Food Safety: CDC Could Further Strengthen Its Efforts to Identify and Respond to Foodborne Illnesses

What GAO Found

The roles and responsibilities of the Centers for Disease Control and Prevention (CDC) during a multistate foodborne illness outbreak include analyzing federal foodborne illness surveillance networks to identify outbreaks, leading investigations to determine the food causing the outbreak, and communicating with the public. CDC also works to build and maintain federal, state, territorial, and local capacity to respond to foodborne illness outbreaks by awarding funds to state and local public health agencies and through other initiatives.

In identifying and responding to multistate foodborne illness outbreaks, CDC faces challenges related to clinical methods and communication, and it has taken some steps to respond to these challenges. One challenge stems from the increasing clinical use of culture-independent diagnostic tests (CIDTs). CIDTs diagnose foodborne illnesses faster and cheaper than traditional methods, but because they do not create DNA fingerprints that can specify a pathogen, they may reduce CDC’s ability to identify an outbreak. A CDC working group recommended in May 2018 that CDC develop a plan to respond to the increasing use of CIDTs. By developing a plan, CDC will have greater assurance of continued access to necessary information. CDC also faces a challenge in balancing the competing needs for timeliness and accuracy in its outbreak communications while maintaining public trust. CDC has an internal framework to guide its communications decisions during outbreaks, and it recognizes that stakeholders would like more transparency about these decisions. By making its framework publicly available, CDC could better foster public trust in its information and guidance during outbreaks.

CDC has taken steps to evaluate its performance in identifying and responding to multistate outbreaks. Specifically, CDC has developed general strategic goals (see fig.) and taken initial steps to develop performance measures. However, CDC has not yet established other elements of a performance assessment system—an important component of effective program management.

CDC’s Use of Elements of Program Performance Assessment Systems

In particular, CDC has not set specific performance goals, used performance measures to track progress, or conducted a program evaluation of its multistate foodborne illness outbreak investigation efforts. By implementing all elements of a performance assessment system, CDC could better assess its progress toward meeting its goals, identify potentially underperforming areas, and use that information to improve its performance.

Why GAO Did This Study

CDC has estimated that each year, one in six people in the United States gets a foodborne illness, 128,000 are hospitalized, and 3,000 die. CDC data show increases in the number of reported multistate foodborne illness outbreaks—groups of two or more linked cases in multiple states—in recent years. Such outbreaks are responsible for a disproportionate number of hospitalizations and deaths, compared with single-state outbreaks.

GAO was asked to review CDC’s response to multistate foodborne illness outbreaks. This report examines (1) CDC’s roles and responsibilities, (2) challenges that CDC faces and the extent to which it has addressed these challenges, and (3) the extent to which CDC evaluates its performance. GAO reviewed agency documents and data; conducted site visits and case studies; and interviewed federal, state, and local public health officials, as well as representatives of stakeholder groups.

What GAO Recommends

GAO is recommending that CDC (1) develop a plan to respond to the increasing use of CIDTs, (2) make publicly available its decision-making framework for communicating about multistate foodborne illness outbreaks, and (3) implement all the elements of a performance assessment system. CDC concurred with all three recommendations.

For more information, contact Steve D. Morris at (202) 512-3841 or morriss@gao.gov.

