Secretary Antony J. Blinken With Roula Khalaf of The Financial Times

Antony J. Blinken, Secretary of State

London, England

Grosvenor House Hotel

QUESTION:  Antony Blinken, good to see you, and thanks for being with us at the Global Boardroom.

SECRETARY BLINKEN:  Great to join you.  Thank you.

QUESTION:  Let’s start – let’s start with the pandemic.  The U.S. wants to lead the global response to COVID-19.  We always hear that.  But at the same time, there have been criticism that, one, you’re not sharing patents; two, there is an effective ban on exports of some raw materials that are needed in – for vaccine production elsewhere; and there’s also been criticism of Washington’s response to what’s – what – the horrendous situation right now in India, where China, Russia, others have really been ahead, at least in speaking out and in trying to help.

So my question to you is:  Are you leading in the way that you would want?  And is China winning the vaccine – in vaccine diplomacy?

SECRETARY BLINKEN:  Well, I think we are leading, and I think we’re going to be leading increasingly effectively.  Because let’s step back for one second and look at what we’ve done, but also critically where we’re going.  On day one of this administration, President Biden put us back into the World Health Organization, which is critical.  And of course, we are now the leading contributor in the world to COVAX, the facility that makes vaccines available, particularly to low and middle-income countries – $2 billion invested, another 2 billion between now and the end of 2022 as other countries step up.  And of course, that’s not as obvious in some ways or not as direct.  It doesn’t seem to have an American flag on it.  But it is a critical vehicle for making available vaccines.  There have been some challenges with COVAX.  It’s been underfunded to date.  And of course, India had been a primary supplier, and for obvious reason that’s been pulled back.  But COVAX remains an important facility.

In addition, besides that, we’ve worked closely with partners in the so-called Quad – with Australia, with Japan, and India – to find other ways to increase vaccine production and access over time.  We made some initial contributions, loans to our closest land neighbors, Canada and Mexico.  And now that our population has full access to vaccines, we are in a place where, with some of the vaccines that we’ve contracted for, including the AstraZeneca vaccines, of which there are about 60 million, we’ll be able to move out and make those available.

We share this conviction.  No one in the world will be fully safe until in effect everyone is.  And as long as the virus is replicating somewhere, it could be mutating.  And as long as it’s mutating, it could come back to bite anyone, including the United States.  So we’re really leaning into this.

QUESTION:  So you are starting to lean into this now, but would it have made sense months ago to – for the U.S. and for other countries, including the UK, to say we’re going to vaccinate our populations, all of those, let’s say, over 40, and then we’re going to start sharing with the rest of the world; rather than, we’re going to vaccinate as much as possible as quickly as possible, and then if we’ve got leftovers, we’ll give them away?

SECRETARY BLINKEN:  Well, I think everyone has an obligation and feels an obligation to vaccinate their own populations.  But beyond that, just as it’s necessary for our own security and well-being to see the rest of the world vaccinated, so is it important for the security and well-being of the rest of the world to see Americans vaccinated.  This works in both directions.  And I think we’ve had to do both.  Now we’re in a position where I believe we can.

So we’re putting in place a process for the vaccines we contracted for that can be made available, but also critically looking at ways that we can ramp up production with other countries around the world so that there is a constant and growing supply.  We also don’t know what some of the contingencies are going to be going forward.  Are people going to need booster shots at some point?  As younger people are able to get the vaccine, we have to provide for that.  All of that’s being factored in.

And then maybe a word about India, because it’s so, so important.  This has touched Americans profoundly, because we have, as does the UK, such deep connections to India, to the Indian people.  And we’ve seen the images.  We’ve talked to colleagues and friends.  We’ve made a very significant effort very quickly to try to get to India as much as we could of what it needs most critically in this moment.  Oxygen supplies, the various things that go into holding and distributing oxygen, PPE, therapeutics, precursors to the extent that they’re needed for vaccines – all of that has started to flow.  We’re in direct, regular contact with our counterparts from India.

Beyond that, what I’ve seen really is an amazing mobilization not just of the United States Government, but of our private sector, and of Indian Americans as well.  I was on a call a week ago with virtually every leading CEO – it was a who’s who – all wanting to help.  And the government, our government, is coordinating those efforts.  So we are doing everything we can.

India came to our assistance early on in our hour of need when we were having real struggles with COVID-19, providing millions and millions, for example, of protective masks.  We remember that, and we’re determined to do everything we can to help now.

QUESTION:  Let me ask you – President Biden said in his speech to Congress last month that he hears from other world leaders that they’re happy to see the U.S. back, but they often ask for how long.  How are you dealing with such concerns, and what are you hearing from your counterparts?

SECRETARY BLINKEN:  Well, I’ve heard some of the same thing.  I’ve heard a real – a profound satisfaction that we are back, that we are engaged, that we’re working closely with allies and partners and others, both on a direct bilateral basis, but also through institutions – multilateralism, as it’s called in the lingo of foreign policy.

