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Testimony: 

United States General Accounting Office
GAO: 

Testimony: 

Before the Subcommittee on Oversight and Investigations, Committee on 
Energy and Commerce, House of Representatives: 

For Release on Delivery: 
Expected at 9:00 a.m. 
Tuesday, June 25, 2002: 

Homeland Security: 

New Department Could Improve Coordination but May Complicate Public 
Health Priority Setting: 

Statement of Janet Heinrich: 
Director, Health Care—Public Health Issues: 

GAO-02-883T: 

Mr. Chairman and Members of the Committee: I appreciate the 
opportunity to be here today to discuss the proposed creation of the 
Department of Homeland Security. Since the terrorist attacks of 
September 11, 2001, and the subsequent anthrax incidents, there has 
been concern about the ability of the federal government to prepare 
for and coordinate an effective public health response to such events, 
given the broad distribution of responsibility for that task at the 
federal level. Our earlier work found, for example, that more than 20 
federal departments and agencies carry some responsibility for 
bioterrorism preparedness and response and that these efforts are 
fragmented.[Footnote 1] Emergency response is further complicated by 
the need to coordinate actions with agencies at the state and local 
level, where much of the response activity would occur. 

The President's proposed Homeland Security Act of 2002 would bring 
many of these federal entities with homeland security responsibilities—
including public health preparedness and response—into one department, 
in an effort to mobilize and focus assets and resources at all levels 
of government. The aspects of the proposal concerned with public 
health preparedness and response would involve two primary changes to 
the current system, which are found in Title V of the proposed bill. 
First, the proposal would transfer certain emergency preparedness and 
response programs from multiple agencies to the new department. 
Second, it would transfer the control over, but not the operation of, 
other public health preparedness assistance programs, such as 
providing emergency preparedness planning assistance to state and 
local governments, from the Department of Health and Human Services 
(BHS) to the new department.[Footnote 2] 

In order to assist the committee in its consideration of this 
extensive reorganization of our government, my remarks today will 
focus on Title V of the President's proposal and the implications of 
(1) the proposed transfer of specific public health preparedness and 
response programs currently housed in BHS into the new department and 
(2) the proposed transfer of control over certain other public health 
preparedness assistance programs from BHS to the new department. My 
testimony today is based largely on our previous and ongoing work on 
federal, state, and local preparedness in responding to bioterrorist 
threats,[Footnote 3] as well as a review of the proposed legislation. 

In summary, we believe that the proposed reorganization has the 
potential to repair the fragmentation we have noted in the 
coordination of public health preparedness and response programs at 
the federal, state, and local levels. As we have recommended, the 
proposal would institutionalize the responsibility for homeland 
security in federal statute. We expect that, in addition to improving 
overall coordination, the transfer of programs from multiple agencies 
to the new department could reduce overlap among programs and 
facilitate response in times of disaster. However, we have concerns 
about the proposed transfer of control from BHS to the new department 
for public health assistance programs that have both basic public 
health and homeland security functions. These dual-purpose programs 
have important synergies that we believe should be maintained. We are 
concerned that transferring control over these programs, including 
priority setting, to the new department has the potential to disrupt 
some programs that are critical to basic public health 
responsibilities. We do not believe that the President's proposal is 
sufficiently clear on how both the homeland security and the public 
health objectives would be accomplished. 

Background: 

Federal, state, and local government agencies have differing roles 
with regard to public health emergency preparedness and response. The 
federal government conducts a variety of activities, including 
developing interagency response plans, increasing state and local 
response capabilities, developing and deploying federal response 
teams, increasing the availability of medical treatments, 
participating in and sponsoring exercises, planning for victim aid, 
and providing support in times of disaster and during special events 
such as the Olympic games. One of its main functions is to provide 
support for the primary responders at the state and local level, 
including emergency medical service personnel, public health 
officials, doctors, and nurses. This support is critical because the 
burden of response falls initially on state and local emergency 
response agencies. 

