In a new Government Accountability Office (GAO) report, Influenza Pandemic: Sustaining Focus on the Nation's Planning and Preparedness Efforts, to the chairman of the House Committee on Homeland Security, Congress’ investigative arm warned that even though “national priorities are shifting as a pandemic has yet to occur, and the nation’s financial crisis and other national issues have become more immediate and pressing … an influenza pandemic [nevertheless] remains a real threat to our nation and to the world.”

GAO, as HSToday.us has been reporting, has issued numerous audits of the federal government’s efforts to help the nation better prepare for, respond to, and recover from a possible influenza pandemic, but now, despite the previous administration’s actions to prepare for a pandemic, “including developing a national strategy and implementation plan, much more [still] needs to be done” by the government to adequately prepare the nation for the unprecedented ravaging of a pandemic, GAO has determined.

The Obama administration’s FY2010 federal budget contains no additional funding for pandemic preparedness, but the omnibus spending bill passed in the House and pending in the Senate would provide slightly more than $500 million for expenses necessary to prepare for and respond to an influenza pandemic for activities including the development and purchase of vaccine, antivirals, necessary medical supplies, diagnostics, and other surveillance tools.

Funds may also be used for the construction or renovation of privately owned facilities for the production of pandemic influenza vaccines and other biologics if the HHS Secretary finds such construction or renovation necessary to secure sufficient supplies of such vaccines or biologics.

Appropriations for pandemic preparedness that were contained in both the House and Senate versions of the recent economic stimulus bill were excised during conference committee.

Meanwhile, as states’ also have been slammed by the economic downturn, many have cut back on their own pandemic preparedness planning and initiatives, a lot of which has been dependant on federal assistance.

Pandemic preparedness authorities have warned that despite the federal government’s economic malaise, this is not the time to be cutting back on funding for preparedness for any potential catastrophic mass casualty disaster. Indeed, should a pandemic erupt before either the nation, or the world’s, economies turn around, its impact would be far, far worse than it would be otherwise, authorities told HSToday.us.

In its new report, GAO stated that “strengthening preparedness for large-scale public health emergencies, such as an influenza pandemic, is one of the 13 urgent issues that we identified as among those needing the immediate attention of the new administration and Congress during this transition period.

HSToday.us has consistently reported that federal preparedness efforts for a catastrophic mass casualty natural disaster or terrorist attack that requires unprecedented mobilization of emergency medical care is far from the level of readiness it needs to be at, and that “creeping complacency” over the need for such readiness has become a substantive hindrance to preparedness planning efforts.

In so far as a pandemic is concerned, GAO stated that, “given the consequences of a severe influenza pandemic, in 2006 we developed a strategy for our work that would help support Congress’s decision making and oversight related to pandemic planning. Our strategy was built on a large body of work spanning two decades, including reviews of government responses to prior disasters such as Hurricanes Andrew and Katrina, the devastation caused by the 9/11 terror attacks, efforts to address the Year 2000 (Y2K) computer challenges, and assessments of public health capacities in the face of bioterrorism and emerging infectious diseases such as Severe Acute Respiratory Syndrome (SARS).”

GAO stated “the strategy was built around six key themes, noting that “while all of these themes are interrelated, our earlier work underscored the importance of leadership, authority, and coordination, a theme that touches on all aspects of preparing for, responding to, and recovering from an influenza pandemic.”

“In the past three years, we have issued 11 reports and two testimonies on influenza pandemic planning, which address these key themes,” GAO said, adding, “we have made 23 recommendations based on the findings from many of these reports and testimonies.”

Only thirteen of these recommendations have been acted upon by the responsible federal agencies, GAO told lawmakers this week, highlighting that “while the responsible federal agencies have generally agreed with our recommendations, ten recommendations have not yet been implemented.”

GAO has three pandemic-related reviews underway on the status of implementing the National Strategy for Pandemic Influenza Implementation Plan (National Pandemic Implementation Plan); plans to protect the federal workforce during a pandemic; and the effect of a pandemic on the telecommunications capacity needed to sustain critical financial market activities.

Based on its audits of federal pandemic preparedness efforts in recent years and of its recommendations, GAO concluded that:

• Leadership roles and responsibilities need to be clarified and tested, and coordination mechanisms could be better utilized;
• Efforts are underway to improve the surveillance and detection of pandemic-related threats in humans and animals, but targeting assistance to countries at the greatest risk has been based on incomplete information;
• Pandemic planning and exercising has occurred in the United States and other countries, but planning gaps remain;
• Further actions are needed to address the capacity to respond to and recover from an influenza pandemic;
• Federal agencies have provided considerable guidance and pandemic-related information, but could augment their efforts;
• Performance monitoring and accountability for pandemic preparedness needs strengthening.

