Health agency labeled high-risk, unprepared
US watchdog says recommendations ignored, tallies ‘persistent deficiencies’
A US government watchdog said the Health and Human Services Department, or HHS, the government’s main health agency, repeatedly ignored recommendations to improve its pandemic response and is not prepared to adequately respond to public health emergencies.
The report by the nonpartisan Government Accountability Office, or GAO, issued on Jan 27, added the HHS to its high-risk list of United States federal departments and programs susceptible to waste, fraud, and abuse unless there are significant changes.
The office said that the warning is intended to highlight the need for improvements before another crisis spurred by a pathogen, extreme weather, or a bioterrorist attack.
Investigators “found persistent deficiencies” in how the agency has led the response to the coronavirus pandemic and public health emergencies dating back to 2007, the GAO concluded. It cited continued problems relating to coordination among public health agencies, the collection of infectious-disease surveillance data, and the securing of appropriate testing and medical supplies.
The department’s response to the COVID-19 pandemic has “highlighted long-standing concerns we have raised about its ability to execute its role leading federal public health and medical preparedness for, and response to, such public health emergencies”, the GAO said in its report, which was shared with nine congressional committees.
“For over a decade, we have found issues with how HHS’s leadership prepares for and responds to emergencies, including COVID-19, other infectious diseases, and extreme weather events, such as hurricanes,” the office wrote in the report.
The GAO’s concerns about the department span four presidential administrations and public health emergencies, ranging from infectiousdisease outbreaks such as Ebola and Zika to extreme weather events such as hurricanes.
The watchdog said that it has made 115 recommendations to the department about its leadership and coordination of public health emergencies since 2007 but only 33 have been implemented.
On the pandemic, the GAO said it had warned about shortages of coronavirus tests beginning in September 2020, and in January 2021 it recommended the department develop a comprehensive national testing strategy, which health officials in May promised would be forthcoming. But to date, HHS has not provided this document, according to the investigators.
The watchdog also faulted the department for ignoring more recent recommendations, such as a January 2021 warning that the department needed to better coordinate its management of the Strategic National Stockpile, which contains supplies, medicines, and devices for lifesaving care to be used in a crisis.
But as of January 2022, HHS “has not developed a formal process for engaging with key stakeholders on a supply strategy for pandemic preparedness”, according to the GAO.
The agency said the department’s deficiencies include failure to establish clear roles and responsibilities for other partners involved in the pandemic or disaster response, issues in collecting and analyzing data to inform decision-making, difficulties providing clear and consistent communication to key partners and the public, and problems establishing transparency and accountability to help ensure program integrity and build public trust.
Some of the HHS testing, supply chain, and coordination problems identified by the accountability office were highlighted by US President Joe Biden when he took office last year.
The GAO said it recognizes that numerous public health emergencies converging and occurring simultaneously “can present significant challenges and tax already strained resources”.
However, the report concluded: “Waiting to address the deficiencies we have identified in HHS’s leadership and coordination of public health emergencies is not an option as it is not possible to know precisely when the next threat will occur; only that it will come.”
Jessica Farb, the GAO’s managing director for healthcare, said the agency had also identified examples of good performance at the department during the pandemic.
HHS officials said that they were reviewing the GAO report and its conclusions.