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Emerging Infectious Diseases: Asian SARS Outbreak Challenged International and National Responses

GAO-04-564 Published: Apr 28, 2004. Publicly Released: Apr 28, 2004.
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Severe acute respiratory syndrome (SARS) emerged in southern China in November 2002 and spread rapidly along international air routes in early 2003. Asian countries had the most cases (7,782) and deaths (729). SARS challenged Asian health care systems, disrupted Asian economies, and tested the effectiveness of the International Health Regulations. GAO was asked to examine the roles of the World Health Organization (WHO), the U.S. government, and Asian governments (China, Hong Kong, and Taiwan) in responding to SARS; the estimated economic impact of SARS in Asia; and efforts to update the International Health Regulations.


Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services To strengthen the international response, the Secretary of Health and Human Services (HHS), in collaboration with the Secretary of State, should work with WHO and official representatives from other WHO member states to strengthen WHO's global infectious disease network capacity to respond to disease outbreaks, for example, by expanding the available pool of public health experts.
Closed – Implemented
On August 26, 2008, HHS/CDC wrote to GAO saying that they are committed to expanding the pool of trained public health experts, have a Cooperative Agreement with WHO aimed at strengthening capacity to detect and respond to emerging infections, and have several programs that expand the available pool of public health experts in other countries in support of GAO's recommendation. These programs include the Global Disease Detection Program (GDD) and the Field Epidemiology and Laboratory Training Programs, which are designed to develop and strengthen public health capacity overseas to rapidly detect and respond to emerging infectious disease threats. Six GDD Centers--located in each of WHO's six regions--are collaborations between the CDC and the host nations, with the involvement of other partners, including WHO. Our report entitled Global Health: U.S. Agencies Support Programs to Build Overseas Capacity for Infectious Disease Surveillance (GAO-07-1186) discusses these programs' obligations, goals, and activities as well as U.S. agencies' monitoring of the progress achieved by these programs.
Department of Health and Human Services To help Health and Human Services prevent the introduction, transmission, or spread of infectious diseases into the United States, the Secretary of HHS should complete the necessary steps to ensure that the agency can obtain passenger contact information in a timely and comprehensive manner, including, if necessary, the promulgation of regulations specifically for this purpose.
Closed – Implemented
In December 2005, the HHS Inspector General wrote to GAO saying that HHS/CDC had initiated the rulemaking process to address this recommendation. The Notice of Proposed Rule Making was published in the Federal Register on November 30, 2005, for public comment. Since that time, CDC periodically informed GAO of the status of its rulemaking. On July 31, 2008, CDC notified GAO that it is finalizing its rule and planning to issue the final rule by the end of calendar year 2008.
Department of State To protect U.S. government employees and their families working overseas and to better support other U.S. citizens living or traveling overseas, we recommend that the Secretary of State should continue to work with the Secretaries of Health and Human Services and Defense to identify public and private sector resources for medical evacuations during infectious disease outbreaks and develop procedures for arranging these evacuations. Such efforts could include (1) working with private air ambulance companies and the Department of Defense to determine their capacity for transporting patients with an emerging infectious disease such as SARS, and (2) working to develop agreements under which U.S. medical facilities near international ports of entry will accept medically evacuated patients with infectious diseases such as SARS.
Closed – Not Implemented
In 2007, State officials told GAO that they had not been able to secure additional airlift for medical evacuations. Neither the private sector nor the Department of Defense has added additional airlift since the 2002-2003 SARS outbreak underscored the need for increased capacity. According to State officials, there is no expectation that new medical evacuation aircraft will be added in the future. As of August 2008, the relevant contacts at State did not respond to requests for information on actions taken. State's liaison with GAO suggested that the recommendation be closed as "State did not respond."

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Disease controlDisease detection or diagnosisEconomic analysisEpidemicsHealth resources utilizationInfectious diseasesInternational cooperationPublic healthPublic health legislationPublic health researchRespiratory diseasesSyndromesEmerging infectious diseases