The President's proposal transfers control over many of the programs 
that provide preparedness and response support for the state and local 
governments to a new Department of Homeland Security. Among other 
changes, the proposed bill transfers BHS's Office of the Assistant 
Secretary for Public Health Emergency Preparedness to the new 
department. Included in this transfer is the Office of Emergency 
Preparedness (OEP), which currently leads the National Disaster 
Medical System (NDMS)[Footnote 4] in conjunction with several other 
agencies and the Metropolitan Medical Response System (MMRS).[Footnote 
5] The Strategic National Stockpile,[Footnote 6] currently 
administered by the Centers for Disease Control and Prevention (CDC), 
would also be transferred, although the Secretary of Health and Human 
Services would still manage the stockpile and continue to determine 
its contents. 

Under the President's proposal, the new department would also be 
responsible for all current BHS public health emergency preparedness 
activities carried out to assist state and local governments or 
private organizations to plan, prepare for, prevent, identify, and 
respond to biological, chemical, radiological, and nuclear events and 
public health emergencies. Although not specifically named in the 
proposal, this would include CDC's Bioterrorism Preparedness and 
Response program and the Health Resources and Services 
Administration's (HRSA) Bioterrorism Hospital Preparedness Program. 
These programs provide grants to states and cities to develop plans 
and build capacity for communication, disease surveillance, 
epidemiology, hospital planning, laboratory analysis, and other basic 
public health functions. Except as directed by the President, the 
Secretary of Homeland Security would carry out these activities 
through BHS under agreements to be negotiated with the Secretary of 
BHS. Further, the Secretary of Homeland Security would be authorized 
to set the priorities for these preparedness and response activities. 

Reorganization Has Potential to Improve Coordination 

The consolidation of federal assets and resources in the President's 
proposed legislation has the potential to improve coordination of 
public health preparedness and response activities at the federal, 
state, and local levels. Our past work has detailed a lack of 
coordination in the programs that house these activities, which are 
currently dispersed across numerous federal agencies. In addition, we 
have discussed the need for an institutionalized responsibility for 
homeland security in federal statute.[Footnote 7] The proposal 
provides the potential to consolidate programs, thereby reducing the 
number of points of contact with which state and local officials have 
to contend, but coordination would still be required with multiple 
agencies across departments. Many of the agencies involved in these 
programs have differing perspectives and priorities, and the proposal 
does not sufficiently clarify the lines of authority of different 
parties in the event of an emergency, such as between the Federal 
Bureau of Investigation (FBI) and public health officials 
investigating a suspected bioterrorist incident. Let me provide you 
more details. 

We have reported that many state and local officials have expressed 
concerns about the coordination of federal public health preparedness 
and response efforts.[Footnote 8] Officials from state public health 
agencies and state emergency management agencies have told us that 
federal programs for improving state and local preparedness are not 
carefully coordinated or well organized. For example, federal programs 
managed by the Federal Emergency Management Agency (FEMA), Department 
of Justice (DOJ), and OEP and CDC all currently provide funds to 
assist state and local governments. Each program conditions the 
receipt of funds on the completion of a plan, but officials have told 
us that the preparation of multiple, generally overlapping plans can 
be an inefficient process.[Footnote 9] In addition, state and local 
officials told us that having so many federal entities involved in 
preparedness and response has led to confusion, making it difficult 
for them to identify available federal preparedness resources and 
effectively partner with the federal government. 

The proposed transfer of numerous federal response teams and assets to 
the new department would enhance efficiency and accountability for 
these activities. This would involve a number of separate federal 
programs for emergency preparedness and response, including FEMA; 
certain units of DOJ; and BHS's Office of the Assistant Secretary for 
Public Health Emergency Preparedness, including OEP and its NDMS and 
MMRS programs, along with the Strategic National Stockpile. In our 
previous work, we found that in spite of numerous efforts to improve 
coordination of the separate federal programs, problems remained, and 
we recommended consolidating the FEMA and DOJ programs to improve the 
coordination.[Footnote 10] The proposal places these programs under 
the control of one person, the Under Secretary for Emergency 
Preparedness and Response, who could potentially reduce overlap and 
improve coordination. This change would make one individual 
accountable for these programs and would provide a central source for 
federal assistance. 

