COVID-19: Pandemic Lessons Highlight Need for Public Health Situational Awareness Network

What GAO Found

Since 2006, a number of federal legal guidelines have mandated that the Department of Health and Human Services (HHS) take steps to enhance the nation’s situational consciousness of threats associated to public well being emergencies, such because the COVID-19 pandemic. Specifically, HHS was required to determine a close to real-time digital nationwide public well being situational consciousness functionality by means of an interoperable community of methods. This community was for use to facilitate early detection of and fast response to doubtlessly catastrophic infectious illness outbreaks.

More than 15 years after the legislation initially mandated it, the federal authorities doesn’t but have this wanted situational consciousness community functionality. If this community had been out there, it might have been used to supply very important info to higher handle a well timed COVID-19 response.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 reiterated the necessity for HHS to enhance situational consciousness capabilities. The following summarizes key necessities within the act and the extent to which HHS has carried out them as of March 2022.

Summary of statutory necessities associated to the development of situational consciousness for public well being emergencies and the extent to which HHS has carried out them as of March 2022

Summary of necessities

Implementation standing

Adopt technical and reporting requirements.

Provide grants to determine built-in methods.

Develop a plan for sharing and securing info.

Establish a close to real-time digital nationwide public well being situational consciousness and biosurveillance functionality.

Facilitate coordination amongst related companies.

Conduct a public assembly with specialists in public well being by December 21, 2019.

Utilize relevant interoperability requirements and outline minimal information components.

Develop a technique and implementation plan by December 24, 2020.

Conduct a assessment of the info and data transmitted by the community by June 24, 2021 and each 6 years thereafter.

Develop a price range plan by June 24, 2021, and on an annual foundation thereafter.

Legend: ● Requirement is absolutely carried out; ◑ Requirement is partially carried out; ○ Requirement is just not carried out Source: GAO evaluation of The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 and different associated legal guidelines, and Department of Health and Human Services (HHS) information. I GAO-22-104600

The lack of serious progress in implementing the necessities within the act is due, partially, to the division failing to prioritize the necessities of the act and never establishing an applicable administration and governance construction. Such a construction would come with a lead operational division with outlined roles and obligations for implementation of statutory necessities, and a corporation to supply oversight of those efforts. During GAO’s assessment, HHS started drafting a piece plan meant to handle the necessities of the 2019 act. However, HHS has not supplied a timeframe for finishing the work plan.

In January 2022, GAO designated HHS management and coordination of a variety of public well being emergencies as excessive danger. For greater than a decade, GAO has reported on HHS’s execution of its lead position in getting ready for, and responding to, public well being emergencies and have discovered persistent deficiencies in its potential to carry out this position. Similarly, HHS has not supplied the management obligatory to hold out its required obligations within the 2019 act.

Public well being entities skilled quite a lot of challenges and recognized classes discovered from the COVID-19 pandemic that would higher inform HHS in creating and implementing the general public well being situational consciousness and biosurveillance community. Specifically, state survey respondents recognized various information-sharing challenges that they skilled within the administration of public well being info. The following summarizes the highest 4 challenges state survey respondents most frequently rated as difficult.

State Reported Challenges in Managing Public Health Information throughout COVID-19

Summary of statutory requirements related to the improvement of situational awareness for public health emergencies and the extent to which HHS has implemented them as of March 2022

Additional challenges—limitations on information collected, elevated reporting necessities, and impediments to health-related information sharing and collaboration—had been recognized by public well being organizations on the nationwide, state, and native ranges. Thirty states recognized classes that HHS might use in planning for the community. The three classes that states recognized most frequently had been

  1. enhance public well being reporting by, for instance, standardizing and sharing information amongst federal entities and states to enhance surveillance wants;
  2. collaborate early with stakeholders by, for instance, involving state and native stakeholders all through the whole lot of emergency reponse actions; and
  3. set up a public well being infrastructure to allow information sharing by, for instance, implementing the community required by the 2019 act.

After having over two years of expertise in responding to COVID-19, HHS had not taken steps, as of March 2022, to establish, doc, and share the entire challenges and classes discovered from the pandemic. These challenges and classes may very well be integrated into the planning and implementation of the general public well being situational consciousness and biosurveillance community. Until HHS takes steps to establish, doc, share, and incorporate classes discovered from the COVID-19 pandemic, alternatives to enhance the response to future and ongoing public well being emergencies by studying from previous challenges will doubtless be missed.

Why GAO Did This Study

The COVID-19 pandemic has drawn consideration to the pressing want for public well being officers to entry real-time details about rising threats to allow them to make well timed, responsive selections. For over a decade, federal legislation has mandated that HHS enhance the nation’s situational consciousness of those threats.

The most up-to-date mandate, enacted in 2019, included a provision for GAO to report on HHS’s efforts to implement these enhancements. The CARES Act additionally included a provision for GAO to conduct monitoring and oversight of the federal response to the pandemic.

This report examines (1) the extent to which HHS has made progress towards implementing the necessities within the 2019 act; and (2) the challenges and classes discovered from COVID-19 that HHS might incorporate in planning for a situational consciousness and biosurveillance community.

GAO reviewed HHS documentation, comparable to grants supplied to states, technical and reporting requirements, and adoption plans. It additionally analyzed documentation and in contrast it to necessities within the act.

In addition, GAO surveyed public well being officers from 50 U.S. states, the District of Columbia, and 5 U.S. territories. Thirty-nine states, the District of Columbia and three U.S. territories (hereinafter collectively known as states) responded to the survey, for a response price of 77 p.c. GAO assessed these responses to establish COVID-19 challenges and classes discovered. Further, GAO interviewed representatives from eight public well being organizations representing state and native ranges, such because the National Governors Association and National Association of County and City Health Officials, in addition to HHS officers.

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