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As of January 31, 2023, there are 4842 open recommendations that still need to be addressed. 473 of these are priority recommendations, those that we believe warrant priority attention. Learn more about our priority designation on our Recommendations page.

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1 - 18 of 18 Recommendations, including 0 Priority Recommendations
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Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited

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1 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of the CDC should expand the scope of its analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to include the prevalence of falls and fall-related injuries among adults under age 65 who may be at higher risk of falls, including adults with disabilities, and, as appropriate, share findings with ACL and other agencies overseeing relevant programmatic efforts. For example:

  • CDC could analyze existing BRFSS data on adults aged 45 to 64 and share findings, as appropriate.
  • CDC could propose asking adults aged 18 to 44 the two BRFSS fall-related questions, as part of the survey update process.

(Recommendation 1)

Open

HHS agreed with this recommendation and described steps CDC and ACL plan to take to implement it. For example, CDC plans to include a fall-related question in the 2023 BRFSS, which will allow additional analysis on adults aged 45 to 64. Additionally, ACL plans to share information among its disability programs to raise awareness of falls risk for adults with disabilities. In doing so, it plans to coordinate with federal partners on the most current and relevant information to be shared. We will monitor the agency's progress in implementing this recommendation.

Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement

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3 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should implement controls for the entry of data into its Quarantine Activity Reporting System (QARS), including by providing adequate training and standard operating procedures that are documented and institutionalized for system users and by conducting consistent validation checks. (Recommendation 1)
Open

The CDC concurred with this recommendation and said it would take steps to implement it. When we confirm what actions the CDC has taken in response to this recommendation, we will provide updated information.

Centers for Disease Control and Prevention The Director of CDC should assess additional opportunities to improve the quality of air passenger information it collects and manages— including opportunities to increase automation by adopting or establishing data exchange standards—and take action, as appropriate, based on this assessment. (Recommendation 2)
Open

The CDC concurred with this recommendation and said it would take steps to implement it. When we confirm what actions the CDC has taken in response to this recommendation, we will provide updated information.

Centers for Disease Control and Prevention The Director of CDC should re-design QARS or deploy a new data system that would allow CDC to more effectively facilitate contact tracing for air passengers and conduct disease surveillance for air travel. (Recommendation 3)
Open

The CDC concurred with this recommendation and said it would take steps to implement it. When we confirm what actions the CDC has taken in response to this recommendation, we will provide updated information.

COVID-19: Current and Future Federal Preparedness Requires Fixes to Improve Health Data and Address Improper Payments

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2 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should define specific action steps and time frames for the agency's data modernization efforts. See the Public Health Data Collection and Standardization enclosure. (Recommendation 9)
Open

As of September 2022, HHS did not provide an update.

Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention, in coordination with state, tribal, local, and territorial jurisdiction and public health organization partners, should ensure the agency builds upon its existing surveillance approach by detailing specific objectives for how it will achieve its COVID-19 surveillance goals and describing how it will assess progress toward meeting them. See the COVID-19 Surveillance enclosure. (Recommendation 10)
Open

The Department of Health and Human Services (HHS) agreed with our recommendation, and the Centers for Disease Control and Prevention noted that it will continue efforts to develop a document summarizing its COVID-19 surveillance goals and how it will assess progress towards meeting them. As of September, 2022, HHS had not provided an update on its efforts to implement the recommendation. When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference

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2 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The CDC Director should ensure that procedures for reporting and addressing potential political interference in scientific decision-making are developed and documented, including adding a definition of political interference. (Recommendation 1)
Open

As of October 2022, HHS was updating its departmental scientific integrity policy and its operating divisions, including the CDC, were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference.

Centers for Disease Control and Prevention The CDC Director should ensure that CDC employees and contractors performing scientific activities are trained on how to report allegations of political interference in scientific decision-making. (Recommendation 2)
Open

As of October 2022, HHS was updating its departmental scientific integrity policy and its operating divisions were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference. Following publication of the updated departmental scientific integrity policy, HHS will develop scientific integrity training for employees, contractors, and other persons

Tribal Epidemiology Centers: HHS Actions Needed to Enhance Data Access

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2 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should develop written guidance for TECs on how to request data. Such guidance should include information on data potentially available to TECs, how to request data, agency contacts, criteria the agency will use to review such requests, and time frames for receiving an agency response to data requests. (Recommendation 2)
Open

HHS agreed with our recommendation. As of September 2022, HHS told us that CDC had begun drafting guidance for TECs on how to request data. To inform this guidance, CDC reported establishing an internal workgroup, engaging with Tribal and other partners, and collaborating with IHS. CDC officials anticipated publishing its first iteration of guidance on major CDC surveillance systems and data sets and information on how to access them on its Tribal Support website in the fourth quarter of calendar year 2022. To fully implement this recommendation, CDC must complete development of written

Centers for Disease Control and Prevention The Director of CDC should develop and document agency procedures on reviewing TEC requests for and making data available to TECs. These procedures should include a description of data potentially available to TECs, agency contacts, criteria for reviewing TEC data requests, and time frames for responding to TEC requests. (Recommendation 3)
Open

HHS agreed with our recommendation. As of September 2022, HHS told us that CDC is working to improve agency procedures on reviewing TEC requests for data and making data available to TECs. As part of this process, CDC reported establishing a network of CDC points of contact for planning and implementing these procedures, and reviewing current CDC data policies to see what, if anything, should be updated. To fully implement this recommendation, CDC must develop procedures on reviewing TEC requests for and making data available to TECs.

