	Background

Influenza pandemic—caused by a novel strain of influenza virus for which  there is little resistance and which therefore is highly transmissible among  humans—continues to be a real and significant threat facing the United  States and the world. As previously mentioned, we have ongoing  work assessing the status of implementing this plan. Leadership Roles and Responsibilities Need to Be Clarified and Tested, and Coordination Mechanisms Could Be Better Utilized

Our prior work evaluating catastrophic event preparedness, response, and  recovery has shown that in the event of a catastrophic disaster, the  leadership roles, responsibilities, and lines of authority for the response at  all levels must be clearly defined and effectively communicated to  facilitate rapid and effective decision making, especially in preparing for  and in the early hours and days after the event. However, federal  government leadership roles and responsibilities for preparing for and  responding to a pandemic continue to evolve and will require further  clarification and testing before the relationships of the many leadership  positions are well understood. Efforts Are Underway to Improve the Surveillance and Detection of Pandemic-Related Threats in Humans and Animals, but Targeting Assistance to Countries at the Greatest Risk Has Been Based on Incomplete Information

International disease surveillance and detection efforts serve to address  the threat posed by infectious diseases, such as an influenza pandemic,  before they develop into widespread outbreaks. However, we reported that gaps in available information from other  countries limited the capacity for comprehensive, well-informed  comparisons of risk levels by country. Strong advance planning, both within and among federal, state, and local  governments and other organizations, as well as robust training and  exercise programs to test these plans in advance of a real disaster, are  essential to best position the nation to prepare for, respond to, and  recover from major catastrophes such as an influenza pandemic. Further Actions Are Needed to Address the Capacity to Respond to and Recover from an Influenza Pandemic

Improving the nation’s response capability to catastrophic disasters, such  as an influenza pandemic, is essential. Over the past several years,  we have identified potential information-sharing barriers, critical success  factors, and other key management issues that should be considered to  facilitate information sharing among and between government entities and  the private sector. HHS (including CDC), DHS, and other federal agencies have provided a  variety of influenza pandemic information and guidance for states and  local communities through Web sites and meetings with states. Performance Monitoring and Accountability for Pandemic Preparedness Needs Strengthening

As indicated earlier, in August 2007 we reported that although the National  Pandemic Strategy and Implementation Plan identified the overarching  goals and objectives for pandemic planning, the documents had some  gaps. Most of the implementation plan’s performance measures consist of  actions to be completed, such as disseminating guidance, but the measures  are not always clearly linked with intended results. There have been some other instances where performance and  accountability has been strengthened. Although much  has been done, many challenges remain, as is evidenced by the fact that  almost half of the recommendations that we have made over the past 3  years have still not been fully implemented. Given the change in  administration and the associated transition of senior federal officials, it  will be essential for this administration to continue to exercise and test the  shared leadership roles that have been established between HHS and DHS,  as well as the relative roles, responsibilities, and authorities for a  pandemic among the federal government, state and local governments and  the private sector. Appendix I: Open Recommendations from GAO’s Work on an Influenza Pandemic as of February 2009

	Influenza Pandemic: HHS Needs to Continue Its Actions and Finalize Guidance for Pharmaceutical Interventions, GAO-08-671, September 30, 2008

The Secretary of Health and  Human Services should  expeditiously finalize guidance to  assist state and local jurisdictions  to determine how to effectively  use limited supplies of antivirals  and pre-pandemic vaccine in a  pandemic, including prioritizing  target groups for pre-pandemic  vaccine. (2) HSC did not comment on the recommendation  and has not indicated if it plans to implement it. For example the two agencies meet on a regular  basis to discuss such coordination. Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer  Federal Leadership Roles and an Effective National Strategy. Financial Market Preparedness: Significant Progress Has Been Made,  but Pandemic Planning and Other Challenges Remain.
Why GAO Did This Study

GAO has conducted a body of work over the past several years to help the nation better prepare for, respond to, and recover from a possible influenza pandemic, which could result from a novel strain of influenza virus for which there is little resistance and which therefore is highly transmissible among humans. GAO's work has pointed out that while the previous administration had taken a number of actions to plan for a pandemic, including developing a national strategy and implementation plan, much more needs to be done. However, national priorities are shifting as a pandemic has yet to occur, and other national issues have become more immediate and pressing. Nevertheless, an influenza pandemic remains a real threat to our nation and the world. For this report, GAO synthesized the results of 11 reports and two testimonies issued over the past 3 years using six key thematic areas: (1) leadership, authority, and coordination; (2) detecting threats and managing risks; (3) planning, training, and exercising; (4) capacity to respond and recover; (5) information sharing and communication; and (6) performance and accountability. GAO also updated the status of recommendations in these reports.

What GAO Found

Leadership roles and responsibilities need to be clarified and tested, and coordination mechanisms could be better utilized. Shared leadership roles and responsibilities between the Departments of Health and Human Services (HHS) and Homeland Security (DHS) and other entities are evolving, and will require further testing and exercising before they are well understood. Although there are mechanisms in place to facilitate coordination between federal, state, and local governments and the private sector to prepare for an influenza pandemic, these could be more fully utilized. Efforts are underway to improve the surveillance and detection of pandemic-related threats, but targeting assistance to countries at the greatest risk has been based on incomplete information. Steps have been taken to improve international disease surveillance and detection efforts. However, information gaps limit the capacity for comprehensive comparisons of risk levels by country. Pandemic planning and exercising has occurred, but planning gaps remain. The United States and other countries, as well as states and localities, have developed influenza pandemic plans. Yet, additional planning needs still exist. For example, the national strategy and implementation plan omitted some key elements, and HHS found many major gaps in states' pandemic plans. Further actions are needed to address the capacity to respond to and recover from an influenza pandemic. An outbreak will require additional capacity in many areas, including the procurement of additional patient treatment space and the acquisition and distribution of medical and other critical supplies, such as antivirals and vaccines for an influenza pandemic. Federal agencies have provided considerable guidance and pandemicrelated information, but could augment their efforts. Federal agencies, such as HHS and DHS, have shared information in a number of ways, such as through Web sites and guidance, but state and local governments and private sector representatives would welcome additional information on vaccine distribution and other topics. Performance monitoring and accountability for pandemic preparedness needs strengthening. Although certain performance measures have been established in the National Pandemic Implementation Plan to prepare for an influenza pandemic, these measures are not always linked to results. Further, the plan does not contain information on the financial resources needed to implement it.

What GAO Recommends

GAO has made 23 recommendations in its reports--13 of these have been implemented and 10 remain outstanding. Continued leadership focus on pandemic preparedness remains vital, as the threat has not diminished.