Defense Civil Support: DOD, HHS, and DHS Should Use Existing Coordination Mechanisms to Improve Their Pandemic Preparedness
Highlights
What GAO Found
The Department of Defense (DOD) has developed guidance and plans to direct its efforts to provide assistance in support of civil authorities—in particular the Departments of Health and Human Services (HHS) and Homeland Security (DHS)—in the event of a domestic outbreak of a pandemic disease. For example, the Department of Defense Global Campaign Plan for Pandemic Influenza and Infectious Diseases 3551-13 provides guidance to DOD and the military services on planning and preparing for a pandemic outbreak. DOD's Strategy for Homeland Defense and Support to Civil Authorities states that DOD often is expected to play a prominent supporting role to primary federal agencies. DOD also assists those agencies in the preparedness, detection, and response to other non-pandemic viruses, such as the recent outbreak of the Zika virus.
Figure 1: Photograph of the Aedes aegypti Mosquito Responsible for Spreading the Zika Virus
Source: Department of Defense | GAO-17-150
HHS and DHS have plans to guide their response to a pandemic, but their plans do not explain how they would respond in a resource-constrained environment in which capabilities like those provided by DOD are limited. DOD coordinates with the agencies, but existing coordination mechanisms among HHS, DHS, and DOD could be used to improve preparedness. HHS's Pandemic Influenza Plan is the departmental blueprint for its preparedness and response to an influenza pandemic. DHS's National Response Framework is a national guide on how federal, state, and local governments are to respond to such incidents. DOD, HHS, and DHS have mechanisms—such as interagency working groups, liaison officers, and training exercises—to coordinate their response to a pandemic. For example, training exercises are critical in preparing these agencies to respond to an incident by providing opportunities to test plans, improve proficiency, and assess capabilities and readiness. These existing mechanisms provide the agencies opportunities to improve their preparedness and response to a pandemic. HHS and DHS plans do not specifically identify what resources would be needed to support a response to a pandemic in which demands exceeded federal resources. These officials stated that there would be no way of knowing in advance what resources would be required. HHS and DHS are in the process of updating their plans and thus have an opportunity to coordinate with each other and with DOD to determine the appropriate actions to take should DOD's support be limited.
Why GAO Did This Study
The U.S. Army estimates that if a severe infectious disease pandemic were to occur today, the number of U.S. fatalities could be almost twice the total number of battlefield fatalities in all of America's wars since the American Revolution in 1776. A pandemic occurs when an infectious agent emerges that can be efficiently transmitted between humans and has crossed international borders. DOD's day-to-day functioning and the military's readiness and operations abroad could be impaired if a large percentage of its personnel are sick or absent, and DOD's assistance to civil authorities might be limited.
House Report 114-102 included a provision for GAO to assess DOD's planning and coordination to support civil authorities during a pandemic. This report assesses the extent to which (1) DOD has guidance and plans for supporting civil authorities in the event of a domestic outbreak of a pandemic disease and (2) HHS and DHS have plans to respond to a pandemic if DOD support capabilities are limited, and they have mechanisms to coordinate their pandemic preparedness and response. GAO reviewed agency pandemic guidance and plans, interagency coordination mechanisms, and pandemic-related exercises and after-action reports.
Recommendations
GAO recommends that DOD, HHS, and DHS use existing coordination mechanisms to explore opportunities to improve preparedness and response to a pandemic if DOD's capabilities are limited. DOD, HHS, and DHS concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | As DOD plans to respond to a pandemic, the Secretary of Defense should direct the Under Secretary of Defense for Policy and other DOD officials, as appropriate, to use DOD's existing coordination mechanisms with HHS and the Federal Emergency Management Agency (FEMA) to explore opportunities to improve their preparedness and response to a pandemic if DOD's capabilities are limited. | DOD concurred with this recommendation. DOD hosted Hidden Peril V table top exercise on May 23, 2017. Hidden Peril V tested how an interagency response to a domestic pandemic influenza outbreak would occur and included what HHS and FEMA would do if DOD support was limited. DOD issued an after-action report on the results of the table top exercise on June 27, 2017. The results of the exercise showed that HHS and FEMA will need to de-conflict their leadership roles in a public health crisis, and HHS will need to work with Congress to determine how they might more quickly gain access to funding that will allow them to surge response efforts to a pandemic. Also, the after-action report... identified a list of planning considerations to improve response during a pandemic at all levels of government. Specifically, the report recommended that: (1) a lead federal department or agency must be clearly identified for complex domestic incidents near or just under the Stafford Act threshold; (2) funding must be received quickly by the identified lead federal department or agency in cases of complex domestic incidents, such as pandemic response; (3) federal pandemic response guidance must incorporate awareness of states' varying levels of response capacity, capability, and preparedness, and must consider second- and third-order consequences of federal decisions or recommendations on state and local governments and populations; (4) political leadership must be engaged early and often to ensure understanding of policy decisions' potential unintended consequences; (5) preplanned messaging, coordinated thoroughly from the federal through local levels and cognizant of local realities, can facilitate a smoother whole-of-government response; (6) the Intelligence Community and the public health network must form a comprehensive picture of the disease outbreak in order to provide tailored and timely information to the federal, state, and local responders to slow the spread of the disease; and (7) the idiosyncratic nature of all stages of a pandemic necessitates thorough contingency planning, including the expectation that the federal government workforce will be compromised. Subsequent to the table top exercise, DOD documented the following recommendations for HHS and FEMA: (1) HHS and DHS (FEMA) should collect data to project the number and types of medical and support personnel and equipment needed to respond to a pandemic; (2) ensure capabilities are accessible and available for rapid implementation; and (3) HHS and DHS (FEMA) should pre-identify medical capabilities from federal, state, local, public, and private sector entities and establish arrangements to respond as the demand warrants. Based on these actions, this recommendation is closed as implemented.
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| Department of Health and Human Services | As HHS plans to respond to a pandemic, the Secretary of Health and Human Services should direct the Assistant Secretary for Preparedness and Response to use HHS's existing coordination mechanisms with DOD and FEMA to explore opportunities to improve their preparedness and response to a pandemic if DOD's capabilities are limited. | HHS concurred with this recommendation. HHS and the Office of the Assistant Secretary for Preparedness and Response (ASPR) has been working with DOD and DHS through the National Security Council to draft a National Biodefense Strategy in keeping with Section 1086 of the National Defense Authorization Act for Fiscal Year 2017 (P.L. 114-328). While the National Biodefense Strategy is not specific to any pandemic planning and preparedness, it incorporates many of the same levels of communication in keeping with the broader concept of biosecurity. ASPR chairs the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE). Established in 2006, PHEMCE is the federal coordinating body...
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| Federal Emergency Management Agency | As DHS, through FEMA, plans to respond to a pandemic, the Secretary of Homeland Security should direct the Administrator of FEMA to use FEMA's existing coordination mechanisms with DOD and HHS to explore opportunities to improve their preparedness and response to a pandemic if DOD's capabilities are limited. | DHS concurred with this recommendation. FEMA continues to collaborate with interagency partners, including DOD and HHS, to coordinate and plan for a variety of hazards, including pandemics. HHS is the Lead Federal Agency for federal public health and medical response, which includes pandemics. FEMA coordinates federal support for consequence management. Federal interagency partners are postured to support the whole community response to a potential pandemic threat posed by emerging or re-emerging viral pathogens and support HHS, as requested, to assist state, local, tribal, and territorial partners with related preparedness and response activities. As the interagency coordinator for...
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