And sure, there’s a question about the durability.  I understand that.  But I think that the more we can show success, the more we can show especially to our own people that this kind of engagement, this kind of work with other countries is actually delivering results for them, the more we’re going to be able to sustain that going forward.  That really is the, I think, the challenge.  If we demonstrate that our kind of engaged foreign policy is making a real difference in the lives of our fellow citizens, they’re going to support that, and they’re going to support that going forward irrespective of who’s president.

QUESTION:  Let’s talk about China, the biggest strategic challenge that the U.S. now faces.  You laid out your positions, both you and the Chinese in Alaska, and the U.S. said it’s going to stand up to its values.  The Chinese weren’t too happy with that, and said they wouldn’t accept interference in the core issues, whether it’s Tibet, Taiwan, Xinjiang.  What did you learn in Alaska about the Chinese approach that you may not have known?

SECRETARY BLINKEN:  I’m not sure we learned anything new about their approach.  And we did, after the public fireworks, have about eight or ten hours of very direct conversation covering a whole series of issues – the adversarial, the competitive, and the cooperative.  Because all three are features of our relationship.  But we wanted to have an opportunity to speak directly and clearly to our Chinese counterparts just so that there are no misunderstandings and no miscommunication, especially about what we’re all about.

And the case that we made to them is as follows:  We are not about trying to contain China, or to hold China down.  What we are about is upholding the international rules-based order that we’ve invested so much in over many decades, that has served us well, but not just us; we think, for all its imperfections, it’s served the world pretty well – including, by the way, China.  And anyone who takes action that would disrupt that order, that would challenge that order, that would seek to undermine it, we’re going to stand up and protect it.

So to your points, when China says to us things that we complain about, whether it’s Xinjiang and the egregious treatment of Uyghurs or whether it’s Taiwan or whether it’s Tibet or whether it’s Hong Kong, that these are internal matters, they don’t regard us, that’s simply not true.  When it comes to Xinjiang, for example, China signed on to the Universal Declaration of Human Rights at the United Nations.  When it is not making good on its —

QUESTION:  But a lot of countries signed up to the Declaration of Human Rights and —

SECRETARY BLINKEN:  Well, that’s the point, but our point is we take this seriously.  And this is part of the rules-based order.  And if you’re not going to abide by your commitments, we’re going to say something about it.  And we have the right to.  With regard to Taiwan, if you’re —

QUESTION:  I want to come back – I want to come back —

SECRETARY BLINKEN:  Go ahead.

QUESTION:  — to the whole human rights questions.  But I’m interested in what happens next.  What are you – what – and what are you hoping to accomplish this year, for example?

SECRETARY BLINKEN:  Look, we’re engaged with China in a whole variety of places on a variety of issues as is part of the normal course of doing business.  We’re engaged with them right now on Iran and the effort to return to compliance with the JCPOA.  There are going to be no doubt discussions about North Korea and its nuclear program going forward.  We’re talking about climate.  President Xi was – participated in President Biden’s climate summit.  There are a whole series of areas where we have clearly overlapping interests and we’re engaged.  But beyond that, we want the engagement that we have with China to be results-oriented and practically focused on getting things done, not just talk for the sake of talk.  That’s what we’re focused on.

QUESTION:  So one thing that you said is that the U.S. wants to rebuild to demonstrate the resilience of its own democracy and then approach China from a position of strength.  I’m still trying to figure out what the end goal is.  You said it’s not to contain China, but do you think that you can convince China to actually change its behavior?

SECRETARY BLINKEN:  I think in some areas, particularly when it’s not just the United States.  It is countries around the world that feel aggrieved by some practice that China is engaged in coming together.  That stands a much better chance.  Let’s just take economic and commercial issues, for example.  When it’s the United States alone complaining about them, we’re 25 percent of world GDP.  If we’re working closely with other similarly aggrieved countries, mostly democracies, that might well be 40, 50, 60 percent of world GDP.  That’s a lot harder for China to ignore.

And we’ve seen in the past when countries that have been unhappy about the conduct of the government in Beijing on a particular issue actually engage in it together, we’re more likely to get China to make changes.  I don’t want to exaggerate the prospects, but at the very least, countries should be standing up in defense of a rules-based order that has served all of us very well.

QUESTION:  You’ve talked about alliances and the fact that you want to work with allies and to coordinate sanctions and other measures.  China can wield a lot of economic pressure.  And we’ve seen that play out where – countries that feel that they are trapped between the U.S. and China, including in Europe.  Are you confident that you can get people on your side without them having to succumb to Chinese pressure?

SECRETARY BLINKEN:  Well, a couple of things.  First, we’re not asking countries to choose.  We recognize that countries have complicated relationships, including with China, including economic relationships.  And the issue is not that those need to be cut off or ended.  But there are certain basic criteria.  There are certain basic rules that all of us, we think, should abide by.

