Public Health Preparedness: Building and Maintaining Infrastructure … – Government Accountability Office

What GAO Found

The COVID-19 pandemic demonstrated the importance of a strong public health infrastructure to prepare for and respond to threats, including a skilled workforce, and physical infrastructure, such as laboratories. The Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC) annually supports public health infrastructure in jurisdictionsstates, localities, and territoriesthrough two key preparedness programs: (1) Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases and (2) Public Health Emergency Preparedness. The programs' award amounts to jurisdictions from annual appropriations totaled about $845 million on average per year from fiscal year 2019 through 2022. Separately, in fiscal years 2021 through 2023, using supplemental appropriations from the most recent COVID-19 relief law, CDC also provided jurisdictions with about $7.1 billion in awards to enhance infrastructure. Of this, $3.5 billion can be used over 5 years for a new longer-term infrastructure investment to help with future threats. Jurisdiction officials GAO spoke with cited important benefits of awards from both annual and supplemental appropriations, such as supporting epidemiology staff and purchasing supplies for laboratories.

Selected jurisdictions and stakeholder groups identified several challenges building and maintaining infrastructure to be sufficiently prepared for public health threats. These include challenges in the following areas:

Jurisdictions are key partners in preparing for and responding to public health threats. The infrastructure challenges they face can impact how quickly and effectively CDC and other response partners are able to contain these threats, as was demonstrated during the COVID-19 pandemic. According to CDC officials, increased and ongoing investments in public health infrastructure are vital to the response to contain threats on a national level.

CDC is the primary federal agency responsible for helping strengthen jurisdictions' public health infrastructure to aid emergency preparedness and response capabilities.

The CARES Act includes a provision for GAO to report on the federal response to the COVID-19 pandemic. This report (1) describes CDC awards to support jurisdictions' public health infrastructure for preparedness, and (2) examines challenges selected jurisdictions and stakeholder groups identified to building and maintaining such infrastructure.

GAO analyzed CDC's data on awards provided to jurisdictions using annual appropriations and certain supplemental appropriations made in response to the pandemic. Specifically, GAO analyzed annual award data from fiscal year 2018 (the year GAO last reported on award data) through 2022 (most recent data available at the time of GAO's review). GAO also analyzed data on awards using appropriations from the most recently enacted COVID-19 relief lawthe American Rescue Plan Act of 2021.

GAO interviewed officials from a nongeneralizable sample of 12 jurisdictionsselected based on governance structure, funding received, and rurality. GAO also interviewed representatives from 10 stakeholder groups representing public health professionals and policy organizations, among others.

GAO provided a draft of this report to HHS for review and comment. HHS provided technical comments, which GAO incorporated as appropriate.

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

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Public Health Preparedness: Building and Maintaining Infrastructure ... - Government Accountability Office