Absent a Strategy and Biosurveillance- Specific Capability Efforts, Existing Federal Activities Help Support State and Local Capabilities

In the absence of a national biosurveillance strategy, the federal  government has some efforts, including emergency preparedness,  disease-specific surveillance, and laboratory enhancement programs, that  provide resources and information that state and city officials say are  critical to their efforts to build and maintain capabilities. The federal  programs and initiatives that officials identified during interviews as useful  for supporting their biosurveillance capabilities generally fell into four  categories, which respondents to our follow-up questionnaire ranked in  descending order of importance as follows: (1) grants and cooperative  agreements, (2) nonfinancial technical and material assistance, (3)  guidance, and (4) information sharing. Because the resources that constitute a national biosurveillance capability  are largely owned by nonfederal entities, a national strategy that  considers how to leverage existing efforts and resources in federal, state,  tribal, local, and insular jurisdictions could improve efforts to build and  maintain a national biosurveillance capability. State and City Officials Report Leadership and Planning Challenges That Could Be Considered in a National Biosurveillance Strategy

The third set of challenges state and city officials that we interviewed  reported included (1) difficulty planning for longer-term capability-building  efforts because of uncertainty from year to year about whether project  funds would be available; (2) difficulty planning to invest in basic  capabilities for multiple disease threats because federal funding has  focused on specific diseases rather than strategically building core  capabilities; (3) limited leadership and planning—at all levels of the  biosurveillance enterprise—to support regional and integrated disease  data-surveillance approaches; and (4) differing priorities and other  partnership issues. Federal Agencies Have Provided Financial and Technical Assistance That Can Support Tribal and Insular Capabilities

According to federal and professional association officials that work with  tribal and insular jurisdictions, federal agencies provide disease-specific  funding and cooperative agreements, as well as training and technical  assistance, to support public-health and animal-health surveillance  capacity. Although federal, state, and local officials we interviewed generally  agreed that a comprehensive national assessment may improve the  nation’s ability to conduct biosurveillance, all the officials we interviewed  acknowledged that such an assessment would be a complex undertaking. Until it conducts an assessment of nonfederal biosurveillance capabilities,  the federal government will continue to lack key information about the  baseline status, strengths, weaknesses, and gaps across the  biosurveillance enterprise to guide development and maintenance of a  national biosurveillance capability. A national strategy like the one we  recommended in June 2010—one capable of guiding federal agencies  and its key stakeholders to systematically identify risks, resources to  address those risks, and investment priorities—may be better positioned  to guide development and maintenance of the capability if it takes into  account the particular challenges and opportunities inherent in partnering  with nonfederal jurisdictions such as state, tribal, local, and insular  governments. Moreover, efforts to build the capability  would benefit from a framework that facilitates assessment of  jurisdictions’ baseline capabilities and critical gaps across the entire  biosurveillance enterprise. Recommendations for Executive Action

In order to help build and maintain a national biosurveillance capability in  a manner that accounts for the particular challenges and opportunities of  reliance on state and local partnerships, we recommend the Homeland  Security Council direct the National Security Staff to take the following  action as part of its implementation of our previous recommendation for a  national biosurveillance strategy:    Ensure that the national biosurveillance strategy (1) incorporates a  means to leverage existing efforts that support nonfederal  biosurveillance capabilities, (2) considers challenges that nonfederal  jurisdictions face in building and maintaining biosurveillance  capabilities, and (3) includes a framework to develop a baseline and  gap assessment of nonfederal jurisdictions’ biosurveillance  capabilities. Agency Comments and Our Evaluation

We provided a draft of this report for review to the National Security Staff,  DHS, HHS, DOI, USDA, the Department of Justice; and the state and city  officials who contributed to our review. The National Security Staff  acknowledged the accuracy of the information contained in the report but  did not comment on the recommendation. We determined that because the federal government relies on  nonfederal resources to support a national biosurveillance capability, our  June 2010 findings about using the strategy to determine how to leverage  resources, weigh the costs and benefits of investments, and define roles  and responsibilities were particularly germane to the federal government’s  efforts to partner with nonfederal biosurveillance enterprise partners to  support a national biosurveillance capability.
Why GAO Did This Study

The nation is at risk for a catastrophic biological event. The Implementing Recommendations of the 9/11 Commission Act directed GAO to report on biosurveillance--to help detect and respond to such events--at multiple jurisdictional levels. In June 2010, GAO recommended that the National Security Staff lead the development of a national biosurveillance strategy, which is now under development. This report focuses on nonfederal jurisdictions, which own many of the resources that support a national capability. It discusses (1) federal support for state and local biosurveillance; (2) state and local challenges; (3) federal support and challenges for tribal and insular areas and (4) federal assessments of nonfederal capabilities. To conduct this work, GAO interviewed select federal-agency, jurisdiction, and association officials and reviewed relevant documents. To collect information on federal efforts and challenges, we also sent standardized questionnaires to seven states and two cities.

What GAO Found

The federal government has efforts to support health preparedness that state and city officials identified as critical to their biosurveillance capabilities. The efforts these officials identified fell into four categories: (1) grants and cooperative agreements, (2) nonfinancial technical and material assistance, (3) guidance, and (4) information sharing. Within each of the categories, the officials identified specific federal efforts that were essential to their biosurveillance activities. For example, public-health officials described cooperative agreements from the Centers for Disease Control and Prevention that provided resources for disease investigation, as well as guidance on federal priorities. However, as with our June 2010 findings about federal biosurveillance, in the absence of a national strategy, these efforts are not coordinated or targeted at ensuring effective and efficient national biosurveillance capabilities. Because the resources that constitute a national biosurveillance capability are largely owned by nonfederal entities, a national strategy that considers how to leverage nonfederal efforts could improve efforts to build and maintain a national biosurveillance capability. State and city officials identified common challenges to developing and maintaining their biosurveillance capabilities: (1) state policies that restrict hiring, travel, and training in response to budget constraints; (2) ensuring adequate workforce, training, and systems; and (3) the lack of strategic planning and leadership to support long-term investment in cross-cutting core capabilities, integrated biosurveillance, and effective partnerships. A national biosurveillance strategy that considers planning and leadership challenges at all levels of the biosurveillance enterprise may help partners across the enterprise find shared solutions for an effective national biosurveillance capability. The federal government provides some resources to help control disease in humans and animals in tribal and insular areas, but there are no specific efforts to ensure these areas can contribute to a national biosurveillance capability. Resources include cooperative agreements, disease-specific funding, training, and technical assistance. Surveillance capacity varies among tribes and insular areas, but common challenges include limited health infrastructure including human- and animal-health professionals and systems. The federal government has not conducted a comprehensive assessment of state and local jurisdictions' ability to contribute to a national biosurveillance capability, as called for in presidential directive. According to federal, state, and local officials, the magnitude and complexity of such an assessment is a challenge. Until it conducts such an assessment, the federal government will lack key information to support a national biosurveillance capability. A national strategy like the one we previously recommended--one capable of guiding federal agencies and its key stakeholders to systematically identify gaps, resources to address those gaps, and investment priorities--would benefit from an assessment of jurisdictions' baseline capabilities and critical gaps across the entire biosurveillance enterprise.

What GAO Recommends

GAO recommends that the National Security Staff ensure the strategy considers (1) existing federal efforts, (2) challenges, and (3) assessment of nonfederal capabilities. GAO provided a draft of this report to the National Security Staff, and the federal, state and city officials who contributed information. The National Security Staff acknowledged the accuracy of the report, but did not comment on the recommendation.