And in particular when it comes to trade and commerce, we want to see a race to the top, not a race to the bottom when it comes to basic investment standards, when it comes to making sure that we’re paying mind to the environment, when we’re making sure that we’re protecting the rights of workers, when we’re protecting intellectual property and technology theft.  All of those things need to be front and center, but that’s not inconsistent with countries engaging with China, but we want to see them engaging, as I said, to a high standard, not a low standard.  And that’s profoundly in their interest.  Again, when countries are doing that together, it’s more likely that China will have to play by those rules, not rules it arbitrarily sets that prove to be a race to the bottom, not the top.

QUESTION:  There’s a lot of Cold War rhetoric and a lot of people assuming that we have entered now into a new Cold War and making comparisons with the Soviet Union.  Would you describe the current situation as a new Cold War?

SECRETARY BLINKEN:  I resist putting labels on most relationships, including this one, because it’s complex.  And as I said, if you look at it, we’ve seen unfortunately in recent years the government in Beijing acting more repressively at home and aggressively abroad.  And when I look at the relationship, I see adversarial aspects.  I see competitive aspects.  I see cooperative aspects – all three.

And what we’ve said and what we believe strongly is whatever aspect we’re looking at, we have to be able to engage China from a position of strength, and that means a few things.  It means actually working with allies and partners, not disparaging them.  That is a position of strength.  It means leaning in and engaging in the vast array of multilateral and international organizations because that’s where so many of the rules are made.  That’s where the norms are shaped.  And if we’re not leaning in, we know that Beijing is likely to be trying to do so in our place.  And it means critically – and maybe most critically – actually investing in ourselves, investing in our own people, in our workers, in our technology, in our infrastructure.  If we do that, then I think we’re going to be fine.

QUESTION:  Do you think – do you think companies should be preparing for possible conflict with China over Taiwan?

SECRETARY BLINKEN:  Look, we’ve had over many years consistent with the “one China” policy, consist with the Taiwan Relations Act, the six communiques – the Three Communiques, excuse me, the Six Assurances – all of this language that you hear.  The bottom line is we have managed Taiwan, I think, quite well and quite effectively.  What is very troubling and very concerning is that Beijing seems to be taking a different approach, acting aggressively.  And I think that we are committed to making sure that Taiwan has the means to defend itself.  That commitment is not going away.  And at the same time, I think it would be a very serious mistake for anyone to try to disrupt by force the existing status quo.

QUESTION:  Okay.  So let me ask you this:  Do you think that U.S. companies should be sponsoring the Beijing Olympics?

SECRETARY BLINKEN:  We’re still a ways away from the Beijing Olympics, something that we’ll look at in the months ahead.  We’ll certainly talk to other countries, to allies and partners, to get their perspective, but that’s not something we’ve focused on yet.

QUESTION:  And have you decided who to invite yet to the U.S. Democracy Summit?  There are sort of two views of this in Europe.  one is that this will very helpful, especially vis-a-vis China; the other is that what you risk doing is carving up the world into blocs, and to go back to our Cold War – my Cold War question, initiating a new Cold War.

SECRETARY BLINKEN:  So this is not about initiating a Cold War.  This is all about doing our part to make sure that democracy is strong, resilient, and meeting the needs of its people.  You know what we’ve seen over the last 15 years is unfortunately something of a democratic recession around the world: countries falling back on the basic metrics of democracy.  The United States has had its own challenges visible for the world to see when it comes to democracy.

So we think this is – President Biden thinks this is an important moment for democracies to come together, think together, reason together, and ultimately act together.  A big part of this is going to be looking at ourselves and the challenges that we face and ultimately, how we can be more effective in delivering for our citizens, because that is the test.  And when you hear autocracies challenging democracies, the argument they’re making is they can’t deliver; we’re delivering more effectively, we’re delivering more efficiently.  We have to be able to answer that question with conviction and with confidence that no, the system that we believe in is more effective in making a real difference in the lives of our citizens.  So a big part of this conversation is going to be talking about ways we can do that better.

QUESTION:  Talking – well, you mentioned human rights before, and obviously, you personally have made a huge commitment on human rights.  But a lot of people would say that they see tough rhetoric but not so tough action.  For example, you have said that you would have to work and that you will work with the crown prince of Saudi Arabia, even though you did publish – the administration did publish the report on Jamal – the murder of Jamal Khashoggi, which clearly states that the crown prince was ultimately responsible.

So should we imagine that the crown prince will one day be invited to the White House, for example?

SECRETARY BLINKEN:  Well, to my knowledge, the crown prince has no plans anytime soon to come to the United States, but pause for one second on that question, and you mentioned it already.  We put out a report with the imprimatur of the United States making clear responsibility for the heinous murder of Mr. Khashoggi.  And of course, this had been reported in the news, in the FT, among other places.  It’s not that there was necessarily anything new factually, but to have that with the imprimatur of the United States behind it, I think in and of itself was meaningful.

