Influenza Pandemic: Opportunities Exist to Clarify Federal
Leadership Roles and Improve Pandemic Planning (26-SEP-07,
GAO-07-1257T).
An influenza pandemic is a real and significant potential threat
facing the United States and the world. Pandemics are unlike
other emergencies because they are not a singular event nor
discretely bounded in space and time. This testimony addresses
(1) federal leadership roles and responsibilities for preparing
for and responding to a pandemic, (2) our assessment of the
Strategy and Plan, and (3) opportunities to increase clarity of
federal leadership roles and responsibilities and improve
pandemic planning. GAO used its characteristics of an effective
national strategy to assess the Strategy and Plan. The issues
discussed in the testimony are based primarily on the GAO report,
Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer
Federal Leadership Roles and an Effective National Strategy
(GAO-07-781). In this report, GAO recommended that (1) The
Secretaries of Homeland Security and Health and Human Services
develop rigorous testing, training, and exercises for pandemic
influenza to ensure that federal leadership roles and
responsibilities are clearly defined, understood and work
effectively and (2) HSC set a time frame to update the Plan,
involve key stakeholders, and more fully address the
characteristics of an effective national strategy. The
Departments of Homeland Security and Health and Human Services
concurred. The HSC did not comment.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-07-1257T
ACCNO: A76748
TITLE: Influenza Pandemic: Opportunities Exist to Clarify
Federal Leadership Roles and Improve Pandemic Planning
DATE: 09/26/2007
SUBJECT: Critical infrastructure
Emergency management
Emergency preparedness
Emergency response plans
Federal/state relations
Homeland security
Infectious diseases
Influenza
Pandemic
Performance measures
Program evaluation
Public health
Risk management
Strategic planning
******************************************************************
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GAO-07-1257T
* [1]Background
* [2]Federal Leadership Roles Are Unclear, Evolving, and Untested
* [3]Federal Leadership Roles and Responsibilities Are Unclear an
* [4]Exercising and Testing of Plans Is Crucial in Ensuring Capac
* [5]Gaps in the National Strategy and Plan Limit Their Usefulnes
* [6]Opportunities Exist To Clarify Federal Leadership Roles and
* [7]Contacts and Acknowledgments
* [8]GAO's Mission
* [9]Obtaining Copies of GAO Reports and Testimony
* [10]Order by Mail or Phone
* [11]To Report Fraud, Waste, and Abuse in Federal Programs
* [12]Congressional Relations
* [13]Public Affairs
Testimony
Before the Subcommittee on Emerging Threats, Cybersecurity, and Science
and Technology, Committee on Homeland Security, House of Representatives
United States Government Accountability Office
GAO
For Release on Delivery
Expected at 10:00 a.m. EDT
Wednesday, September 26, 2007
INFLUENZA PANDEMIC
Opportunities Exist to Clarify Federal Leadership Roles and Improve
Pandemic Planning
Statement of Bernice Steinhardt, Director
Strategic Issues
GAO-07-1257T
Mr. Chairman and Members of the Subcommittee:
I am pleased to appear here today to discuss the federal government's
efforts to prepare for and respond to a possible influenza pandemic. An
influenza pandemic is a real and significant threat facing the United
States and the world. Although the timing and severity of the next
pandemic is unpredictable, there is widespread agreement that a pandemic
will occur at some point. Unlike incidents that are discretely bounded in
space or time (such as a storm or a terrorist attack), a pandemic is not a
singular event, but is likely to come in waves, each lasting weeks or
months, and could pass through communities of all sizes across the nation
and the world simultaneously.
Today, I will discuss (1) federal leadership roles and responsibilities
for preparing for and responding to a pandemic, (2) our assessment of the
National Strategy for a Pandemic Influenza (Strategy) and the
Implementation Plan for the National Strategy for a Pandemic Influenza
(Plan), and (3) opportunities to increase the clarity of federal
leadership roles and responsibilities and improve pandemic planning.
