Lessons from the H1N1 Pandemic Should Be Incorporated into Future Planning
GAO-11-632, Jun 27, 2011
The 2009 H1N1 influenza pandemic was the first human pandemic in over four decades, and the Centers for Disease Control and Prevention (CDC) estimate that there were as many as 89 million U.S. cases. Over $6 billion was available for the response, led by the Departments of Health and Human Services (HHS) and Homeland Security (DHS), with coordination provided by the Homeland Security Council (HSC) through its National Security Staff (NSS). In particular, HHS's CDC worked with states and localities to communicate with the public and to distribute H1N1 vaccine and supplies. GAO was asked (1) how HHS used the funding, (2) the key issues raised by the federal response, and (3) the actions taken to identify and incorporate lessons learned. GAO reviewed documents and interviewed officials from five states about their interaction with the federal government. GAO also reviewed documents and interviewed officials from HHS, DHS, the Department of Labor's Occupational Safety and Health Administration (OSHA), NSS, and others, such as associations.
As of December 2010, HHS had spent about two-thirds of the $6.15 billion that it had available for the H1N1 pandemic response. HHS spent the majority of the funds on developing and purchasing H1N1 vaccine and providing grants to all the states and selected local jurisdictions. State and local health officials reported that the grant funding was critical to their response efforts but also noted challenges presented by the grants' administrative requirements. HHS's spending plans for the remaining $1.98 billion include longer-term pandemic preparation efforts, such as activities to reduce the length of time required to produce a vaccine. Several key issues were raised by the federal government's response to the H1N1 pandemic. (1) Prior pandemic planning efforts and federal funding paid off, although specific aspects of prior planning were not relied on because of the nature of the H1N1 pandemic. For example, interagency meetings and exercises built relationships that were valuable during the response. Prior funding built capacity in several areas, including vaccine production. (2) The credibility of all levels of government was diminished when the amount of vaccine available to the public in October 2009 did not meet expectations set by federal officials. However, state and local jurisdictions valued the flexibility that they had in deciding their distribution methods. Additionally, while the use of a central distributor for the vaccines was generally cited as an effective practice, the 100- dose minimum order was viewed to be problematic. (3) Public surveys generally found CDC's communication efforts to be successful in reaching a range of audiences; however, these messages fell short in meeting the needs of some non-English-speaking populations. (4) Deployment of the Strategic National Stockpile--a supply of medicines and medical supplies to be used for a national emergency--met the established goal. However, CDC and state officials identified gaps in planning, including disparities between the materials expected and those delivered, as well as the need for long-term storage plans for stockpile materials. The NSS asked federal agencies--including HHS and DHS--to complete after-action reports based on their involvement in the pandemic response. The NSS has not determined if these reports--and the associated lessons learned--will be shared with key stakeholders. Nevertheless, a DHS official commented that sharing lessons from the reports with key stakeholders would foster a spirit of government transparency and might help build stakeholder trust. GAO recommends that the HSC direct the NSS, in concert with HHS and DHS, to incorporate lessons from the H1N1 pandemic into future planning and share these lessons with key stakeholders. NSS agreed to take the recommendations under advisement. HHS, DHS, and OSHA provided comments and generally agreed with our findings.
- Review Pending
- Closed - implemented
- Closed - not implemented
Recommendations for Executive Action
Recommendation: In order to help the federal government prepare for a future influenza pandemic, the Homeland Security Council should direct the National Security Staff to work with the Departments of Health and Human Services and Homeland Security--as well as other federal agencies and state and local jurisdictions, as applicable--to update planning and exercising by incorporating lessons learned from federal agencies' H1N1 after-action reports and the lessons we identified from the H1N1 pandemic. These lessons may include (1) developing communication strategies for better managing public expectations about pandemic vaccine availability while working to reduce the length of time required to produce a pandemic vaccine; (2) identifying state and local jurisdictions' need for materials for non-English-speaking populations and examining ways to facilitate the timely and efficient translation of key communication materials; and (3) updating Strategic National Stockpile (SNS) plans by identifying tools for tracking SNS supplies, ensuring that the supplies in the SNS meet the needs of states and local jurisdictions, and accommodating previously unanticipated scenarios, such as the need for possible long-term storage or recovery of unused supplies.
Agency Affected: Executive Office of the President: Homeland Security Council
Status: Closed - Implemented
Comments: At the request of the Homeland Security Council's National Security Staff, the Departments of Health and Human Services and Homeland Security each completed H1N1 after action reports. Based on these after action reports, each agency developed improvement plans for updating their agency operational plans and exercises. The Department of Health and Human Service's (HHS) improvement plan was publicly issued in May 2012 and the Department of Homeland Security's was completed in May of 2011, but has not yet been publicly issued. The agency implementation plans addressed the lessons that the agencies and we identified in our report. Specifically, HHS and GAO identified issues during the 2009 H1N1 pandemic that arose around the need to manage public expectations about pandemic vaccine availability. HHS's improvement plan identifies steps to improve awareness of and communication about vaccine production, distribution, and coverage. Second, HHS and GAO identified the need for materials for non-English-speaking populations and examining ways to facilitate the timely and efficient translation of key communication materials. Accordingly, the improvement plan identifies plans for improving the translation of culturally appropriate materials with non-English speaking communities across the United States. Third, HHS and GAO identified the need to update Strategic National Stockpile (SNS) plans by identifying tools for tracking SNS supplies, ensuring that the supplies in the SNS meet the needs of states and local jurisdictions, and accommodating previously unanticipated scenarios, such as the need for possible long-term storage or recovery of unused supplies. In its improvement plan, HHS articulates plans to reassess its current strategies and develop new plans for items in the SNS, such as antiviral medicines and ventilators.
Recommendation: In order to help key stakeholders prepare for a future influenza pandemic or other public health emergencies, the Homeland Security Council should direct the National Security Staff to work with the Departments of Health and Human Services and Homeland Security--as well as other federal agencies, as applicable--to share the relevant findings of their after-action reports with key stakeholders, such as state and local governments.
Agency Affected: Executive Office of the President: Homeland Security Council
Comments: At the request of the Homeland Security Council's National Security Staff, the Departments of Health and Human Services and Homeland Security each issued H1N1 after action reports. Each of these reports was submitted to the NSS, which was responsible for approving the distribution plan for the findings. In May 2012, HHS publicly posted its retrospective and improvement plan on its website. HHS specifically noted that it shared its plans to expand wide-ranging collaboration between HHS and its many stakeholders as we re-enter the inter-pandemic phase and work together to enhance the public health resiliency of the nation. The after action report and improvement plan that the Department of Homeland Security developed has not yet been made publicly available.