The proposed transfer of MMRS, a collection of local response systems 
funded by BHS in metropolitan areas, has the potential to enhance its 
communication and coordination. Officials from one state told us that 
their state has MMRSs in multiple cities but there is no mechanism in 
place to allow communication and coordination among them. Although the 
proposed department has the potential to facilitate the coordination 
of this program, this example highlights the need for greater regional 
coordination, an issue on which the proposal is silent. 

Because the new department would not include all agencies having 
public health responsibilities related to homeland security, 
coordination across departments would still be required for some 
programs. For example, NDMS functions as a partnership among BHS, the 
Department of Defense (DOD), the Department of Veterans Affairs (VA), 
FEMA, state and local governments, and the private sector. However, as 
the DOD and VA programs are not included in the proposal, only some of 
these federal organizations would be brought under the umbrella of the 
Department of Homeland Security. Similarly, the Strategic National 
Stockpile currently involves multiple agencies. It is administered by 
CDC, which contracts with VA to purchase and store pharmaceutical and 
medical supplies that could be used in the event of a terrorist 
incident. Recently expanded and reorganized, the program will now 
include management of the nation's inventory of smallpox vaccine. 
Under the President's proposal, CDC's responsibilities for the 
stockpile would be transferred to the new department, but VA and BHS 
involvement would be retained, including continuing review by experts 
of the contents of the stockpile to ensure that emerging threats, 
advanced technologies, and new countermeasures are adequately 
considered. 

Although the proposed department has the potential to improve 
emergency response functions, its success is contingent on several 
factors. In addition to facilitating coordination and maintaining key 
relationships with other departments, these include merging the 
perspectives of the various programs that would be integrated under 
the proposal, and clarifying the lines of authority of different 
parties in the event of an emergency. As an example, in the recent 
anthrax events, local officials complained about differing priorities 
between the FBI and the public health officials in handling suspicious 
specimens. According to the public health officials, FBI officials 
insisted on first informing FBI managers of any test results, which 
delayed getting test results to treating physicians. The public health 
officials viewed contacting physicians as the first priority in order 
to ensure that effective treatment could begin as quickly as possible. 

New Department's Control of Essential Public Health Capacities Raises 
Concern: 

The President's proposal to shift the responsibility for all programs 
assisting state and local agencies in public health emergency 
preparedness and response from BHS to the new department raises 
concern because of the dual-purpose nature of these activities. These 
programs include essential public health functions that, while 
important for homeland security, are critical to basic public health 
core capacities." Therefore, we are concerned about the transfer of 
control over the programs, including priority setting, that the 
proposal would give to the new department. We recognize the need for 
coordination of these activities with other homeland security 
functions, but the President's proposal is not clear on how the public 
health and homeland security objectives would be balanced. 

Under the President's proposal, responsibility for programs with dual 
homeland security and public health purposes would be transferred to 
the new department. These include such current HHS assistance programs 
as CDC's Bioterrorism Preparedness and Response program and HRSA's 
Bioterrorism Hospital Preparedness Program. Functions funded through 
these programs are central to investigations of naturally occurring 
infectious disease outbreaks and to regular public health 
communications, as well as to identifying and responding to a 
bioterrorist event. For example, CDC has used funds from these 
programs to help state and local health agencies build an electronic 
infrastructure for public health communications to improve the 
collection and transmission of information related to both 
bioterrorist incidents and other public health events.[Footnote 12] 
Just as with the West Nile virus outbreak in New York City, which 
initially was feared to be the result of bioterrorism,[Footnote 13] 
when an unusual case of disease occurs public health officials must 
investigate to determine whether it is naturally occurring or 
intentionally caused. Although the origin of the disease may not be 
clear at the outset, the same public health resources are needed to 
investigate, regardless of the source. 

