What GAO Found

The COVID-19 pandemic demonstrated the significance of a powerful public well being infrastructure to organize for and reply to threats, together with a talented workforce, and bodily infrastructure, resembling laboratories. The Department of Health and Human Services’ (HHS) Centers for Disease Control and Prevention (CDC) yearly helps public well being infrastructure in jurisdictions—states, localities, and territories—via two key preparedness packages: (1) Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases and (2) Public Health Emergency Preparedness. The packages’ award quantities to jurisdictions from annual appropriations totaled about $845 million on common per 12 months from fiscal 12 months 2019 via 2022. Separately, in fiscal years 2021 via 2023, utilizing supplemental appropriations from the latest COVID-19 aid regulation, CDC additionally offered jurisdictions with about $7.1 billion in awards to reinforce infrastructure. Of this, $3.5 billion can be utilized over 5 years for a brand new longer-term infrastructure funding to assist with future threats. Jurisdiction officers GAO spoke with cited essential advantages of awards from each annual and supplemental appropriations, resembling supporting epidemiology workers and buying provides for laboratories.

Selected jurisdictions and stakeholder teams recognized a number of challenges constructing and sustaining infrastructure to be sufficiently ready for public well being threats. These embrace challenges within the following areas:

• Temporary public well being funding. Officials from almost all jurisdictions and stakeholder teams expressed concern in regards to the sample of elevated federal funding for an emergency response, adopted by a lower in funding after that emergency ends. This sample could make it onerous for jurisdictions to put money into long-term sustainable efforts to organize for future public well being threats.
   
• Varying ranges of jurisdictional funding. Jurisdictions have main accountability to organize for and reply to threats. However, there may be variation within the quantity of funding jurisdictions present for preparedness and response. This impacts the extent to which jurisdictions could have to depend on CDC awards for such functions, in line with two stakeholder teams.
   
• Building a public well being workforce. Jurisdictions’ officers famous that as a result of awards utilizing COVID-19 supplemental appropriations have been short-term, workforce will increase have been additionally largely short-term. Even for the brand new award that can be utilized over 5 years, officers from eight jurisdictions famous considerations about completely growing their workforces due to uncertainty of longer-term funding. Officials from six jurisdictions and 5 stakeholder teams additionally expressed considerations in regards to the availability of a ample public well being workforce, attributable to burnout and different elements.

Jurisdictions are key companions in making ready for and responding to public well being threats. The infrastructure challenges they face can affect how rapidly and successfully CDC and different response companions are in a position to include these threats, as was demonstrated in the course of the COVID-19 pandemic. According to CDC officers, elevated and ongoing investments in public well being infrastructure are very important to the response to include threats on a nationwide stage.

Why GAO Did This Study

CDC is the first federal company chargeable for serving to strengthen jurisdictions’ public well being infrastructure to assist emergency preparedness and response capabilities.

The CARES Act features a provision for GAO to report on the federal response to the COVID-19 pandemic. This report (1) describes CDC awards to assist jurisdictions’ public well being infrastructure for preparedness, and (2) examines challenges chosen jurisdictions and stakeholder teams recognized to constructing and sustaining such infrastructure.

GAO analyzed CDC’s knowledge on awards offered to jurisdictions utilizing annual appropriations and sure supplemental appropriations made in response to the pandemic. Specifically, GAO analyzed annual award knowledge from fiscal 12 months 2018 (the 12 months GAO final reported on award knowledge) via 2022 (most up-to-date knowledge out there on the time of GAO’s assessment). GAO additionally analyzed knowledge on awards utilizing appropriations from essentially the most lately enacted COVID-19 aid regulation—the American Rescue Plan Act of 2021.

GAO interviewed officers from a nongeneralizable pattern of 12 jurisdictions—chosen primarily based on governance construction, funding acquired, and rurality. GAO additionally interviewed representatives from 10 stakeholder teams representing public well being professionals and coverage organizations, amongst others.

GAO offered a draft of this report back to HHS for assessment and remark. HHS offered technical feedback, which GAO included as applicable.

For extra data, contact Mary Denigan-Macauley at (202) 512-7114 or deniganmacauleym@gao.gov.