Briefing With Assistant Secretary for African Affairs Tibor P. Nagy and U.S. Ambassador to Ethiopia Michael A. Raynor on the Situation in Ethiopia’s Tigray Region

Tibor P. Nagy, Jr., Assistant SecretaryBureau of African Affairs

Michael A. Raynor, U.S. Ambassador to Ethiopia

Via Teleconference

MR ICE: Thank you. Good afternoon, everyone, and thank you for joining us for this briefing on the situation in Ethiopia. I’m sure you’ve all seen Secretary’s Pompeo’s statements on the issue where the United States has clearly expressed our deep concern over the continued fighting and the situation in Ethiopia’s Tigray region.

Today, I am very happy to have with us Assistant Secretary for African Affairs Tibor Nagy and the U.S. Ambassador to Ethiopia Michael Raynor, who both have extensive knowledge of Ethiopia and can share insights into the current situation, provide the U.S. perspective, and elaborate on the U.S. policy behind our current response. Assistant Secretary Nagy is going to begin with some opening remarks, and then we’re going to take a few questions.

Just as a reminder, this briefing is on the record but embargoed until the end of the call. Okay. If you would like to go ahead and get into our question queue, I invite you to dial 1-0 and that will put you into the queue. The operator will give us those same instructions before we go to the Q&A. With that, I am going to turn it over to Assistant Secretary Nagy. Sir.

ASSISTANT SECRETARY NAGY: Thanks so, so much, J.T., and thanks also for mentioning the Secretary’s statement. From the first attacks on November 3rd by the Tigray People’s Liberation Front, TPLF, on Ethiopian National Defense Force bases in the Tigray region, we have publicly and privately highlighted our grave concern. We strongly urge an immediate de-escalation of tensions, a cessation of hostilities, and a return to peace. The protection and security of all civilians is essential. Our top priority is ensuring the welfare, protection, and security of U.S. citizens. The U.S. Embassy in Addis Ababa continues to work closely with the United Nations and others to relocate U.S. citizens in Tigray, as conditions permit. We appreciate the UN’s support in this regard. The United States continues to coordinate with the Ethiopian Government, local authorities, and our international partners to ensure that civilians in and around the Tigray region have access to needed humanitarian assistance.

As of today, the fighting in Tigray continues, and events last weekend suggest that the TPLF seeks to internationalize the conflict. The TPLF leadership has admitted responsibility for the November 13 missile launches at airports in Bahir Dar and Gondar, in the Amhara region, and the November 14 attack in Eritrea. These unacceptable attacks make the situation more dangerous, and the Secretary condemned them in his most recent statement. We have been in contact with Eritrean Government officials and are urging their continued restraint.

In Addis Ababa, Washington, across the region, and internationally, we are working with partners toward a quick end to the conflict. We’ve also been in close communication with representatives of the Ethiopian diaspora regarding the situation in Tigray. We continue to press the Ethiopian Government to restore communication in the region as an act of accountability and transparency and to enable greater contact with civilians, including American citizens in the region. We also urge both sides to maintain access for humanitarian organizations to provide essential assistance to vulnerable groups in the region. We have been unequivocal with the Ethiopian Government and the TPLF that civilian lives must be protected and humanitarian access must be ensured.

We remain deeply concerned over reports that civilians have been purposely targeted and attacked. We condemn the November 12 massacre in Mai-Kadra, apparently perpetrated by TPLF soldiers and militia as they retreated from the town. We urge independent investigations of all reports of atrocities and attacks against civilians. Those found responsible must be held accountable in accordance with the law. Additionally, we are working with the Ethiopian Human Rights Commission and the Ethiopian Government to ascertain why several journalists were recently arrested, their current status and well-being, and what charges they are facing.

We are also closely tracking the outflow of civilians to neighboring countries and are in close contact with UN and other humanitarian officials regarding contingency plans on their response. We urge neighboring countries to keep their borders open to asylum seekers fleeing the violence.

We welcome the generosity demonstrated by the people of Sudan in hosting Ethiopian refugees. The United States has been one of the largest contributors to humanitarian assistance to the region, providing more than $320 million in FY2020 to the UN High Commissioner for Refugees, the UNHCR; the World Food Program; UN Children’s Fund, UNICEF; the International Organization for Migration, IOM; and other humanitarian organization partners to provide protection and assistance for refugees, internally displaced persons, and conflict victims in Sudan. U.S. humanitarian assistance provides refugees and IDPs in Sudan with shelter, food, and access to clean water and sanitation, health care, and other lifesaving support. Some of this assistance is already being deployed by our partners to respond to the urgent needs of newly arrived Ethiopian asylum seekers.

Before I turn over to questions, I do want to mention one personal note. As some of you know, this situation absolutely breaks my heart. I had several tours in Ethiopia, including ambassador during the Ethio-Eritrean War. Just like Ambassador Raynor, I know the region very well. We have the highest regard, admiration for the people of Ethiopia and especially for the Tigrayans who suffered the most during that war.

So with that, we welcome your questions.

MR ICE: Thank you, Assistant Secretary Nagy. Just as a reminder, to get into the question queue I invite you to dial 1-0. And at this point, let’s go to the line of Will Mauldin at The Wall Street Journal.

QUESTION: Thank you so much for having this call. I was wondering if you could just help maybe set this into context in the region what surrounding countries such as Sudan, Somalia, Djibouti, Eritrea have at stake or have been involved – how they’ve been involved in the conflict for some of us who don’t know the region as well, and how they’ve been involved in the relief efforts. Thank you.

ASSISTANT SECRETARY NAGY: Sure. That’s a great question and thank you. Ethiopia, most especially since Prime Minister Abiy has taken power, is the linchpin in the region, of course, with over a hundred million people and a 2,000-year-old history as a state – the only country in Sub-Saharan Africa that was never colonized. It is a key strategic partner for the United States. It’s a land that’s also the largest landlocked country on earth, Djibouti critically important because the Port of Djibouti is the main source for all overland transport to Ethiopia.

Ethiopians have been very much involved in trying to re-establish the state in Somalia by contributing both to AMISOM, the peacekeeping operation, but also providing some additional troops, because Ethiopia itself has a large region which is inhabited by ethnic Somalis. The other borders – South Sudan, Sudan – Sudan and Ethiopia, of course, have a long, long history of their relations, and the Sudanese have provided refuge for Ethiopians fleeing a whole series of conflicts in Ethiopia going back to the time of the emperor.

And then, of course, the other border is Eritrea. As you know, Ethiopia and Eritrea fought a bitter, bitter war, 1998 to 2000. Now with Prime Minister Abiy, relations have been normalized. And one of the goals coming out of this is the United States very much wants Ethiopia to be able to continue playing a positive role in the region, exporting stability, and hopefully at some point in the not-too-distant future prosperity as well, as one of the prime minister’s goals is to transform Ethiopia from a state-led economy to an open market economy. Over.

MR ICE: Hey, Mike, do you have anything to add to that?

AMBASSADOR RAYNOR: Just maybe a couple of minor points. Nothing to – nothing to detract from what you said. Certainly, our embassies in the region are engaging with their host countries, coordinating perceptions, talking about possible approaches towards solutions. And as Tibor mentioned that Ethiopia is basically a net exporter of security to the broader region, and so there have been expressions of concerns by neighboring countries about what the current dynamics might mean for their stability as well.

And in terms of the Sudan generosity in hosting refugees, just to note that already that’s over 35,000 refugees at a rate that had been between 4- and 5,000 a day. That seems to have gone down a bit over the last day or so to about 1,500 a day. So we don’t know that that suggests any trend. But certainly, we’re gauging that the countries in the region are looking very hard at having to play a constructive role in fostering peace and a quick end to the conflict. Over.

MR ICE: Okay. Let’s go to the line of Shaun Tandon, AFP.

QUESTION: (Inaudible) a little bit of Will’s question. Have you seen any evidence of foreign military involvement in this conflict, whether in terms of troops, obviously, or in terms of military equipment?

And if I could follow up on something that Tibor said at the beginning. You mentioned being in touch with Eritrean officials. What do you see, if anything, coming out of this diplomatically? I mean, could this be part of a greater reconciliation between the United States and Eritrea? Do you see that as a possibility or are there still major obstacles to improving the relationship with Eritrea? Thanks.

ASSISTANT SECRETARY NAGY: Yeah, thanks. When I visited Eritrea a little over a year ago, I mentioned at the time that from the United States point of view, we would be delighted to have the same type of positive relations with Eritrea that we have with Ethiopia.

