Sécurité Sanitaire Mondiale: Financements, activités et évaluations de l’USAID et des CDC relatifs aux capacités des pays à faire face aux menaces des maladies infectieuses avant l’apparition du COVID-19

This is the French language highlights associated with GAO-21-359.

Constats du GAO

Au 31 mars 2020, l’Agence des États-Unis pour le développement international (USAID) et les Centres des États-Unis pour le contrôle et la prévention des maladies (CDC) ensemble avaient alloué un total de plus de 1,2 milliard de dollars et avaient décaissé environ 1 milliard pour financer des activités de sécurité sanitaire mondiale (global health security – GHS), sur des fonds affectés durant les années fiscales 2015 à 2019. L’USAID et les CDC ont soutenu des activités de renforcement des capacités des pays dans 11 domaines techniques en rapport avec la lutte contre les maladies infectieuses. Les fonds engagés ont soutenu des activités de GHS dans pas moins de 34 pays, dont 25 étaient partenaires du Programme d’action pour la sécurité sanitaire mondiale (Global Health Security Agenda – GHSA).

Activités soutenues par les États-Unis en Éthiopie pour renforcer la sécurité sanitaire mondiale

Les évaluations de responsables officiels des États-Unis portant sur les capacités de 17 pays partenaires du GHSA à faire face aux menaces des maladies infectieuses révèlent qu’à la fin de l’année fiscale 2019, la plupart de ces pays avaient des capacités dans chacun des 11 domaines techniques retenus mais connaissaient diverses difficultés. Les équipes-pays interinstitutionnelles américaines réalisent des évaluations de capacités bisannuelles dont le personnel du siège de l’USAID et des CDC se sert pour assurer un suivi des progrès des pays. Selon les évaluations de l’année fiscale 2019, 14 pays avaient développé ou démontré des capacités dans la plupart des domaines techniques. Les rapports ont démontré par ailleurs que la plupart des capacités de ces pays étaient restées stables ou avaient augmenté par rapport à 2016 et 2017. C’est dans le domaine technique de la résistance aux antimicrobiens qu’ont été enregistrées les plus fortes augmentations de capacités, par exemple dans la mise en place de systèmes de surveillance. Dans son analyse des rapports, le GAO a constaté que les difficultés les plus fréquentes en matière de renforcement des capacités de GHS étaient les faiblesses des institutions de l’État et le manque de ressources et de capital humain. Selon des responsables officiels, certaines de ces difficultés peuvent être résolues par plus de financement, d’assistance technique ou d’efforts diplomatiques des États-Unis, mais beaucoup d’autres restent en dehors du control du gouvernement des États-Unis.

Ceci est une version publique d’un rapport confidentiel émis par le GAO en février 2021; les informations jugées sensibles par l’USAID et les CDC en ont été omises.

Pourquoi cette étude du GAO

La survenue de la maladie à coronavirus (COVID-19) en décembre 2019 a démontré que les maladies infectieuses peuvent causer des pertes de vie catastrophiques et infliger des dommages durables à l’économie mondiale. L’USAID et les CDC dirigent les efforts déployés par les États-Unis pour renforcer la sécurité sanitaire mondiale, à savoir la capacité mondiale à se préparer à lutter contre les maladies infectieuses, à les détecter et à y riposter, ainsi qu’à réduire ou à prévenir leur propagation sur le plan international. Ces efforts comprennent des activités liées au GHSA, qui vise à accélérer l’obtention de progrès en matière de respect des règlements et autres accords mondiaux relatifs à la santé.

Le rapport 114-693 de la Chambre des représentants prévoyait un examen, par le Government Accountability Office (GAO), de l’emploi des fonds de GHS. Dans ce rapport, le GAO examine, pour les 5 années fiscales précédant le début de la pandémie de COVID-19 : 1) l’état des financements et des activités de l’USAID et des CDC relatifs à la GHS et 2) des évaluations d’organismes des États -Unis, réalisées à la fin de l’année fiscale 2019, portant sur les capacités des pays partenaires du GHSA à faire face aux menaces des maladies infectieuses et sur les difficultés que ces pays ont dû relever pour renforcer leurs capacités.

Le GAO a analysé des documents d’organismes des États-Unis et d’organismes internationaux. Le GAO a aussi interviewé des responsables officiels à Washington et à Atlanta (Géorgie) ainsi qu’en Ethiopie, en Indonésie, au Sénégal et au Viet Nam. Le GAO a choisi ces pays sur la base de critères tels que la présence de personnel de multiples organismes des États-Unis. Le GAO a également analysé des évaluations interinstitutionnelles des capacités des pays à faire face aux menaces des maladies infectieuses durant l’année fiscale 2019 et les a comparées aux données de référence de 2016 et 2017.

