Global Health Security: USAID and CDC Funding, Activities, and Assessments of Countries’ Capacities to Address Infectious Disease Threats before COVID-19 Onset

Pour la version française de cette page, voir GAO-21-484.

What GAO Found

As of March 31, 2020, the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC) had obligated a combined total of more than $1.2 billion and disbursed about $1 billion for global health security (GHS) activities, using funds appropriated in fiscal years 2015 through 2019. USAID and CDC supported activities to help build countries’ capacities in 11 technical areas related to addressing infectious disease threats. The obligated funding supported GHS activities in at least 34 countries, including 25 identified as Global Health Security Agenda (GHSA) partner countries.

U.S.-Supported Activities in Ethiopia to Strengthen Global Health Security

U.S. officials’ assessments of 17 GHSA partner countries’ capacities to address infectious disease threats showed that at the end of fiscal year 2019, most countries had some capacity in each of the 11 technical areas but faced various challenges. U.S. interagency country teams produce biannual capacity assessments that USAID and CDC headquarters officials use to track the countries’ progress. According to fiscal year 2019 assessment reports, 14 countries had developed or demonstrated capacity in most technical areas. In addition, the reports showed the majority of capacities in each country had remained stable or increased since 2016 and 2017. The technical area antimicrobial resistance showed the largest numbers of capacity increases—for example, in the development of surveillance systems. GAO’s analysis of the progress reports found the most common challenges to developing GHS capacity were weaknesses in government institutions, constrained resources, and insufficient human capital. According to agency officials, some challenges can be overcome with additional U.S. government funding, technical support, or diplomatic efforts, but many other challenges remain outside the U.S. government’s control.

This is a public version of a sensitive report that GAO issued in February 2021. Information that USAID and CDC deemed sensitive has been omitted.

Why GAO Did This Study

The outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019 demonstrated that infectious diseases can lead to catastrophic loss of life and sustained damage to the global economy. USAID and CDC have led U.S. efforts to strengthen GHS—that is, global capacity to prepare for, detect, and respond to infectious disease threats and to reduce or prevent their spread across borders. These efforts include work related to the multilateral GHSA initiative, which aims to accelerate progress toward compliance with international health regulations and other agreements.

House Report 114-693 contained a provision for GAO to review the use of GHS funds. In this report, GAO examines, for the 5 fiscal years before the onset of the COVID-19 pandemic, (1) the status of USAID’s and CDC’s GHS funding and activities and (2) U.S. agencies’ assessments, at the end of fiscal year 2019, of GHSA partner countries’ capacities to address infectious disease threats and of challenges these countries faced in building capacity.

GAO analyzed agency, interagency, and international organization documents. GAO also interviewed agency officials in Washington, D.C., and Atlanta, Georgia, and in Ethiopia, Indonesia, Senegal, and Vietnam. GAO selected these four countries on the basis of factors such as the presence of staff from multiple U.S. agencies. In addition, GAO analyzed interagency assessments of countries’ capacities to address infectious disease threats in fiscal year 2019 and compared them with baseline assessments from 2016 and 2017.

For more information, contact David Gootnick at (202) 512-3149 or gootnickd@gao.gov.

