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Sustaining Focus on Preparedness: Further Actions and Accountability

March 31, 2009

3 In February 2009, the General Accountability Office issued a report on the status of pandemic influenza planning. This is the final 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 Federal Efforts.

This post is focused on these sections of the report: Further Actions Are Needed to Address the Capacity to Respond to and Recover from an Influenza Pandemic, Performance Monitoring and Accountability for Pandemic Preparedness Needs Strengthening, and Concluding Observations.

The Further Actions section is divided into two areas, Medical Surge Capacity and Antivirals and Vaccine Capacity, that need significant work  because they hint at the distribution of limited resources. How should the federal government guide, or recommend, how limited resources should be utilized in a pandemic?

The types of public health emergencies that a lot of our planning has gone into has focused on location constrained incidents: a bioterror attack or a naturally limited disease outbreak, for example. In response to that, the Emergency Management Assistance Compact was developed to facilitate the sharing of resources between member states. Upon review, GAO feels that depending on the EMAC to organize response during a pandemic is troublesome because every state will be, or has the potential to be adversely affected, and would be loathe to lend limited support. In this way, our planned first line of medical surge capacity is likely to be unavailable.

The report notes that several states are working towards developing “altered standards of care” guidance to be utilized as resources, including ventilators, hospital beds and intensive care units, are consumed and unavailable. The GAO (and me) views this as a positive development and has reached out to HHS to ask that they facilitate the sharing of this information.

HHS did not comment on the recommendation, and it has not indicated if it plans to implement it.

Guidance on this issue is something that states and locals have asked for in the past, especially after their plans were reviewed by HHS and this area was found to contain “major gaps.”

The next section deals with antivirals and vaccine capacity. This is where the bulk of pandemic influenza spending has gone, and while significant work has been done:

[GAO] found that the availability of antivirals and vaccines in a pandemic could be inadequate to meet demand due to limited production, distribution, and administrative capacity.

While this quote is based upon a report that is a little more than a year old, not much has changed because it will take several years for new facilities to come online and weak international surveillance will further delay the start of any vaccine production schedule.

In light of these shortcomings, HHS has developed guidance on prioritization for distribution of antivirals and expects to release guidance on vaccine distribution soon.

The Performance Monitoring section of this report was the most depressing to me. I literally have notes in the margins next to each paragraph saying, “Which to focus on,” “Where to start,” and “This again?” While I should just excerpt the whole section, I wrote this description in the margins and hope that it serves to highlight the poor job done of monitoring:

How to fail? Propose a task. Assign it to no one, give no guidance on how best to complete it, give no funding with which to work on it, and give no metric or timeline with which to gauge success. In short, no one will be blamed for doing nothing, no money was spent, and there is no oversight that can pick out this failure.

The conclusion of the report is short and direct. It notes the glaring failure to implement recommendations:

Although much has been done, many challenges remain, as evidenced by the fact that almost half of the recommendations that we have made over the past 3 years have still not been fully implemented.

Called out specifically as what should be priorities are the need for better leadership on the issue of pandemic planning, and better international surveillance systems. Tomorrow starts Secretary-designate Sebelius confirmation hearings. Hopefully soon we’ll begin to see a new commitment to pandemic planning.

Image credit: GAO

One Comment leave one →
  1. March 31, 2009 7:08 pm

    Another upcoming ray of light in the standards of care area is a set of workshops hosted by IOM. I have a post coming out tomorrow morning on it, or you can go to ( for details from IOM.

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