As far as internationalizing the conflict goes, that is one absolute danger that we are doing our best, and I think the entire region is doing its best, to avoid. As I mentioned, we expressed our thanks to Eritrea for not being provoked when they were attacked by missiles because apparently, one of the aims of the TPLF hardcore leadership was to try to internationalize the conflict so that they could – that that would be a way to try to really fan the flames of patriotism within the general population of Tigray, and we appreciate the fact that Eritrea has been restrained.

Obviously, the Ethiopian Government is also very keen to keep the situation from being internationalized because that would be destabilizing to the entire region, which, as you guys note, historically has been one of the most unstable regions in Africa, if not the world.

MODERATOR: Okay. Let’s go to the line of Carol Morello at The Washington Post. Carol.

QUESTION: You mentioned – Tibor, you mentioned you’ve seen there have been atrocities committed. Have you seen any evidence that genocide has happened in Tigray? And is there any hope at this stage of mediation, or is Prime Minister Abiy going to fight on until he has full control of Tigray?

ASSISTANT SECRETARY NAGY: Well, because of the lack of communications, the reports – we have heard the sporadic reports of incidents, which some of the human rights organizations have characterized could be labeled as war crimes, but that’s why one of the things we very much want is an independent investigation, which will be very important when the means are available for that.

What was the second part of your question?

MR ICE: Operator, Carol will have to get back into the queue. Would you open up her line again, please?

ASSISTANT SECRETARY NAGY: Yeah, she had a second question.

AMBASSADOR RAYNOR: This is Mike. I think – sorry.

QUESTION: Is there any hope of mediation at this stage —

ASSISTANT SECRETARY NAGY: Oh, yeah, but – yeah, excellent.

QUESTION: — or is Prime Minister Abiy going to fight on until he has full control?

ASSISTANT SECRETARY NAGY: Yeah, excellent, okay, that’s very important. And we get that question immediately: “What about mediation?” “Why don’t you hop on an airplane, get over there?”

Mediation, I think it’s very important to underscore – it’s a tactic, it’s a way to get to the goal. It’s not a goal in itself. I mean, our goal is a quick end to the conflict, restoration of peace, protection of civilians. At a point where mediation will become useful, i.e. that the two parties indicate an interest in mediation, you can bet that the United States would be there in an instant. A whole series of regional leaders, continental leaders, other international leaders have reached out with offers of mediation. At this point, neither party, from everything we hear, is interested in mediation.

However, having said that, I think it’s also very important to keep in mind that on the one hand, everybody focuses on the military campaign. But alongside the military campaign, there are indications that there’s very much a political campaign going on within Ethiopia, because you talk about Tigrayans; Tigrayans are not the enemy, and the Ethiopian Government acknowledges this very strongly that Tigrayans are one of the many ethnic groups in Ethiopia. And even the TPLF – you talk about the TPLF; it is a – it’s a large, large party. You have hundreds of thousands of members.

The – from my conversations, the Ethiopian Government is in very strong opposition during this campaign to some of the leadership of the TPLF, and Ambassador Raynor can add additional details, but I understand that the Ethiopian Government has already appointed an interim administration to start administering those parts of Tigray which are being returned to state authority from the TPLF regime. Mike, is that correct?

AMBASSADOR RAYNOR: That’s correct.

MR ICE: Very well. Let’s go to Simon Ateba at Today News Africa.

QUESTION: Simon Ateba from Today News Africa in Washington, D.C. Prime Minister Abiy Ahmed has jailed most of his political opponents. He has used the excuse of COVID-19 to postpone the election. On Thursday, Abiy accused the director-general of the World Health Organization, Dr. Tedros, of seeking to procure weapons for the TPLF, and right now his army continues to bomb civilians in Tigray. Have you seen any evidence that the WHO chief is trying to procure weapons for the TPLF? And what else can the U.S. Government do to end the ongoing war and also to protect civilians? And do you think that the U.S. Government has not done enough to check Prime Minister Abiy Ahmed? The humanitarian organizations say that almost 7,000 people are in jail right now, and he refuses to release them because they oppose him politically. Thank you.

ASSISTANT SECRETARY NAGY: Thanks very much. The U.S. Government is doing everything possible to end the conflict, to return to peace, to urge for the protection of civilians. We’ve called for restoring communications. It’s not the United States Government that has to stop the fighting. It’s the two sides that are going to have to stop the fighting.

Regarding any allegations about charges made, you have to go to the sources for those charges because those are not coming from the United States Government. But as I said, we have engaged with all sides in Ethiopia. We have engaged in the region. We have spoken and we continue to speak. We are looking for opportunities wherever those opportunities come up to promote a return to peace.

So when it comes to stopping the fighting, as I have to say, it’s the people engaged in the fighting that have to stop the fighting. Over, thank you.

MR ICE: Let’s go to the line of Conor Finnegan at ABC News.

QUESTION: Thank you for doing this. Just following up on Carol’s question, and maybe the idea of more that the U.S. Government could do to push those two sides so that you don’t need mediation, can you speak at all to the Secretary’s involvement? Has he been in touch with Prime Minister Abiy? And would more higher-level pressure from the U.S. help here? And just to be clear, when you say you’ve been in touch with all sides, have you had contact with the TPLF yourself? Thank you.

ASSISTANT SECRETARY NAGY: First of all, I have not, but Ambassador Raynor has. As far as the Secretary’s involvement, the Secretary right now is on travel, and we are obviously discussing on what more higher-level U.S. engagement we can propose as events unfold. Anybody who has worked with these two sides I think can appreciate the fact that they have very, very strong opinions on what they want to do and when they want to do it. As I said before, to us, mediation is not the goal. Resumption of peace is the goal. Mediation, in fact, is a very good tactic, but it can only be used when the people involved or the sides involved are prepared for mediation. Over.

AMBASSADOR RAYNOR: Tibor, maybe I could just add a little bit to that, first to note that over the past week, though I certainly don’t put my stature up with the Secretary, over the past week I have spoken with Prime Minister Abiy and with TPLF Chairman Debretsion. And of course, the central and, again, and the first point I made was the importance of military de-escalation and cessation of fighting. And of course, I explored with both of them the extent to which mediation or dialogue or negotiation might be a tool toward that end. And I will tell you that at the time of my conversations there was no receptivity to that approach. There was a strong commitment on both sides to see the military conflict through. And in fact, neither side felt they could articulate a basis for a negotiated or a mediated solution at that time.

That said, we continue to be very closely attuned to developments on the ground and to opportunities they might create, to press additionally and then perhaps in different ways toward that possibility. As Tibor noted, that’s not the end. That’s a potential tool toward an end, and we remain attuned to that and then to raise that however we think constructive. Over.

ASSISTANT SECRETARY NAGY: Thanks, Mike.

MR ICE: Let’s go to Anna Kara of Associated Press.

OPERATOR: One moment, please.

QUESTION: Can you hear me okay?

OPERATOR: Your line is open, go ahead.

QUESTION: Thank you. Even if there’s no appetite for dialogue from either side, aren’t there other efforts toward a humanitarian ceasefire or a humanitarian corridor underway, and what progress are they making? And also, what is your best guess of the number of combatants killed and civilians killed? Thank you.

ASSISTANT SECRETARY NAGY: Okay. On the last part there, unfortunately, because of a lack of communications, as far as casualty figures are concerned, I don’t want to give you bad numbers. I would suggest, if you want to get an exact count, ask directly of the Ethiopians, because they’re the ones that have the exact number.

Mike, you want to talk about the humanitarian corridor aspect? Because that’s very, very important.

AMBASSADOR RAYNOR: It is indeed, and it’s an aspect that we, along with other humanitarian governments, including the United Nations, have been pressing from the outside: establishing humanitarian access for commodities – fuel, gas, other items; establishing a (inaudible) corridor to enable the insertion of those supplies but also to facilitate and monitor civilians. That – we raised that with the government. They said they would look at that. When I raised that with the TPLF, they did not really engage on that possibility. But we continue to press it very hard.

Another aspect of this is the Ethiopian Government continues to articulate a vision of the military conflict coming to an end fairly soon, a week or two from now, which isn’t to say that (inaudible) there isn’t a humanitarian crisis on the ground, because there absolutely is. And we continue to press very hard in concert with the donor community, the international community, the United Nations, to get access immediately to the region and to establish safe egress from the region. Over.

MR ICE: Now let’s go to the line of Michel Ghandour at Middle East Broadcast Network. Over.