States are planning to use funds from these assistance programs to 
build the dual-purpose public health infrastructure and core 
capacities that the recently enacted Public Health Security and 
Bioterrorism Preparedness and Response Act of 2002[Footnote 14] stated 
are needed. States plan to expand laboratory capacity, enhance their 
ability to conduct infectious disease surveillance and epidemiological 
investigations, improve communication among public health agencies, 
and develop plans for communicating with the public. States also plan 
to use these funds to hire and train additional staff in many of these 
areas, including epidemiology. 

Our concern regarding these dual-purpose programs relates to the 
structure provided for in the President's proposal. The Secretary of 
Homeland Security would be given control over programs to be carried 
out by another department. The proposal also authorizes the President 
to direct that these programs no longer be carried out in this manner, 
without addressing the circumstances under which such authority would 
be exercised. We are concerned that this approach may disrupt the 
synergy that exists in these dual-purpose programs. We are also 
concerned that the separation of control over the programs from their 
operations could lead to difficulty in balancing priorities. Although 
the BHS programs are important for homeland security, they are just as 
important to the day-to-day needs of public health agencies and 
hospitals, such as reporting on disease outbreaks and providing alerts 
to the medical community. The current proposal does not clearly 
provide a structure that ensures that both the goals of homeland 
security and public health will be met. 

Concluding Observations: 

Many aspects of the proposed consolidation of response activities are 
in line with our previous recommendations to consolidate programs, 
coordinate functions, and provide a statutory basis for leadership of 
homeland security. The transfer of the BHS medical response programs 
has the potential to reduce overlap among programs and facilitate 
response in times of disaster. However, we are concerned that the 
proposal does not provide the clear delineation of roles and 
responsibilities that we have stated is needed. We are also concerned 
about the broad control the proposal grants to the new department for 
public health preparedness programs. Although there is a need to 
coordinate these activities with the other homeland security 
preparedness and response programs that would be brought into the new 
department, there is also a need to maintain the priorities for basic 
public health capacities that are currently funded through these dual-
purpose programs. We do not believe that the President's proposal 
adequately addresses how to accomplish both objectives. 

Mr. Chairman, this completes my prepared statement. I would be happy 
to respond to any questions you or other Members of the Committee may 
have at this time. 

Contact and Acknowledgments: 

For further information about this testimony, please contact me at 
(202) 512-7118. Marcia Crosse, Greg Ferrante, Deborah Miller, and 
Roseanne Price also made key contributions to this statement. 

[End of section] 

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Uncertainty Remains. [hyperlink, 
http://www.gao.gov/products/GAO-02-610]. Washington, D.C.: June 7, 
2002. 

Homeland Security: Responsibility and Accountability for Achieving 
National Goals. [hyperlink, http://www.gao.gov/products/GAO-02-627T]. 
Washington, D.C.: April 11, 2002. 

Homeland Security: Progress Made; More Direction and Partnership 
Sought. [hyperlink, http://www.gao.gov/products/GAO-02-490T]. 
Washington, D.C.: March 12, 2002. 

Homeland Security: Challenges and Strategies in Addressing Short- and 
Long-Term National Needs. [hyperlink, 
http://www.gao.gov/products/GAO-02-160T]. Washington, D.C.: November 
7, 2001. 

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Efforts. [hyperlink, http://www.gao.gov/products/GAO-02-208T]. 
Washington, D.C.: October 31, 2001. 

Homeland Security: Need to Consider VA's Role in Strengthening Federal 
Preparedness. [hyperlink, http://www.gao.gov/products/GAO-02-145T]. 
Washington, D.C.: October 15, 2001. 

Homeland Security: Key Elements of a Risk Management Approach. 
[hyperlink, http://www.gao.gov/products/GAO-02-150T]. Washington, 
D.C.: October 12, 2001. 