This statement is based on our August 14, 2007, report, requested by the
Ranking Member, Senate Budget Committee; the Chairman and Ranking Member,
House Committee on Oversight and Government Reform; and the Chairman,
House Committee on Homeland Security.^1 Our objectives in that report were
to address the extent to which (1) federal leadership roles and
responsibilities for preparing for and responding to a pandemic are
clearly defined and documented and (2) the Strategy and the Plan address
the characteristics of an effective national strategy; we conducted our
work in accordance with generally accepted government auditing standards.
We analyzed relevant documents, interviewed cognizant federal officials,
and assessed the Strategy and Plan to determine the extent to which they
jointly addressed the six desirable characteristics of an effective
national strategy that we developed and used in previous work.^2 While
national strategies necessarily vary in content, the six characteristics
we identified apply to all such planning documents and can help ensure
that they are effective management tools.
^1GAO, Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer
Leadership Roles and an Effective National Strategy, [14]GAO-07-781
(Washington, D.C.: Aug. 14, 2007).
^2See GAO, Combating Terrorism: Evaluation of Selected Characteristics in
National Strategies Related to Terrorism, [15]GAO-04-408T (Washington,
D.C.: Feb. 3, 2004); Rebuilding Iraq: More Comprehensive National Strategy
Needed to Help Achieve U.S. Goals, [16]GAO-06-788 (Washington, D.C.: July
11, 2006); and Financial Literacy and Education Commission: Further
Progress Needed to Ensure an Effective National Strategy, [17]GAO-07-100
(Washington, D.C.: Dec. 4, 2006).
In summary, although the administration has taken an active approach to
this potential disaster by developing a Strategy and Plan, and has
undertaken a number of other efforts, much more needs to be done to ensure
that the Plan is more viable and can be effectively implemented in the
event of an influenza pandemic.
o Key federal leadership roles and responsibilities for preparing
for and responding to a pandemic continue to evolve and will
require further clarification and testing before the relationships
of the many leadership positions are well understood. Most of
these leadership roles involve shared responsibilities, and it is
not clear how these would work in practice. Because initial
actions may help limit the spread of an influenza virus, the
effective exercise of shared leadership roles and responsibilities
could have substantial consequences. However, only one national,
multisector pandemic-related exercise has been held, and that was
prior to issuance of the Plan.
o The Strategy and Plan do not fully address the characteristics
of an effective national strategy and contain gaps that could
hinder the ability of key stakeholders to effectively execute
their responsibilities. In addition to the fact that the Strategy
and Plan do not clarify how responsible officials will share
leadership responsibilities, they do not include a description of
the resources required to implement the Plan, and consequently do
not provide a picture of priorities or how adjustments might be
made in view of resource constraints. Additionally, state and
local jurisdictions that will play crucial roles in preparing for
and responding to a pandemic were not directly involved in
developing the Plan, and the linkage of the Strategy and Plan with
other key plans is unclear.
The gaps in the Strategy and Plan are particularly troubling
because they can affect the usefulness of these planning documents
for those with key roles to play and, with no mechanisms for
future updates or progress assessments, limit opportunities for
congressional decision makers and the public to assess the extent
of progress being made or to consider what areas or actions may
need additional attention.
We made two recommendations in our August 2007 report to address
these concerns.
o We recommended that the Secretaries of Homeland Security and
Health and Human Services work together to develop and conduct
rigorous testing, training, and exercises for pandemic influenza
to ensure that the federal leadership roles are clearly defined
and understood and that leaders are able to effectively execute
shared responsibilities to address emerging challenges. Once the
leadership roles have been clarified through testing, training and
exercising, the Secretaries of Homeland Security and Health and
Human Services should ensure that these roles and responsibilities
are clearly understood by nonfederal partners.
o Our report also recommended that the Homeland Security Council
(HSC) establish a specific process and time frame for updating the
Plan. This process should involve key nonfederal stakeholders and
incorporate lessons learned from exercises and other sources. The
next update of the Plan could be improved by addressing the gaps
we identified.