COVID-19: HHS Agencies' Planned Reviews of Vaccine Distribution and Communication Efforts Should Include Stakeholder Perspectives

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2 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention As CDC finalizes its plans for an after action review related to its COVID-19 vaccine distribution and communication efforts, the Director of the Centers for Disease Control and Prevention should ensure the agency obtains feedback during the life cycle of the response from key stakeholders, including state and local health officials, and incorporates their perspectives as it conducts its review. (Recommendation 1)
Open

CDC concurred with this recommendation. In September 2022, HHS noted it would provide additional information on this recommendation next month. We will continue to monitor the agency's actions in this area.

Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should share relevant findings of its after action review related to vaccine distribution and communication with key stakeholders, such as state and local health officials, and other federal agencies, as appropriate. (Recommendation 2)
Open

CDC concurred with this recommendation. In November 2021, CDC agreed the agency should share relevant findings with key stakeholders, as appropriate, from its after action review once completed. In September 2022, HHS said it would provide additional information on this recommendation next month. We will continue to monitor the agency's actions in this area.

Small Business Research Programs: Agencies Should Further Improve Award Timeliness

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1 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should evaluate the effectiveness of steps taken to improve SBIR award timeliness and take any necessary additional steps in order to consistently meet SBA award timeliness guidelines. (Recommendation 7)
Open – Partially Addressed

HHS agreed with this recommendation. According to an April 2022 HHS letter responding to our report as well as additional information provided by the Centers for Disease Control and Prevention (CDC), the CDC stated its intent to take steps to identify the organizational processes, systems, and policies that may offer opportunities for increased efficiencies. CDC also stated it had modified the roles and responsibilities of staff engaged in the SBIR program and provided documentation of these roles and responsibilities, as of November 2021. Going forward, we will follow up to obtain data on CDC

Food Safety: CDC Could Further Strengthen Its Efforts to Identify and Respond to Foodborne Illnesses

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1 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should implement a program performance assessment system for its multistate foodborne illness outbreak investigations, including setting performance goals, assessing progress toward achieving those goals with performance measures, and conducting program evaluations. (Recommendation 3)
Open – Partially Addressed

CDC officials have taken some steps to develop goals and objectives for addressing foodborne, waterborne, and environmentally transmitted infections and to incorporate them into their strategic plan. Specifically, CDC began a project in 2021 to design and implement an outbreak performance management system. CDC said that the initial version of this performance evaluation system should be finalized by 2022. CDC plans to incorporate all data sources needed for the performance evaluation system into SEDRIC, the System for Enteric Disease Response, Investigation, and Coordination, a cloud-based

Antibiotic Resistance: Additional Federal Actions Needed to Better Determine Magnitude and Reduce Impact

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4 Open Recommendations
Agency Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should take steps to determine participation rates and distribution needed in the AR Option of the National Healthcare Safety Network for conducting regional and national assessments of antibiotic resistance of public health importance. (Recommendation 1)
Open – Partially Addressed

The Department of Health and Human Services concurred with this recommendation. As of June 2021, CDC stated that it has worked to encourage voluntary reporting to the Antibiotic Use and Resistance module. CDC also noted that it seeks to extend geographic coverage of AR data and will include caveats about data representativeness in its reports. In April 2022, CDC told us they are continuing to work with CMS to explore options to increase reporting and encourage reporting to the Antibiotic Use and Reporting module. Finally, CDC noted that assessing representativeness was delayed due to the

Centers for Disease Control and Prevention The Director of CDC should ensure that CDC's evaluation of its surveillance system for antibiotic-resistant gonorrhea includes measures of its representativeness, such as comparison of the trends in the sample population with those in the overall U.S. population, using specially designed studies if needed. (Recommendation 2)
Open – Partially Addressed

The Department of Health and Human Services and the Centers for Disease Control and Prevention concurred with this recommendation. As of June 2021, CDC has taken some actions to address antibiotic-resistant gonorrhea, including publishing a report on a new type of resistant gonorrhea in the United States and evaluating new tests for resistant gonorrhea. In April 2022, CDC officials stated they are developing methods to create national estimates to account for possible biases within CDC's surveillance system, including constructing mathematical models to assess representativeness of

Centers for Disease Control and Prevention The Director of CDC should provide information on uncertainties for antibiotic resistance estimates in its consolidated Threats Reports, including standard errors or confidence intervals, as appropriate. (Recommendation 3)
Open

The Department of Health and Human Services generally concurred with this recommendation. As of June 2021, in a recent CDC publication on a variety of antibiotic-resistant infections in U.S. hospitals, data presented include confidence intervals and the report included discussion of key limitations in interpreting the data. However, CDC did not yet incorporate this sort of analysis into its consolidated Threats Reports, and the publication did not include information on all CDC-identified antibiotic resistant threats. Further, the publication is limited in scope to hospital patient infections

Centers for Disease Control and Prevention The Director of CDC should develop a plan for timely, consolidated reports of antibiotic resistance in priority pathogens at regular intervals. (Recommendation 4)
Open

The Department of Health and Human services concurred with this recommendation. As of June 2021, CDC stated that it is committed to updating the Threats Report at regular intervals and have begun planning for the next iteration. CDC noted that it will continue exploring reasonable timeframes for such reports given potential disruption such as the current pandemic. In April 2022, CDC officials stated that planning is ongoing for the next report to be released in the coming years and that they plan to develop a more established plan for updates to this report. They are also assessing best

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