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    The 2020 filing season occurred during the global COVID-19 pandemic, introducing challenges that the Internal Revenue Service (IRS) had to respond to quickly to fulfill its mission-essential functions. IRS took steps to protect the integrity of its operations, help ensure the health and safety of its employees, and provide relief to taxpayers. For example, IRS closed all its processing and service facilities for several weeks before re-opening with health and safety measures and extended the filing season deadline to July 15, 2020. IRS's 2020 processing of e-filed returns was generally on par with prior years. However, IRS's overall 2020 performance was significantly impacted by its reliance on manual processes such as for paper returns, and its limited ability to process returns remotely while processing centers were closed. As a result, as of December 2020, IRS had a significant backlog of unprocessed returns and taxpayer correspondence. Additionally, costs increased including interest on delayed refunds which exceeded $3 billion in fiscal year 2020. IRS has not revised its estimates for addressing all of the backlog due to operational uncertainties created by the pandemic. Doing so would help IRS determine how best to address the backlog and perform 2021 filing season activities. Refund Interest Paid to Taxpayers, Fiscal Years 2019 and 2020 GAO also found that about 23 percent of business tax returns were filed on paper even though an e-file option is available. IRS has not comprehensively identified barriers to business-related e-filing nor taken specific actions to increase e-filing. Doing so would help reduce the volume of costly paper-based work and improve services to business filers. Further, during the filing season, IRS transitioned nearly two-thirds of its phone customer service staff to telework, but was unable to do so for returns processing staff because most of its paper-based work is not set up to be performed remotely. As of late October 2020, about one-third of these staff remained on paid leave. Identifying and implementing alternative work assignments for staff that remain on paid leave would better support IRS operations and reduce costs. IRS has not fully identified and assessed all risks to the 2021 filing season—including those exacerbated by the COVID-19 pandemic—consistent with enterprise risk management practices. IRS identified some risks in October 2020 after GAO raised concerns, but did not fully address all essential elements of enterprise risk management, such as identifying options for risk response. Doing so would better position IRS to respond to risks during the 2021 filing season. In early 2021, after receiving a draft of this report, IRS provided additional information on its risk management efforts. GAO will review this information to determine if these efforts are sufficient to address its recommendation. During the annual tax filing season, generally from January to mid-April, IRS processes more than 150 million individual and business tax returns and provides telephone, correspondence, online, and in-person services to tens of millions of taxpayers. Due to the COVID-19 pandemic and to provide relief to taxpayers, IRS extended the 2020 filing and payment deadline by 3 months to July 15, 2020. GAO was asked to review IRS's performance during the 2020 filing season. This report (1) describes the changes IRS made to operations and services for the 2020 filing season due to the COVID-19 pandemic; (2) assesses IRS's performance on providing customer service and processing individual and business income tax returns during the 2020 filing season and compare to prior filing seasons, where appropriate; and (3) evaluates IRS's plans to prepare for the 2021 filing season. GAO analyzed IRS documents, filing season performance data, and employee timecard data; assessed IRS's plans for the 2021 filing season; and interviewed cognizant officials. GAO is making seven recommendations, including that IRS revise estimates for addressing its backlog; identify and address barriers to e-filing for business taxpayers; identify and consider implementing alternative work assignments for returns processing staff on paid leave; and identify and assess risks to the 2021 filing season. IRS agreed with four recommendations and disagreed with three. GAO believes that the recommendations remain warranted. For more information, contact Jessica Lucas-Judy at (202) 512-6806 or lucasjudyj@gao.gov.
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    In Crime Control and Security News
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  • COVID-19 Contracting: Observations on Contractor Paid Leave Reimbursement Guidance and Use
    In U.S GAO News
    Section 3610 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act generally authorizes agencies at their discretion to reimburse a contractor for the cost of paid leave incurred during the pandemic so that it can maintain its workforce in a ready state. Between March 2020—when the CARES Act was enacted—and early July 2020, the Office of Management and Budget (OMB) and each of the seven other agencies in GAO's review issued guidance to implement section 3610. While largely similar, GAO's work identified some differences across these guidance documents, including the extent to which the rates used to calculate these reimbursements could include profit or fees. OMB issued additional guidance on July 14, 2020, that addressed these differences and clarified how agencies should handle each situation. For example, OMB noted that profit or fees should generally not be reimbursed but provided options for addressing situations in which removing profit or fees would be burdensome. OMB advised agencies to report the amount reimbursed using section 3610 authority via contract modifications to the Federal Procurement Data System-Next Generation (FPDS-NG). After excluding reported obligations identified by agency officials as not associated with section 3610 authority, the reported data indicated that agencies made relatively little use of the authority through July 2020 (see figure). However, the Department of Energy (DOE) reimbursed contractors for almost $550 million in paid leave costs, stating it used existing obligations rather than adding funding via a contract modification. As a result, these amounts were not reported to FPDS-NG as section 3610 reimbursements. Obligations Using Section 3610 Authority Reported to the Federal Procurement Data System-Next Generation by Selected Agencies from January 31 to July 20, 2020 Agency officials and industry representatives GAO interviewed identified several factors that limited section 3610 obligations to date, including the absence of dedicated funding. With the exceptions of the Department of Defense (DOD) and DOE, agency officials GAO met with either did not expect a large amount or were uncertain about the level of future requests for section 3610 reimbursements. DOD officials stated that they expected requests amounting to billions of dollars. In March 2020, Congress passed the CARES Act, which provides over $2 trillion in emergency assistance and healthcare response