COVID-19: HHS Agencies' Planned Reviews of Vaccine Distribution and Communication Efforts Should Include Stakeholder Perspectives
Fast Facts
When COVID-19 vaccines became available, the federal government sent most doses to states to distribute but also set up its own vaccine distribution programs.
State and local health officials said the federal programs helped higher-risk groups get vaccinated. But they also said they had little to no information about how the federal doses were allocated—making it difficult for states to allocate their own doses when vaccine supply was limited.
Two Department of Health and Human Services agencies plan to review their vaccination efforts to identify lessons learned. We recommended they seek input from state and local officials.
U.S. Army soldier administering a COVID-19 vaccine in Houston, Texas
Highlights
What GAO Found
In late 2020 and early 2021, agencies within the Department of Health and Human Services (HHS) set up federal programs for vaccine distribution and administration. State and local health officials and other stakeholders GAO interviewed said these programs helped higher-risk populations access COVID-19 vaccination. For example, the Health Resources and Services Administration's (HRSA) health center program provided vaccinations in medically underserved areas. However, these stakeholders also cited challenges, such as initially having limited or no information on the doses federal programs were sending to pharmacies and health centers in their communities. They said this made it difficult to decide which sites, including pharmacies and health centers, to send their own allocated doses when supply was limited.
Stakeholders told GAO the Centers for Disease Control and Prevention's (CDC) education materials, such as provider toolkits, were useful to address the public's concerns about the safety of COVID-19 vaccines, but providers would have liked them sooner to be able start promoting vaccination earlier. These stakeholders, including health officials, said they had difficulty managing public expectations and responding to questions about vaccine availability when they did not receive advance notice about changes in federal priority groups for vaccination.
Individual Being Vaccinated as Part of a Federal Program
Officials from HHS agencies—CDC and HRSA—stated they intend to conduct after action reviews to identify lessons learned from their COVID-19 vaccine distribution and communication efforts. However, officials said they have not finalized their plans for conducting such reviews, nor do they plan to do so while they continue to respond to the pandemic and have ongoing programs. Thus, it is uncertain whether they will gather input, including on an ongoing basis, from key stakeholders instrumental in vaccine distribution and communication efforts, such as state and local health officials, or whether the results will be shared with those stakeholders. Doing so will help ensure CDC and HRSA learn what worked well and identify areas for improvement to inform future vaccination efforts.
Why GAO Did This Study
Vaccination remains critical in the federal response to the COVID-19 pandemic. Vaccine implementation—prioritizing, allocating, distributing, and administering doses—requires coordination among federal, state, and local levels and other stakeholders. HHS agencies—including CDC and HRSA—set up federal vaccine distribution programs, such as CDC's retail pharmacy program that sends doses directly to pharmacies. The federal government also sends vaccine doses to states for further distribution.
The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines (1) stakeholder perspectives on federal programs to distribute and administer COVID-19 vaccines, (2) efforts to inform health officials, providers, and the public about vaccination, and (3) actions HHS agencies are taking to evaluate their vaccine implementation efforts.
GAO reviewed data and documents from HHS, CDC, and HRSA, and reviewed information from and interviewed state and local health officials in four states and one city selected, in part, for geographic variation. GAO also interviewed other stakeholders, including 12 national associations representing health care providers and others.
Recommendations
GAO is making four recommendations, including that CDC and HRSA obtain input from and share lessons learned with key stakeholders as they conduct their future reviews. HHS concurred with GAO's recommendations.
Recommendations for Executive Action
| 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) |
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.
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| 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) |
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.
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| Health Resources and Services Administration | As HRSA finalizes its plans for an after action review related to its COVID-19 vaccine distribution and communication efforts, the Administrator of the Health Resources and Services Administration 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 3) |
HRSA concurred with this recommendation. In May 2022, HHS described how HRSA had obtained feedback from key stakeholders, including federal, state, and local health officials, throughout the life cycle of the COVID-19 response on HRSA's COVID-19 vaccine programs. HRSA did this in a variety of ways, including through listening sessions, technical assistance calls, webinars, and surveys. In August 2022, HRSA reported it had completed its after action review specifically focused on its COVID-19 vaccine and distribution efforts, and incorporated feedback from stakeholders on the strengths of and potential areas of improvement. HHS reported that HRSA used the feedback to inform continuous quality improvement of HRSA's COVID-19 vaccine programs-including its communications, technical assistance, and operations-as availability and demand for COVID-19 vaccine changed with the pandemic. For example, HRSA used stakeholder feedback to update agency guidance on how health centers could offer health education in a culturally appropriate manner and clarified vaccine ordering and reporting processes.
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| Health Resources and Services Administration | The Administrator of the Health Resources and Services Administration 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. (Recommendation 4) |
HRSA concurred with this recommendation. In August 2022, HRSA reported it had completed its after action review specifically focused on its COVID-19 vaccine distribution and communication efforts and incorporated relevant feedback from stakeholders on potential areas of improvement. HRSA noted it shared its findings from this review with key stakeholders, including state and local officials, during a meeting held in July 2022.
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