Contingency Planning

Further Efforts Needed to Ensure Clear Federal Leadership Roles, Effective National Strategy for Pandemic

September 26, 2007

An influenza pandemic is a real and significant potential threat facing the United States and the world. Pandemics occur when a novel virus emerges that can easily be transmitted among humans who have little immunity. In 2005, the Homeland Security Council (HSC) issued a National Strategy for Pandemic Influenza and, in 2006, an Implementation Plan.

Congress and others are concerned about the federal government's preparedness to lead a response to an influenza pandemic. This report assesses how clearly federal leadership roles and responsibilities are defined and the extent to which the strategy and plan address six characteristics of an effective national strategy. To do this, the Government Accountability Office analyzed key emergency and pandemic-specific plans, interviewed agency officials and compared the strategy and plan with the six characteristics GAO identified.

The executive branch has taken an active approach to help address this potential threat, including establishing an online information clearinghouse, developing planning guidance and checklists, awarding grants to accelerate development and production of new technologies for influenza vaccines within the United States and assisting state and local government pandemic planning efforts; 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.

The strategy and plan do not specify how the leadership roles and responsibilities will work in addressing the unique characteristics of an influenza pandemic, which could occur simultaneously in multiple locations and over a long period. A pandemic could extend well beyond health and medical boundaries, affecting critical infrastructure, the movement of goods and services across the nation and the globe, the economy and security.

Although the Department of Health and Human Services' (HHS) Secretary is to lead the public health and medical response and the Department of Homeland Security's (DHS) Secretary is to lead overall non-medical support and response actions, the plan does not clearly address these simultaneous responsibilities or how these roles are to work together, particularly over an extended period and at multiple locations across the country. In addition, the DHS secretary has pre-designated a national Principal Federal Official (PFO) to facilitate pandemic coordination, as well as five regional PFOs and five regional federal coordinating officers. Most of these leadership roles and responsibilities have not been tested under pandemic scenarios, leaving it unclear how they will work. Because initial actions may help limit the spread of an influenza virus, the effective exercise of shared leadership roles and responsibilities could have substantial consequences; however, only one national multi-sector pandemic-related exercise has been held and that was prior to the issuance of the plan.

While the strategy and plan are an important first step in guiding national preparedness, they do not fully address all six characteristics of an effective national strategy. Specifically, they fully address only one of the six characteristics, by reflecting a clear description and understanding of problems to be addressed, and do not address one characteristic because the documents do not describe the financial resources needed to implement actions. Although the other characteristics are partially addressed, important gaps exist that could hinder the ability of key stakeholders to effectively execute their responsibilities, including state and local jurisdictions that will play crucial roles in preparing for and responding to a pandemic were not directly involved in developing the plan, relationships and priorities among actions were not clearly described, performance measures focused on activities that are not always linked to results, insufficient information is provided about how the documents are integrated with other key related plans, and no process is provided for monitoring and reporting on progress.

The GAO recommends that (1) DHS and HHS develop rigorous testing, training, and exercises for pandemic influenza to ensure that federal leadership roles and responsibilities are clearly defined, understood, and work effectively and (2) the HSC set a time frame to update the Plan, involve key nonfederal stakeholders, and more fully address the characteristics of an effective national strategy. DHS and HHS concurred with the report. HSC did not comment.

- GAO