Covid-19: Key Insights from GAO’s Oversight of the Federal Public Health Response

What GAO Found

More than a year after the U.S. declared COVID-19 a public health emergency, the pandemic continues to result in catastrophic loss of life and substantial damage to the economy. It also continues to lay bare the fragmented nature of our public health sector, the fragility of the nation’s medical supply chain, and longstanding disparities in health care access, treatment, and outcomes.

GAO has made 44 recommendations to federal agencies. Of these recommendations, 16 relate to the following public health topics:

COVID-19 Testing. GAO has made two recommendations to date to improve the federal government’s efforts in diagnostic testing for COVID-19, critical to controlling the spread of the virus. In January 2021, GAO recommended that the Department of Health and Human Services (HHS) develop and make publicly available a comprehensive national COVID-19 testing strategy.

Vaccines and Therapeutics. GAO has made two recommendations to improve transparency, communication, and coordination around the government’s efforts to develop, manufacture, and distribute vaccines and therapeutics to prevent and treat COVID-19. For example, in September 2020, GAO recommended that HHS establish a time frame for a national vaccine distribution and administration plan that follows best practices, with federal and nonfederal coordination.

Medical Supply Chain. GAO has made seven recommendations for the federal government to respond to vulnerabilities highlighted by the pandemic in the nation’s medical supply chain, including limitations in personal protective equipment and other supplies necessary to treat individuals with COVID-19. In January 2021, GAO recommended that HHS establish a process for regularly engaging with Congress and nonfederal stakeholders as the agency refines and implements its supply chain strategy for pandemic preparedness, to include the role of the Strategic National Stockpile.

COVID-19 Health Disparities. GAO has made three recommendations to improve COVID-19 data by race and ethnicity, as available data show communities of color bear a disproportionate burden of COVID-19 positive tests, cases, hospitalizations, and deaths. In September 2020, GAO recommended that the Centers for Disease Control and Prevention involve key stakeholders to help ensure the complete and consistent collection of demographic data.

COVID-19 Data. GAO has made two recommendations to improve the collection of data needed to respond to COVID-19 and prepare for future pandemics. GAO recommended in January 2021 that HHS establish an expert committee to help systematically define and ensure the collection of standardized data across the relevant federal agencies and related stakeholders; the absence of such data hinders the ability of the government to respond to COVID-19, communicate the status of the pandemic with citizens, or prepare for future pandemics. 

Although the responsible agencies generally agreed with the majority of the 16 recommendations, only one has been fully implemented. GAO maintains that implementing these recommendations will improve the federal government’s public health response and ability to recover as a nation.

Why GAO Did This Study

As of February 17, 2021, the U.S. had about 27 million cumulative reported cases of COVID-19 and more than 486,000 reported deaths, according to the Centers for Disease Control and Prevention. The country also continues to experience serious economic repercussions.

Five relief laws, including the CARES Act, have appropriated $3.1 trillion to address the public health and economic threats posed by COVID-19. The CARES Act also includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to COVID-19.

This testimony summarizes GAO’s insights from its oversight of the federal government’s pandemic response in a series of comprehensive reports issued from June 2020 through January 2021. In particular, the statement focuses on the public health response, including testing, vaccines and therapeutics, medical supply chain, health disparities, and health data.

GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials and stakeholders for the series of reports on which this testimony is based. See https://www.gao.gov/coronavirus/.

What GAO Recommends

GAO has made 44 recommendations for agencies and four matters for congressional consideration in its comprehensive series of bimonthly reports on the federal response to COVID-19 over the last year. GAO will issue its next report in this series in March 2021.

For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.