The Department of Health and Human Services (HHS) and the
Department of Homeland Security (DHS) concurred with the first
recommendation. The HSC did not comment on the draft report or our
recommendation.
Background
To address the potential threat of an influenza pandemic, the
President and his HSC issued two planning documents. The Strategy
was issued in November 2005 and is intended to provide a
high-level overview of the approach that the federal government
will take to prepare for and respond to an influenza pandemic. It
also articulates expectations for nonfederal entities--including
state, local, and tribal governments; the private sector;
international partners; and individuals--to prepare themselves and
their communities.
The Plan was issued in May 2006 and is intended to lay out broad
implementation requirements and responsibilities among the
appropriate federal agencies and clearly define expectations for
nonfederal entities. The Plan includes 324 action items related to
these requirements, responsibilities, and expectations and most of
them are to be completed before or by May 2009. It is intended to
support the broad framework and goals articulated in the Strategy
by outlining specific steps that federal departments and agencies
should take to achieve these goals. It also describes expectations
regarding preparedness and response efforts of state and local
governments, tribal entities, the private sector, global partners,
and individuals. The Plan's chapters cover categories of actions
that are intended to address major considerations raised by a
pandemic, including protecting human and animal health;
transportation and borders; and international, security, and
institutional considerations.
Federal Leadership Roles Are Unclear, Evolving, and Untested
Several federal leadership roles involve shared responsibilities
for preparing for and responding to an influenza pandemic,
including the Secretaries of Health and Human Services and
Homeland Security, the Administrator of the Federal Emergency
Management Agency (FEMA), a national Principal Federal Official
(PFO), and regional PFOs and Federal Coordinating Officers (FCO).
Many of these leadership roles and responsibilities have not been
tested under pandemic scenarios, leaving unclear how all of these
new and developing relationships would work.
Federal Leadership Roles and Responsibilities Are Unclear and Evolving
The Strategy and Plan do not clarify the specific leadership roles
and responsibilities for a pandemic. Instead, they restate the
existing leadership roles and responsibilities, particularly for
the Secretaries of Homeland Security and Health and Human
Services, prescribed in the National Response Plan (NRP)--an
all-hazards plan for emergencies ranging from hurricanes to
wildfires to terrorist attacks. However, the leadership roles and
responsibilities prescribed under the NRP need to operate somewhat
differently because of the characteristics of a pandemic that
distinguish it from other emergency incidents. For example,
because a pandemic influenza is likely to occur in successive
waves, planning has to consider how to sustain response mechanisms
for several months to over a year--issues that are not clearly
addressed in the Plan.
In addition, the distributed nature of a pandemic, as well as the
sheer burden of disease across the nation, means that the support
states, localities, and tribal entities can expect from the
federal government would be limited in comparison to the aid it
mobilizes for geographically and temporarily bounded disasters
like earthquakes and hurricanes. Consequently, legal authorities,
roles and responsibilities, and lines of authority at all levels
of government must be clearly defined, effectively communicated,
and well understood to facilitate rapid and effective decision
making. This is also important for public and private sector
organizations and international partners so everyone can better
understand what is expected of them before and during a pandemic.
The Strategy and Plan state that the Secretary of Health and Human
Services is responsible for leading the medical response in a
pandemic, while the Secretary of Homeland Security is responsible
for overall domestic incident management and federal coordination.
However, since a pandemic extends well beyond health and medical
boundaries, to include sustaining critical infrastructure, private
sector activities, the movement of goods and services across the
nation and the globe, and economic and security considerations, it
is not clear when, in a pandemic, the Secretary of Health and
Human Services would be in the lead and when the Secretary of
Homeland Security would lead.
A pandemic could threaten our critical infrastructure, such as the
capability to deliver electricity or food, by removing essential
personnel from the workplace for weeks or months. The extent to
which this would be considered a medical response with the
Secretary of Health and Human Services in the lead, or when it
would be under the Secretary of Homeland Security's leadership as
part of his/her responsibility for ensuring that critical
infrastructure is protected, is unclear. According to HHS
officials we interviewed, resolving this ambiguity will depend on
several factors, including how the outbreak occurs and the
severity of the pandemic. Although DHS and HHS officials emphasize
that they are working together on a frequent basis, these roles
and responsibilities have not been thoroughly tested and
exercised.
