COVID-19: Efforts to Increase Vaccine Availability and Perspectives on Initial Implementation

What GAO Found

The federal government has taken several actions to increase the availability of COVID-19 vaccine doses and indicated it expects to have enough doses available for all adults in the United States by the end of May. As of April 1, 2021, the government had purchased 1.2 billion doses of one- and two-dose regimen vaccines. Also, vaccine companies reported making additional manufacturing sites operational, among other actions to expand capacity and mitigate challenges.

Federal officials said projecting future availability of vaccine doses can be difficult, in part because of uncertainty surrounding complex manufacturing processes. Given this uncertainty, coupled with the significant manufacturing and distribution increases needed to have enough vaccine doses available for all adults, managing public expectations is critical. GAO’s prior work has found that timely, clear, and consistent communication about vaccine availability is essential to ensure public confidence and trust, especially as initial vaccine implementation did not match expectations.

COVID-19 Vaccination Site

Stakeholders GAO interviewed identified challenges with initial COVID-19 vaccine implementation. For example, some stakeholders said states often did not have information critical to distribution at the local level, such as how many doses they would receive and when. The federal government has begun initiatives—outlined in a national response strategy—to improve implementation, such as creating new vaccination sites. In its March 2021 distribution strategy, CDC provided a high-level description of its activities and noted that more details would be included in future reports to Congress. To meet the expectations set by recent announcements, such as the planned expansion of vaccine eligibility to all adults and the introduction of tools to help individuals find vaccines, it will be imperative that the federal government effectively coordinate and communicate its plans, as GAO recommended in September 2020.

Why GAO Did This Study

Providing the public with safe and effective vaccines to prevent COVID-19 is crucial to mitigating the public health and economic impacts of the disease. The U.S. had almost 30 million reported cases and over 545,000 reported deaths as of March 27, 2021. The federal government took a critical step in December 2020 in authorizing the first two COVID-19 vaccines and beginning distribution of doses across the nation. The government had distributed about 180.6 million vaccine doses, and about 147.8 million doses had been administered, as of March 27, 2021, according to Centers for Disease Control and Prevention (CDC) data.

The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines, among other issues, actions the federal government has taken to increase the availability of COVID-19 vaccine doses, and challenges with initial vaccine implementation—that is, prioritizing, allocating, distributing, and administering vaccine doses—identified by stakeholders and steps the federal government has taken to improve vaccine implementation.

GAO reviewed documents from the Departments of Defense and Health and Human Services, transcripts of public briefings, data from CDC, and interviewed or received written responses from federal officials, vaccine company representatives, and select public health stakeholders. GAO incorporated technical comments from the Department of Defense, the Department of Health and Human Services, and the Federal Emergency Management Agency as appropriate.

For more information, contact Alyssa M. Hundrup at (202) 512-7114 or hundrupa@gao.gov.

