The federal government also supports preparedness efforts for an  influenza pandemic. States Have Further Developed Important Aspects of Public Health Preparedness, but Additional Work Is Needed

States reported that as of the summer of 2003 they have made  improvements in their preparedness to respond to major public health  threats, but no aspect of preparedness has been fully addressed by all of  the states. Disease Surveillance Systems

Although some states have made improvements to their disease  surveillance systems, the nation’s ability to detect and report a disease  outbreak is not uniformly strong across all states. Communication

Although improving, communication, both among those involved in  responding to a major public health threat—such as public health officials,  health care providers, and emergency management agencies—and with  the public, remains a challenge. Surge Capacity

Most states lack surge capacity—that is, the capacity to respond to the  large influx of patients that could occur during a public health emergency. For example, few states reported that they had the capacity to evaluate,  diagnose, and treat 500 or more patients involved in a single incident. Regional Planning

Few states have regional plans in place that would coordinate the  response among states during a public health emergency, and state  officials remain concerned about a lack of regional planning across state  borders. Few states have completed regional response plans for incidents  of bioterrorism and other public health threats and emergencies. Strategic National Stockpile

Most state plans for using the Strategic National Stockpile in the event of a  public health emergency have not been fully developed. The Federal Influenza Plan Has Not Been Finalized, but State Planning and Other Efforts Continue

Federal officials have not finalized plans for responding to an influenza  pandemic, and state influenza pandemic response plans are in various  stages of completion. In 2000, we recommended  that HHS complete the national plan for responding to an influenza  pandemic, but HHS reported recently that the plan was still under review  within HHS. However, HHS is taking other steps to prepare for an  influenza pandemic. Federal plans for the purchase, distribution, and administration of  vaccines and drugs in response to an influenza pandemic still have not  been finalized, complicating the efforts of states to develop their state  plans and heightening concern about our nation’s ability to respond  effectively to an influenza pandemic.
Why GAO Did This Study

The anthrax incidents in the fall of 2001 and the severe acute respiratory syndrome (SARS) outbreak in 2002-2003 have raised concerns about the nation's ability to respond to a major public health threat, whether naturally occurring or the result of bioterrorism. The anthrax incidents strained the public health system, including laboratory and workforce capacities, at the state and local levels. The SARS outbreak highlighted the challenges of responding to new and emerging infectious disease. The current influenza season has heightened concerns about the nation's ability to handle a pandemic. GAO was asked to examine improvements in state and local preparedness for responding to major public health threats and federal and state efforts to prepare for an influenza pandemic. This testimony is based on GAO's recent report, HHS Bioterrorism Preparedness Programs: States Reported Progress but Fell Short of Program Goals for 2002, GAO-04- 360R (Feb. 10, 2004). This testimony also updates information contained in GAO's report on federal and state planning for an influenza pandemic, Influenza Pandemic: Plan Needed for Federal and State Response, GAO- 01-4 (Oct. 27, 2000).

What GAO Found

Although states have further developed many important aspects of public health preparedness, since April 2003, no state is fully prepared to respond to a major public health threat. States have improved their disease surveillance systems, laboratory capacity, communication capacity, and workforce needed to respond to public health threats, but gaps in each remain. Moreover, regional planning between states is lacking, and many states lack surge capacity--the capacity to evaluate, diagnose, and treat the large numbers of patients that would present during a public health emergency. Although states are developing plans for receiving and distributing medical supplies and material for mass vaccinations from the Strategic National Stockpile in the event of a public health emergency, most of these plans are not yet finalized. HHS has not published the federal influenza pandemic plan, and most of the state plans have not been finalized. In 2000, GAO recommended that HHS complete the national plan for responding to an influenza pandemic, but according to HHS, the plan is still under review. Absent a federal plan, key questions about the federal role in the purchase, distribution, and administration of vaccines and antiviral drugs during a pandemic remain unanswered. HHS reports that most states continue to develop their state plans despite the lack of a federal plan.