In addition to these tools and guidance, other actions included HHS grant  awards totaling $350 million to state and local governments for pandemic  planning and more than $1 billion to accelerate development and  production of new technologies for influenza vaccines within the United  States. Federal Government Leadership Roles and Responsibilities Need Clarification and Testing

While the Strategy and Plan describe the broad roles and responsibilities  for preparing for and responding to a pandemic influenza, they do little to  clarify existing emergency response roles and responsibilities. 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. Additionally, the Plan states that the  Secretary of Homeland Security would be responsible for coordinating the  overall response to the pandemic; implementing policies that facilitate  compliance with recommended social distancing measures; providing for a  common operating picture for all departments and agencies of the federal  government; and ensuring the integrity of the nation’s infrastructure,  domestic security, and entry and exit screening for influenza at the  borders. In addition, 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. DHS is taking steps to further clarify federal leadership roles and  responsibilities. However, the Strategy and Plan do not address all of the  characteristics of an effective national strategy as we identified in our  prior work. 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. However, they only  partially address four and do not address one of the characteristics at all. Although the Strategy states that it  will be consistent with the National Security Strategy and the Strategy for  Homeland Security, it does not specify how they are related. We found that the Strategy and Plan address this characteristic  by describing the potential problems associated with a pandemic as well  as potential threats and vulnerabilities. The Plan  also did not describe a process for monitoring and reporting on the action  items. 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. The administration has taken an active approach  to this potential disaster by establishing an information clearinghouse for  pandemic information; developing numerous planning guidelines for  governments, businesses, nongovernmental organizations, and individuals;  issuing the Strategy and Plan; completing many action items contained in  the Plan; and continuing efforts to complete the remaining action items. 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 responsibilities could  have substantial consequences, both in the short and long term. Appendix I: Scope and Methodology

Our reporting objectives were to review the extent to which (1) federal  leadership roles and responsibilities for preparing for and responding to a  pandemic are clearly defined and (2) the National Strategy for Pandemic  Influenza (Strategy) and the Implementation Plan for the National  Strategy for Pandemic Influenza (Plan) address the characteristics of an  effective national strategy. To review the extent to which the Strategy and Plan address the  characteristics of an effective national strategy, we analyzed the Strategy  and Plan; reviewed key relevant sections of major statutes, regulations,  directives, national strategies, and plans discussed in the Plan; and  interviewed officials in agencies that the Strategy and Plan identified as  lead agencies in preparing for and responding to a pandemic. Financial Market Preparedness: Significant Progress Has Been Made,  but Pandemic Planning and Other Challenges Remain.
Why GAO Did This Study

An influenza pandemic is a real and significant potential threat facing the United States and the world. Pandemics occur when a novel virus emerges that can easily be transmitted among humans who have little immunity. In 2005, the Homeland Security Council (HSC) issued a National Strategy for Pandemic Influenza and, in 2006, an Implementation Plan. Congress and others are concerned about the federal government's preparedness to lead a response to an influenza pandemic. This report assesses how clearly federal leadership roles and responsibilities are defined and the extent to which the Strategy and Plan address six characteristics of an effective national strategy. To do this, GAO analyzed key emergency and pandemic-specific plans, interviewed agency officials, and compared the Strategy and Plan with the six characteristics GAO identified.

What GAO Found

The executive branch has taken an active approach to help address this potential threat, including establishing an online information clearinghouse, developing planning guidance and checklists, awarding grants to accelerate development and production of new technologies for influenza vaccines within the United States, and assisting state and local government pandemic planning efforts. However, federal government 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. The Strategy and Plan do not specify how the leadership roles and responsibilities will work in addressing the unique characteristics of an influenza pandemic, which could occur simultaneously in multiple locations and over a long period. A pandemic could extend well beyond health and medical boundaries, affecting critical infrastructure, the movement of goods and services across the nation and the globe, and economic and security considerations. Although the Department of Health and Human Services' (HHS) Secretary is to lead the public health and medical response and the Department of Homeland Security's (DHS) Secretary is to lead overall nonmedical support and response actions, the Plan does not clearly address these simultaneous responsibilities or how these roles are to work together, particularly over an extended period and at multiple locations across the country. In addition, the Secretary of DHS has designated a national Principal Federal Official (PFO) to facilitate pandemic coordination as well as five regional PFOs and five regional Federal Coordinating Officers. Most of these leadership roles and responsibilities have not been tested under pandemic scenarios, leaving it unclear how they will work. 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 the issuance of the Plan. While the Strategy and Plan are an important first step in guiding national preparedness, they do not fully address all six characteristics of an effective national strategy. Specifically, they fully address only one of the six characteristics, by reflecting a clear description and understanding of problems to be addressed, and do not address one characteristic because the documents do not describe the financial resources needed to implement actions. Although the other characteristics are partially addressed, important gaps exist that could hinder the ability of key stakeholders to effectively execute their responsibilities, including 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, relationships and priorities among actions were not clearly described, performance measures focused on activities that are not always linked to results; insufficient information is provided about how the documents are integrated with other key related plans, and no process is provided for monitoring and reporting on progress.