Pour plus d’informations, s’adresser à David Gootnick au (202) 512-3149 ou à gootnickd@gao.gov.

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    What GAO Found The U.S. Capitol Police (Capitol Police) may benefit from applying practices to help implement recommendations from auditing entities, such as those from GAO and the Capitol Police Office of the Inspector General (OIG). These effective practices include the following: Provide management oversight over the prompt remediation of deficiencies and delegate authority. Federal internal control standards state that management should oversee the prompt remediation of deficiencies. This should be done by communicating the corrective actions to the appropriate personnel and delegating authority for completing these actions. Communicate regularly with auditing entities on the status of recommendations. Engagement between Capitol Police and auditing agency leaders could provide important leadership attention to help ensure actions are taken to implement recommendations. Work with Congress to address recommendations. Congress plays a key role in providing oversight and maintaining focus on recommendations from audit entities. For example, federal agencies, including the Capitol Police, are required to report on the implementation status of public recommendations. Further, agencies can also assess the need for legislation to address recommendations and report their findings to Congress. Follow key organizational transformation practices . As the Capitol Police takes steps to implement recommendations from auditing entities, the agency may benefit from following key organizational transformation practices, such as (1) setting implementation goals and a timeline, (2) dedicating an implementation team to manage the transformation process, and (3) involving employees to obtain their ideas and gain their ownership for the transformation. Coordination between the Capitol Police and its Board is critical to addressing its recommendations. The Capitol Police Board (the Board) is charged with oversight of the Capitol Police. Given the oversight role of the Board, the Capitol Police may need approval from the Board in order to take actions to address recommendations from auditing entities. GAO's 2017 work on the Board assessed whether the Board, in fulfilling its role in overseeing the Capitol Police, had developed and implemented policies that incorporate leading practices to facilitate accountability, transparency, and effective external communication. In that effort, GAO examined the Board's main governing document, its Manual of Procedures, and determined that it fully incorporated one leading practice and partially incorporated five others. Specifically, the Board's manual did develop processes for the internal functions of the Board but did not address any Board responsibilities in ensuring that any audit findings and recommendations to the Capitol Police were promptly resolved. By incorporating leading practices into its manual, the Board can ensure it is facilitating accountability, transparency, and effective external communication as it fulfills its oversight role of the Capitol Police. Why GAO Did This Study The attack on the U.S. Capitol on January 6, 2021, highlighted the critical need to identify and address deficiencies in the management and security functions of the Capitol Police. Various auditing entities have work ongoing related to the attack on the U.S. Capitol, including GAO and the Capitol Police OIG. It is important that the Capitol Police is well positioned to respond to existing and future recommendations from auditing entities. To do so, Capitol Police will also need to work closely with the Capitol Police Board, which has varied and wide-ranging oversight roles and responsibilities per statute. This statement discusses (1) effective practices for addressing recommendations from auditing agencies and (2) GAO's open recommendation to the Capitol Police Board from February 2017. To identify effective practices for addressing recommendations, GAO reviewed reports and testimonies issued from July 2003 through March 2021 that discussed the implementation of GAO recommendations, federal internal control standards, and organizational transformation. GAO also reviewed its February 2017 report on the Capitol Police Board, and used information gathered from its recommendation follow up efforts with the Capitol Police Board in 2020 and 2021.
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  • Justice Department Defends Health Care Workers from Being Forced to Perform Abortions with Vermont Lawsuit
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    The Justice Department’s Civil Rights Division today filed a civil lawsuit in Vermont federal court against the University of Vermont Medical Center (UVMMC) for violating the federal anti-discrimination statute known as the “Church Amendments.” That statute prohibits health care entities like UVMMC from discriminating against health care workers who follow their conscience and refuse to perform or assist with abortions.
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  • Request Denied for Preliminary Injunction on the Administration’s Landmark New Regulations Implementing under the National Environmental Policy Act
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    On Friday, Sept. 11, Judge James T. Jones of the U.S. District Court for the Western District of Virginia denied a request for a preliminary injunction against the Administration’s landmark new regulations implementing under the National Environmental Policy Act (NEPA), which will modernize environmental review, enhance the information-gathering process, and facilitate more meaningful public participation in the protection of our environment. These regulations had not been subject to a major revision since 1978, when they were first promulgated, and they were in need of modernization to improve the infrastructure permitting process.
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  • International Trio Indicted in Austin for Illegal Exports to Russia
    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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  • Defense Health Care: Actions Needed to Define and Sustain Wartime Medical Skills for Enlisted Personnel
    In U.S GAO News
