The Government Accountability Office (GAO) recommended in a new audit report that the Department of Defense (DOD), Department of Health and Human Services (HHS) and Department of Homeland Security (DHS) use their existing coordination mechanisms to explore opportunities to improve preparedness and response to a pandemic if DOD’s capabilities are limited. All three departments concurred with GAO’s recommendations.
GAO reported, HHS and DHS have plans to guide their response to a pandemic, but their plans do not explain how they would respond in a resource-constrained environment in which capabilities like those provided by DOD are limited.”
GAO found that, “DOD coordinates with the agencies, but existing coordination mechanisms among HHS, DHS and DOD could be used to improve preparedness.”
HHS’s Pandemic Influenza Plan is the departmental blueprint for its preparedness and response plan to responding to an influenza pandemic, and DHS’s National Response Framework is a national guide on how federal, state and local governments are to respond to mass casualty pandemics and other widespread public health situations.
DOD, HHS, and DHS all “have mechanisms—such as interagency working groups, liaison officers and training exercises—to coordinate their response to a pandemic,” but GAO said, “HHS and DHS plans do not specifically identify what resources would be needed to support a response to a pandemic in which demands exceeded federal resources … officials stated that there would be no way of knowing in advance what resources would be required. HHS and DHS are in the process of updating their plans and thus have an opportunity to coordinate with each other and with DOD to determine the appropriate actions to take should DOD’s support be limited,” which many public health preparedness experts and authorities have long said will be strained very quickly, as Homeland Security Today has reported.
DHS’s IG audit report stated, “DOD’s day-to-day functioning and the military’s readiness and operations abroad could be impaired if a large percentage of its personnel are sick or absent, and DOD’s assistance to civil authorities might be limited.”
In 2008, there were three reports reinforcing what emergency public health preparedness authorities had been sounding alarms about for the previous last half-decade — and that is emergency care and individual preparedness for emergencies had continued to worsen – despite the billions that had been spent on preparedness and efforts to emphasize individual disaster readiness.
Last October, DHS’s Inspector General (IG) found DHS does not always provide clear guidance or sufficient oversight of component’s pandemic plans, implementation of pandemic readiness training, completion of reporting requirements and identification of the personal protective equipment and supplies needed for a pandemic response.
“Maintaining oversight to ensure components have adequately planned and prepared for pandemics is critical to allowing components to maintain their mission essential functions when a pandemic occurs,” the IG’s report stated. “As a result, the department cannot be assured that its preparedness plans can be effectively executed during a pandemic event.”
This is not the first time a DHS OIG audit has revealed vulnerabilities in the department’s public health preparedness efforts. During a House Committee on Oversight and Government Reform hearing October 2014, DHS IG John Roth testified DHS had not effectively managed and overseen its inventory of pandemic preparedness supplies.”
A year earlier, the DHS IG had told the House Committee on Oversight and Government Reform DHS had not effectively managed and overseen its inventory of pandemic preparedness supplies, including protective equipment and antiviral drugs, calling into question the ability of DHS personnel to effectively respond to a pandemic.
With the importance of the continued operations of DHS during a pandemic, Congressappropriated $47 million in supplemental funding to DHS to train, plan and prepare for a potential pandemic. DHS used the funding to stockpile protective equipment and antiviral drugs for pandemic response.
However, the IG said DHS did not adequately assessed its needs before purchasing pandemic preparedness supplies, and then did not adequately manage the purchased supplies.
“Specifically,” the IG reported, DHS “did not have clear and documented methodologies to determine the types and quantities of personal protective equipment and antiviral medical countermeasures it purchased for workforce protection.”
The IG said determining the adequacy of equipment stockpiles required DHS to conduct a needs assessment. However, DHS reportedly spent $9.5 million on protective equipment since 2006, as well as $6.7 for antiviral drugs, without first determining the types and quantity of medication it should purchase or the amount of protective equipment it needed.
The IG expressed concern DHS may not be able to provide pandemic preparedness supplies to crucial personnel necessary to continue operations during a pandemic. Specifically, by failing to implement controls to monitor its stockpiles, DHS cannot be certain whether it has too little, too much or ineffective supplies.
“DHS purchased these supplies without thinking through how they would need to be replaced,” the stated.
The 9/11 Commission’s Blue Ribbon Study Panel: America Needs Improved Leadership and Funding for Biodefense, said in late 2015 there are real concerns America could face a chemical or biological attack, and that the US needs to reorganize its biodefense protocols and increase funding in order to effectively prepare.
In its new audit report, DHS’s IG said, “The Department of Defense has developed guidance and plans to direct its efforts to provide assistance in support of civil authorities—in particular the Departments of Health and Human Services and Homeland Security—in the event of a domestic outbreak of a pandemic disease. For example, the Department of Defense Global Campaign Plan for Pandemic Influenza and Infectious Diseases 3551-13 provides guidance to DOD and the military services on planning and preparing for a pandemic outbreak. DOD’s Strategy for Homeland Defense and Support to Civil Authorities states that DOD often is expected to play a prominent supporting role to primary federal agencies. DOD also assists those agencies in the preparedness, detection, and response to other non-pandemic viruses, such as the recent outbreak of the Zika virus.”
DHS’s IG stated, “The US Army estimates that if a severe infectious disease pandemic were to occur today, the number of US fatalities could be almost twice the total number of battlefield fatalities in all of America’s wars since the American Revolution in 1776.”
For more on public health preparedness, click here, and for trauma care and ERs, click here. Also see the report, When the Crossroads of Health Care and Public Health Never Meet, and, Zombie Terrorists: DOD Showcases Brilliant Strategy for Dealing with New and Unseen Threats.