QUESTION: Thank you for doing this. A follow-up question on the Ethiopian chief of staff saying that WHO Director Tedros used his position to lobby foreign governments to support the Tigray People’s Liberation Front. Do you have anything on that?

And on Sudan, any comment on the news saying that Russia will build a naval base there?

ASSISTANT SECRETARY NAGY: Okay. First of all, on the whole WHO issue, you have to go to the Ethiopians for that. That is coming straight from Ethiopia, so we absolutely have no comment.

And as far as anything having to do with Sudan, we meant for this briefing to be talking about the current situation in Ethiopia and Tigray, so we’ll leave it at that.

MR ICE: Very well. Let’s go to Lara Jakes at the New York Times.

QUESTION: Thanks. Based on what you just said, I feel a little sheepish asking this, but I did want to talk about Sudan and the knock-on effects that the refugee influx has had on a very tenuous time for the transitional government. So I’m wondering if you can tell us a little more and with some specificity what level of (inaudible) support is being given to help Sudan (inaudible) the refugee influx. And also, to what extent you think that this could future disrupt the transitional government there? Thanks.

ASSISTANT SECRETARY NAGY: Okay. Very quickly, I don’t believe that this is going to disrupt the very successful transition which is going on in Sudan. I mean, my gosh, Sudan’s the good news story of the year. And again, on the refugee flow, we’re – USAID, U.S. Agency for International Development, is very much involved in there, in that, as are a number of other partners, looking at what we can do, how we can move quickly. The Sudanese Government also is obviously cooperating very closely.

And it’s a sad truth, but unfortunately Sudan has had to go through with this a number of times. Again, I mean, I give the highest credit to the Government of Sudan. And this has been through a number of their various regimes. Immaterial of what the regimes in Sudan were or what the regimes in Ethiopia were, whenever there were these humanitarian emergencies, the Sudanese have provided just an incredibly welcoming and supportive refuge for the refugees coming out of Ethiopia. Whether they were escaping the emperor or the Marxist Derg or the TPLF government or now, it just a very long history of genuine cordiality and welcome from the people of Sudan for the people of Ethiopia. Over.

MR ICE: Let’s go to the line of Katharine Houreld, Reuters.

OPERATOR: Ms. Houreld’s line has dropped.

MR ICE: Very well. Let’s go to Conor Finnegan at ABC News again.

QUESTION: Thank you for indulging me. Just to follow up on something Ambassador Raynor said about the government signaling this could end shortly, do you expect that fighting in Ethiopia ends with that? Or do you fear that Prime Minister Abiy will push to consolidate elsewhere, in other regions?

And then secondly, the TPLF chairman told the Financial Times at some point this week that a breakup of Ethiopia could be one of the consequences of this. Can you speak to fears of that? Thank you.

ASSISTANT SECRETARY NAGY: Okay. I obviously can’t make any comments on any possible boycott of Ethiopia. I mean, you can imagine that the Ethiopian – the global diaspora is – probably has some very, very divergent views. All you have to do is look at some of the comments that we get on our Twitters.

As far as the fighting leading to other ethnic conflict, you have to say – okay, I’m not privy to the thinking of the TPLF leadership when they started this, but this was not to secede and create an independent state from Ethiopia, because the Ethiopian constitution has a provision for the states to be able to secede peacefully. I mean, again, difficult to tell motivation, but it seems like they were doing this more to depose the prime minister from power and to reassert themselves into the prominent position that they had atop the Ethiopian political spectrum for the last 27 years.

So hopefully right now I think that their tactic has had the opposite effect from what they were planning. And Mike can confirm this, but it seems like this has brought the Ethiopian nation together, at least for the time being, in support of the prime minister, because this has really stoked Ethiopian nationalism, and hopefully that that – those positive forces will remain.

But again, I want to make it very clear that this is not about Tigray. There is no equivalency here. This is not two sovereign states fighting against each other. This is a faction of the government running a region in Ethiopia that has decided to undertake hostilities against the central government, and it has not – in my view – has had the effect that they thought that they were going to get. And Mike, I’ll turn it over to you for the last word, my friend.

AMBASSADOR RAYNOR: Very, very little to add to that. We – again, it comes back to why we’ve been impressing the importance of having de-escalation and cessation of hostilities – not because we necessarily think there’s a risk of expanded (inaudible) engagement beyond the region, but simply because the longer fighting persists, the more risk there is of destabilization of one kind or another.

We, as Tibor said, note that the rest of the country actually remains quite calm at present, no indications of anyone taking up comparable actions elsewhere, and in fact the opposite. Seemingly both regional governments, federal governments, and large swaths of the people galvanizing around the government – the federal government and the national (inaudible). Over.

MR ICE: Okay, I believe we have time for one or two more questions, maybe just one. Operator, I see Katharine Houreld is in the queue. Can we make her connection? Reuters.

OPERATOR: Your line is open.

QUESTION: Hello, can you hear me?

ASSISTANT SECRETARY NAGY: Yep.

QUESTION: Hi there. I just wanted to ask: We’ve received several reports from the rebels about airstrikes in Mekelle, including one that’s just come in saying that there was an airstrike on the university in the center of town. Is the U.S. able to verify any of this through satellite imagery or anything like this? And if you did, would there be any kind of statement on that?

ASSISTANT SECRETARY NAGY: I – again, from my point of view, communications in the region have been cut. We’re getting very little information, aside from anecdotal evidence. So I wish I could give you more information, I just cannot. From what you say, I certainly hope it’s not true about the University of Mekelle. I actually have a honorary doctorate from the University of Mekelle, so again, obvious that that would be tragic, but my information is extremely limited on that. Mike, I’ll turn it over to you in case you can be a little – you have more information. Over.

AMBASSADOR RAYNOR: Thank you. No specific information on specific reports of individual airstrikes. What we will – what we – what I guess I will add is that while fighting persists, we are pressing very hard, both sides, to maximize protections for civilians. From the government, we are getting strong reassurances that they are planning their military campaign around civilians. They’ve told us that they have passed up TPLF targets that they felt would have put civilians at risk. We are pressing at every opportunity, and every time there’s a report that we can engage on, we’re trying to get the details and using those as opportunities to reinforce our messaging about the importance of civilian safety. Over.

MR ICE: Okay. And for our last question, let’s go to Robbie Gramer at Foreign Policy.

QUESTION: Can you hear me?

ASSISTANT SECRETARY NAGY: Robbie? Yeah, sure can.

QUESTION: Great, thanks. I know Carol had asked about genocide before, and I understand that you’re calling for an independent investigation. But already even without one, the UN’s acting special advisor for genocide prevention issued a rare statement expressing concern at these developments – the reported massacre of civilians and how they heighten the risk of genocide. So just to put a finer point on it, do you share this concern, and do you believe what we are seeing in Ethiopia can be considered early warning signs of ethnic cleansing? Thanks.

ASSISTANT SECRETARY NAGY: I cannot honestly say yes to that. We are very concerned with every single example, incident of any of the alleged atrocities. That’s why we want to get an absolute clear handle on them. And that’s why we call for an independent investigation, not an investigation by either side, and then absolutely hold people accountable who committed these acts.

The ethnic dimension is one that everybody is very concerned about. In my own conversations with Ethiopian officials, they are just as concerned, obviously, as people outside the country. We have followed closely the ethnic fractures which have erupted over the last several years as the lid of the previous dictatorship has been loosened over the country and there have been more personal freedoms. And that is absolutely a huge challenge for Prime Minister Abiy and the Ethiopian Government, not just now but definitely going forward. So we obviously are going to monitor this very, very closely, as will our embassy, and report on all incidents, which we take extremely seriously. Over.

MR ICE: Okay. Well, we are over our time at this point. We actually took a couple more questions than we were originally scheduled to take, so appreciate that very much. We appreciate everyone dialing in today. I’d also like to thank Assistant Secretary Nagy and Ambassador Raynor for their time. With that, we’re closing the briefing and the embargo is now lifted. Thank you.

ASSISTANT SECRETARY NAGY: Thanks, J.T., and thanks, Mike.