Moreover, under the Post-Katrina Emergency Management Reform Act
of 2006 (referred to as the Post-Katrina Reform Act in this
testimony), the FEMA Administrator was designated the principal
domestic emergency management advisor to the President, the HSC,
and the Secretary of Homeland Security, adding further complexity
to the leadership structure in the case of a pandemic.^3 The act
also gives the Administrator responsibility for carrying out a
national exercise program to test and evaluate national
preparedness for responding to all-hazards, including an influenza
pandemic.
Other evolving federal leadership roles include those of PFOs and
FCOs. To assist in planning and coordinating efforts to respond to
a pandemic, in December 2006 the Secretary of Homeland Security
predesignated a national PFO and established five pandemic regions
each with a regional PFO and FCO. PFOs are responsible for
facilitating federal domestic incident planning and coordination,
and FCOs are responsible for coordinating federal resources
support in a presidentially declared major disaster or emergency.
However, the relationship of these roles to each other as well as
with other leadership roles in a pandemic is unclear.
U.S. Coast Guard and FEMA officials we met with recognized that
planning for and responding to a pandemic would require different
operational leadership roles and responsibilities than for most
other emergencies. For example, a FEMA official said that given
the number of people who would be involved in responding to a
pandemic, collaboration between HHS, DHS, and FEMA would need to
be greater than for any other past emergencies. Officials are
starting to build on these relationships. For example, some of the
federal officials with leadership roles for an influenza pandemic
met during the week of March 19, 2007, to continue to identify
issues and begin developing solutions. One of the participants
told us that although additional coordination meetings are needed,
it may be challenging since there is no dedicated funding for the
staff working on pandemic issues to participate in these and other
related meetings.
^3Pub. L. No. 109-295, Title VI.
It is also unclear whether the newly established national and
regional positions for a pandemic will further clarify leadership
roles in light of existing and newly emerging plans and issues.
For example, in 2006, DHS made revisions to the NRP and released a
Supplement to the Catastrophic Incident Annex--both designed to
further clarify federal roles and responsibilities and
relationships among federal, state, and local governments and
responders. However, we reported in February 2007 that these
revisions had not been tested and there was little information
available on the extent to which these and other actions DHS was
taking to improve readiness were operational.^4 We also reported
in May 2007 that FEMA has predesignated five teams of FCOs and
PFOs in the Gulf Coast and eastern seaboard states at risk of
hurricanes. However, there is still some question among state and
local first responders about the need for both positions and how
they will work together in disaster response.^5
More recently, DHS reviewed the NRP and its supplemental
documents. One of the issues this review intended to address was
clarifying roles and responsibilities of key structures,
positions, and levels of government, including the role of the PFO
and that position's current lack of operational authority over the
FCO during an emergency. On September 10, 2007, DHS released a
draft National Response Framework to replace the NRP, for public
comment. Comments on the framework are due October 11, 2007, and
comments on the supplemental documents, such as revised Emergency
Support Function specifications, are due by November 9, 2007.
^4GAO, Homeland Security: Management and Programmatic Challenges Facing
the Department of Homeland Security, [25]GAO-07-398T (Washington, D.C.:
Feb. 6, 2007).
^5GAO, Homeland Security: Observations on DHS and FEMA Efforts to Prepare
for and Respond to Major and Catastrophic Disasters and Address Related
Recommendations and Legislation, [26]GAO-07-835T (Washington, D.C.: May
15, 2007).
Exercising and Testing of Plans Is Crucial in Ensuring Capacity
Disaster planning, including for a pandemic influenza, needs to be
tested and refined with a rigorous and robust exercise program to
expose weaknesses in plans and allow planners to refine them.
Exercises--particularly for the type and magnitude of emergency
incidents such as a severe influenza pandemic for which there is
little actual experience--are essential for developing skills and
identifying what works well and what needs further improvement.