Second, of course, we sanctioned a number of people and entities that were directly involved in Mr. Khashoggi’s murder.  But beyond that, we put in place a new rule, a new system to make sure, to the best of our ability, that anyone who would seek to repress or threaten or do harm to people speaking out against their country from the United States – we’d make sure that they no longer had the benefit of being in the United States.  And not just with regard to Saudi Arabia; across the board.

But when we’re thinking about how do we advance our values – not just our interests, but our values – one strong value we have as well as an interest is ending the war in Yemen, which is the worst humanitarian situation in the world.  And that’s speaking volumes right now.  Well, we need some help from Saudi Arabia to do that.  Are we better off in terms of advancing that value, totally cutting off the relationship with Saudi Arabia, or trying to recalibrate it as we’ve done, making clear what is acceptable and what’s not, but also continuing to work with them?  I think we’re better off making sure we can find ways to work together consistent with our values.

QUESTION:  So one of the more recent developments is that the Saudis and the Iranians appear to be talking.  We broke a story about a week ago.  Is that something that you’ve encouraged?

SECRETARY BLINKEN:  Specifically?  No.  But generally, if they’re talking, if others are —

QUESTION:  If they’re talking, sir, you can tell me.

SECRETARY BLINKEN:  Well, I don’t want to speak for them, but if they’re talking, I think that’s generally a good thing.  Talking is usually better than the alternative.  Does it lead to results?  That’s another question.  But talking, trying to take down tensions, trying to see if there’s a modus vivendi, trying to get countries to take actions on things they’re doing that you don’t like – that’s good, that’s positive.

And look, we have, I think, still, when we’re acting at our best, a greater ability than any other country to mobilize others in positive, collective action.  But if countries are talking directly together without us in the middle, that’s maybe even better.

QUESTION:  So let’s talk about Iran.  There are elections – presidential elections coming up and it does look like a hardliner will be elected president.  Now, not to exaggerate the role of a president or of a foreign minister in Iran, but how is that going to affect the indirect negotiations that are now underway?

SECRETARY BLINKEN:  Look, it’s very hard to predict, and certainly, I don’t want to get into hypotheticals about what one outcome or another in Iran’s elections – what impact that would or wouldn’t have on any nuclear negotiations.  And to your point, I think it’s clear who the decider is in the Iranian system, and that’s the supreme leader, and he’s the one who has to make the fundamental decisions about what Iran’s approach would be.

We’ve had serious discussions in Vienna that have gone on now for several weeks.  I think we’ve seen some progress at least in demonstrating the seriousness with which the United States takes the effort to return to mutual compliance with the JCPOA.  We still have a long way to go if we’re going to get anywhere, and in particular, we still have to see whether Iran is willing and able to make the necessary decisions on its part for returning to compliance.  And I think as one of my colleagues said the other day, there is more road yet to go than road that’s been traveled, so let’s see where we get.

QUESTION:  President Putin, as you know, relishes an acknowledgement of his status as one of the world’s most powerful leaders.  Why is President Biden afraid to meet him?  And has he spoken to Angela Merkel, who tried very hard to engage with President Putin but found that he lied to her consistently?

SECRETARY BLINKEN:  First, the President has spoken to Angela Merkel on several occasions, and of course, spoke to her along with President Obama regularly some years ago, including when Russia invaded Ukraine.  And so we well know the challenges that are posed by engaging with President Putin.

But President Biden believes very strongly that it’s important to be clear and direct, and one of the best ways to do that is actually meeting face to face.  He’s had a couple of conversations with President Putin on the phone now, and there’s no secret; he has said to him, including from before he was elected President, he’s been very clear that if Russia engages in reckless, aggressive actions, we will respond.

On the other hand, we do not seek to escalate.  We’d prefer to have a more predictable relationship with Russia, but that is up to Mr. Putin.  And if Russia continues to take reckless and aggressive actions, it can be sure we will respond again.  I think it’s beneficial also to – for the two presidents to be able to speak directly face to face.  There are also areas where it’s in our mutual interest to cooperate.  We’ve already seen one of them, and that was the extension of the New START Treaty.  There are other areas of the so-called strategic stability realm where maybe progress can be made.

But diplomacy is all about actually engaging directly.  And I’ve always been struck; as a diplomat, people sometimes seem to think that’s a problematic thing or some sign of weakness.  Just because you engage with someone doesn’t take the word “no” out of your vocabulary.

QUESTION:  Secretary Blinken, thank you for your time.