Homeland Security: A Framework for Addressing the Nation's Efforts. 
[hyperlink, http://www.gao.gov/products/GAO-01-1158T]. Washington, 
D.C.: September 21, 2001. 

Public Health: 

Bioterrorism: The Centers for Disease Control and Prevention's Role in 
Public Health Protection. [hyperlink, 
http://www.gao.gov/products/GAO-02-235T]. Washington, D.C.: November 
15, 2001. 

Bioterrorism: Review of Public Health Preparedness Programs. 
[hyperlink, http://www.gao.gov/products/GAO-02149T]. Washington, D.C.: 
October 10, 2001. 

Bioterrorism: Public Health and Medical Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-02-141T]. Washington, D.C.: October 9, 
2001. 

Bioterrorism: Coordination and Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-02-129T]. Washington, D.C.: October 5, 
2001. 

Bioterrorism: Federal Research and Preparedness Activities. 
[hyperlink, http://www.gao.gov/products/GAO-01915]. Washington, D.C.: 
September 28, 2001. 

Chemical and Biological Defense: Improved Risk Assessment and 
Inventory Management Are Needed. [hyperlink, 
http://www.gao.gov/products/GAO-01-667]. Washington, D.C.: September 
28, 2001. 

Combating Terrorism: Need for Comprehensive Threat and Risk 
Assessments of Chemical and Biological Attacks. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-99-163]. Washington, D.C.: 
September 14, 1999. 

West Nile Virus Outbreak: Lessons for Public Health Preparedness. 
[hyperlink, http://www.gao.gov/products/GAO/HEHS-00-180]. Washington, 
D.C.: September 11, 2000. 

Chemical and Biological Defense: Program Planning and Evaluation 
Should Follow Results Act Framework. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-99-159]. Washington, D.C.: 
August 16, 1999. 

Combating Terrorism: Observations on Biological Terrorism and Public 
Health Initiatives. [hyperlink, 
http://www.gao.gov/products/GAO/T-NSIAD-99-112]. Washington, D.C.: 
March 16, 1999. 

Combating Terrorism: 

National Preparedness: Technologies to Secure Federal Buildings. 
[hyperlink, http://www.gao.gov/products/GAO-02-687T]. Washington, 
D.C.: April 25, 2002. 

National Preparedness: Integration of Federal, State, Local, and 
Private Sector Efforts Is Critical to an Effective National Strategy 
for Homeland Security. [hyperlink, 
http://www.gao.gov/products/GAO-02-621T]. Washington, D.C.: April 11, 
2002. 

Combating Terrorism: Intergovernmental Cooperation in the Development 
of a National Strategy to Enhance State and Local Preparedness. 
[hyperlink, http://www.gao.gov/products/GAO-02-550T]. Washington, 
D.C.: April 2, 2002. 

Combating Terrorism: Enhancing Partnerships Through a National 
Preparedness Strategy. [hyperlink, 
http://www.gao.gov/products/GAO-02-549T]. Washington, D.C.: March 28, 
2002. 

Combating Terrorism: Critical Components of a National Strategy to 
Enhance State and Local Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-02-548T]. Washington, D.C.: March 25, 
2002. 

Combating Terrorism: Intergovernmental Partnership in a National 
Strategy to Enhance State and Local Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-02-547T]. Washington, D.C.: March 22, 
2002. 

Combating Terrorism: Key Aspects of a National Strategy to Enhance 
State and Local Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-02-473T]. Washington, D.C.: March 1, 
2002. 

Chemical and Biological Defense: DOD Should Clarify Expectations for 
Medical Readiness. [hyperlink, 
http://www.gao.gov/products/GAO-02-219T]. Washington, D.C.: November 
7, 2001. 

Anthrax Vaccine: Changes to the Manufacturing Process. [hyperlink, 
http://www.gao.gov/products/GAO-02-181T]. Washington, D.C.: October 
23, 2001. 

