ebola test Chief lab technician Boré Kaliva at the Prefecture Hospital in Yomou, Guinea, demonstrates the use of the Rapid Diagnostic Test (RDT) for Ebola virus in 2016. (Alaine Kathryn Knipes/CDC)

GAO Assesses USAID, CDC Global Health Security Activities Before COVID-19

USAID and CDC have invested in global health security, helping other countries build capacity to handle infectious diseases. In the 5 years before COVID-19, the agencies spent about $1 billion in over 30 countries.

The agencies assessed several capacity indicators—e.g., the strength of a country’s diagnostic laboratory system—in 17 high-priority countries. In most areas, the capacity to fight infectious diseases had remained stable or increased since 2016 and 2017.

The agencies also found challenges to building capacity—e.g., a lack of trained personnel to implement health policy. Many of these challenges are outside the U.S. government’s control.

As of March 31, 2020, the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC) had obligated a combined total of more than $1.2 billion and disbursed about $1 billion for global health security (GHS) activities, using funds appropriated in fiscal years 2015 through 2019. USAID and CDC supported activities to help build countries’ capacities in 11 technical areas related to addressing infectious disease threats. The obligated funding supported GHS activities in at least 34 countries, including 25 identified as Global Health Security Agenda (GHSA) partner countries.

U.S. officials’ assessments of 17 GHSA partner countries’ capacities to address infectious disease threats showed that at the end of fiscal year 2019, most countries had some capacity in each of the 11 technical areas but faced various challenges. U.S. interagency country teams produce biannual capacity assessments that USAID and CDC headquarters officials use to track the countries’ progress. According to fiscal year 2019 assessment reports, 14 countries had developed or demonstrated capacity in most technical areas. In addition, the reports showed the majority of capacities in each country had remained stable or increased since 2016 and 2017. The technical area antimicrobial resistance showed the largest numbers of capacity increases—for example, in the development of surveillance systems. GAO’s analysis of the progress reports found the most common challenges to developing GHS capacity were weaknesses in government institutions, constrained resources, and insufficient human capital. According to agency officials, some challenges can be overcome with additional U.S. government funding, technical support, or diplomatic efforts, but many other challenges remain outside the U.S. government’s control.

This is a public version of a sensitive report that GAO issued in February 2021. Information that USAID and CDC deemed sensitive has been omitted.

Read the GAO report

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