Mosquito control in the  United States is implemented and overseen at the state and local levels  by entities such as mosquito control districts and health agencies. Zika Funding Prior to September 2016

In April 2016, the Office of Management and Budget and the Secretary of  Health and Human Services announced that they had identified $589  million—$510 million of it from existing Ebola virus disease resources  within HHS, the Department of State, and the U.S. Agency for  International Development—that could quickly be redirected and spent on  immediate efforts to control and respond to the spread of the Zika virus. September 2016 Zika Supplemental Funding

In September 2016, Congress appropriated $932 million to HHS and its  agencies in the Zika Response and Preparedness Act. 1.) The Zika supplemental funding remained available for obligation until  September 30, 2017, for the following purposes:
CDC: to prevent, prepare for, and respond to the Zika virus, health  conditions related to the virus, and other vector-borne diseases,  domestically and internationally. Agencies have until September 30, 2022, to disburse the Zika  supplemental funding appropriated by the Zika Response and  Preparedness Act. HHS Agencies Have Obligated Nearly All of the Zika Supplemental Funding; Disbursements Are Ongoing

		Agencies Obligated Nearly All of Their Zika Supplemental Funding as of September 30, 2017, Primarily Through Cooperative Agreements, Grants, and Contracts

We found that as of September 30, 2017—the end of the Zika  supplemental appropriation’s period of availability—nearly all Zika  supplemental funding had been obligated, primarily through cooperative  agreements, grants, and contracts. For example, according to CDC officials, using  cooperative agreements with application processes familiar to the  awardees helped enable the agency to obligate its funding soon after  receiving the appropriation. The purpose of the 3-year  program is to support prevention activities and treatment services for  women (including pregnant women), children, and men adversely or  potentially affected by the Zika virus. Agencies Had Disbursed About 21 Percent of the Zika Supplemental Funding as of December 31, 2017

We found that as of December 31, 2017, the HHS agencies had  disbursed about 21 percent (approximately $195.5 million of $932 million)  of the Zika supplemental funding. Selected Awardees Undertook Multiple Activities with Zika Supplemental Funding, and Had Varying Experiences Applying for and Managing Funds

		Selected Awardees Used Zika Supplemental Funding for Activities Including Surveillance, Vector Control, Laboratory Capacity, and Health Care Services

Selected awardees we spoke with used Zika supplemental funding for a  variety of activities. According to state  officials, funding for state-run laboratories was used for purchasing  materials, such as those used for testing urine for the Zika virus, and  funding staff located in counties to assist with handling Zika samples and  testing, data entry, and result reporting to surveillance networks. 2. Selected Awardees Had Mixed Experiences Applying for and Managing the Zika Supplemental Funding

While a majority of the 12 selected awardees we spoke with reported  positive experiences with the process of applying for and managing the  Zika supplemental funding, some awardees cited aspects of the process  that were challenging. Awardees we spoke to also cited some challenges to applying for and  managing the Zika supplemental funding. These awardees noted that  various time frames among multiple awards and restrictions on authorized  activities under the awards added administrative burdens that officials  had to deal with while responding to the outbreak. Florida officials said that they had to track  funding separately and identify the activities that could be funded under  each award—administrative requirements that were burdensome during  an emergency response. In October 2017, CDC issued a new notice of funding opportunity that,  according to agency officials, was intended to help minimize the  administrative burden on these awardees (e.g., preparing applications  and other paperwork) during significant public health emergencies by pre- approving public health departments in these jurisdictions to rapidly  receive future awards. Agency and Third- Party Comments

We provided a draft of this report to HHS for review and comment. HHS  provided technical comments, which we incorporated as appropriate. 2.
Why GAO Did This Study

Zika—a virus primarily transmitted through mosquito bites—can cause symptoms that include fever, rash, and joint and muscle pain. In pregnant women, the Zika virus can be passed to the fetus and cause severe brain defects. In response to an outbreak in the United States and its territories, Congress appropriated $932 million in September 2016 through the Zika Response and Preparedness Act to HHS and its agencies to prevent, prepare for, and respond to the Zika virus and its related health conditions, and conduct related research.
The act also included a provision that GAO study the activities supported with the appropriated funds. This report describes (1) the status of funds obligated and disbursed from the Zika supplemental funding appropriated to HHS and its agencies; and (2) how selected awardees used their Zika supplemental funding, and their experiences with applying for and managing the funding. To do this work, GAO reviewed agency documents on Zika supplemental funding and activities, and interviewed officials from the HHS agencies and selected awardees. To select awardees, GAO identified states based on the amount of initial Zika supplemental funding they received from CDC, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration; and selected states with the highest and lowest funding. In total, GAO selected 12 awardees: 10 states, as well as one county and one city from 2 of the 10 states.
GAO provided a draft of this report to HHS. In response, HHS provided technical comments, which were incorporated as appropriate.

What GAO Found

As of September 30, 2017, Department of Health and Human Services’ (HHS) agencies had obligated nearly all of the $932 million of Zika supplemental funding Congress appropriated in 2016 through the use of multiple funding mechanisms, including cooperative agreements, grants, and contracts. Four HHS agencies had small unobligated balances as of the September 30, 2017, obligation deadline; these balances cannot be used to incur new obligations, but may be used to adjust award amounts in future years. Disbursement of the obligated funds was ongoing, with about 21 percent of the Zika supplemental funding (approximately $195.5 million) disbursed as of December 31, 2017. The agencies have until September 30, 2022, to disburse the remainder.
The 12 awardees GAO interviewed—officials from 10 states and two local entities—funded multiple activities with their Zika supplemental funding, and had varying experiences applying for and managing the funds.
Awardees told GAO that they used their funding to support such activities as collection of information about individuals affected by the Zika virus (human surveillance), mosquito control activities, laboratory capacity building, public outreach, and health care services. For example, Florida used Zika supplemental funding in its state-run laboratories to purchase materials for testing Zika virus-related specimens.
A majority of the awardees GAO spoke with reported positive experiences applying for and managing the Zika supplemental funding, including good communication with agency officials and awardees’ familiarity with the mechanisms used to make the awards. However, some awardees noted challenges, such as time frames to use the funding that varied among multiple awards and identifying the activities that could be funded. These challenges added administrative burdens to applying for and managing the Zika supplemental funding while officials were responding to the outbreak, according to the awardees. In October 2017, the Centers for Disease Control and Prevention (CDC) issued a new notice of funding opportunity that agency officials said is intended to help minimize the administrative burden on states and certain localities during emergencies—such as preparing applications—by pre-approving public health departments in these jurisdictions to be eligible to rapidly receive future awards.