Chemical and Biological Defense: DOD Needs to Clarify Expectations for 
Medical Readiness. [hyperlink, http://www.gao.gov/products/GAO-02-38]. 
Washington, D.C.: October 19, 2001. 

Combating Terrorism: Considerations for Investing Resources in 
Chemical and Biological Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-02-162T]. Washington, D.C.: October 
17, 2001. 

Combating Terrorism: Selected Challenges and Related Recommendations. 
[hyperlink, http://www.gao.gov/products/GAO-01-822]. Washington, D.C.: 
September 20, 2001. 

Combating Terrorism: Actions Needed to Improve DOD Antiterrorism 
Program Implementation and Management. [hyperlink, 
http://www.gao.gov/products/GAO-01-909]. Washington, D.C.: September 
19, 2001. 

Combating Terrorism: Comments on H.R. 525 to Create a President's 
Council on Domestic Terrorism Preparedness. [hyperlink, 
http://www.gao.gov/products/GAO-01-555T]. Washington, D.C.: May 9, 
2001. 

Combating Terrorism: Accountability Over Medical Supplies Needs 
Further Improvement. [hyperlink, 
http://www.gao.gov/products/GAO-01-666T]. Washington, D.C.: May 1, 
2001. 

Combating Terrorism: Observations on Options to Improve the Federal 
Response. [hyperlink, http://www.gao.gov/products/GAO-01-660T]. 
Washington, DC: April 24, 2001. 

Combating Terrorism: Accountability Over Medical Supplies Needs 
Further Improvement. [hyperlink, 
http://www.gao.gov/products/GAO-01-463]. Washington, D.C.: March 30, 
2001. 

Combating Terrorism: Comments on Counterterrorism Leadership and 
National Strategy. [hyperlink, 
http://www.gao.gov/products/GAO-01-556T]. Washington, D.C.: March 27, 
2001. 

Combating Terrorism: FEMA Continues to Make Progress in Coordinating 
Preparedness and Response. [hyperlink, 
http://www.gao.gov/products/GAO-01-15]. Washington, D.C.: March 20, 
2001. 

Combating Terrorism: Federal Response Teams Provide Varied 
Capabilities; Opportunities Remain to Improve Coordination. 
[hyperlink, http://www.gao.gov/products/GAO-01-14]. Washington, D.C.: 
November 30, 2000. 

Combating Terrorism: Need to Eliminate Duplicate Federal Weapons of 
Mass Destruction Training. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-00-64]. Washington, D.C.: March 
21, 2000. 

Combating Terrorism: Chemical and Biological Medical Supplies Are 
Poorly Managed. [hyperlink, 
http://www.gao.gov/products/GAO/T-HEHS/AIMD-00-59]. Washington, D.C.: 
March 8, 2000. 

Combating Terrorism: Chemical and Biological Medical Supplies Are 
Poorly Managed. [hyperlink, 
http://www.gao.gov/products/GAO/HEHS/AIMD-00-36]. Washington, D.C.: 
October 29, 1999. 

Combating Terrorism: Observations on the Threat of Chemical and 
Biological Terrorism. [hyperlink, 
http://www.gao.gov/products/GAO/T-NSIAD-00-50]. Washington, D.C.: 
October 20, 1999. 

Combating Terrorism: Need for Comprehensive Threat and Risk 
Assessments of Chemical and Biological Attacks. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-99-163]. Washington, D.C.: 
September 14, 1999. 

Combating Terrorism: Use of National Guard Response Teams Is Unclear. 
[hyperlink, http://www.gao.gov/products/GAO/T-NSIAD-99-184]. 
Washington, D.C.: June 23, 1999. 

Combating Terrorism: Observations on Growth in Federal Programs. 
[hyperlink, http://www.gao.gov/products/GAO/T-NSIAD-99-181]. 
Washington, D.C.: June 9, 1999. 

Combating Terrorism: Analysis of Potential Emergency Response 
Equipment and Sustainment Costs. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-99-151]. Washington, D.C.: June 
9, 1999. 

