	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. 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). 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. 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. 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. 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. 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. Relationships and priorities among action items are not always  clear. Performance measures are focused on activities that are not always  linked to results. The linkage of the Strategy and Plan with other key plans is unclear. The Plan does not contain a process for monitoring and reporting on  progress. 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. Procedures and time frames for updating and revising the Plan were  not established. 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. 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. 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. 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.
Why GAO Did This Study

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.

What GAO Found

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 (1) 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. (2) State and local jurisdictions were not directly involved in developing the Plan, even though they would be on the front lines in a pandemic. (3) Relationships and priorities among action items are not always clear. (4) Performance measures are focused on activities that are not always linked to results. (5) The linkage of the Strategy and Plan with other key plans is unclear. (6) The Plan does not contain a process for monitoring and reporting on progress. (7) The Plan does not describe an overall framework for accountability and oversight and does not clarify how responsible officials would share leadership responsibilities. (8) 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.