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    The Department of Defense (DOD) has reviewed the financial assistance it provides for off-base child care services and taken steps to standardize this assistance across the military services. Specifically, in August 2018, representatives of each service agreed to work toward a goal of standardizing the only element of the fee assistance calculation that varies among the services—the maximum provider rate. DOD officials said that they assess progress toward this goal each year, but have not set a definite deadline for full standardization. With respect to assistance for off-base child care at high-cost duty stations, DOD's 2020 report on its child care programs states that the Air Force, Marines, and Navy review high-cost locations annually, and the services may approve increased provider rate caps for specific high-cost locations. In addition, it states that the services may grant waivers allowing increased fee assistance for individual families experiencing hardship. DOD has also assessed factors that contribute to wait lists for on-base child care. According to DOD’s report, DOD found that wait lists are the result of a myriad of factors, including staff shortages and facility conditions that vary across service locations. Officials said DOD has worked for several years to analyze and address wait lists. In 2017, DOD launched a web portal that consolidates child care data across the services and in August 2019, DOD officials began monthly monitoring of wait list data from this portal. These data allowed DOD to identify four geographic regions and six additional locations that account for the majority of wait lists, and focus their efforts on addressing the issues affecting these regions and locations, according to the report. DOD officials said that any requests for additional resources to help address wait lists must be handled through the individual services’ budgeting processes. DOD offers child care in a variety of on- and off-base settings for children of military families. In fiscal year 2020 these child care programs received nearly $1.2 billion in federal funds; in addition, parents pay a portion of the costs. The National Defense Authorization Act for Fiscal Year 2020 required DOD to report on elements of its financial assistance to off-base child care providers and wait lists for on-base child care, and included a provision for GAO to review DOD's report. This report describes DOD's assessment of (1) financial assistance provided to off-base child care providers, and (2) its efforts to reduce wait lists for child care at military bases. GAO reviewed DOD's report on this assessment, interviewed DOD officials, and reviewed relevant federal law. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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  • F-35 Sustainment: DOD Needs to Address Key Uncertainties as It Re-Designs the Aircraft’s Logistics System
    In U.S GAO News
    The Autonomic Logistics Information System (ALIS) is integral to supporting F-35 aircraft operations and maintenance. However, F-35 personnel at 5 locations GAO visited for its March 2020 report cited several challenges. For example, users at all 5 locations we visited stated that electronic records of F-35 parts in ALIS are frequently incorrect, corrupt, or missing, resulting in the system signaling that an aircraft should be grounded in cases where personnel know that parts have been correctly installed and are safe for flight. At times, F-35 squadron leaders have decided to fly an aircraft when ALIS has signaled not to, thus assuming operational risk to meet mission requirements. GAO found that DOD had not (1) developed a performance-measurement process for ALIS to define how the system should perform or (2) determined how ALIS issues were affecting overall F-35 fleet readiness, which remains below warfighter requirements. DOD recognizes that ALIS needs improvement and plans to leverage ongoing re-design efforts to eventually replace ALIS with a new logistics system. However, as DOD embarks on this effort, it faces key technical and programmatic uncertainties (see figure). Uncertainties about the Future F-35 Logistics Information System These uncertainties are complicated and will require significant planning and coordination with the F-35 program office, military services, international partners, and the prime contractor. For example, GAO reported in March 2020 that DOD had not determined the roles of DOD and the prime contractor in future system development and management. DOD had also not made decisions about the extent to which the new system will be hosted in the cloud as opposed to onsite servers at the squadron level. More broadly, DOD has experienced significant challenges sustaining a growing F-35 fleet. GAO has made over 20 recommendations to address problems associated with ALIS, spare parts shortages, limited repair capabilities, and inadequate planning. DOD has an opportunity to re-imagine the F-35's logistics system and improve operations, but it must approach this planning deliberately and thoroughly. Continued attention to these challenges will help ensure that DOD can effectively sustain the F-35 and meet warfighter requirements. The F-35 Lightning II is DOD's most ambitious and costly weapon system in history, with total acquisition and sustainment costs for the three U.S. military services who fly the aircraft estimated at over $1.6 trillion. Central to F-35 sustainment is ALIS—a complex system that supports operations, mission planning, supply-chain management, maintenance, and other processes. A fully functional ALIS is critical to the more than 3,300 F-35 aircraft that the U.S. military services and foreign nations plan to purchase. Earlier this year, DOD stated that it intends to replace ALIS with a new logistics system. This statement highlights (1) current user challenges with ALIS and (2) key technical and programmatic uncertainties facing DOD as it re-designs the F-35's logistics system. This statement is largely based on GAO's March 2020 report on ALIS ( GAO-20-316 ), as well as previous F-35 sustainment work. GAO previously recommended that DOD develop a performance-measurement process for ALIS, track how ALIS is affecting F-35 fleet readiness, and develop a strategy for re-designing the F-35's logistics system. GAO also suggested that Congress consider requiring DOD to develop a performance-measurement process for its logistics system. DOD concurred with GAO's recommendations and is taking actions to address them. For more information, contact Diana C. Maurer at (202) 512-9627 or maurerd@gao.gov.
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  • On the UN Human Rights Council’s Embrace of Authoritarian Regimes
    In Crime Control and Security News
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    In Crime News
    Continuing the practice of new administrations, President Biden and the Department of Justice have begun the transition process for the U.S. Attorneys.
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  • MS-13 Member Pleads Guilty to Racketeering Conspiracy Involving Murder and Attempted Murder
    In Crime News
    A Maryland man pleaded guilty today to conspiracy to participate in a racketeering enterprise by murdering a suspected rival gang member and attempting to murder two other victims, in connection with his MS-13 gang activities. 
