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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    In Crime News
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    In Crime News
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    In U.S GAO News
    The Federal Emergency Management Agency (FEMA) took steps prior to the 2018 disasters in the Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawaii to facilitate response in the region, where time and distance from the continental United States create unique challenges. For instance, FEMA increased the capacity of two Pacific-area supply distribution centers and helped develop area specific disaster response plans. FEMA and its federal partners, such as the Department of Defense (DOD), had varied response roles, which local officials in the CNMI, Guam, and Hawaii considered effective. For example, DOD provided temporary roof repair for disaster survivors in the CNMI. Damage from Typhoon Yutu in the Commonwealth of the Northern Mariana Islands (left) and the Kilauea Volcano Eruption in Hawaii (right) As of October 2020, FEMA obligated $877 million—more than 70 percent of which was for Individual and Public Assistance missions—following the 2018 disasters and made progress addressing some region specific challenges. However, FEMA has not fully addressed housing assistance issues in the CNMI. For example, it experienced delays implementing its Permanent Housing Construction program in the CNMI due to contracting shortfalls and lack of experienced staff. As of October 2020, only about 30 percent of homes were completed and returned to survivors. GAO found that these housing assistance challenges are consistent with lessons learned from prior FEMA missions in other remote areas of the U.S. Developing guidance that addresses lessons learned in the Permanent Housing Construction program could help streamline assistance to disaster survivors. GAO also identified delays in FEMA's obligation of Public Assistance program funds—used to repair or replace disaster-damaged public infrastructure such as utilities, roads, and schools—in the CNMI, Guam, and Hawaii. Specifically, on average, it took over a year for FEMA to approve funds for projects awarded after the 2018 disasters. FEMA and local officials identified potential reasons for the delays, including cost estimation challenges. FEMA established cost factors in the CNMI to account for higher construction costs, and GAO found that FEMA collects some data on the timeliness of individual steps in the process. However, FEMA has not analyzed the data to help identify causes of the delays, which could allow it to target solutions to address them. The CNMI, Guam, and Hawaii experienced an unprecedented number of natural disasters in 2018—including typhoons, earthquakes, mudslides, and volcanic eruptions. FEMA is the lead federal agency responsible for helping states and territories prepare for, respond to, and recover from natural disasters. Due to the remoteness of Hawaii and the Pacific territories, disaster response and recovery can be challenging. Title IX of the Additional Supplemental Appropriations for Disaster Relief Act of 2019 includes a provision for GAO to review FEMA's response and recovery efforts for 2018 natural disasters, including those in the Pacific region. This report examines (1) how FEMA and its federal partners prepared for and responded to the 2018 disasters in the CNMI, Guam, and Hawaii; and (2) the extent to which FEMA assisted the CNMI, Guam, and Hawaii in recovering from the 2018 natural disasters. GAO analyzed program documents, response plans, and data on FEMA obligations, expenditures, and grant process steps as of October 2020; interviewed federal, state, territorial, and local officials; and visited disaster-damaged areas in Hawaii. GAO is making four recommendations, including that FEMA (1) incorporate lessons learned into Permanent Housing Construction guidance; and (2) use performance data to identify and address inefficiencies in the Public Assistance program. The Department of Homeland Security concurred, and FEMA is taking actions in response. For more information, contact Chris Currie at (404) 679-1875 or curriec@gao.gov.
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    In Crime News
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  • Disaster Recovery: COVID-19 Pandemic Intensifies Disaster Recovery Challenges for K-12 Schools
    In U.S GAO News
    Local education officials in natural disaster-affected areas told us the Coronavirus Disease 2019 (COVID-19) pandemic has exacerbated mental health issues and contributed to lost instructional time, staff burnout, delays in recovery projects, and financial strain in their communities. These officials explained that after the natural disaster, restoring students' mental health was a top priority. Many local education officials said that the services needed to treat trauma and other disaster-related mental health issues were not readily available in their areas, and some noted that providing mental health services has been especially difficult during the pandemic. For example, one official said that because half of her students live in poverty, they usually access mental health services through the school, and were cut off from those services during the pandemic. Some local education officials said they were also particularly worried about the effects of the pandemic on their low-income and other at-risk students, noting that these students are especially vulnerable to learning loss. The COVID-19 pandemic has also affected districts by slowing progress on some disaster recovery projects. For example, an official in a district affected by wildfire said that an effort to restore running water to damaged school buildings was delayed due the pandemic. The U.S. Department of Education (Education) supported school recovery efforts by awarding nearly $1.4 billion to assist schools in over 30 states and U.S. territories with recovery from presidentially-declared major disasters occurring between 2017 and 2019, although some local education officials reported difficulty in using these grant funds during the pandemic. Education provided this funding through the Immediate Aid to Restart School Operations (Restart) and the Project School Emergency Response to Violence grant programs, among others. Local education officials from several districts and counties said that they are using or planning to use Education disaster grants to provide mental health services to students and cover other costs associated with re-opening, such as additional transportation services, but that during the pandemic this was sometimes challenging. For example, officials in two counties said that timeframes for using Restart funds, which expire after 2 years, were too short for long-term recovery needs such as mental health services, particularly with the compounding effects of the pandemic. Education officials said that grantees may request waivers to extend the end dates of these grants and that as of October 2020, no Restart grantees who experienced a 2018 disaster had done so. With regard to oversight, Education officials said they paused on-site monitoring efforts for recent disaster grants as a result of the pandemic, but have continued to hold quarterly phone calls with Restart grantees. These grantees have noted some challenges related to the grant program but have not discussed specific technical assistance needs, according to Education officials. More than 260 presidentially-declared major disasters have occurred since 2017, affecting every state and several U.S. territories, according to the Federal Emergency Management Agency (FEMA). Many of these natural disasters have had devastating effects, including rendering K-12 school facilities unusable for lengthy periods of time. These schools are now experiencing the compounding challenge of recovering from natural disasters while managing effects of the COVID-19 pandemic. Social distancing practices and building closures are meant to keep staff and students safe, but may also complicate recovery efforts for disaster-affected districts. The Additional Supplemental Appropriations for Disaster Relief Act of 2019 provided funds for GAO to audit issues related to presidentially-declared major disasters that occurred in 2018. We reviewed (1) how the COVID-19 pandemic has affected schools recovering from recent natural disasters; and (2) support Education has provided to help school recover from recent natural disasters and how the COVID-19 pandemic has affected schools' use of these resources. We interviewed 29 local education officials representing over 50 school districts in California, Commonwealth of the Northern Mariana Islands, Florida, and Hawaii, which were selected because they were affected by a diverse set of major natural disasters in 2018 that occurred in a mix of populated and less-populated areas. In addition, through a national school superintendents association, we convened a discussion group of superintendents who have experienced natural disasters and mentor other affected districts. Finally, we reviewed federal guidance and interviewed Education officials. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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