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    The Department of Transportation (DOT) uses a multistep, centralized process to prioritize and select research activities it will fund. DOT's modal administrations—which focus on specific modes of transportation like air, rail, and highways—conduct and manage most of DOT's research. The modal administrations GAO spoke to used a variety of methods to prioritize and select research, including soliciting stakeholders' feedback on research needs. The Office of the Assistant Secretary for Research and Technology (OST-R) is responsible for reviewing this proposed research to ensure alignment with DOT's strategic plans and to prevent duplicative research efforts, as required by statute. DOT has multiple efforts to facilitate research collaboration both externally and internally, but in guidance to promote collaboration, OST-R did not incorporate all leading practices. Specifically, OST-R established topical-research working groups on 12 multimodal subject areas in October 2018 and issued accompanying guidance. This guidance incorporated some leading collaboration practices, such as directing working groups to identify leadership roles and relevant participants. However, the guidance did not incorporate two leading practices—defining and monitoring progress toward long-term outcomes and regularly updating and monitoring written agreements. Taking steps to ensure the working groups follow these practices could provide OST-R greater assurance that the groups coordinate their efforts effectively, better plan long-term research, and better position themselves to address future transportation challenges. OST-R has taken some steps to help ensure that its public database on DOT-funded research projects (the Research Hub) contains complete and accurate information, as required by DOT's data management policy; however, data reliability issues remained. For example, as of July 2019—the latest available data at the time of GAO's analysis—36 percent of records in the database were missing research partners' contact information, hindering the research community's ability to obtain current project details. Taking additional steps, such as providing instructions to the modal administrations on how to improve the completeness and accuracy of the information they give OST-R for the Research Hub, would help ensure the database is fulfilling DOT's intended purpose that it serve as a reliable source of information on the department's research portfolio. Examples of Research Activities on Advanced Driver-Assistance Systems and Connected Vehicles Funded by the U.S. Department of Transportation DOT's research activities are critical to DOT's mission to make the nation's transportation system safer and more efficient. To meet current research needs and prepare for emerging technologies, DOT partners with public and private entities. In fiscal year 2018, DOT funded about 2,300 partners and had a research budget exceeding $1 billion. GAO was asked to review DOT's research activities. This report addresses: (1) how DOT prioritizes and selects which research activities it will undertake; (2) the extent to which DOT facilitates research collaboration with external stakeholders and across the department; and (3) the extent to which DOT ensures its Research Hub database contains complete and accurate project information. GAO reviewed documents and analyzed data from DOT; observed DOT-funded research; interviewed DOT officials from OST-R and four selected modal administrations; and used GAO's leading collaboration practices to assess the extent of collaboration. GAO also interviewed 17 DOT research partners, including universities and associations. GAO recommends that OST-R (1) take steps to ensure the topical-research working groups follow all leading collaboration practices, and (2) take additional steps to ensure the information in the Research Hub is complete and accurate. DOT concurred with GAO's recommendations. For more information, contact Elizabeth Repko at (202) 512-2834 or repkoe@gao.gov.
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  • Weapon Systems Cybersecurity: Guidance Would Help DOD Programs Better Communicate Requirements to Contractors
    In U.S GAO News
    Since GAO's 2018 report, the Department of Defense (DOD) has taken action to make its network of high-tech weapon systems less vulnerable to cyberattacks. DOD and military service officials highlighted areas of progress, including increased access to expertise, enhanced cyber testing, and additional guidance. For example, GAO found that selected acquisition programs have conducted, or planned to conduct, more cybersecurity testing during development than past acquisition programs. It is important that DOD sustain its efforts as it works to improve weapon systems cybersecurity. Contracting for cybersecurity requirements is key. DOD guidance states that these requirements should be treated like other types of system requirements and, more simply, “if it is not in the contract, do not expect to get it.” Specifically, cybersecurity requirements should be defined in acquisition program contracts, and criteria should be established for accepting or rejecting the work and for how the government will verify that requirements have been met. However, GAO found examples of program contracts omitting cybersecurity requirements, acceptance criteria, or verification processes. For example, GAO found that contracts for three of the five programs did not include any cybersecurity requirements when they were awarded. A senior DOD official said standardizing cybersecurity requirements is difficult and the department needs to better communicate cybersecurity requirements and systems engineering to the users that will decide whether or not a cybersecurity risk is acceptable. Incorporating Cybersecurity in Contracts DOD and the military services have developed a range of policy and guidance documents to improve weapon systems cybersecurity, but the guidance usually does not specifically address how acquisition programs should include cybersecurity requirements, acceptance criteria, and verification processes in contracts. Among the four military services GAO reviewed, only the Air Force has issued service-wide guidance that details how acquisition programs should define cybersecurity requirements and incorporate those requirements in contracts. The other services could benefit from a similar approach in developing their own guidance that helps ensure that DOD appropriately addresses cybersecurity requirements in contracts. DOD's network of sophisticated, expensive weapon systems must work when needed, without being incapacitated by cyberattacks. However, GAO reported in 2018 that DOD was routinely finding cyber vulnerabilities late in its