2). COCOMs Have Taken Numerous Actions to Prepare for an Influenza Pandemic

COCOMs have taken numerous management and operational actions to  prepare for an influenza pandemic and the COCOMs’ efforts are evolving. However, each established or intends to establish a group  to prepare for pandemic influenza. COCOMs Have Conducted Exercises for Pandemic Influenza Plans

To test their pandemic influenza plans, five of the nine COCOMs have  conducted a pandemic influenza-related exercise. COCOMs have used  various strategies to inform personnel about pandemic influenza, including  using various media outlets, training programs, and outreach events. COCOMs Have Coordinated with Other Nations

Each of the geographic COCOMs has started to work or plans to work  with nations in its area of responsibility to raise awareness about and  assess capabilities for responding to avian and pandemic influenza. As a result, the unity and  cohesiveness of DOD’s pandemic influenza preparation could be impaired  and the potential remains for confusion among officials and gaps and  duplication in actions taken by the COCOMs relative to the military  services and other DOD organizations in implementing tasks, such as the  actions assigned to DOD as a lead agency in the national implementation  plan. While we recognize the difficulty in  planning for an influenza pandemic, not yet developing options to mitigate  the effects of such factors may place at risk the COCOM commanders’  ability to protect their personnel—including military and civilian  personnel, contractors, dependents, and beneficiaries—or to perform their  missions during an influenza pandemic. Roles, Responsibilities, and Authorities of Key Organizations Relative to Others Are Not Fully and Clearly Defined

The roles, responsibilities, and authorities of key organizations involved in  DOD’s pandemic influenza planning and preparedness efforts relative to  other organizations leading and supporting the department’s pandemic  influenza planning efforts—including NORTHCOM as the lead for DOD’s  planning and the individual COCOMs—remained unclear because of the  continued lack of sufficiently detailed guidance from the Secretary of  Defense or his designee. DOD Has Not Identified Resources to Complete Planning and Preparedness Activities

We identified a disconnect between the COCOMs’ planning and  preparedness activities and resources, including funding and personnel, to  complete those activities. DOD generally concurred with our recommendation, but had not yet taken  actions to address this recommendation. The continued lack of a link  between the COCOMs’ planning and preparedness activities and the  resources required for them may limit the COCOMs’ ability to effectively  prepare for and respond to an influenza pandemic. These  officials reported that their lack of control over DOD’s stockpile of  antivirals has limited their ability to plan to use this resource. For example, if a nation decides to close its borders at the start  of a pandemic, COCOMs and installations may not be able to obtain  needed supplies, such as antivirals. Recommendations for Executive Action

To reduce the potential for confusion, gaps, and duplications in the  COCOMs’ pandemic influenza planning and preparedness efforts and  enhance the unity and cohesiveness of DOD’s efforts, we recommend that  the Secretary of Defense instruct the ASD(HD&ASA) to issue guidance  that specifies the following:    Which of the actions assigned to DOD in the Implementation Plan for  the National Strategy for Pandemic Influenza and other pandemic  influenza-related planning tasks apply to the individual COCOMs,  military services, and other organizations within DOD, as well as what  constitutes fulfillment of these actions. To increase the likelihood that COCOMs are more fully prepared to  protect personnel and perform ongoing missions during an influenza  pandemic, we recommend that the Secretary of Defense instruct the Joint  Staff to work with the COCOMs to develop options to mitigate the effects  of factors that are beyond the COCOMs’ control, such as limited detailed  information from other federal agencies on the support expected from  DOD, lack of control over DOD’s antiviral stockpile, limited information  on decisions that other nations may make during an influenza pandemic,  reliance on civilian medical providers for medical care, and reliance on  military services for medical materiel.
Why GAO Did This Study

An influenza pandemic could impair the military's readiness, jeopardize ongoing military operations abroad, and threaten the day-to-day functioning of the Department of Defense (DOD) due to a large percentage of sick or absent personnel. GAO was asked to examine DOD's pandemic influenza planning and preparedness efforts. GAO previously reported that DOD had taken numerous actions to prepare departmentwide, but faced four management challenges as it continued its efforts. GAO made recommendations to address these challenges and DOD generally concurred with them. This report focuses on DOD's combatant commands (COCOM) and addresses (1) actions the COCOMs have taken to prepare and (2) management challenges COCOMs face going forward. GAO reviewed guidance, plans, and after-action reports and interviewed DOD officials and more than 200 officials at the 9 COCOMs.

What GAO Found

COCOMs have taken numerous management and operational actions to prepare for an influenza pandemic, and the COCOMs' efforts are evolving. Each of DOD's nine COCOMs has established or intends to establish a working group to prepare for an influenza pandemic. Additionally, eight of the nine COCOMs have developed or are developing a pandemic influenza plan. Half of the COCOMs have conducted exercises to test their pandemic influenza plans and several are taking steps to address lessons learned. Five of the nine COCOMs have started to use various media, training programs, and outreach events to inform their personnel about pandemic influenza. Each of the geographic COCOMs has worked or plans to work with nations in its area of responsibility to raise awareness about and assess capabilities for responding to avian and pandemic influenza. Although COCOMs have taken numerous actions, GAO identified three management challenges that may prevent the COCOMs from being fully prepared to effectively protect personnel and perform missions during an influenza pandemic, two of which are related to issues GAO previously recommended that DOD address. First, the roles, responsibilities, and authorities of key organizations relative to others involved in DOD's planning efforts remained unclear in part due to the continued lack of sufficiently detailed guidance from the Secretary of Defense or his designee. As a result, the unity and cohesiveness of DOD's efforts could be impaired and the potential remains for confusion and gaps or duplication in actions taken by the COCOMs relative to the military services and other DOD organizations, such as in completing actions assigned to DOD in the Implementation Plan for the National Strategy for Pandemic Influenza. Second, GAO identified a disconnect between the COCOMs' planning and preparedness activities and resources, including funding and personnel, to complete these activities, in part, because DOD's guidance does not identify the resources required to complete these activities. The continued lack of a link between planning and preparedness activities and resources may limit the COCOMs' ability to effectively prepare for and respond to an influenza pandemic, including COCOMs' ability to exercise pandemic influenza plans in the future. Third, GAO identified factors that are beyond the COCOMs' control--such as limited detailed guidance from other federal agencies on support expected from DOD, lack of control over DOD's stockpile of antivirals, limited information on decisions that other nations may make during an influenza pandemic, reliance on civilian medical providers for medical care, and reliance on military services for medical materiel--that they have not yet fully planned how to mitigate. While GAO recognizes the challenge of pandemic influenza planning, not yet developing options to mitigate the effects of factors that are beyond their control may place at risk the COCOM commanders' ability to protect their personnel and perform missions during an influenza pandemic. For example, if a nation decides to close its borders at the start of a pandemic, COCOMs and installations may not be able to obtain needed supplies, such as antivirals.