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However, in light of the elimination of the White House Cybersecurity Coordinator position in May 2018, it remains unclear which official ultimately maintains responsibility for not only coordinating execution of the Implementation Plan , but also holding federal agencies accountable once activities are implemented. NSC staff stated responsibility for duties previously attributed to the White House Cyber Coordinator were passed to the senior director of NSC's Cyber directorate; however, the staff did not provide a description of what those responsibilities include. NSC staff also stated that federal entities are ultimately responsible for determining the status of the activities that they lead or support and for communicating implementation status to relevant NSC staff. However, without a clear central leader to coordinate activities, as well as a process for monitoring performance of the Implementation Plan activities, the White House cannot ensure that entities are effectively executing their assigned activities intended to support the nation's cybersecurity strategy and ultimately overcome this urgent challenge. Increasingly sophisticated cyber threats have underscored the need to manage and bolster the cybersecurity of key government systems and the nation's cybersecurity. The risks to these systems are increasing as security threats evolve and become more sophisticated. GAO first designated information security as a government-wide high-risk area in 1997. This was expanded to include protecting cyber critical infrastructure in 2003 and protecting the privacy of personally identifiable information in 2015. In 2018, GAO noted that the need to establish a national cybersecurity strategy with effective oversight was a major challenge facing the federal government. GAO was requested to review efforts to protect the nation's cyber critical infrastructure. The objectives of this report were to (1) describe roles and responsibilities of federal entities tasked with supporting national cybersecurity, and (2) determine the extent to which the executive branch has developed a national strategy and a plan to manage its implementation. To do so, GAO identified 23 federal entities responsible for enhancing the nation's cybersecurity. Specifically, GAO selected 13 federal agencies based on their specialized or support functions regarding critical infrastructure security and resilience, and 10 additional entities based on analysis of its prior reviews of national cybersecurity, relevant executive policy, and national strategy documents. GAO also analyzed the National Cyber Strategy and Implementation Plan to determine if they aligned with the desirable characteristics of a national strategy. GAO is making one matter for congressional consideration, that Congress should consider legislation to designate a leadership position in the White House with the commensurate authority to implement and encourage action in support of the nation's cybersecurity. GAO is also making one recommendation to the National Security Council to work with relevant federal entities to update cybersecurity strategy documents to include goals, performance measures, and resource information, among other things. The National Security Council neither agreed nor disagreed with GAO's recommendation. For more information, contact Nick Marinos at (202) 512-9342 or marinosn@gao.gov.
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    The Food and Drug Administration (FDA) has regulated most over-the-counter (OTC) drugs—that is, drugs available without a prescription—through the OTC monograph process. FDA has described an OTC monograph as a "rulebook" for marketing safe and effective OTC drugs, such as aspirin, cough and cold medicine, and hand sanitizer. OTC monographs established conditions—such as active ingredients, indications for use, dosage forms, and product labeling—under which an OTC drug was generally recognized as safe and effective. According to FDA officials, before the CARES Act, which was enacted in March 2020, the agency's ability to update and finalize monographs in response to safety issues and to reflect new scientific information was limited by the rulemaking process the agency was required to follow, as well as insufficient resources. Agency officials estimated that it took at least 6 years to complete the required rulemaking process. Additionally, the agency reported it was critically under-resourced to regulate the estimated 100,000 OTC drugs marketed through the monograph process. However, the CARES Act provided for a new process to regulate these OTC drugs rather than the rulemaking process. FDA officials expect it will take less time to update and finalize requirements for OTC drugs using the new process. The CARES Act also authorized FDA to assess user fees to provide additional resources to regulate OTC drugs. Although FDA officials said this new process and user fees should improve its regulation of OTC drugs, the agency's analysis of the effect of the CARES Act is still ongoing. FDA officials told GAO that prior to the CARES Act, they used various methods to identify and respond to safety issues related to OTC drugs. For example, to identify these issues, FDA officials said they read medical literature related to safety issues and reviewed reports submitted to the agency's adverse event reporting system. To respond to these issues, FDA took steps such as issuing drug safety communications to consumers and requesting that manufacturers make changes to a drug's labeling. For example, in 2015, two FDA advisory committees recommended that cough and cold drugs with codeine be removed from the relevant OTC monograph for use in drugs in children. In 2018, FDA also issued a drug safety communication stating the risks outweighed the benefits for the use of these drugs in children. However, FDA officials said these methods were not a substitute for rulemaking because manufacturers could legally market their OTC drugs without making requested safety changes until the rulemaking process was completed. According to FDA officials, the new process for regulating OTC drugs included in the CARES Act could improve FDA's ability to address identified safety risks in a more timely and efficient manner in the future. The act established an expedited process to address safety issues that pose an imminent hazard to public health or to change a drug's labeling to mitigate a significant or unreasonable risk of a serious adverse event. OTC drugs prevent and treat a variety of conditions; for example, sunscreen is used to help prevent sunburn. FDA officials and stakeholders, such as industry representatives and patient and provider groups, have questioned whether the monograph process used to regulate most OTC drugs has been overly burdensome and has limited FDA's ability to quickly update and finalize monographs in response to potential safety issues for consumers. Enacted in March 2020, the CARES Act changed how FDA regulates OTC drugs. The Sunscreen Innovation Act included a provision for GAO to review FDA's regulation of OTC drugs. This report describes, among other issues, (1) the factors that affected FDA's ability to regulate OTC drugs and (2) how FDA identified and responded to safety issues associated with these drugs. GAO reviewed federal statutes and agency documents and interviewed FDA officials and stakeholders familiar with the monograph process. These stakeholders included representatives from the OTC drug industry, health care provider and consumer groups, and researchers. The Department of Health and Human Services provided technical comments on this report, which GAO incorporated as appropriate. For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.
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    The Department of Homeland Security (DHS) and each of its major components face the same key drivers of employee engagement—as measured by the Office of Personnel Management's Federal Employee Viewpoint Survey (OPM FEVS)—as the rest of the federal government (see table). Higher scores on the OPM FEVS indicate that an agency has the conditions that lead to higher employee engagement, a component of morale. Key Drivers of Employee Engagement across the Federal Government, the Department of Homeland Security (DHS), and within Each DHS Component Agency DHS has implemented department-wide employee engagement initiatives, including efforts to support DHS employees and their families. Additionally, DHS's major operational components, such as U.S. Customs and Border Protection and the Transportation Security Administration, among others, have developed annual action plans to improve employee engagement. However, DHS has not issued written guidance on action planning and components do not consistently include key elements in their plans, such as outcome-based performance measures. Establishing required action plan elements through written guidance and monitoring the components to ensure they use measures to assess the results of their actions to adjust, reprioritize, and identify new actions to improve employee engagement would better position DHS to make additional gains in this area. In addition, approval from the DHS Office of the Chief Human Capital Officer (OCHCO) and component leadership for these plans would help ensure department-wide commitment to improving employee engagement. DHS has faced challenges with low employee morale and engagement—an employee's sense of purpose and commitment—since it began operations in 2003. DHS has made some progress in this area, but data from the 2019 OPM FEVS show that DHS continues to rank lowest among similarly-sized federal agencies. GAO has reported that increasing employee engagement can lead to improved agency performance, and it is critical that DHS do so given the importance of its missions. GAO was asked to review DHS employee morale. This report addresses (1) drivers of employee engagement at DHS and (2) the extent that DHS has initiatives to improve employee engagement and ensures effective engagement action planning. To answer these objectives, GAO used regression analyses of 2019 OPM FEVS data to identify the key drivers of engagement at DHS. GAO also reviewed component employee engagement action plans and met with officials from DHS and component human capital offices as well as unions and employee groups. GAO is making three recommendations. DHS OCHCO should, in its anticipated written guidance, establish the elements required in employee engagement action plans and the approval process for these plans. OCHCO should also monitor components' action planning to ensure they review and assess the results of their actions to improve employee engagement. DHS concurred with GAO's recommendations. For more information, contact Chris Currie at (404) 679-1875 or CurrieC@gao.gov.