    What GAO Found The military departments have not fully defined, tracked, and assessed wartime medical skills for enlisted medical personnel. The departments have defined these skills for 73 of 77 occupations. However, among other issues, the Army and the Air Force have not defined skills for numerous highly-skilled subspecialties that require additional training and expertise, such as Army Critical Care Flight Paramedics. Subspecialty personnel are key to supporting lifesaving medical care during deployed operations. The Army does not consistently track wartime medical skills training for enlisted medical personnel in its official system. The military departments are not able to fully assess the preparedness of enlisted medical personnel because, according to officials, they have not developed performance goals and targets for skills training completion. As a result, the military departments lack reasonable assurance that all enlisted medical personnel are ready to perform during deployed operations. The Department of Defense (DOD) has not fully developed plans and processes to sustain the wartime medical skills of enlisted medical personnel. While the Defense Health Agency (DHA) has initiated planning efforts to assess how the military departments' three primary training approaches sustain readiness (see figure), these efforts will not fully capture needed information. For example, DHA's planned metrics to assess the role of military hospitals and civilian partnerships in sustaining readiness would apply to a limited number of enlisted occupations. As a result, DHA is unable to fully assess how each training approach sustains readiness and determine current and future training investments. Approaches to Train Enlisted Medical Personnel's Wartime Medical Skills DOD officials have identified challenges associated with implementing its training approaches. For example, DOD relies on civilian partnerships to sustain enlisted medical personnel's skills, but DOD officials stated that licensing requirements and other issues present challenges to establishing and operationalizing civilian partnerships. DOD has not analyzed or responded to such risks, and may therefore be limited in its ability to sustain wartime medical skills. Why GAO Did This Study DOD has over 73,000 active-duty enlisted medical personnel who must be ready to provide life-saving care to injured and ill servicemembers during deployed operations, using their wartime medical skills. Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's efforts to maintain enlisted personnel's wartime medical skills. This report examines, among other objectives, the extent to which (1) the military departments have defined, tracked, and assessed enlisted personnel's wartime medical skills, and (2) DOD has developed plans and processes to sustain these skills and assessed risks associated with their implementation. GAO analyzed wartime medical skills checklists and guidance; reviewed plans for skills sustainment; and interviewed officials from DOD and military department medical commands and agencies, and nine inpatient military medical treatment facilities.
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    Beam Suntory Inc. (Beam), a Chicago-based company that produces and sells distilled beverages, has agreed to pay a criminal monetary penalty of $19,572,885 to resolve the department’s investigation into violations of the Foreign Corrupt Practices Act (FCPA).
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    In Crime News
    Two Virginia attorneys were sentenced today on federal extortion charges for their roles in a scheme to extort a multinational chemicals company by threatening to inflict substantial financial and reputational harm on the company if their demands for a $200 million payment disguised as a purported “consulting agreement” were not met.
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    A federal jury convicted a Virginia man today for downloading images and videos depicting children as young as four years old being sexually abused and for utilizing the Darknet to solicit and promote child pornography.
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  • United States Reaches Agreement to Protect New Orleans Waterways and Lake Pontchartrain
    In Crime News
    Today, the U.S. Environmental Protection Agency (EPA) and the Department of Justice announced a settlement with the Churchill Downs Louisiana Horseracing Company LLC, d/b/a Fair Grounds Corporation (Fair Grounds) that will resolve years of Clean Water Act (CWA) violations at its New Orleans racetrack. Under the settlement, Fair Grounds will eliminate unauthorized discharges of manure, urine and process wastewater through operational changes and construction projects at an estimated cost of $5,600,000. The company also will pay a civil penalty of $2,790,000, the largest ever paid by a concentrated animal feeding operation in a CWA matter.
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  • Navy Ships: Timely Actions Needed to Improve Planning and Develop Capabilities for Battle Damage Repair
    In U.S GAO News
    What GAO Found The Navy has identified several challenges with using its regular maintenance capability (which restores ships to fully operational status) to provide battle damage repairs during a great power conflict. Challenges include—the lack of established doctrine for battle damage repair, unclear command and control roles, and a shortage of repair capacity. The Navy Process for Repairing Ships Damaged in Battle The Navy is in the early stages of determining how it will provide battle damage repair during a great power conflict. Eight organizations are responsible for the Navy's 15 battle damage repair planning efforts, however the Navy has not designated an organization to lead and oversee these efforts. Without designated leadership, the Navy may be hindered in its efforts to address the many challenges it faces in sustaining its ships during a great power conflict. The Navy develops ship vulnerability models during a ship's acquisition to estimate damage during a conflict. These models are also used to inform war games that refine operational approaches and train leaders on decision-making. However, the Navy does not update these models over a ship's decades-long service life to reflect changes to key systems that could affect model accuracy. As a result, it lacks quality data on ship mission-critical failure points to inform its analysis of battle damage repair needs. Without periodically assessing and updating its models to accurately reflect the ship's mission-critical systems, the Navy has limited its ability to assess and develop battle damage repair capabilities necessary to sustain