HHS Has Spent Almost 70 Percent of Available Supplemental Funds

From June 2009 through December 2010, HHS spent about $4.17 billion  (about two-thirds) of the $6.15 billion that it had available from the 2009  supplemental appropriation, according to HHS’s report to the Congress on  pandemic influenza preparedness spending. The majority of these funds were provided to the states through  Public Health Emergency Response (PHER) grants. HHS spent the remaining $1 billion (24 percent) on other purposes. Federal Response to the H1N1 Pandemic Highlighted a Number of Key Issues

Several key issues were raised by the federal government’s response to the  H1N1 pandemic. Not All Aspects of the Existing Strategy and Plan Were Relied on, but Earlier Funding and Planning Paid Off

			Elements of National Pandemic Strategy and Implementation Plan Were Not Relied on Because of the Nature of the H1N1 Pandemic

Given the specific characteristics of the H1N1 pandemic, the federal  government did not rely on some aspects of the national pandemic  strategy and national pandemic implementation plan, such as critical  infrastructure protection and border and trade measures. Prior Federal Funding and Planning Built Capacity and Interagency Relationships, Which Facilitated the Federal Response

Federal funding and planning for pandemic preparedness prior to the  onset of the H1N1 pandemic paid off by building capacity in several areas,  including (1) vaccine production, (2) influenza diagnosis, and (3) antiviral  drug development and stockpiling. Officials  from HHS’s ASPR and CDC, DHS, and Education stated that these  interagency meetings, working together on existing pandemic and  nonpandemic programs, and exercises conducted prior to the H1N1  pandemic built relationships that were valuable for the H1N1 pandemic  response. The credibility of all levels of government was diminished when the  amount of vaccine available to the public in October 2009 did not meet  expectations set by federal officials. While the use of a central vaccine distributor was generally cited as an  effective practice by state and local health officials during the H1N1  pandemic, some state health officials noted challenges with the  distribution process. Nevertheless, a DHS official commented that sharing lessons from the  reports with stakeholders would foster a spirit of government  transparency and might help build stakeholder trust. Furthermore, the NSS did not indicate how the  after-action reports—and the associated lessons learned—will be used in  future planning and preparedness efforts. Conclusions

The H1N1 pandemic was the first human influenza pandemic in more than  four decades. Although the NSS has requested that  federal agencies prepare after-action reports, NSS officials have not  decided how they will work with HHS and DHS to incorporate these  lessons into any future planning, as called for by the National Response  Framework, or how they will share these lessons with key stakeholders. Recommendations for Executive Action

We recommend that the Homeland Security Council direct the National  Security Staff to take the following two actions: In order to help the federal government prepare for a future influenza  pandemic, work with the Departments of Health and Human Services  and Homeland Security—as well as other federal agencies and state  and local jurisdictions, as applicable—to update planning and  exercising by incorporating lessons learned from federal agencies’  H1N1 after-action reports and the lessons we identified from the H1N1  pandemic. These lessons may include    developing communication strategies for better managing public  expectations about pandemic vaccine availability while working to  reduce the length of time required to produce a pandemic vaccine;  identifying state and local jurisdictions’ need for materials for non- English-speaking populations and examining ways to facilitate the  timely and efficient translation of key communication materials;  and    updating SNS plans by identifying tools for tracking SNS supplies,  ensuring that the supplies in the SNS meet the needs of states and  local jurisdictions, and accommodating previously unanticipated  scenarios, such as the need for possible long-term storage or  recovery of unused supplies.
Why GAO Did This Study

The 2009 H1N1 influenza pandemic was the first human pandemic in over four decades, and the Centers for Disease Control and Prevention (CDC) estimate that there were as many as 89 million U.S. cases. Over $6 billion was available for the response, led by the Departments of Health and Human Services (HHS) and Homeland Security (DHS), with coordination provided by the Homeland Security Council (HSC) through its National Security Staff (NSS). In particular, HHS's CDC worked with states and localities to communicate with the public and to distribute H1N1 vaccine and supplies. GAO was asked (1) how HHS used the funding, (2) the key issues raised by the federal response, and (3) the actions taken to identify and incorporate lessons learned. GAO reviewed documents and interviewed officials from five states about their interaction with the federal government. GAO also reviewed documents and interviewed officials from HHS, DHS, the Department of Labor's Occupational Safety and Health Administration (OSHA), NSS, and others, such as associations.

What GAO Found

As of December 2010, HHS had spent about two-thirds of the $6.15 billion that it had available for the H1N1 pandemic response. HHS spent the majority of the funds on developing and purchasing H1N1 vaccine and providing grants to all the states and selected local jurisdictions. State and local health officials reported that the grant funding was critical to their response efforts but also noted challenges presented by the grants' administrative requirements. HHS's spending plans for the remaining $1.98 billion include longer-term pandemic preparation efforts, such as activities to reduce the length of time required to produce a vaccine. Several key issues were raised by the federal government's response to the H1N1 pandemic. (1) Prior pandemic planning efforts and federal funding paid off, although specific aspects of prior planning were not relied on because of the nature of the H1N1 pandemic. For example, interagency meetings and exercises built relationships that were valuable during the response. Prior funding built capacity in several areas, including vaccine production. (2) The credibility of all levels of government was diminished when the amount of vaccine available to the public in October 2009 did not meet expectations set by federal officials. However, state and local jurisdictions valued the flexibility that they had in deciding their distribution methods. Additionally, while the use of a central distributor for the vaccines was generally cited as an effective practice, the 100- dose minimum order was viewed to be problematic. (3) Public surveys generally found CDC's communication efforts to be successful in reaching a range of audiences; however, these messages fell short in meeting the needs of some non-English-speaking populations. (4) Deployment of the Strategic National Stockpile--a supply of medicines and medical supplies to be used for a national emergency--met the established goal. However, CDC and state officials identified gaps in planning, including disparities between the materials expected and those delivered, as well as the need for long-term storage plans for stockpile materials. The NSS asked federal agencies--including HHS and DHS--to complete after-action reports based on their involvement in the pandemic response. The NSS has not determined if these reports--and the associated lessons learned--will be shared with key stakeholders. Nevertheless, a DHS official commented that sharing lessons from the reports with key stakeholders would foster a spirit of government transparency and might help build stakeholder trust.

What GAO Recommends

GAO recommends that the HSC direct the NSS, in concert with HHS and DHS, to incorporate lessons from the H1N1 pandemic into future planning and share these lessons with key stakeholders. NSS agreed to take the recommendations under advisement. HHS, DHS, and OSHA provided comments and generally agreed with our findings.