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COVID-19: GAO Recommendations Can Help Federal Agencies Better Prepare for Future Public Health Emergencies

GAO-23-106554 Published: Jul 11, 2023. Publicly Released: Jul 11, 2023.
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Fast Facts

The nation is still recovering from the public health and economic effects of the COVID-19 pandemic and needs to be ready for future emergencies.

In this report, we summarize our newer recommendations in key areas, including public health preparedness and the distribution of federal assistance. We also update our data on COVID-19 funds spent.

We've regularly reported on the federal government's $4.7 trillion pandemic response since 2020. As of April 2023, we've made 386 recommendations to 26 federal agencies and 19 suggestions to Congress to strengthen response and preparedness. About 45% of those have been fully or partially addressed.

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What GAO Found

This report presents key findings and recommendations of GAO's recent COVID-19 oversight reports in several topic areas, with an eye towards helping federal agencies to better prepare for future emergencies. Summarized below are two of the topic areas and corresponding recommendations.

Public health preparedness

Public health preparedness and response includes access to diagnostic testing and medical countermeasures—drugs, vaccines, and supplies—and access to real-time information about emerging threats. However, some deficiencies in the Department of Health and Human Services' (HHS) ability to lead federal efforts to prepare for and respond to public health emergencies hindered the nation's response to the COVID-19 pandemic.

GAO has made recommendations that could help HHS better respond to future emergencies. For example, in a June 2022 report, GAO found that HHS had made minimal progress toward establishing a public health situational awareness and biosurveillance network, which federal law required HHS to establish. GAO made 12 recommendations, including that HHS incorporate lessons learned from the COVID-19 pandemic into plans for implementing this network, which could be used to provide vital information to manage a timely response in a future emergency. As of April 2023, all of these recommendations remained open.

Improper payments and fraud

The risk of improper payments, including from fraud, greatly increased during the pandemic. As federal agencies sought to expedite payments to individuals and businesses affected by the COVID-19 pandemic, agencies used some processes that GAO has previously reported can increase fraud risk.

GAO has made recommendations that could help agencies decrease the risk of improper payments and fraud in a future emergency. For example, in a December 2022 report, we reported that estimates indicate substantial levels of fraud and potential fraud in the Unemployment Insurance (UI) system during the pandemic. We reported that the Department of Labor (DOL) had taken steps to address UI fraud risks, but had not yet developed an antifraud strategy. We recommended that DOL develop and implement a UI antifraud strategy that is consistent with GAO's Fraud Risk Framework. As of April 2023, this recommendation remained open.

Five Areas Related to GAO's Fraud Risk Framework

Five Areas Related to GAO's Fraud Risk Framework

Why GAO Did This Study

The COVID-19 pandemic has had an unprecedented effect on the nation's public health and economy. Since March 2020, Congress has provided over $4 trillion to fund efforts to help the nation respond to and recover from the pandemic.

The CARES Act includes a provision for GAO to report regularly on the public health and economic effects of the pandemic and the federal response. This report summarizes GAO's findings and associated recommendations from COVID-19 oversight reports issued from April 2022 through April 2023. This report includes the topics of (1) public health preparedness, (2) improper payments and fraud, (3) vulnerable populations, (4) distribution of federal COVID-19 funding, and (5) COVID-19 and the economy. This report also includes updates for selected indicators related to public health, the economy, and federal COVID-19 funding and spending.


GAO has made 386 recommendations to executive branch agencies and 19 matters for congressional consideration to strengthen the transparency and accountability of the federal response to the pandemic. As of April 2023, the agencies had fully or partially addressed 47 percent of these recommendations and Congress had fully addressed two matters.

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EconomyEmergency preparednessFederal agenciesFraudImproper paymentspandemicsPublic healthPublic health emergenciesHealth careDeaths