development process. A Senate report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's implementation of cybersecurity for weapon systems in development. GAO's report addresses (1) the extent to which DOD has made progress in implementing cybersecurity for weapon systems during development, and (2) the extent to which DOD and the military services have developed guidance for incorporating weapon systems cybersecurity requirements into contracts. GAO reviewed DOD and service guidance and policies related to cybersecurity for weapon systems in development, interviewed DOD and program officials, and reviewed supporting documentation for five acquisition programs. GAO also interviewed defense contractors about their experiences with weapon systems cybersecurity. GAO is recommending that the Army, Navy, and Marine Corps provide guidance on how programs should incorporate tailored cybersecurity requirements into contracts. DOD concurred with two recommendations, and stated that the third—to the Marine Corps—should be merged with the one to the Navy. DOD's response aligns with the intent of the recommendation. For more information, contact W. William Russell at (202) 512-4841 or russellw@gao.gov.
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    Three telemarketing company owners were charged for their alleged participation in a $47 million health care fraud, kickback, and money laundering scheme involving the referral of medically unnecessary cancer genetic tests to labs in exchange for kickbacks.
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    Citing the latest act of violence this year, in which a judge's family and officers at two federal courthouses have come under attack, the Judiciary has stepped up its call to congressional leaders for a series of safety measures “to protect the safety of the public at our nation’s courthouses.”
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    In Crime News
    A four–count federal grand jury indictment returned in Austin and unsealed today charges three foreign nationals – a Russian citizen and two Bulgarian citizens – with violating the International Emergency Economic Powers Act (IEEPA), Export Control Reform Act (ECRA), and a money laundering statute in a scheme to procure sensitive radiation-hardened circuits from the U.S. and ship those components to Russia through Bulgaria without required licenses.
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    In Crime News
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    In U.S Courts
    Federal courts are coordinating with state and local health officials and the Centers for Disease Control and Prevention (CDC) to obtain information about the coronavirus (COVID-19) to aid their response, recovery, and reopening efforts. Courts are regularly releasing orders to address operating status, public and employee safety, and other court business.
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    In Crime News
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  • Performance and Accountability Report Fiscal Year 2020
    In U.S GAO News
    Presented is GAO's Performance and Accountability Report for fiscal year 2020. In the spirit of the Government Performance and Results Act, this annual report informs the Congress and the American people about what we have achieved on their behalf. The financial information and the data measuring GAO's performance contained in this report are complete and reliable. This report describes GAO's performance measures, results, and accountability processes for fiscal year 2020. In assessing our performance, we compared actual results against targets and goals that were set in our annual performance plan and performance budget and were developed to help carry out our strategic plan. An overview of our annual measures and targets for 2020 is available here, along with links to a complete set of our strategic planning and performance and accountability reports. This report includes A Fiscal Year 2020 Performance and Financial Snapshot for the American Taxpayer, an introduction, four parts, and supplementary appendixes as follows: A Fiscal Year 2020 Performance and Financial Snapshot for the American Taxpayer This section provides an overview of GAO's performance and financial information for fiscal year 2020 and outlines GAO's near-term and future work priorities. Introduction This section includes the letter from the Comptroller General and a statement attesting to the completeness and reliability of the performance and financial data in this report and the effectiveness of our internal control over financial reporting. This section also includes a summary discussion of our mission, strategic planning process, and organizational structure, strategies we use to achieve our goals, and process for assessing our performance. Management's Discussion and Analysis This section discusses our agency-wide performance results and use of resources in fiscal year 2020. It also includes, among other things, information on our internal controls and the management challenges and external factors that affect our performance. Performance Information This section includes details on our performance results by strategic goal in fiscal year 2020 and the targets we are aiming for in fiscal year 2021. Financial Information This section includes details on our finances in fiscal year 2020, including a letter from our Chief Financial Officer, audited financial statements and notes, and the reports from our external auditor and Audit Advisory Committee. This section also includes an explanation of the information each of our financial statements conveys. Inspector General's View of GAO's Management Challenges This section includes our Inspector General's perspective on our agency's management challenges. Appendixes This section provides the report's abbreviations and describes how we ensure the completeness and reliability of the data for each of our performance measures. For more information, contact Timothy Bowling (202) 512-6100 or bowlingt@gao.gov.
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    In Crime News
    On Friday, the Environment and Natural Resources Division publicly distributed a memorandum summarizing important principles and priorities for environmental enforcement. The memorandum, issued Jan. 14 by outgoing Assistant Attorney General Jeffrey Bossert Clark, emphasizes that robust enforcement of our nation's environmental laws remains one of the division’s highest priorities. It emphasizes that, when engaged in criminal and civil enforcement, it is important that the division continue to enhance the fair and impartial application of the law.
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    In Crime News
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