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    The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) analyzes national-level data by birth sex to assess health outcomes for women veterans. For example, it analyzes frequency data to identify their most common health conditions. However, VHA is limited in its assessment of health outcomes for the lesbian, gay, bisexual, and transgender (LGBT) veteran population because it does not consistently collect sexual orientation or self-identified gender identity (SIGI) data. VHA officials stated that providers may record veterans' sexual orientation—which can be used to identify lesbian, gay, and bisexual veterans—in non-standardized clinical notes in electronic health records. However, without a standardized field, providers may not be consistently collecting these data, and VHA does not know the total number of these veterans in its system. VHA officials recognize the importance of consistently collecting these data, but have yet to develop and implement a field for doing so. VHA collects SIGI data—which can be used in part to identify transgender veterans—in enrollment, administrative, and electronic health record systems. Although VHA has worked to improve the collection of these data, GAO found inconsistencies in how VHA records SIGI and, according to VA, 89 percent of veterans' records lack SIGI information. VHA added a field to collect this information in the administrative system; however, these data are not linked to electronic health records. As such, VHA providers cannot see the data during clinical visits when determining the appropriate services for transgender veterans, such as screening certain transgender men for breast and cervical cancers, as required by VHA policy. VHA's plan to link SIGI data across both systems has been postponed several times, and the data remain unlinked. VHA Sexual Orientation and Self-Identified Gender Identity (SIGI) Data Collection Limitations, Fiscal Year 2020 Until VHA can more consistently collect and analyze sexual orientation and SIGI data for the veteran population served, it will have a limited understanding of the health care needs of LGBT veterans, including any disparities they may face. VHA provides care to a diverse population of veterans, including women and LGBT veterans. These veterans may experience differences in health outcomes that are closely linked with social or economic disadvantage, and VA considers it important to analyze the services they receive as well as their health outcomes to improve health equity. House Report 115-188 included a provision for GAO to review VA's data collection and reporting procedures for information on veterans' gender and sexual orientation. This report describes how VHA assesses health outcomes for women veterans and examines the extent to which VHA assesses health outcomes for LGBT veterans. GAO reviewed VHA directives and VHA's Health Equity Action Plan. GAO interviewed officials from VHA's Women's Health Services and LGBT Health Program, VHA researchers who focus on women and LGBT veterans, and representatives from other health care systems with experience collecting gender and sexual orientation information. GAO is making four recommendations to VA to consistently collect sexual orientation and SIGI data, and analyze these data to assess health outcomes for LGBT veterans. VA concurred with GAO's recommendations and identified actions it is taking to address them. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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    As of August 20, 2020, the U.S. had over 5.5 million cumulative reported cases of COVID-19, and 158,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted between March and July 2020 to provide appropriations for the response to COVID-19. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to COVID-19. This second report examines federal spending on the COVID-19 response; indicators for monitoring public health and the economy; and the status of matters for congressional consideration and recommendations from GAO’s June 2020 report (GAO-20-625). GAO reviewed data through June 30, 2020 (the latest available) from USAspending.gov, a government website with data from government agencies. GAO also obtained, directly from the agencies, spending data, as of July 31, 2020, for the six largest spending areas, to the extent available. To develop the public health indicators, GAO reviewed research and federal guidance. To understand economic developments, GAO reviewed data from federal statistical agencies, the Federal Reserve, and Bloomberg Terminal, as well as economic research. To update the status of matters for congressional consideration and recommendations, GAO reviewed agency and congressional actions. In response to the national public health and economic threats caused by COVID-19, four relief laws making appropriations of about $2.6 trillion had been enacted as of July 31, 2020. Overall, federal obligations and expenditures government-wide of these COVID-19 relief funds totaled $1.5 trillion and $1.3 trillion, respectively, as of June 30, 2020. GAO also obtained preliminary data for six major spending areas as of July 31, 2020 (see table). COVID-19 Relief Appropriations, Obligations, and Expenditures for Six Major Spending Areas, as of July 2020 Spending area Appropriationsa ($ billions) Preliminary obligationsb ($ billions) Preliminary expendituresb ($ billions) Business Loan Programs 687.3 538.1 522.2c Economic Stabilization and Assistance to Distressed Sectors 500.0 30.4 19.2c Unemployment Insurance 376.4 301.1 296.8 Economic Impact Payments 282.0 273.5 273.5 Public Health and Social Services Emergency Fund 231.7 129.6 95.9 Coronavirus Relief Fund 150.0 149.5 149.5 Total for six spending areas 2,227.4 1,422.2 1,357.0 Source: GAO analysis of data from the Department of the Treasury, USAspending.gov, and applicable agencies. | GAO-20-708 aCOVID-19 relief appropriations reflect amounts appropriated under the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146; Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); and Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020). These data are based on appropriations warrant information provided by the Department of the Treasury as of July 31, 2020. These amounts could increase in the future for programs with indefinite appropriations, which are appropriations that, at the time of enactment, are for an unspecified amount. In addition, this table does not represent transfers of funds that federal agencies may make between appropriation accounts or transfers of funds they may make to other agencies. bObligations and expenditures data for July 2020 are based on preliminary data reported by applicable agencies. cThese expenditures relate to the loan subsidy costs (the loan’s estimated long-term costs to the United States government). The CARES Act included a provision for GAO to assess the impact of the federal response on public health and the economy. The following are examples of health care and economic indicators that GAO is monitoring. Health care. GAO’s indicators are intended to assess the nation’s immediate response to COVID-19 as it first took hold, gauge its recovery from the effects of the pandemic over the longer term, and determine the nation’s level of preparedness for future pandemics, involving subsequent waves of either COVID-19 or other infectious diseases. For example, to assess the sufficiency of testing—a potential indicator of the system’s response and recovery—GAO suggests monitoring the proportion of tests in a given population that are positive for infection. A higher positivity rate can indicate that testing is not sufficiently widespread to find all cases. That is higher positivity rates can indicate that testing has focused on those most likely to be infected and seeking testing because they have symptoms, and may not be detecting COVID-19 cases among individuals with no symptoms. Although there is no agreed-upon threshold for the test positivity rate, governments should target low positivity rates. The World Health Organization recommends a test positivity rate threshold of less than 5 percent over a 14-day period. As of August 12, 2020, 12 states and the District of Columbia had met this threshold (38 states had not). Resolve to Save Lives, another organization, recommends a threshold of less than 3 percent over a 7-day period, and 11 states and the District of Columbia had met this threshold (39 states had not) as of August 12, 2020. GAO also suggests monitoring mortality from all causes compared to historical norms as an indicator of the pandemic’s broad effect on health care outcomes. Mortality rates have tended to be consistent from year to year. This allows an estimation of how much mortality rose with the onset of the pandemic, and provides a baseline by which to judge a return to pre-COVID levels. According to Centers for Disease Control and Prevention data, about 125,000 more people died from all causes January 1–June 13 than would normally be expected (see figure). CDC Data on Higher-Than-Expected Weekly Mortality, January 1 through June 13, 2020 Note: The figure shows the number of deaths from all causes in a given week that exceeded the upper bound threshold of expected deaths calculated by CDC on the basis of variation in mortality experienced in prior years. Changes in the observed numbers of deaths in recent weeks should be interpreted cautiously as this figure relies on provisional data that are generally less complete in recent weeks. Data were accessed on July 16, 2020. Economy. GAO updated information on a number of indicators to facilitate ongoing and consistent monitoring of areas of the economy supported by the federal pandemic response, in particular the COVID-19 relief laws. These indicators suggest that economic conditions—including for workers, small businesses, and corporations—have improved modestly in recent months but remain much weaker than prior to the pandemic. In June and July initial regular unemployment insurance (UI) claims filed weekly averaged roughly 1.4 million (see figure), which was six and a half times higher than average weekly claims in 2019, but claims have decreased substantially since mid-March, falling to 971,000 in the week ending August 8, 2020. Increasing infections in some states and orders to once again close or limit certain businesses are likely to pose additional challenges for potentially fragile economic improvements, especially in affected sectors, such as the leisure and hospitality sector. National Weekly Initial Unemployment Insurance Claims, January 2019–July 2020 Note: See figure 5 in the report. As GAO reported in June, consistent with the urgency of responding to serious and widespread health issues and economic disruptions, federal agencies gave priority to moving swiftly where possible to distribute funds and implement new programs designed to help small businesses and the newly unemployed, for example. However, such urgency required certain tradeoffs in achieving transparency and accountability goals. To make mid-course corrections, GAO made three recommendations to federal agencies: To reduce the potential for duplicate payments from the Paycheck Protection Program (PPP)—a program that provides guaranteed loans through lenders to small businesses—and unemployment insurance, GAO recommended that the Department of Labor (DOL), in consultation with the Small Business Administration (SBA) and the Department of the Treasury (Treasury), immediately provide information to state unemployment agencies that specifically addresses PPP loans, and the risk of improper unemployment insurance payments. DOL issued guidance on August 12, 2020, that, among other things, clarified that individuals working full-time and being paid through PPP are not eligible for UI. To recoup economic impact payments totaling more than $1.6 billion sent to decedents, GAO recommended that the Internal Revenue Service (IRS) consider cost-effective