Emergency Assistance for Zika: USAID Supported Activities Overseas but Could Improve Funds Tracking and Response Planning
Fast Facts
The Zika virus appeared in the Western Hemisphere in May 2015 and spread to many countries in less than a year. Zika can have mild or unnoticed symptoms, but it can also cause severe birth defects.
In response, USAID supported a range of activities overseas, including mosquito control, public awareness, and research. However, USAID didn't track Zika funding by country and took longer than desired to get response efforts launched in some countries.
To better position the agency for future outbreaks, we recommended that USAID track funding by country and take steps to improve its infectious disease response planning.
Mosquito That Carries the Zika Virus Viewed under a Microscope
Mosquito That Carries the Zika Virus Viewed under a Microscope
Highlights
What GAO Found
The U.S. Agency for International Development (USAID) and the Department of State (State) obligated $385 million of the total $390 million available for international Zika response and disbursed $264 million as of September 2018. USAID obligated 95 percent of the total funding. USAID and State provided some country information to Congress but did not provide, or take steps to track, funding on a country basis. According to USAID officials, tracking funding information by country would be helpful in the future. The ability to compile funding by country when responding to future infectious disease outbreaks would enable USAID to provide additional information to key decision makers to better support spending oversight and inform budgetary and planning decisions.
In response to the Zika outbreak, USAID and State supported a broad range of activities overseas, including mosquito control, research efforts, and medical evacuations. In one activity, USAID implementing partners monitored mosquito populations; in another, they researched methods to reduce Zika virus transmission rates. USAID implementing partners reported various outputs from selected activities. For example, an implementing partner reported that its awareness campaign on Zika prevention reached more than 5 million people.
USAID-Supported Worker Collects Insects for Monitoring Purposes in a Home in Honduras (left), and Mosquito That Carries the Zika Virus Viewed under a Microscope (right)
USAID faced sustainability and timeliness challenges in implementing its Zika response. According to agency and other officials, one-time funding and a short time frame posed a challenge related to sustainability of Zika response activities. In response, USAID worked to align activities with those of host governments and other organizations so they could continue in the long term. However, USAID's emergency response planning did not fully address the challenge of timely implementation of response activities in countries without bilateral USAID health programs. Twenty-two of 26 countries with Zika response activities did not have bilateral USAID health programs when the Zika outbreak began. As a result, response activities took additional time to deploy in some countries where USAID first had to establish relationships with key host country officials. Although USAID developed an infectious disease response plan in 2018, the plan does not provide guidance on how to address the timely implementation challenge in countries without bilateral health programs. By improving its planning, such as by adding such guidance in its 2018 plan, USAID would be better positioned to respond quickly to future disease outbreaks.
Why GAO Did This Study
The World Health Organization (WHO) declared the Zika virus a public health emergency of international concern in February 2016. According to WHO, as of March 2017, 79 countries and territories—including 48 in the Western Hemisphere—reported evidence of ongoing Zika transmission. In April 2016, USAID and State repurposed $215 million for Zika from funds appropriated for Ebola. Subsequently, the Zika Response and Preparedness Appropriations Act, 2016, provided over $175 million in supplemental funding to USAID and State to support Zika response efforts overseas. The act also included a provision for GAO to review the status of USAID and State actions to respond to Zika. In March 2019, the Centers for Disease Control and Prevention downgraded its international travel warning for Zika.
This report examines (1) the status of USAID and State funding for U.S. Zika response overseas, (2) activities supported by these funds, and (3) implementation challenges, if any, and responses to any challenges. GAO reviewed information from U.S. agencies and met with U.S. and host country officials in Washington, D.C. GAO also conducted fieldwork in a nongeneralizable sample of countries in Latin America and the Caribbean where agencies implemented key response activities.
Recommendations
USAID should (1) take steps to ensure it is able to compile funding information by country for future infectious disease emergency responses and (2) take steps to improve its infectious disease response planning. USAID concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| U.S. Agency for International Development | The Administrator of USAID should take steps to ensure that, in responding to future public health emergencies of international concern, the agency is able to compile funding information broken down by country. (Recommendation 1) |
In May 2019, GAO reported that the U.S. Agency for International Development (USAID) provided some country information to Congress on the status of USAID funding for U.S. Zika response overseas but did not provide, or take steps to track, funding on a country basis. GAO also reported that according to USAID officials, tracking funding information by country would be helpful in the future. GAO recommended that the Administrator of USAID take steps to ensure that, in responding to future public health emergencies of international concern, the agency is able to compile funding information broken down by country. USAID agreed with our recommendation and took corrective action. In response to GAO's recommendation, USAID took steps to ensure that in responding to any future public health emergency of international concern, it will compile and report by country on funding obligated and disbursed to implementers. In July 2019, USAID established a requirement and process to track Bureau for Global Health funding obligated for preparedness and response activities supporting a public health emergency of international concern on a by-country basis. USAID incorporated such a requirement to track funding for responding to a public health emergency of international concern by country into the programming process prior to the obligation of funds, and into the terms of awards. USAID issued an agency notice, in July 2019, to direct USAID operating units to track all funding for activities to prepare for and respond to the tenth outbreak of Ebola in the Eastern Democratic Republic of Congo, which the World Health Organization declared a public health emergency of international concern, on a country basis. These actions, which enable USAID to provide key decision makers with information to better support spending oversight and inform budgetary and planning decisions, implemented the recommendation.
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| U.S. Agency for International Development | The Administrator of USAID should take steps to improve its infectious disease response planning to address the challenge of initiating response activities in countries without bilateral USAID health programs in a timely manner. (Recommendation 2) |
In May 2019, GAO reported that the U.S. Agency for International Development's (USAID) emergency Zika response planning did not fully address the challenge of timely implementation of response activities in countries without bilateral USAID health programs. GAO recommended that the Administrator of USAID take steps to improve its infectious disease response planning to address the challenge of initiating response activities in countries without bilateral USAID health programs in a timely manner. GAO made this recommendation because USAID's response to Zika took additional time in some countries without bilateral USAID health programs and because infectious disease response planning that addresses countries without bilateral USAID health programs would better position USAID to quickly respond to infectious disease outbreaks, such as Zika, whenever the need arises. USAID agreed with our recommendation and took corrective action. In response to GAO's recommendation, in July 2019, USAID conducted a meeting concerning processes and resources related to infectious disease outbreaks, specifically for USAID missions and overseas offices without bilateral USAID health programs. With the goal of ensuring that USAID missions and overseas offices, even those without bilateral USAID health programs, stay aware of local outbreaks and send an email alert when there is an outbreak that may require international or additional assistance, USAID identified specific actions for officers at such locations to take, including establishing points of contact with the Ministry of Health and World Health Organization Country Office and completing a points of contact form. USAID's Bureau for Global Health (GH) distributed a points of contact template to the desk officers and program officers to maintain consistency across USAID. GH will coordinate with the desk officers and program officers to ensure that this information is updated on an annual basis and that there are continued engagements with points of contact. These actions, which better position USAID to quickly respond to infectious disease outbreaks whenever the need arises, implemented the recommendation.
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