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Sustaining Focus on Pandemic Preparedness: Federal Efforts

March 27, 2009

2 In February 2009, the General Accountability Office issued a report on the status of pandemic influenza planning. This is the second post in a series of three in depth reviews of the results that were arrived at in the report. The other two posts are linked here: National and International Efforts and Further Actions and Accountability.

This post is focused on these sections of the report: Leadership Roles and
Responsibilities Need to Be Clarified and Tested, and Coordination Mechanisms Could Be Better Utilized, and Federal Agencies Have Provided Considerable Guidance and Pandemic-Related Information, but Could Augment Their Efforts.

The Leadership Roles section of this report was extremely eye-opening. It seems like such a simple thing:

[I]n the event of a catastrophic disaster, the leadership roles, responsibilities, and lines of authority for the response at all levels must be clearly defined and effectively communicated to facilitate rapid and effective decision making[.]

That’s why we go through all of those ICS/NIMS courses, right? So we know who’s in charge and who  to report to.  Well, according to the report, this is the list I was able pull together of people–at the federal level–who have leadership roles and responsibilities in a pandemic event:

  • Secretary, Department of Health and Human Services
  • Secretary, Department of Homeland Security
  • Administrator, FEMA (who advises the President, Sec’y DHS, and HSC)
  • Federal and 5 regional Principal Federal Officials (PFOs)
  • Federal Coordinating Officers (FCOs) at each of the five newly established pandemic regions

Got it?

It’d be great if all of these moving parts meshed together nicely, but the report questions how these roles would interact with each and with other leadership roles. The GAO has previously noted that state and local first responders even question the need to have both PFOs and FCOs. In fact, another GAO report/testimony (pdf) given just last week noted that because of the confusion between the leadership roles of DHS, FEMA, PFOs and FCOs during the Hurricane Katrina response, no PFOs have been deployed since then.

In the event of an animal outbreak, DHS and USDA have been charged with identifying and responding to the event. As recently as June 2007, the two departments did not coordinate any planning on this, and only agreed to proceed with such coordination after a GAO report pointed it out.

Again, this post is focused on federal efforts, but the federal response would obviously not happen in a vacuum. The National Pandemic Implementation Plan has noted that due to the size and scope of a pandemic event, the federal government’s level of support is likely to be limited and is depending on the states and local government to provide the bulk of the response. Everyone in public health and pandemic flu planning knows that’s the case, but now consider the question I raised above, who’s in charge? The states and locals run the response, with each of their own command structures, then all of those folks listed above also direct the response, too? Or do they? Once again, who’s in charge?

Finally, this section looks at public/private coordination. While the report notes that such coordination is ongoing, based solely on past reports, the private and local government sectors felt there was inadequate levels of leadership and guidance from the federal government. The report also praises the Federal Executive Boards that have been established in major metropolitan areas as effective means of developing and coordinating public/private pandemic planning.

The section on pandemic-related information and guidance is, at least to me, very important because it focuses on the amount of preparation for risk communication and public information in a pandemic. After a quick intro to risk communication, the report describes the utter failure of public information in the 2004-2005 flu season, when there was a shortage of the vaccine. Some of the public information successes are the establishment of the website, the Lessons Learned Information Sharing website, state and regional pandemic flu summits and the development of preparedness checklists.

It’s not all peachy-keen, though. Interviewed state and local officials said they could use more guidance on these issues. There was one point not noted in this section, though, that I really had to mention. In terms of funding, the GAO broke down the HHS Influenza Pandemic Supplement from 2006. I’ve reproduced this chart below.


You’ll notice, at the top there, the 1% of funding given to risk communications. Now, maybe I’m just being a jealous communicator, but given that HHS has noted in recent guidance, non-pharmaceutical interventions are expected to cut the infection rate of a pandemic in half. I wonder who is going to teach those interventions but the public health educators and outreach folks? Now, looking at spending money where it will do the most good, and understanding that everyone understands that vaccines will not be available for up to six months after the pandemic begins, and will not be produced in enough quantity to reach everyone. And vaccine production is getting more than 60 times the funding. Again, maybe I’m being jealous, or maybe I’m just taking a risk-based approach.

Image credit: GAO


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