According to the Strategy for Homeland Defense and Support to Civil  Authorities, DOD often is expected to play a prominent supporting role to  primary federal agencies in their response efforts. HHS and DHS Have Plans to Respond to a Pandemic, but Their Plans Do Not Explain How They Would Respond If DOD’s Capabilities Are Limited, and Coordination Mechanisms Among the Three Agencies Exist That Could Enhance Their Preparedness

HHS and DHS have plans to guide their responses to a pandemic, but  their plans do not explain how they would respond in a resource- constrained environment where state and local capabilities are  overwhelmed or unavailable, and other federal capabilities, like DOD’s,  are limited. HHS and DHS plans also do not specifically address what resources  would be needed to support a response to a pandemic in an environment  where federal resources, including DOD, are exceeded by demands. HHS officials stated that there would be no way of knowing in advance  what unique facts, circumstances, or conditions might occur to determine  what resources would be needed. Exercises play an instrumental role in preparing these  agencies to respond to an incident by providing opportunities to test  plans, improve proficiency, and assess capabilities and readiness. Unless DOD, HHS, and DHS explore opportunities to enhance their  existing coordination mechanisms—such as working groups, Defense  Coordinating Officers, and training exercises—to identify approaches for  responding to a pandemic in the event that DOD’s capabilities are limited,  HHS and FEMA risk being unprepared to respond. HHS  and DHS are in the process of updating their plans, which presents an  opportunity for them to coordinate with each other and with DOD to  determine the appropriate actions to take should DOD’s support be  limited during a pandemic. As HHS plans to respond to a pandemic, we recommend that the  Secretary of Health and Human Services direct the Assistant Secretary  for Preparedness and Response to use HHS’s existing coordination  mechanisms with DOD and FEMA to explore opportunities to improve  their preparedness and response to a pandemic if DOD’s capabilities are  limited. Appendix I: DOD’s Preparedness, Detection of, and Response to Zika Virus

The Department of Defense (DOD) also assists federal agencies in  combating other non-pandemic viruses that have occurred, such as the  recent Zika virus. This report assesses the extent to which (1) DOD has guidance  and plans for supporting civil authorities in the event of a domestic  outbreak of a pandemic disease, and (2) HHS and DHS have plans to  respond to a pandemic if DOD’s support capabilities are limited, and they  have mechanisms to coordinate their pandemic preparedness and  response with DOD. To determine the extent to which HHS and DHS have plans to respond to  a pandemic if DOD’s support capabilities are limited, and they have  mechanisms to coordinate their pandemic preparedness and response  with DOD, we obtained and analyzed pandemic planning guidance, such  as HHS’s Pandemic Influenza Plan, DHS’s National Response  Framework, and Federal Interagency Operational Plans to identify these  primary agencies’ roles and responsibilities in support of civil authorities  and in the event of a severe disease pandemic.
Why GAO Did This Study

The U.S. Army estimates that if a severe infectious disease pandemic were to occur today, the number of U.S. fatalities could be almost twice the total number of battlefield fatalities in all of America's wars since the American Revolution in 1776. A pandemic occurs when an infectious agent emerges that can be efficiently transmitted between humans and has crossed international borders. DOD's day-to-day functioning and the military's readiness and operations abroad could be impaired if a large percentage of its personnel are sick or absent, and DOD's assistance to civil authorities might be limited.
House Report 114-102 included a provision for GAO to assess DOD's planning and coordination to support civil authorities during a pandemic. This report assesses the extent to which (1) DOD has guidance and plans for supporting civil authorities in the event of a domestic outbreak of a pandemic disease and (2) HHS and DHS have plans to respond to a pandemic if DOD support capabilities are limited, and they have mechanisms to coordinate their pandemic preparedness and response. GAO reviewed agency pandemic guidance and plans, interagency coordination mechanisms, and pandemic-related exercises and after-action reports.

What GAO Found

Strategy for Homeland Defense and Support to Civil Authorities states that DOD often is expected to play a prominent supporting role to primary federal agencies. DOD also assists those agencies in the preparedness, detection, and response to other non-pandemic viruses, such as the recent outbreak of the Zika virus.
HHS and DHS have plans to guide their response to a pandemic, but their plans do not explain how they would respond in a resource-constrained environment in which capabilities like those provided by DOD are limited. DOD coordinates with the agencies, but existing coordination mechanisms among HHS, DHS, and DOD could be used to improve preparedness. HHS's Pandemic Influenza Plan is the departmental blueprint for its preparedness and response to an influenza pandemic. DHS's National Response Framework is a national guide on how federal, state, and local governments are to respond to such incidents. DOD, HHS, and DHS have mechanisms—such as interagency working groups, liaison officers, and training exercises—to coordinate their response to a pandemic. For example, training exercises are critical in preparing these agencies to respond to an incident by providing opportunities to test plans, improve proficiency, and assess capabilities and readiness. These existing mechanisms provide the agencies opportunities to improve their preparedness and response to a pandemic. HHS and DHS plans do not specifically identify what resources would be needed to support a response to a pandemic in which demands exceeded federal resources. These officials stated that there would be no way of knowing in advance what resources would be required. HHS and DHS are in the process of updating their plans and thus have an opportunity to coordinate with each other and with DOD to determine the appropriate actions to take should DOD's support be limited.

What GAO Recommends

GAO recommends that DOD, HHS, and DHS use existing coordination mechanisms to explore opportunities to improve preparedness and response to a pandemic if DOD's capabilities are limited. DOD, HHS, and DHS concurred with GAO's recommendations.