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    The number of disability claims for veterans living abroad—in foreign countries or U.S. territories—increased 14 percent from fiscal years 2014 to 2019. During this time period, claims processing time frames improved. In fiscal year 2019, the Veterans Benefits Administration (VBA) of the Department of Veterans Affairs (VA) approved comparable percentages of disability claims for veterans living abroad and domestically—63 percent and 64 percent respectively. However, for a subset of these claims—those where veterans likely received a disability medical exam scheduled by Department of State (State) embassy staff—approval rates were often lower. Veterans' access to disability medical exams abroad improved as VBA has increasingly relied on contracted examiners, rather than embassy-referred examiners, to conduct these exams. According to VBA, this shift expanded the pool of trained examiners abroad and increased the frequency and depth of VBA's quality reviews for contract exams. These quality reviews help VBA and its contractor identify and address common errors, according to VBA and contractor officials. However, several factors continue to limit some veterans' ability to access quality disability medical exams (see figure). Factors That Impair the Access of Veterans Living Abroad to Quality Disability Medical Exams Unknown quality of certain exams: A subset of veterans living abroad receive disability medical exams from an embassy-referred provider. VBA does not systematically assess the quality of these exams. Without doing so, VBA cannot determine if such exams affect the approval rates of veterans who receive them or contribute to longer processing times and are unable to make informed decisions about their use. Travel reimbursement: Under current VA regulations, VA is not authorized to reimburse veterans for travel expenses for certain services incurred in foreign countries as it is for those incurred within the United States, including U.S. territories. Consequently, some veterans living in foreign countries may be unable to afford to travel to exams. Examiner reimbursement: The Veterans Health Administration's (VHA) Foreign Medical Program reimburses examiners referred by embassy staff via paper checks in U.S. currency. These checks may be slow to arrive and not accepted by foreign banks, according to State and other officials and staff we interviewed. Such payment issues can deter examiners from being willing to conduct disability medical exams and thus limit veterans' access to these exams in foreign countries. Of the roughly 1 million disability claims VBA processed in fiscal year 2019, 18,287 were for veterans living abroad. Veterans living abroad are entitled to the same disability benefits as those living domestically, but GAO previously reported that veterans living abroad may not be able to access disability medical exams as readily as their domestic counterparts. VBA uses medical exam reports to help determine if a veteran should receive disability benefits. GAO was asked to review the disability claims and exam processes for veterans living abroad. Among other things, this report examines disability claims trends for veterans living abroad and these veterans' ability to access quality disability medical exams. GAO analyzed VBA claims data for fiscal years 2014 to 2019; assessed data reliability; reviewed relevant federal laws, regulations, policies, and contract documents; and interviewed employees of VBA, State, and other stakeholders. GAO is making five recommendations, including that VBA assess the quality of embassy-referred exams, VBA and VHA assess whether to reimburse beneficiaries for travel to disability medical exams in foreign countries, and that VBA and VHA pay examiners located by embassy staff electronically. The Department of Veterans Affairs concurred with GAO's recommendations. For more information, contact Elizabeth Curda at (202) 512-7215 or curdae@gao.gov.
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    In Travel
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  • Kenyan National Indicted for Conspiring to Hijack Aircraft on Behalf of the Al Qaeda-Affiliated Terrorist Organization Al Shabaab
    In Crime News
    The Department of Justice announced the unsealing of an indictment charging Cholo Abdi Abdullah with six counts of terrorism-related offenses arising from his activities as an operative of the foreign terrorist organization al Shabaab, including conspiring to hijack aircraft in order to conduct a 9/11-style attack in the United States.  Abdullah was arrested in July 2019 in the Philippines on local charges, and was subsequently transferred on Dec. 15, 2020 in connection with his deportation from the Philippines to the custody of U.S. law enforcement for prosecution on the charges in the indictment.  Abdullah was transported from the Phillippines to the United States yesterday, and is expected to be presented today before Magistrate Judge Robert W. Lehrburger in Manhattan federal court.  The case is assigned to United States District Judge Analisa Torres.
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  • Service Acquisitions: DOD’s Report to Congress Identifies Steps Taken to Improve Management, But Does Not Address Some Key Planning Issues
    In U.S GAO News
    The Department of Defense (DOD) relies on contractors to provide a wide array of services, including support for management, information technology, and weapon systems. DOD obligated about $190 billion on service acquisitions in fiscal year 2019 (see figure). Department of Defense Obligations for Service Acquisitions by Military Department and Defense Agencies and Field Activities, Fiscal Year 2019 Since 2001, GAO has highlighted service acquisitions as an issue for oversight within the DOD Contract Management area in its High-Risk List. Among other things, the High-Risk List and GAO's prior work have identified that: DOD's service requirements reviews were narrowly focused on individual contracts rather than entire capability portfolios, DOD's efforts to use its inventory of contracted services to inform management decisions were hindered by data collection issues, and DOD's budget exhibits did not clearly identify service acquisitions. In October 2020, DOD issued a report to Congress describing its current mechanisms and plans for managing and overseeing service contracts. GAO found that this report addresses some of the key issues identified in GAO's High-Risk List, but does not address others. Requirement reviews. The DOD report summarizes guidance the department issued in January 2020 that links requirements reviews to budget trade-offs, and clarifies the relationship between service acquisition management and category management activities. Category management is an Office of Management and Budget-led, government-wide initiative to reorganize government spending around fewer, larger contracts and use the government's purchasing power to buy like a single enterprise. These efforts have the potential to improve how requirements reviews support budget trade-off decisions within and across capability portfolios. Inventory of contracted services. The DOD report discusses the department's recent transition to the government-wide system other federal agencies use to collect data for their inventories of contracted services, and explains that this transition is intended to reduce the burden of data collection for defense contractors and improve compliance. However, the report does not discuss how DOD plans to use this data to