHS official reported that there are no plans to conduct further workshops, additional regional meetings could provide a forum for state and federal officials to address gaps in states' planning identified by the HHS-led review and to maintain the momentum of states' pandemic preparedness through this next governmental transition.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To help maintain a continuity of focus on state pandemic planning efforts and to further assist states in their pandemic planning, the Secretaries of Health and Human Services and Homeland Security, in coordination with other federal agencies, should convene additional meetings of the states in the five federal influenza pandemic regions to help them address identified gaps in their planning.

    Agency Affected: Department of Health and Human Services

    Status: Closed - Implemented

    Comments: While the five federal influenza pandemic regions were deactivated, the Department of Health and Human Services (HHS) took a variety of measures to support states' pandemic planning and address identified planning gaps. According to HHS, HHS's 2009 H1N1 Influenza Improvement Plan indicated that HHS worked with states on a number of areas where planning gaps had been identified, including mass vaccination, surveillance and laboratory, communication, community-wide healthcare coalitions, facilitating medical surge, antiviral drug distribution plan, community containment plan, and policy process for school closure and communication. HHS also stated that it continues to work with states through the Public Heath Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) cooperative agreements. Both the PHEP and HPP capability guidance documents address fatality management and continuity planning, which were other areas identified as having planning gaps. The Centers for Disease Control (CDC) and Assistant Secretary for Preparedness and Response (ASPR) also released in March 2011 new guidance for states to help them identify gaps in preparedness, with a focus on all-hazards planning which has direct relevance to pandemic planning.

    Recommendation: To help maintain a continuity of focus on state pandemic planning efforts and to further assist states in their pandemic planning, the Secretaries of Health and Human Services and Homeland Security, in coordination with other federal agencies, should convene additional meetings of the states in the five federal influenza pandemic regions to help them address identified gaps in their planning.

    Agency Affected: Department of Homeland Security

    Status: Closed - Implemented

    Comments: While the five federal influenza pandemic regions were deactivated, DHS worked with states to address identified gaps in planning for critical infrastructure protection for a pandemic. In an interview with DHS's Assistant Secretary and Deputy Assistant Secretary for Infrastructure Protection on July 30, 2012 related to our report on critical infrastructure protection for a pandemic (GAO-08-36), the officials stated that DHS has worked with the critical infrastructure sectors to address these gaps. First, DHS has worked with each of the critical infrastructure sectors--including the energy, food and agriculture, telecommunications, transportation, and water sectors to develop sector-specific guidance on pandemic influenza preparedness. Although critical infrastructure was not affected during the H1N1 pandemic because the pandemic was not as severe as it could have been, the sector-specific guides were also updated in September and October of 2009 after the H1N1 pandemic. In reviewing this guidance, we found that it addressed a number of the coordination and planning challenges including (1) clarifying federal and state roles and responsibilities, (2) identifying and developing strategies for addressing crucial cross-sector interdependencies, and (3) identifying additional investments needed for training and infrastructure. In addition, DHS has offered a series of webinars to the sectors on topics related to pandemic preparedness, such as partnering for critical infrastructure preparedness and critical infrastructure resilience. DHS officials said that they continue to rely on the critical infrastructure coordinating councils to collaborate with other federal agencies, state and local governments and the private sector on all hazards issues related to pandemic influenza, such as preparedness and response to an anthrax outbreak.

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