Combating Terrorism: Use of National Guard Response Teams Is Unclear. 
[hyperlink, http://www.gao.gov/products/GAO/NSIAD-99-110]. Washington, 
D.C.: May 21, 1999. 

Combating Terrorism: Observations on Federal Spending to Combat 
Terrorism. [hyperlink, 
http://www.gao.gov/products/GAO/T-NSIAD/GGD-99-107]. Washington, D.C.: 
March 11, 1999. 

Combating Terrorism: Opportunities to Improve Domestic Preparedness 
Program Focus and Efficiency. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-99-3]. Washington, D.C.: 
November 12, 1998. 

Combating Terrorism: Observations on the Nunn-Lugar-Domenici Domestic 
Preparedness Program. [hyperlink, 
http://www.gao.gov/products/GAO/T-NSIAD-99-16]. Washington, D.C.: 
October 2, 1998. 

Combating Terrorism: Observations on Crosscutting Issues. [hyperlink, 
http://www.gao.gov/products/GAO/TNSIAD-98-164]. Washington, D.C.: 
April 23, 1998. 

Combating Terrorism: Threat and Risk Assessments Can Help Prioritize 
and Target Program Investments. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-98-74]. Washington, D.C.: April 
9, 1998. 

Combating Terrorism: Spending on Governmentwide Programs Requires 
Better Management and Coordination. [hyperlink, 
http://www.gao.gov/products/GAO/NSIAD-98-39]. Washington, D.C.: 
December 1, 1997. 

Disaster Assistance: 

Disaster Assistance: Improvement Needed in Disaster Declaration 
Criteria and Eligibility Assurance Procedures. [hyperlink, 
http://www.gao.gov/products/GAO-01-837]. Washington, D.C.: August 31, 
2001. 

Chemical Weapons: FEMA and Army Must Be Proactive in Preparing States 
for Emergencies. [hyperlink, http://www.gao.gov/products/GAO-01-850]. 
Washington, D.C.: August 13, 2001. 

Federal Emergency Management Agency: Status of Achieving Key Outcomes 
and Addressing Major Management Challenges. [hyperlink, 
http://www.gao.gov/products/GAO-01-832]. Washington, D.C.: July 9, 
2001. 

Budget and Management: 

Budget Issues: Long-Term Fiscal Challenges. [hyperlink, 
http://www.gao.gov/products/GAO-02-467T]. Washington, D.C.: February 
27, 2002. 

Results-Oriented Budget Practices in Federal Agencies. [hyperlink, 
http://www.gao.gov/products/GAO-01-1084SP]. Washington, D.C.: August 
2001. 

Managing for Results: Federal Managers' Views on Key Management Issues 
Vary Widely Across Agencies. [hyperlink, 
http://www.gao.gov/products/GAO-01-592]. Washington, D.C.: May 25, 
2001. 

Determining Performance and Accountability Challenges and High Risks. 
[hyperlink, http://www.gao.gov/products/GAO-01-159SP]. Washington, 
D.C.: November 2000. 

Managing for Results: Using the Results Act to Address Mission 
Fragmentation and Program Overlap. [hyperlink, 
http://www.gao.gov/products/GAO-AIMD-97-146]. Washington, D.C.: August 
29, 1997. 

Government Restructuring: Identifying Potential Duplication in Federal 
Missions and Approaches. [hyperlink, 
http://www.gao.gov/products/GAO/T-AIMD-95-161]. Washington, D.C.: June 
7, 1995. 

Government Reorganization: Issues and Principles. [hyperlink, 
http://www.gao.gov/products/GAO/T-GGD/AIMD95-166]. Washington, D.C.: 
May 17, 1995. 

Grant Design: 

Grant Programs: Design Features Shape Flexibility, Accountability, and 
Performance Information. [hyperlink, 
http://www.gao.gov/products/GAO/GGD-98-137]. Washington, D.C.: June 
22, 1998. 