inform decision-making and workforce planning, the key issues GAO has identified in past work. Future-year spending plans. The DOD report does not discuss our finding in a prior report that DOD could improve its ability to strategically manage service acquisitions by improving visibility on future budgetary requirements. Instead, DOD's report states that DOD plans to address capability gaps in budget planning for service contracts in a separate effort in response to a provision in the National Defense Authorization Act for Fiscal Year 2020 that might address GAO's recommendations. DOD officials told GAO they are working to better understand that provision before initiating their effort. The Senate report on the National Defense Authorization Act for Fiscal Year 2020 included a provision for the Secretary of Defense to submit a report to the congressional defense committees on current mechanisms for overseeing defense service contracts, and for GAO to assess this report. DOD issued its report to Congress in the second week of October 2020. This GAO report assesses the extent to which that DOD report addresses service acquisition issues identified in GAO's High-Risk List and other products. GAO reviewed DOD's report to Congress on defense service acquisitions and GAO's past reports on defense service acquisitions, including GAO's 2019 High-Risk List and 11 other products issued between 2011 and 2018. GAO collected and assessed additional documentation from DOD offices and military departments, and interviewed officials from these offices and departments to collect additional information about DOD plans to improve service acquisitions. For more information, contact Timothy DiNapoli at (202) 512-4841 or DiNapoliT@gao.gov.
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  • Assistant Attorney General Beth A. Williams Delivers Opening Remarks at the Federalist Society, Colorado Lawyers Chapter Panel Discussion: “Reviewing the Supreme Court’s 2019/20 Term”
    In Crime News
    Thank you for that kind introduction, Will, and for the invitation to join you today. Though I wish I could join you in person, even at this distance, it is a great pleasure to be here with you all.
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  • Lifting Self-Imposed Restrictions on the U.S.-Taiwan Relationship
    In Crime Control and Security News
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  • Arkansas Project Manager Pleads Guilty to Bank Fraud and False Statements in Connection with COVID-Relief Fraud
    In Crime News
    A project manager employed by a major retailer has pleaded guilty to bank fraud charges for filing fraudulent bank loan applications seeking more than $8 million in forgivable Paycheck Protection Program (PPP) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
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  • Judges, Lawyers Bring Life Skills to Virtual Classroom Activities for Home and School
    In U.S Courts
    High school teachers can bring real-life civics into their virtual lessons when they invite federal judges and volunteer attorneys to facilitate a civil discourse and decision-making simulation with students at home or in the classroom this fall.
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    In Crime Control and Security News
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  • Statement of the Department of Justice Antitrust Division on the Closing of Its Investigation of London Stock Exchange Group and Refinitiv
    In Crime News
    Assistant Attorney General Makan Delrahim of the Antitrust Division of the U.S. Department of Justice issued the following statement today in connection with the closing of the division’s investigation into the proposed acquisition of Refinitiv by the London Stock Exchange Group (LSEG): “After an extensive review of the proposed transaction, the Antitrust Division determined that the combination of LSEG and Refinitiv is unlikely to result in harm to competition or American consumers.”
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  • Ohio Man Pleads Guilty to Paying Co-Conspirator to Illegally Dump Drums of Hazardous Waste
    In Crime News
    An Ohio man pleaded guilty in the Southern District of Ohio before U.S. District Judge Edmund A. Sargus Jr. to conspiring to illegally transport and dispose of hazardous waste at several area apartment complexes.
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  • Orlando Cordia Hall Executed for 1994 Kidnapping and Murder of 16-Year-Old Girl
    In Crime News
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  • Financial Audit: Federal Deposit Insurance Corporation Funds’ 2020 and 2019 Financial Statements
    In U.S GAO News
    GAO found (1) the financial statements of the Deposit Insurance Fund (DIF) and of the Federal Savings and Loan Insurance Corporation (FSLIC) Resolution Fund (FRF) as of and for the years ended December 31, 2020, and 2019, are presented fairly, in all material respects, in accordance with U.S. generally accepted accounting principles; (2) although internal controls could be improved, the Federal Deposit Insurance Corporation (FDIC) maintained, in all material respects, effective internal control over financial reporting relevant to the DIF and to the FRF as of December 31, 2020; and (3) with respect to the DIF and to the FRF, no reportable instances of noncompliance for 2020 with provisions of applicable laws, regulations, contracts, and grant agreements GAO tested. In commenting on a draft of this report, FDIC stated that it was pleased to receive unmodified opinions on the DIF's and the FRF's financial statements. In regard to the significant deficiency in internal control over contract payment review processes, FDIC stated that it began taking steps to address this issue and will work to enhance control activities and expand monitoring capabilities in this area. Further, FDIC stated that it recognizes the essential role a strong internal control program plays in an agency achieving its mission. FDIC added that its commitment to sound financial management has been and will remain a top priority. Section 17 of the Federal Deposit Insurance Act, as amended, requires GAO to audit the financial statements of the DIF and of the FRF annually. In addition, the Government Corporation Control Act requires that FDIC annually prepare and submit audited financial statements to Congress and authorizes GAO to audit the statements. This report responds to these requirements. For more information, contact James R. Dalkin at (202) 512-3133 or dalkinj@gao.gov.
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  • Justice Department Announces National Response Center and Offer to Bring Assistance to Minneapolis Police Department to Support Law Enforcement and Safe Communities Through Fair Policing
    In Crime News
    The Justice Department, in an announcement by Assistant Attorney General for the Civil Rights Division Eric S. Dreiband, Principal Deputy Assistant Attorney General of the Office of Justice Programs (OJP) Katharine T. Sullivan, and U.S. Attorney for the District of Minnesota Erica H. MacDonald, unveiled a new National Response Center Initiative and offered the assistance to the Minneapolis Police Department (MPD) to support law enforcement, and review, enhance and reform policies and practices to prevent the use of excessive force. The BJA Law Enforcement Training and Technical Assistance Response Center will be a national resource for all state, local, and tribal law enforcement agencies.
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