Pandemic Preparedness: Adequate?

A brief GAO report asks if we're really prepared, especially at the federal level, for a flu pandemic. The short answer is, no. Although we have a National Strategy for Pandemic Influenza and an Implementation Plan for the strategy, critical questions remain. For one thing, it's not clear how everyone will play in the sandbox together:

Key federal leadership roles and responsibilities for preparing for and responding to a pandemic continue to evolve and will require further clarification and testing before the relationships of the many leadership positions are well understood. Most of these leadership roles involve shared responsibilities and it is unclear how they will work in practice. ...

Several federal leadership roles involve shared responsibilities for preparing for and responding to an influenza pandemic, including the Secretaries of Health and Human Services and Homeland Security, the Administrator of the Federal Emergency Management Agency (FEMA), a national Principal Federal Official (PFO), and regional PFOs and Federal Coordinating Officers (FCO). Many of these leadership roles and responsibilities have not been tested under pandemic scenarios, leaving unclear how all of these new and developing relationships would work.

Specifically:

[S]ince a pandemic extends well beyond health and medical boundaries, to include sustaining critical infrastructure, private sector activities, the movement of goods and services across the nation and the globe, and economic and security considerations, it is not clear when, in a pandemic, the Secretary of Health and Human Services would be in the lead and when the Secretary of Homeland Security would lead.

Moreover, under the Post-Katrina Emergency Management Reform Act of 2006 (referred to as the Post-Katrina Reform Act in this testimony), the FEMA Administrator was designated the principal domestic emergency management advisor to the President, the HSC, and the Secretary of Homeland Security, adding further complexity to the leadership structure in the case of a pandemic.

Another question: How is this plan coordinated with the North American Plan for Avian & Pandemic Influenza? (See this post for background.)

Exercises might reveal potential problems, but:

[O]nly one national, multi-sector pandemic-related exercise has been held, and that was prior to issuance of the Plan.

GAO also points to in this Strategy and Plan that ought to be included in such documents:

The Strategy and Plan do not fully address the characteristics of an effective national strategy and contain gaps that could hinder the ability of key stakeholders to effectively execute their responsibilities. Specifically, some of the gaps include

• The Strategy and Plan do not address resources, investments, and risk management and consequently do not provide a picture of priorities or how adjustments might be made in view of limited resources.
• State and local jurisdictions were not directly involved in developing the Plan, even though they would be on the front lines in a pandemic. Officials told us that state, local, and tribal entities were not directly involved in reviewing and commenting on the Plan, but the drafters of the Plan were generally aware of their concerns.
• Relationships and priorities among action items are not always clear.
• Performance measures are focused on activities that are not always linked to results.
• The linkage of the Strategy and Plan with other key plans is unclear.
• The Plan does not contain a process for monitoring and reporting on progress. While most of the action items have deadlines for completion, ranging from 3 months to 3 years, the Plan does not identify a process to monitor and report on the progress of the action items nor does it include a schedule for reporting progress.
• The Plan does not describe an overall framework for accountability and oversight and does not clarify how responsible officials would share leadership responsibilities.
• Procedures and time frames for updating and revising the Plan were not established.

The lack of engagement with state and local officials is especially troubling, especially given the lack of clarity regarding roles. It's just this sort of thing that collaborative effort should be able to resolve.