After reading GAO’s conclusions about the government’s laxity in each of these areas – which are discussed in detail in GAO’s report - the top public health preparedness official for a northeastern state told HSToday.us Monday that the consensus of a distillation of planers and public health preparedness officials in the northeast is that “this is old news. It’s old, ‘oh hum’ news to us," stressing that "there’s nothing new that tells us what we need to be doing to deal with this when it happens."

The official said that this has been one of the federal government’s deficiencies all along with regard to its guidelines to states and localities for pandemic preparedness.

The official told HSToday.us that “the best that I can say very briefly is that the federal authorities are still operating at the 40,000 foot level and do not have the means to achieve the perspective that we have on the ground. This is an inevitable feature of their bureaucratic structure.”

Continuing, the official said, “no offense to them, but continuing talk of oversight, performance data collection, functional committee jurisdictions amid gentle hand wringing over the prospect of mass mortality leave many of us cold. They seem to have the complacent attitude that once they have written an outline, the problems will naturally resolve themselves.”

“The one statement by the previous [Health and Human Services] Secretary to the effect that once a pandemic hits, ‘you are on your own,’ has been embraced by us and had led us to develop the following responses, among many others,” the official continued:

• “States in our region are dealing with plans for a reasonable allocation of resources in pandemic ... now further mitigated by a diminishing economy;
• “We are organized to respond through our acute care hospital, emergency management, epidemic surveillance, medical reserve corps and area communications networks;
• “We long ago determined that antivirals were not the answer, and that federal reliance on this treatment arm was doomed from the outset, a perceived toxic mix of science and politics. The Fed's complacent reliance on big pharma was not lost on us;
• “In the absence of hard data from central sources we are developing our own mass fatality management system since the deceased, in large numbers, will themselves become a public health hazard. Public education, demonstrating deep respect for various cultural sensitivities, is mandatory;
• “We are devising protocols for altered standards of care that are particular to our region and to our regional political structure. This will promulgated to the public, such is the great need for transparency in this most delicate area;
• “We are drilling all aspects of our pandemic response at  local and regional  levels; and
• “Given the fact that the first in line for vaccination are Homeland and Public Security personnel, we face a daunting problem of enlisting our health care workers.
• “Working with the granting process and its associated guidance formulas we still feel obligated to tailor our activities to the specific populations we serve.”

“At its post-9/11 peak, federal homeland security grant funds totaled less than $4 billion per year spread over hundreds, if not thousands, of jurisdictions across the United States,” wrote Matt A. Mayer, head of the Heritage Foundation's Homeland Security and the States Project, which seeks to decentralize elements of homeland security from the federal government to state and local entities, in his new report, An Analysis of Federal, State, and Local Homeland Security Budgets.

Mayer said “while the Clinton Administration created grant programs specifically aimed at paying for the personnel costs of state and local law enforcement officers, the Bush Administration typically took the position that personnel costs were inherently state and local obligations. The aim of federal homeland security grants should be centered on building critical capabilities, which includes buying equipment, training first preventers and responders, and conducting exercises to test competency. This approach makes sense, and the Obama Administration should carefully weigh the options before making any drastic changes in that policy.”

Continuing, Mayer wrote that, “arguably, hiring a local first responder with federal funds supplants rather than supplements state or local funding. Conversely, acquiring a decontamination capability for chemical, biological, radiological, or nuclear agents with federal funds supplements the state or local funds that were already used to hire the local first responder who will use the capability. Using finite federal funds for filling core personnel needs only ensures that states and localities will divert their own resources to other uses and that critical homeland security capabilities will not be developed as personnel costs—a key driver of the cost of government—absorb an increasing share of federal grant funds.”

“Moreover,” Mayer stated, “providing federal funds to high-risk jurisdictions to prevent or respond to a terrorist attack—given the national impact such an attack would have on the whole country—is a defensible use of taxes paid by individuals living outside of those jurisdictions. The same argument cannot be made for using the taxes paid by Iowans to hire a police office in Rochester, New York, to battle chronic crime. If Rochester needs more police officers, then its citizens should pay for those positions.

“Admittedly, much of the focus on federal grant funds is driven by governors, mayors, city councilmen, and county commissioners (and their federal elected representatives) who are eager for the next round of federal government largesse. These jurisdictions need political leadership less focused on the relatively insignificant federal funds that they receive—just $23 billion over eight years—and more focused on ensuring that their public safety secretaries, state patrol superintendents, police chiefs, sheriffs, fire chiefs, homeland security advisers, and emergency management directors receive the necessary general-fund appropriations to hire the requisite number of personnel and to build the critical capabilities necessary in this age of terror.”