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    The U.S. Army Corps of Engineers (Corps) has taken steps to implement its Navigation and Ecosystem Sustainability Program (NESP)—a dual-purpose program for navigation improvements and ecosystem restoration along the Upper Mississippi River system. Specifically, in 2004 the Corps identified 24 navigation improvement projects and 1,010 ecosystem restoration projects and proposed a plan for implementing them. For example, the Corps plans to construct or extend 12 locks to facilitate commercial barge traffic along the river system (see fig.), which the states of Illinois, Iowa, Minnesota, Missouri, and Wisconsin have generally relied on as their principal conduit for export-bound agricultural products. The Corps also plans to restore floodplains along the river system and backwaters that provide habitat for hundreds of species of wildlife. While the total estimated program cost is $7.9 billion, as of October 2020, the Corps has initiated technical studies and designs for 47 NESP projects at a cost of approximately $65 million. Barge Tow at Lock and Dam 15 in Rock Island, Illinois However, the Corps has identified several challenges facing the program, and it has taken steps to mitigate them. Specifically, the Corps was unable to implement NESP projects for 7 years because the program did not receive funding in fiscal years 2011 through 2017, in part because the Corps identified other projects as higher priorities. To mitigate this challenge, the Corps reprogrammed funding to help ensure projects could be executed when funds became available. Another challenge is that the Corps has not yet established partnership agreements that are needed for some NESP ecosystem projects. Corps officials said that about 15 to 20 percent of the ecosystem projects will require partnership agreements in which partners commit to share 35 percent of the project costs, typically through the purchase of land for the project. The officials said that partners may be reluctant to make financial commitments to projects while NESP funding is uncertain. Furthermore, the partnership agreements can take up to 18 months to put in place. To help expedite program implementation, Corps officials said they have pursued projects in fiscal year 2020 that can begin without a commitment from project partners. The Upper Mississippi River system provides approximately $1 billion in annual benefits to the nation’s economy through boating, fishing, and other uses, according to a Corps report. It also supports more than 2.5 million acres of aquatic, wetland, forest, grassland, and agricultural habitats. In 1986, Congress declared its intent to recognize the system as a nationally significant commercial navigation system and a nationally significant ecosystem. However, the Upper Mississippi River’s navigation system has faced significant delays in commercial boating and barge traffic, and human activity has caused a decline in environmental quality, according to a 2004 Corps report. The Corps initiated studies in 1989 and 1990 to identify ways to improve the river system. The Corps issued a feasibility report in 2004 that identified improvement projects, and in 2007 Congress formally authorized NESP and the projects identified in the report. GAO was asked to review NESP. This report describes (1) the steps the Corps has taken to implement NESP and (2) the challenges the Corps has identified to fully implementing the program and steps the Corps is taking to address these challenges. To conduct this work, GAO reviewed Corps reports, documents, and data from fiscal year 2005—the year in which the Corps began implementing NESP projects—through fiscal year 2020. GAO also interviewed Corps officials. For more information, contact Mark Gaffigan at (202) 512-3841 or gaffiganm@gao.gov.
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  • Social Security Contracting: Relevant Guidance Should Be Revised to Reflect the Role of Contracting Personnel in Software Development
    In U.S GAO News
    The approach followed by the Social Security Administration (SSA) in awarding and overseeing contracts generally aligns with the requirements GAO reviewed. For the 27 contracts and orders GAO reviewed, SSA varied its approach depending on the contract type used and the dollar value. For example, one of SSA's written acquisition plans acknowledged the risks to the government associated with time-and-materials contracts. From fiscal year 2015 through 2019, SSA obligated 22.7 percent of its contract dollars on time-and-material contracts compared with 10.5 percent at other civilian agencies. In addition, from fiscal year 2015 through 2019, the rate at which SSA used competitive award procedures to achieve the best value for the agency increased by nearly 20 percentage points. This increase was the result of the agency's increased use of competition in its contracting for information technology (IT). SSA relies heavily on IT resources to support the administration of its programs and related activities. During fiscal years 2015 through 2019, about 65 percent of the $8.3 billion in contract obligations were for IT goods and services compared with about 16 percent at other civilian agencies. The figure shows the percentage of obligations for IT goods and services at SSA. Percentage of Social Security Administration's Contract Obligations for Goods and Services during Fiscal Years 2015 through 2019 SSA adopted an Agile approach to software development for some of its critical IT programs in 2015. An Agile approach to software development involves incremental improvements to software rather than the more traditional single-track approach. Subsequently, SSA developed an IT modernization plan in 2017 that states SSA will use an Agile methodology. GAO's draft Agile Assessment Guide states that an organization's acquisition policies and guidance should support an Agile development approach and identify clear roles for contracting personnel, since this is a different approach than federal agencies previously used. However, GAO found SSA's acquisition handbook does not specifically identify a role for contracting personnel with respect to contracts and task orders involving Agile, which GAO has identified as a leading practice. Identifying a role for contracting personnel in the Agile process