options for notifying ineligible recipients of economic impact payments how to return payments. IRS has taken steps to address this recommendation. According to a Treasury official, nearly 70 percent of the payments sent to decedents have been recovered. However, GAO was unable to verify that amount before finalizing work on this report. GAO is working with Treasury to determine the number of payments sent to decedents that have been recovered. Treasury was considering sending letters to request the return of remaining outstanding payments but has not moved forward with this effort because, according to Treasury, Congress is considering legislation that would clarify or change payment eligibility requirements. To reduce the potential for fraud and ensure program integrity, GAO recommended that SBA develop and implement plans to identify and respond to risks in PPP to ensure program integrity, achieve program effectiveness, and address potential fraud. SBA has begun developing oversight plans for PPP but has not yet finalized or implemented them. In addition, to improve the government’s response efforts, GAO suggested three matters for congressional consideration: GAO urged Congress to take legislative action to require the Department of Transportation (DOT) to work with relevant agencies and stakeholders, such as HHS, the Department of Homeland Security (DHS), and international organizations, to develop a national aviation-preparedness plan to ensure safeguards are in place to limit the spread of communicable disease threats from abroad, while also minimizing any unnecessary interference with travel and trade. In early July 2020, DOT collaborated with HHS and DHS to issue guidance to airports and airlines for implementing measures to mitigate the public health risks associated with COVID-19, but it has not developed a preparedness plan for future communicable disease threats. DOT has maintained that HHS and DHS should lead such planning efforts as they are responsible for communicable disease response and preparedness planning, respectively. In June 2020, HHS stated that it is not in a position to develop a national aviation-preparedness plan as it does not have primary jurisdiction over the entire aviation sector or the relevant transportation expertise. In May 2020, DHS stated that it had reviewed its existing plans for pandemic preparedness and response activities and determined it is not best situated to develop a national aviation-preparedness plan. Without such a plan, the U.S. will not be as prepared to minimize and quickly respond to future communicable disease events. GAO also urged Congress to amend the Social Security Act to explicitly allow the Social Security Administration (SSA) to share its full death data with Treasury for data matching to help prevent payments to ineligible individuals. In June 2020, the Senate passed S.4104, referred to as the Stopping Improper Payments to Deceased People Act. If enacted, the bill would allow SSA to share these data with Treasury's Bureau of the Fiscal Service to avoid paying deceased individuals. Finally, GAO urged Congress to use GAO's Federal Medical Assistance Percentage (FMAP) formula for any future changes to the FMAP—the statutory formula according to which the federal government matches states' spending for Medicaid services—during the current or any future economic downturn. Congress has taken no action thus far on this issue. GAO incorporated technical comments received the Departments of Labor, Commerce, Health and Human Services, Transportation, and the Treasury; the Federal Reserve; Office of Management and Budget; and Internal Revenue Service. The Small Business Administration commented that GAO did not include information on actions taken and controls related to its loan forgiveness program or its plans for loan reviews. GAO plans to provide more information on these topics in its next CARES Act report. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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  • COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted Actions
    In U.S GAO News
    In the government’s ongoing response to the COVID-19 pandemic, the Congress and the administration have taken action on multiple fronts to address challenges that have contributed to catastrophic loss of life and profound economic disruption. These actions have helped direct much-needed federal assistance to support many aspects of public life, including local public health systems and private-sector businesses. However, the nation faces continued public health risks and economic difficulties for the foreseeable future. Among other challenges, the public health system, already strained from months of responding to COVID-19 cases, will face the additional task of managing the upcoming flu season. At the same time, many of the federal, state, and local agencies responsible for responding to the ongoing public health emergency are called on to prepare for and respond to the current hurricane season. Timely and concerted federal leadership will be required in responding to these and other challenges. GAO has identified lessons learned and issues in need of continued attention by the Congress and the administration, including the need to collect reliable data that can drive decision-making; to establish mechanisms for accountability and transparency; and to protect against ongoing cyber threats to patient information, intellectual property, public health data, and intelligence. Attention to these issues can help to make federal efforts as effective as possible. GAO has also identified a number of opportunities to help the federal government prepare for the months ahead while improving the ongoing federal response: Medical Supply Chain The Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA), with support from the Department of Defense (DOD), have taken numerous, significant efforts to mitigate supply shortages and expand the medical supply chain. For example, the agencies have coordinated to deliver supplies directly to nursing homes and used Defense Production Act authorities to increase the domestic production of supplies. However, shortages of certain types of personal protective equipment and testing supplies remain due to a supply chain with limited domestic production and high global demand. The Food and Drug Administration (FDA) and FEMA have both identified shortages, and officials from seven of the eight states GAO interviewed in July and August 2020 identified previous or ongoing shortages of testing supplies, including swabs, reagents, tubes, pipettes, and transport media. Testing supply shortages have contributed to delays in turnaround times for testing results. Delays in processing test results have multiple serious consequences, including delays in isolating those who test positive and tracing their contacts in a timely manner, which can in turn exacerbate outbreaks by allowing the virus to spread undetected. In addition, states and other nonfederal entities have experienced challenges tracking supply requests made through the federal government and planning for future needs. GAO is making the following recommendations: HHS, in coordination with FEMA, should immediately document roles and responsibilities for supply chain management functions transitioning to HHS, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain. HHS, in coordination with FEMA, should further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate supply chain shortages for the remainder of the pandemic. HHS and FEMA—working with relevant stakeholders—should devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the COVID-19 pandemic response. HHS and the Department of Homeland Security (DHS) objected to GAO’s initial draft recommendations. GAO made revisions based on their comments. GAO maintains that implementation of its modified recommendations is both warranted and prudent. These actions could contribute to ensuring a more effective response by helping to mitigate challenges with the stability of the medical supply chain and the ability of nonfederal partners to track, plan, and budget for ongoing medical supply needs. Vaccines and Therapeutics Multiple federal agencies continue to support the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19. These efforts are aimed at accelerating the traditional timeline to create a vaccine (see figure). Traditional Timeline for Development and Creation of a Vaccine Note: See figure 5 in the report. As these efforts proceed, clarity on the federal government’s plans for distributing and administering vaccine, as well as timely, clear, and consistent communication to stakeholders and the public about those plans, is essential. DOD is supporting HHS in developing plans for nationwide distribution and administration of a vaccine. In September 2020, HHS indicated that it will soon send a report to Congress outlining a distribution plan, but did not provide a specific date for doing so. GAO recommends that HHS, with support from DOD, establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and in developing such a plan ensure that it is consistent with best practices for project planning and scheduling and outlines an approach for how efforts will be coordinated across federal agencies and nonfederal entities. DOD partially concurred with the recommendation, clarifying that it is supporting HHS in developing plans for nationwide distribution and administration of vaccine. HHS neither agreed nor disagreed with the recommendation, but noted factors that complicate the publication of a plan. GAO maintains that a time frame is necessary so all relevant stakeholders will be best positioned to begin their planning.On September 16, 2020, HHS and DOD released two documents outlining a strategy for any COVID-19 vaccine. GAO will evaluate these documents and report on them in future work.GAO will also continue to conduct related work, including examining federal efforts to accelerate the development and manufacturing of COVID-19 vaccines and therapeutics. COVID-19 Data Data collected by the Centers for Disease Control and Prevention (CDC) suggest a disproportionate burden of COVID-19 cases, hospitalizations, and deaths exists among racial and ethnic minority groups, but GAO identified gaps in these data. To help address these gaps, on July 22, 2020, CDC released a COVID-19 Response Health Equity Strategy. However, the strategy does not assess whether having the authority to require states and jurisdictions to report race and ethnicity information is necessary to ensure CDC can collect such data. CDC’s strategy also does not specify how it will involve key stakeholders, such as health care providers, laboratories, and state and jurisdictional health departments. GAO recommends that CDC (1) determine whether having the authority to require the reporting of race and ethnicity information for cases, hospitalizations, and deaths is necessary for ensuring more complete data, and if so, seek such authority from Congress; (2) involve key stakeholders to help ensure the complete and consistent collection of demographic data; and (3) take steps to help ensure its ability to comprehensively assess the long-term health outcomes of persons with COVID-19, including by race and ethnicity. HHS agreed with the recommendations. In addition, HHS’s data on COVID-19 in nursing homes do not capture the early months of the pandemic. HHS’s Centers for