Federal Grants: Design Improvements Could Help Federal Resources Go 
Further. [hyperlink, http://www.gao.gov/products/GAO/AIMD-97-7]. 
Washington, D.C.: December 18, 1996. 

Block Grants: Issues in Designing Accountability Provisions. 
[hyperlink, http://www.gao.gov/products/GAO/AIMD-95-226]. Washington, 
D.C.: September 1, 1995. 

[End of section] 

Footnotes: 

[1] U.S. General Accounting Office, Bioterrorism: Federal Research and 
Preparedness Activities, [hyperlink, 
http://www.gao.gov/products/GAO-01-915], (Washington, D.C.: Sept. 28, 
2001). 

[2] These changes are primarily covered by Sections 502 and 505, 
respectively, in Title V of the President's proposed legislation. 

[3] See "Related GAO Products" at the end of this testimony. 

[4] In the event of an emergency, the National Disaster Medical System 
has response teams that can provide support at the site of a disaster. 
These include specialized teams for burn victims, mental health teams, 
teams for incidents involving weapons of mass destruction, and 
mortuary teams that can be deployed as needed. About 2,000 civilian 
hospitals have pledged resources that could be marshaled in any 
domestic emergency under the system. 

[5] The Metropolitan Medical Response System is a program that 
provides support for local community planning and response 
capabilities for mass casualty and terrorist incidents in metropolitan 
areas. 

[6] The stockpile, previously called the National Pharmaceutical 
Stockpile, consists of two major components. The first component is 
the 12-Hour Push Packages, which contain pharmaceuticals, antidotes, 
and medical supplies and can be delivered to any site in the United 
States within 12 hours of a federal decision to deploy assets. The 
second component is the Vendor Managed Inventory. 

[7] U.S. General Accounting Office, Homeland Security: Responsibility 
and Accountability for Achieving National Goals, [hyperlink, 
http://www.gao.gov/products/GAO-02-627T] (Washington, D.C.: Apr. 11, 
2002). 

[8] U.S. General Accounting Office, Bioterrorism: Federal Research and 
Preparedness Activities, [hyperlink, 
http://www.gao.gov/products/GAO-01-915], (Washington, D.C.: Sept. 28, 
2001). 

[9] U.S. General Accounting Office, Combating Terrorism: 
Intergovernmental Partnership in a National Strategy to Enhance State 
and Local Preparedness, [hyperlink, 
http://www.gao.gov/products/GAO-02-547T] (Washington, D.C.: Mar. 22, 
2002). 

[10] U.S. General Accounting Office, Combating Terrorism: Selected 
Challenges and Related Recommendations, [hyperlink, 
http://www.gao.gov/products/GAO-01-822] (Washington, D.C., Sept. 20, 
2001). 

[11] The recently enacted Public Health Security and Bioterrorism 
Preparedness and Response Act of 2002 (P.L.107-188) cited core public 
health capacities that state and local governments need, including 
effective public health surveillance and reporting mechanisms, 
appropriate laboratory capacity, properly trained and equipped public 
health and medical personnel, and communications networks that can 
effectively disseminate relevant information in a timely and secure 
manner. 

[12] These include the Health Alert Network (HAN), a nationwide system 
that facilitates the distribution of health alerts, dissemination of 
prevention guidelines and other information, distance learning, 
national disease surveillance, and electronic laboratory reporting, 
and Epi-X, a secure Web-based disease surveillance network for 
federal, state, and local epidemiologists that provides tools for 
searching, tracking, discussing, and reporting on diseases and is 
therefore a key element in any disease investigation. 

[13] U.S. General Accounting Office, West Nile Virus Outbreak: Lessons 
for Public Health Preparedness, [hyperlink, 
http://www.gao.gov/products/GAO/HEHS-00-180] (Washington, D.C.: Sept. 
11, 2000). 

[14] P.L. 107-188. 

[End of section] 

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