Our prior work examining the preparation for and response to
Hurricane Katrina highlighted the importance of realistic
exercises to test and refine assumptions, capabilities, and
operational procedures, and build upon strengths.^6
While pandemic influenza scenarios have been used to exercise
specific response elements, such as the distribution of stockpiled
medications at specific locations or jurisdictions, no national
exercises have tested the new federal leadership structure for
pandemic influenza.^7 The only national multisector pandemic
exercise to date was a tabletop simulation conducted by members of
the cabinet in December 2005. This tabletop exercise was prior to
the release of the Plan in May 2006, the establishment of a
national PFO and regional PFO and FCO positions for a pandemic,
and enactment of the Post-Katrina Reform Act.
Gaps in the National Strategy and Plan Limit Their Usefulness
Our work found that the Strategy and Plan do not address all of
the characteristics of an effective national strategy as
identified in our prior work. While national strategies
necessarily vary in content, the six characteristics we identified
apply to all such planning documents and can help ensure that they
are effective management tools. Gaps and deficiencies in these
documents are particularly troubling in that a pandemic represents
a complex challenge that will require the full understanding and
collaboration of a multitude of entities and individuals. The
extent to which these documents, that are to provide an overall
framework to ensure preparedness and response to a pandemic
influenza, fail to adequately address key areas could have
critical impact on whether the public and key stakeholders have a
clear understanding and can effectively execute their roles and
responsibilities.
^6GAO, Hurricane Katrina: GAO's Preliminary Observations Regarding
Preparedness, Response, and Recovery, [27]GAO-06-442T (Washington, D.C.:
Mar. 8, 2006).
^7Congressional Research Service, Pandemic Influenza: Domestic
Preparedness Efforts, RL 33145 (Washington, D.C.: Feb. 20, 2007).
Specifically, we found that the documents fully address only one
of the six characteristics of an effective national
strategy--problem definition and risk assessment--because they
identified the potential problems associated with a pandemic as
well as potential threats, challenges, and vulnerabilities. The
Strategy and Plan did not address one characteristic--resources,
investments, and risk management--because they did not discuss the
financial resources and investments needed to implement the
actions called for and therefore, do not provide a picture of
priorities or how adjustments might be made in view of resource
constraints. They partially addressed the four remaining
characteristics, as shown in table 1.
Table 1: Extent to Which the Strategy and Plan Address GAO's
Desirable Characteristics of an Effective National Strategy
Partially Does not
Desirable characteristic Addresses addresses address
Clear purpose, scope, and methodology X
Problem definition and risk assessment X
Goals, subordinate objectives, activities, X
and performance measures
Resources, investments, and risk management X
Organizational roles, responsibilities, and X
coordination
Integration and implementation X
Source: GAO analysis of the National Strategy for Pandemic
Influenza and Implementation Plan for the National Strategy for
Pandemic Influenza.
More specifically, the following are highlights of some of the
gaps in the Strategy and Plan.
o The Strategy and Plan do not address resources,
investments, and risk management. Developing and
sustaining the capabilities stipulated in the Plan
would require the effective use of federal, state,
and local funds. Given that funding needs may not be
readily addressed through existing mechanisms and
could stress existing government and private
resources, it is critical for the Plan to lay out
funding requirements. For example, one of the primary
objectives of domestic vaccine production capacity is
for manufacturers to produce enough vaccine for the
entire U.S. population within 6 months. However, the
Plan states that production capacity would depend on
the availability of future appropriations. Despite
the fact that the production of enough vaccine for
the population would be critical if a pandemic were
to occur, the Plan does not provide even a rough
estimate of how much the vaccine could cost for
consideration in future appropriations.
o State and local jurisdictions were not directly
involved in developing the Strategy and Plan. Neither
the Strategy nor Plan described the involvement of
key stakeholders, such as state, local, and tribal
entities, in their development, even though these
stakeholders would be on the front lines in a
pandemic and the Plan identifies actions they should
complete. Officials told us that state, local, and
tribal entities were not directly involved in
reviewing and commenting on the Plan, but the
drafters of the Plan were generally aware of their
concerns.
o Relationships and priorities among action items are
not always clear. While some action items depend on
other action items, these linkages are not always
apparent in the Plan. An HHS official who helped
draft the Plan acknowledged that while an effort was
made to ensure linkages among action items, there may
be gaps in the linkages among interdependent action
items within and across the Plan's chapters that
focused on such issues as human health, animal
health, and transportation and borders
considerations.