should better position SSA to achieve its IT modernization goals and provide appropriate levels of oversight. SSA is responsible for delivering services that touch the lives of virtually every American. To do so, SSA relies on a variety of products and services, including information technology (IT) systems. SSA obligates approximately $1.5 billion annually to procure goods and services, 65 percent of which are IT-related. GAO was asked to assess how SSA implements its contracting and acquisition processes. This report examines: (1) how SSA awards and oversees contracts for products and services, and (2) the extent to which SSA has updated its guidance regarding the role of contracting personnel in software development efforts. GAO reviewed SSA's acquisition policies, interviewed contracting officials, and reviewed a non-generalizable sample of 27 high- and lower value contracts and orders with dollars obligated in fiscal years 2014 through 2018. GAO also examined data from fiscal years 2015-2019 to determine what SSA contracted for and reviewed IT guidance. GAO compared SSA's practices to leading practices for Agile software development with respect to the roles of contracting personnel. GAO recommends that SSA revise relevant guidance to identify the roles of contracting personnel in Agile software development. SSA agreed with this recommendation. For more information, contact William Woods at (202) 512-4841 or woodsw@gao.gov.
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  • Pregnant Women in DOJ Custody: U.S. Marshals Service and Bureau of Prisons Should Better Align Policies with National Guidelines
    In U.S GAO News
    GAO analyses of available data show that from calendar year 2017 through 2019, there were at least 1,220 pregnant women in U.S. Marshals Service (USMS) custody and 524 pregnant women in Bureau of Prisons (BOP) custody. Pregnant Women in USMS and BOP Custody: Number, Age, Race, and Length of Time in Custody from 2017 through 2019 aUSMS does not track pregnancy outcomes, so length of time in custody may include time when the women were not pregnant. For BOP, the length of time represents only the period of pregnancy. GAO analyses also show that pregnant women were held at a variety of facility types from 2017 through 2019. For example, pregnant women spent 68 percent of their time in USMS custody in non-federal facilities where USMS has an intergovernmental agreement. BOP data show that pregnant women spent 21 percent of their time in BOP custody while pregnant at Carswell—BOP's only female Federal Medical Center. While USMS and BOP both have policies that address the treatment and care of pregnant women, not all policies fully align with national guidance recommendations on 16 pregnancy-related care topics. For example, national guidance recommends specialized nutrition and when needed, mental health care. USMS policies fully align on three of 16 care topics and BOP policies fully align on eight of 16. By taking steps to more closely align agency standards and policies with national guidance as feasible, USMS and BOP would be better positioned to help ensure the health of pregnant women in their custody. USMS and BOP data show that the agencies provide a variety of medical care and special accommodations to pregnant women, and both agencies track the use of restraints. For example, USMS data show that women receive prenatal care and BOP data show that women receive prenatal vitamins and lower bunk assignments, among other things. However, USMS could do more to collect data on pregnant and postpartum women in their custody who are placed in restrictive housing. While USMS requests that facilities that hold USMS prisoners submit data on a regular basis indicating which prisoners were placed in restrictive housing, facilities are not required to indicate if any of these prisoners are pregnant or postpartum. In addition, USMS does not have a requirement for facilities to immediately notify USMS when such women are placed in restrictive housing. By requiring these notifications and data collection, USMS would be better positioned to ensure that facilities are complying with its USMS Detention Standards and Department of Justice (DOJ) guidance that state pregnant and postpartum women should not be placed in restrictive housing except in rare situations. Policymakers and advocacy groups have raised questions about the treatment of incarcerated pregnant women, including the use of restrictive housing—removal from the general prisoner population with the inability to leave the cell for the majority of the day—and restraints. Within DOJ, USMS is responsible for prisoners awaiting trial or sentencing. BOP is responsible for sentenced prisoners. GAO was asked to review issues related to pregnant women in USMS and BOP custody. This report examines (1) what DOJ data indicate about pregnant women in USMS and BOP custody; (2) the extent to which USMS and BOP policies align with national guidance on pregnancy-related care; and (3) what is known about the care provided and the extent to which USMS and BOP track when pregnant women are placed in restrictive housing or restraints. GAO analyzed available agency data from calendar years 2017 through 2019, which were the most recent data available; compared agency policies to relevant national guidance; and interviewed officials and a non-generalizable sample of prisoners who had been pregnant in USMS or BOP custody. GAO is making six recommendations, including that USMS and BOP take steps to more closely align their policies with national guidance on pregnancy-related care as feasible, and that USMS require facilities to collect data on and notify USMS when pregnant or postpartum women are placed in restrictive housing. DOJ concurred with our recommendations. For more information, contact Gretta L. Goodwin at (202) 512-8777 or goodwing@gao.gov.
