However, all 50 states, territories, and the District of  Columbia now have influenza pandemic plans according to CDC officials. HHS Has Found Major Gaps in States’ Influenza Pandemic Plans

Since we visited these states and localities, HHS provided feedback to the  states in November 2007 on whether their influenza pandemic plans  addressed certain priority areas, such as fatality management, and found  that there were major gaps nationally in the plans in these priority areas. These updated plans are due in July 2008. According to CDC officials, all states and localities that received this  funding have met the requirement to conduct a discussions-based or  operations-based exercise to test their influenza pandemic plans and to  prepare an after-action report. Officials told us that the changes made as a result of an exercise  included buying additional medical equipment and providing training. In addition, officials at the Dallas County Department  of Health and Human Services (Texas) reported that they identified the  need for, and subsequently developed, an appendix to their influenza  pandemic plan on school closures during a pandemic that included factors  for schools to consider in deciding when to close schools and for how  long. State and Local Officials Reported That They Wanted Additional Federal Influenza Pandemic Guidance

Despite these efforts, state and local officials from all of the states and  localities we interviewed told us that they would like additional federal  influenza pandemic guidance from the federal government on specific  topics to help them to better plan and exercise for an influenza pandemic. A  senior DHS official in the Office of Health Affairs reported that there are  no plans to conduct further regional state workshops on influenza  pandemic. The meetings could also provide a forum for states to build networks with  one another and federal officials. Although all states have developed influenza pandemic plans, the HHS-led  review of states’ influenza pandemic plans in coordination with other  federal agencies found “many major gaps” in planning nationally in 16 out  of 22 priority areas. While the federal government has provided influenza  pandemic guidance on a variety of topics, state and local officials told us  they would welcome additional guidance. Recommendation for Executive Action

To help maintain a continuity of focus on state pandemic planning efforts  and to further assist states in their pandemic planning, we recommend that  the Secretaries of Health and Human Services and Homeland Security, in  coordination with other federal agencies, convene additional meetings of  the states in the five federal influenza pandemic regions to help them  address identified gaps in their planning. Appendix I: Objectives, Scope, and Methodology

The objectives of this study were to (1) describe how selected states and  localities are planning for an influenza pandemic and how their efforts are  involving the federal government, other state and local agencies, tribal  nations, nonprofit organizations, and the private sector, (2) describe the  extent to which selected states and localities have conducted exercises to  test their influenza pandemic planning and incorporated lessons learned  into their planning, and (3) identify how the federal government can  facilitate or help improve state and local efforts to plan and exercise for an  influenza pandemic. Recognizing that we would be limited in our ability to report on all  states in detail, we selected these five states for a number of reasons,  including that these states    comprised over one-third of the United States population;  received over one-third of the total funding from the Department of Health  and Human Services (HHS) and the Department of Homeland Security  (DHS) that could be used for planning or exercising for an influenza  pandemic, and each state received the highest amount of total HHS and  DHS funding that could be used for planning and exercising for an  influenza pandemic respectively within each of the five regions established  by DHS for influenza pandemic preparedness and emergency response;  and   were likely entry points for individuals coming from another country given  that the states bordered either Mexico or Canada or contained major  ports, or both, and accounted for over one-third of the total number of  passengers traveling within the United States, and over half of both  inbound and outbound international air passenger traffic to and from the  United States. We also interviewed HHS, Centers for Disease Control and Prevention  (CDC), and DHS officials about how they are working with states and  localities in planning and exercising for an influenza pandemic and  reviewed documentation that they provided, including the HHS-led  feedback to states on their influenza pandemic plans and the March 2008  planning guidance to assist them in updating their influenza pandemic  plans.
Why GAO Did This Study

The Implementation Plan for the National Strategy for Pandemic Influenza states that in an influenza pandemic, the primary response will come from states and localities. To assist them with pandemic planning and exercising, Congress has provided $600 million to states and certain localities. The Department of Homeland Security (DHS) established five federal influenza pandemic regions to work with states to coordinate planning and response efforts. GAO was asked to (1) describe how selected states and localities are planning for an influenza pandemic and who they involved, (2) describe the extent to which selected states and localities conducted exercises to test their influenza pandemic planning and incorporated lessons learned as a result, and (3) identify how the federal government can facilitate or help improve state and local efforts to plan and exercise for an influenza pandemic. GAO conducted site visits to five states and 10 localities.

What GAO Found

All of the five states and 10 localities reviewed by GAO had developed influenza pandemic plans. In fact, according to officials at the Centers for Disease Control and Prevention (CDC), which administers the federal pandemic funds, all 50 states have developed an influenza pandemic plan, in accordance with federal pandemic funding requirements. At the time of GAO's site visits, officials from the selected states and localities reviewed said that they involved the federal government, other state and local agencies, tribal nations, and nonprofit and private sector organizations in their influenza pandemic planning. Since GAO's site visits, the Department of Health and Human Services (HHS) has provided feedback to the states, territories, and the District of Columbia (hereafter referred to as states) on whether their plans addressed 22 priority areas, such as policy process for school closure and communication. On average the department found that states' plans had "many major gaps" in 16 of the 22 priority areas. In March 2008, HHS, DHS, and other federal agencies issued guidance to states to help them update their pandemic plans, which are due by July 2008, in preparation for another HHS-led review. According to CDC officials, all states and localities that received the federal pandemic funds have met the requirement to conduct an exercise to test their plans. Officials from all of the states and localities reviewed by GAO reported that they had incorporated lessons learned from influenza pandemic exercises into their influenza pandemic planning, such as buying additional medical equipment, providing training, and modifying influenza pandemic plans. For example, as a result of an exercise, officials at the Dallas County Department of Health and Human Services (Texas) reported that they developed an appendix to their influenza pandemic plan on school closures during a pandemic. The federal government has provided influenza pandemic guidance on a variety of topics including an influenza pandemic planning checklist for states and localities and draft guidance on allocating an influenza pandemic vaccine. However, officials of the states and localities reviewed by GAO told GAO that they would welcome additional guidance from the federal government in a number of areas to help them to better plan and exercise for an influenza pandemic, in areas such as community containment (community-level interventions designed to reduce the transmission of a pandemic virus). Three of these areas were also identified as having "many major gaps" in states' plans nationally in the HHS-led review. In January 2008, HHS and DHS, in coordination with other federal agencies, hosted a series of meetings of states in the five federal influenza pandemic regions to discuss the draft guidance on updating their pandemic plans. Although a senior DHS official reported that there are no plans to conduct further workshops, additional regional meetings could provide a forum for state and federal officials to address gaps in states' planning identified by the HHS-led review and to maintain the momentum of states' pandemic preparedness through this next governmental transition.