Medicare & Medicaid Services (CMS) began requiring nursing homes to report COVID-19 data to CDC by May 17, 2020, starting with information as of May 8, 2020, but made reporting prior to May 8, 2020 optional. By not requiring nursing homes to submit data from the first 4 months of 2020, HHS is limiting the usefulness of the data in helping to understand the effects of COVID-19 in nursing homes. GAO recommends that HHS, in consultation with CMS and CDC, develop a strategy to capture more complete data on COVID-19 cases and deaths in nursing homes retroactively back to January 1, 2020. HHS partially agreed with this recommendation by noting the value of having complete data, but expressed concern about the burden of collecting it. GAO maintains the importance of collecting these data to inform the government’s continued response and recovery, and HHS could ease the burden by incorporating data previously reported to CDC or to state or local public health offices. Economic Impact Payments The Department of the Treasury’s (Treasury) Internal Revenue Service (IRS) has issued economic impact payments (EIP) to all eligible individuals for whom IRS has the necessary information to do so; however, not everyone eligible was able to be initially identified. To help ensure all eligible recipients received their payments in a more timely manner, IRS took several actions to address challenges GAO reported on in June, including a policy change—reopening the Non-Filers tool registration period for federal benefit recipients and extending it through September 30—that should allow some eligible recipients to receive supplemental payments for qualifying children sooner than expected. However, Treasury and IRS lack updated information on how many eligible recipients have yet to receive these funds. The lack of such information could hinder outreach efforts and place potentially millions of individuals at risk of missing their payment. GAO recommends that Treasury, in coordination with IRS, (1) update and refine the estimate of eligible recipients who have yet to file for an EIP to help target outreach and communications efforts and (2) make estimates of eligible recipients who have yet to file for an EIP, and other relevant information, available to outreach partners to raise awareness about how and when to file for EIP. Treasury and IRS neither agreed nor disagreed with the recommendations and described actions they are taking in concert with the recommendations to notify around 9 million individuals who may be eligible for an EIP. Coronavirus Relief Fund The Coronavirus Relief Fund (CRF) is the largest program established in the four COVID-19 relief laws that provides aid to states, the District of Columbia, localities, tribal governments, and U.S. territories. Audits of entities that receive federal funds, including CRF payments, are critical to the federal government’s ability to help safeguard those funds. Auditors that conduct single audits follow guidance in the Single Audit Act’s Compliance Supplement, which the Office of Management and Budget (OMB) updates and issues annually in coordination with federal agencies. OMB issued the 2020 Compliance Supplement in August 2020, but the Compliance Supplement specified that OMB is still working with federal agencies to identify the needs for additional guidance for auditing new COVID-19-related programs, including the CRF payments, as well as existing programs with compliance requirement changes. According to OMB, an addendum on COVID-19-related programs, including the CRF payments, will be issued in the fall of 2020. Further delays in issuing this guidance could adversely affect auditors’ ability to issue consistent and timely reports. GAO recommends that OMB, in consultation with Treasury, issue the addendum to the 2020 Compliance Supplement as soon as possible to provide the necessary audit guidance, as many single audit efforts are underway. OMB neither agreed nor disagreed with the recommendation. Guidance for K-12 Schools State and local school district officials tasked with reassessing their operating status and ensuring their school buildings are safe are generally relying on guidance and recommendations from federal, state, and local public health and education officials. However, portions of CDC’s guidance on reopening K-12 schools are inconsistent, and some federal guidance appears misaligned with CDC’s risk-based approach on school operating status. Based on GAO’s review, Education has updated the information and CDC has begun to do so. GAO recommends that CDC ensure that, as it makes updates to its guidance related to schools’ operating status, the guidance is cogent, clear, and internally consistent. HHS agreed with the recommendation. Tracking Contract Obligations Federal agencies are tracking contract actions and associated obligations in response to COVID-19 using a National Interest Action (NIA) code in the Federal Procurement Data System-Next Generation. The COVID-19 NIA code was established in March 2020 and was recently extended until March 31, 2021, while a draft of this report recommending that DHS and DOD extend the code beyond September 30, 2020, was with the agencies for comment. GAO has identified inconsistencies in establishing and closing these codes following previous emergencies, and has continued concerns with the criteria that DHS and DOD rely on to determine whether to extend or close a code and whether the code meets long-term needs. GAO recommends that DHS and DOD make updates to the 2019 NIA Code Memorandum of Agreement so as to enhance visibility for federal agencies, the public, and Congress on contract actions and associated obligations related to disaster events, and to ensure the criteria for extending or closing the NIA code reflect government-wide needs for tracking contract actions in longer-term emergencies, such as a pandemic. DHS and DOD did not agree, but GAO maintains implementation of its recommendation is essential. Address Cybersecurity Weaknesses Since March 2020, malicious cyber actors have exploited COVID-19 to target organizations that make up the health care and public health critical infrastructure sector, including government entities, such as HHS. GAO has identified numerous cybersecurity weaknesses at multiple HHS component agencies, including CMS, CDC, and FDA, over the last 6 years, such as weaknesses in key safeguards to limit, prevent, and detect inappropriate access to computer resources. Additionally, GAO’s March 2019 high-risk update identified cybersecurity and safeguarding the systems supporting the nation’s critical infrastructure, such as health care, as high-risk areas. As of July 2020, CMS, FDA, and CDC had made significant progress by implementing 350 (about 81 percent) of the 434 recommendations GAO issued in previous reports to address these weaknesses. Based on the imminent cybersecurity threats, GAO recommends that HHS expedite implementation of GAO’s prior recommendations regarding cybersecurity weaknesses at its component agencies. HHS agreed with the recommendation. As of September 10, 2020, the U.S. had over 6.3 million cumulative reported cases of COVID-19 and over 177,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted as of September 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of July 31, 2020, the federal government had obligated a total of $1.6 trillion and expended $1.5 trillion of the COVID-19 relief funds as reported by federal agencies on USAspending.gov. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This third report examines key actions the federal government has taken to address the COVID-19 pandemic and evolving lessons learned relevant to the nation’s response to pandemics. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials, as well as industry representatives. GAO is making 16 new recommendations for agencies that are detailed in this Highlights and in the report. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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  • Information Technology: Federal Agencies Need to Take Urgent Action to Manage Supply Chain Risks
    In U.S GAO News
    Few of the 23 civilian Chief Financial Officers Act agencies had implemented seven selected foundational practices for managing information and communications technology (ICT) supply chain risks. Supply chain risk management (SCRM) is the process of identifying, assessing, and mitigating the risks associated with the global and distributed nature of ICT product and service supply chains. Many of the manufacturing inputs for these ICT products and services originate from a variety of sources throughout the world. (See figure 1.) Figure 1: Examples of Locations of Manufacturers or Suppliers of Information and Communications Technology Products and Services None of the 23 agencies fully implemented all of the SCRM practices and 14 of the 23 agencies had not implemented any of the practices. The practice with the highest rate of implementation was implemented by only six agencies. Conversely, none of the other practices were implemented by more than three agencies. Moreover, one practice had not been implemented by any of the agencies. (See figure 2.) Figure 2: Extent to Which the 23 Civilian Chief Financial Officers Act Agencies Implemented Information and Communications Technology (ICT) Supply Chain Risk Management (SCRM) Practices As a result of these weaknesses, these agencies are at a greater risk that malicious actors could exploit vulnerabilities in the ICT supply chain causing disruption to mission operations, harm to individuals, or theft of intellectual property. For example, without establishing executive oversight of SCRM activities, agencies are limited in their ability to make risk decisions across the organization about how to most effectively secure their ICT product and service supply chains. Moreover, agencies lack the ability to understand and manage risk and reduce the likelihood that adverse events will occur without reasonable visibility and traceability into supply chains. Officials from the 23 agencies cited various factors that limited their implementation of the foundational practices for managing supply chain risks. The most commonly cited factor was the lack of federal SCRM guidance. For example, several agencies reported that they were waiting for federal guidance to be issued from the Federal Acquisition Security Council—a cross-agency group responsible for providing direction and guidance to executive agencies to reduce their supply chain risks—before implementing one or more of the foundational practices. According to Office of Management and Budget (OMB) officials, the council expects to complete this effort by December 2020. While the additional direction and guidance from the council could further assist agencies with the implementation of these practices, federal agencies currently have guidance to assist with managing their ICT supply chain risks. Specifically, the National Institute of Standards and Technology (NIST) issued ICT SCRM-specific guidance in 2015 and OMB has required agencies to implement ICT SCRM since 2016. Until agencies implement all of the foundational ICT SCRM practices, they will be limited in their ability to address supply chain risks across their organizations effectively. Federal agencies rely extensively on ICT products and services (e.g., computing systems, software, and networks) to carry out their operations. However, agencies