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    Operation Warp Speed (OWS)—a partnership between the Departments of Health and Human Services (HHS) and Defense (DOD)—aimed to help accelerate the development of a COVID-19 vaccine. GAO found that OWS and vaccine companies adopted several strategies to accelerate vaccine development and mitigate risk. For example, OWS selected vaccine candidates that use different mechanisms to stimulate an immune response (i.e., platform technologies; see figure). Vaccine companies also took steps, such as starting large-scale manufacturing during clinical trials and combining clinical trial phases or running them concurrently. Clinical trials gather data on safety and efficacy, with more participants in each successive phase (e.g., phase 3 has more participants than phase 2). Vaccine Platform Technologies Supported by Operation Warp Speed, as of January 2021 As of January 30, 2021, five of the six OWS vaccine candidates have entered phase 3 clinical trials, two of which—Moderna's and Pfizer/BioNTech's vaccines—have received an emergency use authorization (EUA) from the Food and Drug Administration (FDA). For vaccines that received EUA, additional data on vaccine effectiveness will be generated from further follow-up of participants in clinical trials already underway before the EUA was issued. Technology readiness. GAO's analysis of the OWS vaccine candidates' technology readiness levels (TRL)—an indicator of technology maturity— showed that COVID-19 vaccine development under OWS generally followed traditional practices, with some adaptations. FDA issued specific guidance that identified ways that vaccine development may be accelerated during the pandemic. Vaccine companies told GAO that the primary difference from a non-pandemic environment was the compressed timelines. To meet OWS timelines, some vaccine companies relied on data from other vaccines using the same platforms, where available, or conducted certain animal studies at the same time as clinical trials. However, as is done in a non-pandemic environment, all vaccine companies gathered initial safety and antibody response data with a small number of participants before proceeding into large-scale human studies (e.g., phase 3 clinical trials). The two EUAs issued in December 2020 were based on analyses of clinical trial participants and showed about 95 percent efficacy for each vaccine. These analyses included assessments of efficacy after individuals were given two doses of vaccine and after they were monitored for about 2 months for adverse events. Manufacturing. As of January 2021, five of the six OWS vaccine companies had started commercial scale manufacturing. OWS officials reported that as of January 31, 2021, companies had released 63.7 million doses—about 32 percent of the 200 million doses that, according to OWS, companies with EUAs have been contracted to provide by March 31, 2021. Vaccine companies face a number of challenges in scaling up manufacturing to produce hundreds of millions of doses under OWS's accelerated timelines. DOD and HHS are working with vaccine companies to help mitigate manufacturing challenges, including: Limited manufacturing capacity: A shortage of facilities with capacity to handle the vaccine manufacturing needs can lead to production bottlenecks. Vaccine companies are working in partnership with OWS to expand production capacity. For example, one vaccine company told GAO that HHS's Biomedical Advanced Research and Development Authority helped them identify an additional manufacturing partner to increase production. Additionally, the U.S. Army Corps of Engineers is overseeing construction projects to expand capacity at vaccine manufacturing facilities. Disruptions to manufacturing supply chains: Vaccine manufacturing supply chains have been strained by the global demand for certain goods and workforce disruptions caused by the global pandemic. For example, representatives from one facility manufacturing COVID-19 vaccines stated that they experienced challenges obtaining materials, including reagents and certain chemicals. They also said that due to global demand, they waited 4 to 12 weeks for items that before the pandemic were typically available for shipment within one week. Vaccine companies and DOD and HHS officials told GAO they have undertaken several efforts to address possible manufacturing disruptions and mitigate supply chain challenges. These efforts include federal assistance to (1) expedite procurement and delivery of critical manufacturing equipment, (2) develop a list of critical supplies that are common across the six OWS vaccine candidates, and (3) expedite the delivery of necessary equipment and goods coming into the United States. Additionally, DOD and HHS officials said that as of December 2020 they had placed prioritized ratings on 18 supply contracts for vaccine companies under the Defense Production Act, which allows federal agencies with delegated authority to require contractors to prioritize those contracts for supplies needed for vaccine production. Gaps in the available workforce: Hiring and training personnel with the specialized skills needed to run vaccine manufacturing processes can be challenging. OWS officials stated that they have worked with the Department of State to expedite visa approval for key technical personnel, including technicians and engineers to assist with installing, testing, and certifying critical equipment manufactured overseas. OWS officials also stated that they requested that 16 DOD personnel be detailed to serve as quality control staff at two vaccine manufacturing sites until the organizations can hire the required personnel. As of February 5, 2021, the U.S. had over 26 million cumulative reported cases of COVID-19 and about 449,020 reported deaths, according to the Centers for Disease Control and Prevention. The country also continues to experience serious economic repercussions, with the unemployment rate and number of unemployed in January 2021 at nearly twice their pre-pandemic levels in February 2020. In May 2020, OWS was launched and included a goal of producing 300 million doses of safe and effective COVID-19 vaccines with initial doses available by January 2021. Although FDA has authorized two vaccines for emergency use, OWS has not yet met its production goal. Such vaccines are crucial to mitigate the public health and economic impacts of the pandemic. GAO was asked to review OWS vaccine development efforts. This report examines: (1) the characteristics and status of the OWS vaccines, (2) how developmental processes have been adapted to meet OWS timelines, and (3) the challenges that companies have faced with scaling up manufacturing and the steps they are taking to address those challenges. GAO administered a questionnaire based on HHS's medical countermeasures TRL criteria to the six OWS vaccine companies to evaluate the COVID-19 vaccine development processes. GAO also collected and reviewed supporting documentation on vaccine development and conducted interviews with representatives from each of the companies on vaccine development and manufacturing. For more information, contact Karen L. Howard and Candice N. Wright at (202) 512-6888 or howardk@gao.gov or wrightc@gao.gov.