In addition, we found that the Plan does not
establish priorities among its 324 action items,
which becomes especially important as agencies and
other parties strive to effectively manage scarce
resources and ensure that the most important steps
are accomplished.
o Performance measures are focused on activities that
are not always linked to results. Most of the Plan's
performance measures are focused on activities such
as disseminating guidance, but the measures are not
always clearly linked with intended results. This
lack of linkages to outcomes and results makes it
difficult to ascertain whether progress has in fact
been made toward achieving the national goals and
objectives described in the Strategy and Plan.
o The linkage of the Strategy and Plan with other key
plans is unclear. Although the Strategy states that
it is consistent with the National Security Strategy
and the National Strategy for Homeland Security, it
does not state how it is consistent or describe the
relationships with these two strategies. In addition,
the Plan does not specifically address how the
Strategy, Plan, or other related pandemic plans
should be integrated with the goals, objectives, and
activities of the national initiatives already in
place, such as the interim National Preparedness
Goal.
Further, the Strategy and Plan do not provide
sufficient detail about how the Strategy, action
items in the Plan, and a proposed set of agency plans
are to be integrated with other national strategies
and frameworks. For example, the Plan contains 39
action items that are response related (i.e.,
specific actions are to be taken within a prescribed
number of hours or days after an outbreak). However,
these action items are interspersed among the 324
action items, and the Plan does not describe the
linkages of these response-related action items with
the NRP or other response related plans.
o The Plan does not contain a process for monitoring
and reporting on progress. While most of the action
items have deadlines for completion, ranging from 3
months to 3 years, the Plan does not identify a
process to monitor and report on the progress of the
action items nor does it include a schedule for
reporting progress. According to agency officials,
the HSC is monitoring executive branch agencies'
efforts to complete the action items. However, there
is no specific documentation describing this process
or institutionalizing it. This is important since
some of the action items are not expected to be
completed during this administration. Also, a similar
monitoring process for those actions items for which
nonfederal entities have the lead responsibility does
not appear to exist. Additionally, there is no
explicit timeline for the HSC to report on the
overall progress and thus, when progress is reported
is left to the HSC's discretion.
o The Plan does not describe an overall framework for
accountability and oversight. While the plan contains
broad information on roles and responsibilities and
describes coordination mechanisms for responding to a
pandemic, it does not, as noted earlier, clarify how
responsible officials would share leadership
responsibilities. In addition, it does not describe
an overall accountability and oversight framework.
Agency officials told us that they had identified
individuals to act as overall coordinators to monitor
the action items for which their agencies have lead
responsibility and provide periodic progress reports
to the HSC. However, we could not identify a similar
oversight mechanism for the action items that fall to
state and local governments or the private sector.
This is a concern since some action items,
particularly those that are to be completed by state,
local, and tribal governments or the private sector,
do not identify an entity accountable for carrying
out the action.
o Procedures and time frames for updating and
revising the Plan were not established. The Plan does
not describe a mechanism for updating it to reflect
policy decisions, such as clarifications in
leadership roles and responsibilities and other
lessons learned from exercises, or to incorporate
other needed changes. Although the Plan was developed
as initial guidance and was intended to be updated
and expanded over time, officials in several agencies
told us that specific processes or time frames for
updating and revising it have not been established.