for individuals, families, and businesses affected by COVID-19. The CARES Act also includes a provision for GAO to review federal contracting pursuant to authorities provided in the Act. This report addresses the implementation of section 3610 of the CARES Act, which authorizes federal agencies to reimburse contractors for paid leave related to the COVID-19 pandemic through September 30, 2020. This report describes (1) the extent to which section 3610 implementation guidance provided by selected federal agencies and OMB differs and (2) the extent to which selected federal agencies reported use of section 3610 authority through July 20, 2020. GAO reviewed relevant guidance issued by OMB and the seven federal agencies with contract obligations greater than $10 billion in fiscal year 2019; interviewed cognizant officials from OMB and each agency; and reviewed comments provided by and spoke with representatives from four industry associations. GAO also analyzed public procurement data reported by selected agencies to FPDS-NG through July 20, 2020 on the use of section 3610 authority. GAO will continue to assess how agencies are implementing section 3610 authority as part of a series of planned reports regarding the federal response to COVID-19. For more information, contact Timothy J. DiNapoli at (202) 512-4841 or dinapolit@gao.gov.
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  • Man-Made Chemicals and Potential Health Risks: EPA Has Completed Some Regulatory-Related Actions for PFAS
    In U.S GAO News
    The Environmental Protection Agency (EPA) has completed three of six selected regulatory-related actions for addressing per- and polyfluoroalkyl substances (PFAS) outlined in EPA's PFAS Action Plan . (See fig.) For two of the three completed actions, the steps EPA took were also in response to the National Defense Authorization Act for Fiscal Year 2020 (FY20 NDAA): After proposing a supplemental significant new use rule in February 2020, EPA met a June 2020 deadline set in the FY20 NDAA when the EPA Administrator signed the final rule. Among other things, under the final rule, articles containing certain PFAS as a surface coating, and carpet containing certain PFAS, can no longer be imported into the U.S. without EPA review. EPA incorporated 172 PFAS into the Toxics Release Inventory in June 2020. The FY20 NDAA directed EPA to take this action, extending EPA's original planned action to explore data for listing PFAS chemicals to the inventory. Finally, in March 2020, EPA completed a third regulatory-related action, not required under the FY20 NDAA, when the agency proposed a preliminary drinking water regulatory determination for two PFAS—an initial step toward regulating these chemicals in drinking water. Status of Six Selected Regulatory-Related Actions in the Environmental Protection Agency's (EPA) Per- and Polyfluoroalkyl Substances (PFAS) Action Plan Planned action Status Propose a supplemental significant new use rule. Complete Explore data for listing PFAS chemicals to the Toxics Release Inventory. Complete Propose a drinking water regulatory determination. Complete Monitor PFAS in drinking water. Ongoing Explore industrial sources of PFAS that may warrant potential regulation. Ongoing Continue the regulatory process for a hazardous substances designation. Ongoing Source: GAO analysis of EPA's 2019 PFAS Action Plan. | GAO-21-37 Three of the six selected regulatory-related actions are ongoing, and EPA's progress on these actions varies. For example: As of August 2020, EPA was developing a proposed rulemaking for a nationwide drinking water monitoring rule that includes PFAS, which EPA officials said the agency intends to finalize by December 2021. EPA planned to continue the regulatory process for designating two PFAS as hazardous substances under the Comprehensive Environmental Response, Compensation, and Liability Act, would allow the agency to require responsible parties to conduct or pay for cleanup. On January 14, 2021, EPA issued an advance notice of proposed rulemaking for the hazardous substances designation to get public comment and data to inform the agency's ongoing evaluation of the two PFAS. Beginning in the 1940s, scientists developed a class of heat- and stain-resistant chemicals—PFAS—that are used in a wide range of products, including nonstick cookware, waterproof clothing, and some firefighting foams. PFAS can persist in the environment for decades or longer. The Centers for Disease Control and Prevention has found that most people in the U.S. have been exposed to two of the most widely studied PFAS, likely from consuming contaminated water or food. According to EPA, there is evidence that continued exposure above certain levels to some PFAS may lead to adverse health effects. In February 2019, EPA issued its PFAS Action Plan , which outlined 23 planned actions to better understand PFAS and reduce their risks to the public. GAO was asked to examine the status of regulatory-related actions in EPA's plan. For six regulatory-related actions GAO selected in EPA's PFAS Action Plan , this report examines (1) the number of actions that are complete and the steps EPA took to complete them and (2) the number of actions that are ongoing and EPA's progress toward completing them. GAO first identified those actions in the PFAS Action Plan that may lead to the issuance of federal regulations or could affect compliance with existing regulations. GAO then assessed the status of the actions by reviewing EPA documents and examining EPA's response to related FY20 NDAA requirements. For more information, contact J. Alfredo Gómez at (202) 512-3841 or gomezj@gao.gov.
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  • Department of Justice Announces Arrests in Conspiracy and Dog Fighting Ring Investigation
    In Crime News
    An indictment was unsealed today charging 11 individuals on a 136-count federal indictment including violations of drug conspiracy, drug possession, and drug possession with the intent to distribute, and violations of the dog fighting prohibitions of the federal Animal Welfare Act, and conspiracy to commit the same.
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  • Eighth Circuit Reverses Tax Court in Case Involving Statute of Limitations and Bona Fide Residency
    In Crime News
    The Eighth Circuit Court of Appeals issued a published opinion on Tuesday, Dec. 15, 2020, holding for the government in a case involving the statute of limitations on assessment in the context of bona fide residency in the U.S. Virgin Islands (USVI), announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division.
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  • Fire Extinguisher Manufacturer Ordered to Pay $12 Million Penalty for Delay and Misrepresentations in Reporting Product Defects
    In Crime News
    A federal judge today ordered Walter Kidde Portable Equipment Inc. (Kidde) to pay a $12 million civil penalty in connection with allegations that the company failed to timely inform the Consumer Product Safety Commission (CPSC) about problems with fire extinguishers manufactured by the company, the Department of Justice announced.
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