face numerous ICT supply chain risks, including threats posed by counterfeiters who may exploit vulnerabilities in the supply chain and, thus, compromise the confidentiality, integrity, or availability of an organization's systems and the information they contain. For example, in September 2019, the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency reported that federal agencies faced approximately 180 different ICT supply chain-related threats. To address threats such as these, agencies must make risk-based ICT supply chain decisions about how to secure their systems. GAO was asked to conduct a review of federal agencies' ICT SCRM practices. The specific objective was to determine the extent to which federal agencies have implemented foundational ICT SCRM practices. To do so, GAO identified seven practices from NIST guidance that are foundational for an organization-wide approach to ICT SCRM and compared them to policies, procedures, and other documentation from the 23 civilian Chief Financial Officers Act agencies. This is a public version of a sensitive report that GAO issued in October 2020. Information that agencies deemed sensitive was omitted and GAO substituted numeric identifiers that were randomly assigned for the names of the agencies due to sensitivity concerns. The foundational practices comprising ICT SCRM are: establishing executive oversight of ICT activities, including designating responsibility for leading agency-wide SCRM activities; developing an agency-wide ICT SCRM strategy for providing the organizational context in which risk-based decisions will be made; establishing an approach to identify and document agency ICT supply chain(s); establishing a process to conduct agency-wide assessments of ICT supply chain risks that identify, aggregate, and prioritize ICT supply chain risks that are present across the organization; establishing a process to conduct a SCRM review of a potential supplier that may include reviews of the processes used by suppliers to design, develop, test, implement, verify, deliver, and support ICT products and services; developing organizational ICT SCRM requirements for suppliers to ensure that suppliers are adequately addressing risks associated with ICT products and services; and developing organizational procedures to detect counterfeit and compromised ICT products prior to their deployment. GAO also interviewed relevant agency officials. In the sensitive report, GAO made a total of 145 recommendations to the 23 agencies to fully implement foundational practices in their organization-wide approaches to ICT SCRM. Of the 23 agencies, 17 agreed with all of the recommendations made to them; two agencies agreed with most, but not all of the recommendations; one agency disagreed with all of the recommendations; two agencies neither agreed nor disagreed with the recommendations, but stated they would address them; and one agency had no comments. GAO continues to believe that all of the recommendations are warranted, as discussed in the sensitive report. For more information, contact Carol C. Harris at (202) 512-4456 or harrisCC@gao.gov.
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    TriWest Healthcare Alliance Corp. has agreed to pay the United States $179,700,000 to resolve claims that it received overpayments from the U.S. Department of Veterans Affairs (VA) in connection with its administration of certain VA health care programs, the Department of Justice announced today.
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  • Time and Attendance: Agencies Generally Compiled Data on Misconduct, and Reported Using Various Internal Controls for Monitoring
    In U.S GAO News
    Agencies compiled a variety of data on time and attendance misconduct and fraud. Specifically, 22 of the 24 agencies covered by the Chief Financial Officers Act of 1990 (CFO Act) had some data on instances of time and attendance misconduct—including potential fraud—from fiscal years 2015 through 2019. However, because agencies tracked data differently, the data could not be aggregated across the 22 agencies (see table). The remaining two agencies reported that they did not compile misconduct data agency-wide but began using systems to collect this data in fiscal year 2020. Scope of Agency Data on Time and Attendance Misconduct for Fiscal Years 2015–2019 Level of data compiled; number of years included Number of agencies Data compiled 22 Agency-wide data; all 5 years included 13 Agency-wide data; less than 5 years of data 5 Component-level data; all 5 years included 4 Data not compiled 2 Source: GAO analysis of agency data. | GAO-20-640 Most (19 of 24) agency Inspectors General (IG) reported that they substantiated five or fewer allegations of time and attendance misconduct or fraud over the 5-year period. In total, these IGs substantiated 100 allegations, ranging from zero substantiated allegations at six agencies to more than 10 at four agencies. IGs stated that they might not investigate allegations for several reasons, including resource constraints and limited financial impact. In addition, 20 of 24 agencies reported that they considered fraud risks in payroll or time and attendance, either through assessments of these functions, or as part of a broader agency risk management process, including their annual agency financial reports. Also, 14 of 15 agencies that reported a risk level determined that time and attendance fraud risk was low once they accounted for existing controls. Agencies reported using various internal controls, including technologies, to monitor time and attendance, which can also prevent and detect misconduct. According to agencies and IGs, first-line supervisors have primary responsibility for monitoring employee time and attendance. Additional internal controls include policies, procedures, guidance, and training. Agencies also reported using controls built into their timekeeping system to provide reasonable assurance that time and attendance information is recorded completely and accurately. These controls include requiring supervisory approval of timecards, and using time and attendance system reports to review abnormal reporting. According to agencies and stakeholders GAO spoke with, technology for monitoring time and attendance can help prevent and detect fraud, but may not help when an employee is intent on circumventing controls. Technology alone, they said, cannot prevent fraud. Agencies and IGs also reported using a mix of other technologies to assess allegations of time and attendance misconduct, such as badge-in and -out data, video surveillance, network login information, and government-issued routers. However, agency and IG officials also stated that these technologies have limitations. For example, many of the technologies may not account for when an employee is in training or at an off-site meeting. The federal government is the nation's biggest employer, with about 2.1 million non-postal civilian employees. Misconduct is generally considered an action by an employee that impedes the efficiency of the agency's service or mission. Fraud involves obtaining something of value through willful misrepresentation. In 2018, GAO reported that, on average, less than 1 percent of the federal workforce each year is formally disciplined for misconduct—of which time and attendance misconduct is a subcomponent. Misconduct can hinder an agency's efforts to achieve its mission, and fraud poses a significant risk to the integrity of federal programs and erodes public trust in government. GAO was asked to review agencies' efforts to prevent and address time and attendance misconduct, including fraud. This report describes 1) what is known about the extent of time and attendance misconduct and potential fraud across the 24 CFO Act agencies, and 2) controls and technologies these agencies reported using to monitor employee time and attendance. GAO collected misconduct data from the 24 CFO Act agencies and their IGs. GAO also collected information on fraud risk reporting but did not independently assess agencies' fraud risk. Using a semi-structured questionnaire, GAO obtained information on controls and technologies that agencies reported using to monitor time and attendance and any challenges associated with their use. For more information, contact Chelsa Kenney Gurkin at (202) 512-2964 or gurkinc@gao.gov, or Vijay A. D'Souza at (202) 512-6240 or dsouzav@gao.gov.
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    GAO began 37 new audits that involved the Department of Defense (DOD) in the fourth quarter of fiscal year 2020. Of GAO's 37 requested entrance conferences for those audits, DOD scheduled 33 within 14 days and held 34 within 30 days of GAO's notification. Entrance conferences are initial meetings between agency officials and GAO staff that allow GAO to communicate its audit objectives and enable agencies to assign key personnel to support the audit work. The four entrance conferences that were scheduled more than 14 days after notification were scheduled late due to either difficulties in identifying a primary action officer or aligning the schedules of GAO and DOD officials. The three entrance conferences that were held more than 30 days after notification were scheduled late due to difficulties in aligning the schedules of GAO and DOD officials. GAO's agency protocols govern GAO's relationships with audited agencies. These protocols assist GAO in scheduling entrance conferences with key agency officials within 14 days of their receiving notice of a new audit. The ability of the Congress to conduct effective oversight of federal agencies is enhanced through the timely completion of GAO audits. In past years, DOD experienced difficulty meeting the protocol target for the timely facilitation of entrance conferences. In Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, the Senate Armed Services Committee included a provision for GAO to review DOD's scheduling and holding of entrance conferences. In this report, GAO evaluates the extent to which DOD scheduled entrance conferences within 14 days of receiving notice of a new audit, consistent with GAO's agency protocols, and held those conferences within 30 days. This is the final of four quarterly reports that GAO will produce on this topic for fiscal year 2020. In the first three quarterly reports, GAO found that DOD had improved its ability to meet the protocol target. GAO analyzed data on GAO audits involving DOD and initiated in the fourth quarter of fiscal year 2020 (July 1, 2020, through September 30, 2020). Specifically, GAO identified the number of notification letters requesting entrance conferences that it sent to DOD during that time period. GAO determined the number of days between when DOD received GAO's notification letter for each new audit and when DOD scheduled the entrance conference and assessed whether DOD scheduled entrance conferences within 14 days of notification, which is the time frame identified in GAO's agency protocols. GAO also determined the date that each requested entrance conference was held by collecting this information from the GAO team conducting each audit and assessed whether DOD held entrance conferences for new audits within 30 days of notification, which was the time frame identified in the mandate for this review. For more information, contact Elizabeth Field at (202) 512-2775 or Fielde1@gao.gov.
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