Opportunities Exist To Clarify Federal Leadership Roles and Improve
Pandemic Planning
A pandemic poses some unique challenges and would be unlike other
emergencies given the likelihood of its duration and geographic
coverage. Initial actions may help limit the spread of an
influenza virus, reflecting the importance of a swift and
effective response. Therefore, the effective exercise of shared
leadership roles and implementation of pandemic plans could have
substantial consequences, both in the short and long term.
Since no national pandemic exercises of federal leadership roles
and responsibilities have been conducted since the release of the
Plan in May 2006, and key leadership roles continue to evolve,
rigorous testing, training, and exercising is needed. Exercises
test whether leadership roles and responsibilities, as well as
procedures and processes, are clear and well-understood by key
stakeholders. Additionally, they help identify weaknesses and
allow for corrective action to be taken before an actual emergency
occurs. Consequently, in our August 2007 report, we recommended
that the Secretaries of Homeland Security and Health and Human
Services work together to develop and conduct rigorous testing,
training, and exercises for pandemic influenza to ensure that the
federal leadership roles are clearly defined and understood and
that leaders are able to effectively execute shared
responsibilities to address emerging challenges. Once the
leadership roles have been clarified through testing, training,
and exercising, the Secretaries of Homeland Security and Health
and Human Services should ensure that these roles and
responsibilities are clearly understood by state, local, and
tribal governments; the private and nonprofit sectors; and the
international community. DHS and HHS concurred with the
recommendation, and DHS stated that it is taking action on many of
the shortfalls identified in the report.
The Strategy and Plan are important because they broadly describe
the federal government's approach and planned actions to prepare
for and respond to a pandemic and also set expectations for states
and communities, the private sector, and global partners. The
extent to which the Strategy and Plan fail to adequately address
key areas could have a critical impact on whether key stakeholders
and the public have a clear understanding of their roles and
responsibilities. However, gaps in the Strategy and Plan limit
their usefulness as a management tool for ensuring accountability
and achieving results. The plan is silent on when information will
be reported or when it will be updated. Although the HSC publicly
reported on the status of action items in December 2006 and July
2007, it is unclear when the next report will be issued or how
much information will be released. This lack of transparency makes
it difficult to inform a national dialogue on the progress made to
date or what further steps are needed. It also inhibits
congressional oversight of strategies, funding priorities, and
critical efforts to enhance the nation's level of preparedness.
Therefore, in our August 2007 report we recommended that the HSC
establish a specific process and time frame for updating the Plan.
We stated that this process should involve key nonfederal
stakeholders and incorporate lessons learned from exercises and
other sources. Further, we stated that the Plan could be improved
by including the following information in the next update: (1)
resources and investments needed to complete the action items and
where they should be targeted, (2) a process and schedule for
monitoring and publicly reporting on progress made on completing
the action items, (3) clearer linkages with other strategies and
plans, and (4) clearer descriptions of relationships or priorities
among actions items and greater use of outcome-focused performance
measures. The HSC did not comment on the draft report.
Mr. Chairman and Members of the Subcommittee, this completes my
statement. I would be pleased to respond to any questions that you
might have.
Contacts and Acknowledgments
For further information on this testimony, please contact Bernice
Steinhardt, Director, Strategic Issues, at (202) 512-6806 or
[18]steinhardtb@gao.gov . Individuals making key contributions to
this testimony include Susan Ragland, Allen Lomax, Catherine
Myrick, Susan Sato, and Jordan Wicker.
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Highlights of [29]GAO-07-1257T , a testimony to the Subcommittee on
Emerging Threats, Cybersecurity, and Science and Technology, Committee on
Homeland Security, House of Representatives
September 26, 2007
INFLUENZA PANDEMIC
Opportunities Exist to Clarify Federal Leadership Roles and Improve
Pandemic Planning
An influenza pandemic is a real and significant potential threat facing
the United States and the world. Pandemics are unlike other emergencies
because they are not a singular event nor discretely bounded in space and
time.
This testimony addresses (1) federal leadership roles and responsibilities
for preparing for and responding to a pandemic, (2) our assessment of the
Strategy and Plan, and (3) opportunities to increase clarity of federal
leadership roles and responsibilities and improve pandemic planning. GAO
used its characteristics of an effective national strategy to assess the
Strategy and Plan.