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  • Commercial Space Transportation: FAA Should Examine a Range of Options to Support U.S. Launch Infrastructure
    In U.S GAO News
    Launch providers support the deployment of people and payloads, such as national security and commercial satellites or research probes, into space. The majority of these providers told GAO that U.S. space transportation infrastructure—located at sites across the country—is generally sufficient for them to meet their customers' current requirements. This situation is in part a result of the launch providers' investments in launch sites, along with state and local funding. Launch providers and site operators alike seek future improvements but differ on the type and location of infrastructure required. Some launch providers said that infrastructure improvements would be required to increase launch capacity at existing busy launch sites, while a few site operators said that new infrastructure and additional launch sites would help expand the nation's overall launch capacity. U.S. Commercial Launch Sites with Number of FAA-Licensed Launches, January 2015 - November 2020 The Federal Aviation Administration (FAA) was directed by statute to make recommendations to Congress on how to facilitate and promote greater investments in space transportation infrastructure, among other things. However, FAA's initial draft report was limited because it focused only on two existing FAA programs, rather than a range of options. FAA officials stated that they did not examine other options because of limited time and resources, and that the two identified programs could be implemented quickly because FAA has administrative authority to manage them. Leading practices in infrastructure investment emphasize the importance of conducting an examination of potential approaches, which can help identify how best to support national interests; avoid overlap or duplication of federal effort; and enhance, not substitute, participation by non-federal stakeholders. An examination may also help identify alternatives to making funding available, such as increasing efficiency and capacity through technology improvements. By focusing only on these existing programs, FAA may overlook other options that better meet federal policy goals and maximize the effect of any federal investment. Although FAA has already prepared its initial report to respond to the statute, it still has opportunities, such as during subsequent mandated updates, to report separately on potential approaches. Demand for commercial space launches is anticipated to increase in the coming years. FAA, the agency responsible for overseeing the sites where these launches occur, was directed by statute to submit a report—and update it every 2 years until December 2024—that makes recommendations on how to facilitate and promote greater investments in space transportation infrastructure. The FAA Reauthorization Act of 2018 included a provision for GAO to review issues related to space transportation infrastructure. This report discusses launch providers' and site operators' views on the sufficiency of infrastructure in meeting market demand and assesses the steps FAA has taken to identify options for federal support of space transportation infrastructure, among other things. GAO reviewed relevant regulations; assessed FAA's actions against GAO-identified leading practices; and interviewed FAA officials, commercial launch providers, and representatives from U.S. commercial launch sites that GAO identified as having hosted an FAA-licensed launch since 2015 or having an FAA launch site operator license as of August 2020. GAO recommends that FAA examine a range of potential options to support space transportation infrastructure and that this examination include a discussion of trade-offs. DOT partially concurred, noting that it would provide its mandated report to Congress but not conduct a new examination of a range of options. GAO continues to believe that such an examination is warranted. For more information, contact Heather Krause at (202) 512-2834 or KrauseH@gao.gov.
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  • Principal Deputy Associate Attorney General Claire McCusker Murray Closing Remarks for the 2020 Violence Against Women Tribal Consultation
    In Crime News
    Thanks so much for that kind introduction, Laura. And thanks to all the tribal leaders who joined us this week and helped to make the 15th Annual Violence Against Women Government-to-Government Tribal Consultation a meaningful step towards enhancing the safety of American Indian and Alaska Native women and their communities.
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  • Founder and Chairman of a Multinational Investment Company and a Company Consultant Convicted of Bribery and Public Corruption are Sentenced to Prison
    In Crime News
    The founder and chairman of a multinational investment company and a company consultant were sentenced to prison today for orchestrating a bribery scheme involving independent expenditure accounts and improper campaign contributions.
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    In Crime News
    An indictment was unsealed today charging John David McAfee with tax evasion and willful failure to file tax returns, announced Principal Deputy Assistant Attorney General Richard E. Zuckerman of the Justice Department’s Tax Division and U.S. Attorney D. Michael Dunavant for the Western District of Tennessee. The June 15, 2020 indictment was unsealed following McAfee’s arrest in Spain where he is pending extradition.
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  • Pennsylvania Man Charged with Trafficking in Endangered and Invasive Fish
    In Crime News
    A Pennsylvania man has been indicted in the Western District of Pennsylvania for violating the Lacey Act.
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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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  • Indiana Man Pleads Guilty to Hate Crime for Making Racially-Charged Motivated Threats Toward Black Neighbor and to Unlawful Possession of Firearms
    In Crime News
    The Justice Department announced today that Shepherd Hoehn, 51, pleaded guilty in federal court to making threats to intimidate and interfere with his neighbor, who is Black, because of the neighbor’s race and because the neighbor was exercising his right to fair housing, in violation of 42 U.S.C. § 3631. Hoehn also pleaded guilty to unlawfully possessing firearms, in violation of 18 U.S.C. § 922(g).
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  • Duff to Retire as Administrative Office Director; Judge Mauskopf Named as Successor
    In U.S Courts
    James C. Duff has announced he will retire as the director of the Administrative Office of the U.S. Courts on Jan. 31. Chief Justice John G. Roberts, Jr., has appointed Chief Judge Roslynn R. Mauskopf, of the Eastern District of New York, as his successor, effective Feb. 1.
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  • Member of White Supremacist Gang Pleads Guilty to Violent Assault and Conspiracy to Sell Firearms
    In Crime News
    A member of the Aryan Circle (AC) pleaded guilty Thursday to his role in an October 2016 violent assault, as well as conspiring to sell firearms to a convicted felon. Another individual pleaded guilty on April 19, to conspiring with members of the AC to sell methamphetamine.
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