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 				 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Product.                                                 **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
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][email protected] . Individuals making key contributions to
           this testimony include Susan Ragland, Allen Lomax, Catherine
           Myrick, Susan Sato, and Jordan Wicker.
			  
			  GAO's Mission

           The Government Accountability Office, the audit, evaluation and
           investigative arm of Congress, exists to support Congress in
           meeting its constitutional responsibilities and to help improve
           the performance and accountability of the federal government for
           the American people. GAO examines the use of public funds;
           evaluates federal programs and policies; and provides analyses,
           recommendations, and other assistance to help Congress make
           informed oversight, policy, and funding decisions. GAO's
           commitment to good government is reflected in its core values of
           accountability, integrity, and reliability.
			  
			  Obtaining Copies of GAO Reports and Testimony

           The fastest and easiest way to obtain copies of GAO documents at
           no cost is through GAO's Web site ( [19]www.gao.gov ). Each
           weekday, GAO posts newly released reports, testimony, and
           correspondence on its Web site. To have GAO e-mail you a list of
           newly posted products every afternoon, go to [20]www.gao.gov and
           select "Subscribe to Updates."
			  
			  Order by Mail or Phone

           The first copy of each printed report is free. Additional copies
           are $2 each. A check or money order should be made out to the
           Superintendent of Documents. GAO also accepts VISA and Mastercard.
           Orders for 100 or more copies mailed to a single address are
           discounted 25 percent. Orders should be sent to:

           U.S. Government Accountability Office 441 G Street NW, Room LM
           Washington, D.C. 20548
			  
			  To Report Fraud, Waste, and Abuse in Federal Programs

           To order by Phone: Voice: (202) 512-6000
			  TDD: (202) 512-2537
			  Fax: (202) 512-6061

           Contact:

           Web site: [21]www.gao.gov/fraudnet/fraudnet.htm
			  E-mail: [22][email protected]
			  Automated answering system: (800) 424-5454 or (202) 512-7470
			  
			  Congressional Relations

           Gloria Jarmon, Managing Director, [23][email protected] (202)
           512-4400 U.S. Government Accountability Office, 441 G Street NW,
           Room 7125 Washington, D.C. 20548
			  
			  Public Affairs

           Susan Becker, Acting Managing Director, [24][email protected] (202)
           512-4800 U.S. Government Accountability Office, 441 G Street NW,
           Room 7149 Washington, D.C. 20548

(450630)

This is a work of the U.S. government and is not subject to copyright
protection in the United States. The published product may be reproduced
and distributed in its entirety without further permission from GAO.
However, because this work may contain copyrighted images or other
material, permission from the copyright holder may be necessary if you
wish to reproduce this material separately.

To view the full product, including the scope

and methodology, click on [28]GAO-07-1257T .

For more information, contact Bernice Steinhardt at (202) 512-6806 or
[email protected].

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:[email protected]
  19. http://www.gao.gov/
  20. http://www.gao.gov/
  21. http://www.gao.gov/fraudnet/fraudnet.htm
  22. mailto:[email protected]
  23. mailto:[email protected]
  24. mailto:[email protected]
  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
*** End of document. ***