The issues discussed in the testimony are based primarily on the GAO
report, Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer
Federal Leadership Roles and an Effective National Strategy (
[30]GAO-07-781 ). In this report, GAO recommended that (1) The Secretaries
of Homeland Security and Health and Human Services develop rigorous
testing, training, and exercises for pandemic influenza to ensure that
federal leadership roles and responsibilities are clearly defined,
understood and work effectively and (2) HSC set a time frame to update the
Plan, involve key stakeholders, and more fully address the characteristics
of an effective national strategy. The Departments of Homeland Security
and Health and Human Services concurred. The HSC did not comment.
The administration has taken an active approach to this potential disaster
by, among other things, issuing a National Strategy for Pandemic Influenza
(Strategy) in November 2005, and a National Strategy for Pandemic
Influenza Implementation Plan (Plan) in May 2006. However, much more needs
to be done to ensure that the Strategy and Plan are viable and can be
effectively implemented in the event of an influenza pandemic.
Key federal leadership roles and responsibilities for preparing for and
responding to a pandemic continue to evolve and will require further
clarification and testing before the relationships of the many leadership
positions are well understood. Most of these leadership roles involve
shared responsibilities and it is unclear how they will work in practice.
Because initial actions may help limit the spread of an influenza virus,
the effective exercise of shared leadership roles and responsibilities
could have substantial consequences. However, only one national,
multi-sector pandemic-related exercise has been held, and that was prior
to issuance of the Plan.
The Strategy and Plan do not fully address the characteristics of an
effective national strategy and contain gaps that could hinder the ability
of key stakeholders to effectively execute their responsibilities.
Specifically, some of the gaps include
o The Strategy and Plan do not address resources, investments, and
risk management and consequently do not provide a picture of
priorities or how adjustments might be made in view of limited
resources.
o State and local jurisdictions were not directly involved in
developing the Plan, even though they would be on the front lines
in a pandemic.
o Relationships and priorities among action items are not always
clear.
o Performance measures are focused on activities that are not
always linked to results.
o The linkage of the Strategy and Plan with other key plans is
unclear.
o The Plan does not contain a process for monitoring and reporting
on progress.
o The Plan does not describe an overall framework for
accountability and oversight and does not clarify how responsible
officials would share leadership responsibilities.
o Procedures and time frames for updating and revising the Plan
were not established.
These gaps can affect the usefulness of these planning documents for those
with key roles to play. Also, the lack of mechanisms for future updates or
progress assessments limit opportunities for congressional decision makers
and the public to assess the extent of progress being made or to consider
what areas or actions may be need additional attention. Although the
Homeland Security Council (HSC) publicly reported on the status of action
items in December 2006 and July 2007, it is unclear when the next report
will be issued or how much information will be released.
References
Visible links
14. http://www.gao.gov/cgi-bin/getrpt?GAO-07-781
15. http://www.gao.gov/cgi-bin/getrpt?GAO-04-408T
16. http://www.gao.gov/cgi-bin/getrpt?GAO-06-788
17. http://www.gao.gov/cgi-bin/getrpt?GAO-07-100
18. mailto:steinhardtb@gao.gov
19. http://www.gao.gov/
20. http://www.gao.gov/
21. http://www.gao.gov/fraudnet/fraudnet.htm
22. mailto:fraudnet@gao.gov
23. mailto:JarmonG@gao.gov
24. mailto:Beckers@gao.gov
25. http://www.gao.gov/cgi-bin/getrpt?GAO-07-398T
26. http://www.gao.gov/cgi-bin/getrpt?GAO-07-835T
27. http://www.gao.gov/cgi-bin/getrpt?GAO-06-442T
28. http://www.gao.gov/cgi-bin/getrpt?GAO-07-1257T
29. http://www.gao.gov/cgi-bin/getrpt?GAO-07-1257T
30. http://www.gao.gov/cgi-bin/getrpt?GAO-07-781
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