Public Health Preparedness: HHS Reserve Funding for Emergencies

What GAO Found

The Department of Health and Human Services (HHS) can use a variety of funding options to help address a public health emergency or threat. For example, HHS may use annual or supplemental appropriations that were made for specific agency programs and activities. HHS also has two reserve funds to address immediate needs that arise in the first days or weeks of an emergency.

The Public Health Emergency Fund, established in 1983, is a reserve fund to help HHS agencies, such as the Administration for Strategic Preparedness and Response and the Centers for Disease Control and Prevention (CDC), to rapidly respond to any kind of public health emergency or threat. Such threats include extreme weather; diseases; radiological or nuclear incidents; or acts of terrorism. However, the fund has not received appropriations or been used in over 25 years.

Examples of Possible Immediate Needs during Public Health Emergencies

The Infectious Diseases Rapid Response Reserve Fund, established in 2018, is another reserve fund to allow CDC to rapidly respond to infectious disease threats. This fund received $800 million in appropriations from 2019 through 2023, including $600 million in 2020 after the beginning of the COVID-19 pandemic. From fiscal year 2020 through May 2023, CDC used $211 million from the fund for activities such as diagnostic testing and airport screening to help control the spread and severity of three infectious diseases: COVID-19, Ebola, and mpox (formerly known as monkeypox).

HHS officials described challenges funding immediate needs during selected public health emergencies. For example, prior to the infectious disease fund, HHS officials said it took time to identify and secure funding to address the immediate needs of the Zika outbreak in 2016. They were ultimately able to identify some funds from another program to use for the Zika response.

HHS officials said that the Infectious Diseases Rapid Response Reserve Fund has helped to address some of these challenges, specifically for CDC. In particular they said that having readily available, flexible, and consistently replenished funding has helped CDC respond quickly to emerging infectious disease threats before they worsen. However, HHS officials said they continue to face challenges addressing immediate needs, for example noting that the fund is available only for infectious diseases and not for other public health threats.

Why GAO Did This Study

Public health can be at significant risk during emergencies, like a pandemic or hurricane. State and local governments typically lead the domestic response to a public health emergency. However, if their capabilities are overwhelmed, HHS may provide additional support. To respond immediately to such emergencies, HHS has two reserve funds designed to hold funding over multiple fiscal years, for use as needed.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 included a provision for GAO to review the Public Health Emergency Fund. This report describes: (1) the available resources and specific purposes for which HHS's reserve funds have been used; and (2) HHS officials' perspectives on the challenges obtaining funding to respond to immediate needs of public health threats or emergencies, and how the reserve funds have helped address these challenges.

To conduct this work, GAO reviewed documentation and interviewed current and former agency officials about their use of the funds, any challenges they faced, and any funding characteristics that helped address challenges. To identify challenges, GAO asked HHS officials about their experiences during four selected public health emergencies that were infectious diseases or extreme weather events during the past 20 years—H1N1 influenza, Zika, Hurricane Maria, and mpox.

For more information, contact Mary Denigan-Macauley at (202) 512-7114 or DeniganMacauleyM@gao.gov.