ships in a conflict with a great power competitor. Why GAO Did This Study The ability to repair and maintain ships plays a critical role in sustaining Navy readiness. After the Cold War, the Navy divested many wartime ship repair capabilities. With the rise of great power competitors capable of producing high-end threats in warfare, the Navy must now be prepared to quickly salvage and repair damage to a modern fleet. House Report 116-120, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, included a provision for GAO to assess the Navy's efforts to identify and mitigate challenges in repairing battle-damaged ships during a great power conflict. GAO's report (1) discusses the challenges the Navy has identified in using its regular maintenance capability for battle damage repair, and (2) evaluates the extent to which the Navy has begun developing the battle damage repair capability it requires to prevail in a great power conflict. GAO reviewed relevant guidance and assessed reports on naval war games and other documentation to identify challenges that may impede the planning and repair of battle-damaged ships and efforts to improve the repair capability for a great power conflict.
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  • Environment and Natural Resources Division Distributes Memorandum Summarizing Enforcement Policies and Priorities
    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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  • Queens Acupuncture Clinic Owner Charged with Tax Crimes
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    A federal grand jury in Brooklyn, New York, returned an indictment on June 4, charging a New York City woman with conspiring to defraud the United States and aiding and assisting in the preparation of a false tax return.
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  • Priority Open Recommendations: Department of Labor
    In U.S GAO News
    What GAO Found In April 2020, GAO identified seven priority recommendations for the Department of Labor (DOL). Since then, DOL has implemented one of those recommendations by taking steps to collect better data on how advanced technologies are changing the workplace, which can help DOL and policymakers design training programs that meet the job needs of the future. In May 2021, GAO identified three additional priority recommendations for DOL, bringing the total number to nine. These recommendations involve the following areas: stronger protections for wage earners; enhancing unemployment insurance; and better protections for retirees. DOL's continued attention to these issues could lead to significant improvements in government operations. Why GAO Did This Study Priority open recommendations are the GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional and/or executive branch decision-making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015 GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations. For more information, contact Thomas Costa at (202) 512-4769 or costat@gao.gov.
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  • Federal Protective Service: Better Documented Cost Estimates Could Help Stakeholders Make Security Decisions
    In U.S GAO News
    What GAO Found The Federal Protective Service (FPS) provides security and protection at more than 9,000 federal facilities. FPS performs a variety of security activities in conjunction with the General Services Administration (GSA), which functions as the landlord at most of these facilities, and with the federal agencies, which occupy these facilities as tenants. These stakeholders can provide important perspectives on FPS's performance of its key activities (see figure). The Federal Protective Service's Three Key Security Activities Stakeholders expressed satisfaction with many aspects of FPS's performance of key activities but also identified aspects where they thought FPS could make improvements. For example, stakeholders expressed satisfaction with the professionalism of FPS personnel and commended FPS's coordination in responding to law enforcement incidents. However, some stakeholders said they would like to see FPS oversee contract guards more often. In addition, many stakeholders said that FPS could improve the cost estimates in its security assessment reports. GAO's review of FPS's Facility Security Assessment reports found that cost estimates for the recommended security measures lacked information that could help stakeholders make decisions to accept or reject FPS's recommendations. Specifically, recent reports for 27 selected buildings did not document (1) the assumptions FPS made to produce the cost estimates (e.g., the scope of work) and (2) the sources FPS used to create the estimate. In one report, for example, FPS recommended additional fencing and provided a cost estimate with an exact dollar amount. However, FPS did not document the assumptions it used to develop the estimate, such as the height and linear feet of fence or the fencing material. According to GAO's Cost Estimating and Assessment Guide , cost estimates should provide information about the assumptions and sources used to develop an estimate so that decision-makers can understand the level of uncertainty around the estimate. By providing detailed information about the cost estimates in Facility Security Assessment reports, FPS could better inform stakeholders and potentially increase implementation of recommended security measures, designed to increase the safety of people and property at these facilities. Why GAO Did This Study Over one million employees and a range of visitors seeking services at federal facilities depend on FPS to ensure the safety of both people and property at these locations. This report examines stakeholders' perspectives on FPS's performance of three key activities. GAO identified key activities from FPS data on work hours. GAO held discussion groups with stakeholders from 27 randomly selected facilities where FPS provided guard services and responded to incidents in fiscal year 2019 and analyzed stakeholder responses from 2017-2019 to GSA's and FPS's feedback instruments. These sources of stakeholder views are not representative but collectively provide insight into stakeholders' satisfaction with how FPS is performing key activities. GAO also reviewed agency documents; interviewed FPS officials about FPS's performance; and compared FPS's security assessment reports to criteria in GAO's Cost Estimating and Assessment Guide .
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