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Government watchdog says HHS is at ‘high risk’ of botching a future crisis

GAO criticizes the response to emergencies over four administrations, including coronavirus, Ebola and Zika, as well as extreme weather events

A worker at a Strategic National Stockpile warehouse in Oklahoma City in April 2020. (Sue Ogrocki/AP)
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The Department of Health and Human Services repeatedly ignored recommendations to improve its pandemic response and is at “high risk” of mismanaging a future crisis, a government watchdog warned on Thursday.

Investigators “found persistent deficiencies” in how the agency has led the response to the coronavirus pandemic and past public health emergencies dating to 2007, the Government Accountability Office concluded, citing continued problems coordinating among public health agencies, collecting infectious-disease surveillance data and securing appropriate testing and medical supplies, among areas it said are unresolved.

“The department’s response to the COVID-19 pandemic has highlighted long-standing concerns we have raised about its ability to execute its role leading federal public health and medical preparedness for, and response to, such public health emergencies,” the GAO wrote in its report, which was shared with nine congressional committees.

In one example, the GAO said it had warned about shortages of coronavirus tests beginning in September 2020 and in January 2021 recommended HHS develop a comprehensive national testing strategy — which health officials in May promised would be forthcoming. But “to date, HHS has not provided this document,” investigators wrote.

Inside this hospital in Lanham, Md., there are more covid-19 patients than at any other point in the pandemic. Doctors and nurses are being pushed to the brink. (Video: Whitney Shefte/The Washington Post)

Meanwhile, Americans struggled to find rapid coronavirus tests or get appointments for lab-based tests as the fast-moving omicron wave swept the country before the holidays, and public health experts and lawmakers chastised the administration for not moving more quickly to spur production of tests and make them available.

The GAO said that its warning that the health department is “high risk” is intended to highlight the need for improvements before another crisis spurred by a pathogen, extreme weather or an attack.

“If left unaddressed, these deficiencies will continue to hamper the nation’s ability to be prepared for, and effectively respond to, future threats,” the watchdog wrote.

HHS officials on Thursday said that they were still reviewing the GAO report and its conclusions but were working to improve long-standing challenges inherited by the Biden administration.

“We share GAO’s focus and urgency in battling this once-in-a-century pandemic and desire to ensure we never again face a pandemic of this magnitude,” HHS spokesperson Sarah Lovenheim said in a statement, touting steps taken under the Biden administration to improve vaccination rates, increase access to tests and invest in new treatments.

The GAO’s concerns about HHS span four presidential administrations and an array of public health emergencies, ranging from infectious-disease outbreaks such as Ebola and Zika to extreme weather events such as hurricanes. The watchdog said that it has made 115 recommendations to HHS about its leadership and coordination of public health emergencies since fiscal 2007 but that only 33 have been implemented.

“For more than a decade, we have reported on HHS’s execution of its lead role in preparing for, and responding to, public health emergencies and have found persistent deficiencies in its ability to perform this role,” GAO wrote.

GAO said that it first recommended in 2007 that HHS and the Department of Homeland Security jointly conduct “rigorous testing, training, and exercises” that would allow federal officials to practice working together before an actual emergency. The watchdog also made a similar recommendation about the need for HHS to practice coordination with state and local officials. “These recommendations were not implemented,” GAO noted, arguing such efforts would still be helpful today.

The watchdog also faulted HHS for ignoring more-recent recommendations, such as a January 2021 warning that the department needed to better coordinate its management of the Strategic National Stockpile, which contains supplies, medicines and devices for lifesaving care to be used in a crisis. But “as of January 2022, HHS has not developed a formal process for engaging with key stakeholders on a supply strategy for pandemic preparedness,” the watchdog wrote.

Jessica Farb, the GAO’s managing director for health care, said the decision to label HHS as “high risk” had been under consideration for the past year, given the agency’s persistent challenges. Farb said that the GAO also had identified examples of good performance at HHS during the pandemic.

“There are some things that have been done well,” like the vaccination rollout that began in late 2020 and continued through the spring of 2021, she said.

The White House and congressional leaders have increasingly acknowledged flaws in the nation’s response to the pandemic, laying out proposals to improve oversight and coordination of public health emergencies. A pair of senators this week introduced a bipartisan plan to shore up the nation’s pandemic preparedness and clarify HHS’s role during a crisis.

Some of the HHS testing, supply chain and coordination problems identified by the GAO were also highlighted by President Biden when he took office last year, vowing to address them, although the White House has struggled to fulfill a number of the president’s pledges.

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