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  • Low-Income Workers: Millions of Full-Time Workers in the Private Sector Rely on Federal Health Care and Food Assistance Programs
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    The 12 million wage-earning adults (ages 19 to 64) enrolled in Medicaid—a joint federal-state program that finances health care for low-income individuals—and the 9 million wage-earning adults in households receiving food assistance from the federal Supplemental Nutrition Assistance Program (SNAP) shared a range of common labor characteristics. For example, approximately 70 percent of adult wage earners in both programs worked full-time hours (i.e., 35 hours or more) on a weekly basis and about one-half of them worked full-time hours annually (see figure). In addition, 90 percent of wage-earning adults participating in each program worked in the private sector (compared to 81 percent of nonparticipants) and 72 percent worked in one of five industries, according to GAO’s analysis of program participation data included in the Census Bureau’s 2019 Current Population Survey. When compared to adult wage earners not participating in the programs, wage-earning adult Medicaid enrollees and SNAP recipients in the private sector were more likely to work in the leisure and hospitality industry and in food service and food preparation occupations. Estimated Percentage of Wage-Earning Adult Medicaid Enrollees and Supplemental Nutrition Assistance Program (SNAP) Recipients Working at Least 35 Hours per Week, by Number of Weeks Worked in 2018 GAO’s analysis of February 2020 program data from 15 agencies—six Medicaid agencies and nine SNAP agencies—across 11 states shows that a majority of working adult Medicaid enrollees and SNAP recipients in these states worked for private sector employers. GAO’s analysis also shows that the percentage of working adult Medicaid enrollees and SNAP recipients working for any one employer did not exceed 4 percent in any state that provided data. Most working adults in the programs worked for private sector employers concentrated in certain industries, including restaurants, department stores, and grocery stores. Smaller percentages of working adults in each program in these states worked outside the private sector. For example, less than 10 percent worked for public sector employers, such as state governments, the U.S. Postal Service, or public universities; others worked for nonprofit organizations, such as charities, hospitals, and health care networks, or were self-employed. In October 2020, GAO issued a report entitled Federal Social Safety Net Programs Millions of Full-Time Workers Rely on Federal Health Care and Food Assistance Programs (GAO-20-45.) This testimony summarizes the findings of that report, which examined (1) what is known about the labor characteristics of wage-earning adult Medicaid enrollees and SNAP recipients, and (2) what is known about where wage-earning adult Medicaid enrollees and SNAP recipients work. To answer these questions, GAO analyzed recent Census Bureau data on the labor characteristics of working adults in the two programs. GAO also analyzed recent (Feb. 2020) non-generalizable data on the employers of working adult Medicaid enrollees and SNAP recipients obtained from 15 state agencies across 11 states. GAO selected state agencies that (1) collected, verified, and updated the names of Medicaid enrollees’ and SNAP recipients’ employers; and (2) could extract reliable data. GAO made no recommendations. For more information, contact Cindy S. Brown Barnes at (202) 512-7215 or brownbarnesc@gao.gov.  
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  • Aviation Security Technology: TSA Lacks Outcome-oriented Performance Measures and Data to Help Reach Objectives to Diversify its Marketplace
    In U.S GAO News
    The Transportation Security Administration's (TSA) January 2020 TSA Efforts to Diversify Security Technology (strategy) addresses the requirements of the 2018 TSA Modernization Act (the Act) and outlines 12 strategic initiatives to increase small business participation in its marketplace. Moreover, the strategy's initiatives are generally consistent with common practices cited by comparable federal agencies, including vendor outreach and linking small businesses together with bigger contractors. TSA has not developed outcome-oriented performance measures, such as baseline goals or target timeframes to assess the effectiveness of the initiatives in its strategy. While TSA collects some output metrics on its initiatives, leading practices note that outcome-based measures can help track progress in meeting goals. TSA also has not collected data on small businesses' progress across its acquisition phases, such as capturing the overall time, costs, and ability to meet security requirements. Federal standards call for the use of quality information to achieve objectives. Small businesses GAO met with told us they continue to face challenges entering TSA's marketplace—such as navigating it's testing and evaluation process and identifying security requirements—despite TSA's efforts to address them through ongoing and planned initiatives. Developing outcome-oriented performance measures and collecting data, will better position TSA to assess the effectiveness of its initiatives to diversify its security technology marketplace. Examples of Transportation Security Administration (TSA) Security-Related Technologies With the ongoing threat of terrorism, TSA is looking to innovative technologies to improve security. In response to the Act, TSA developed a strategy to promote innovation and increase small business participation in its security technology marketplace. The Act includes a provision for GAO to review this strategy. This report examines, among other things, (1) the extent to which TSA's strategy includes the statutory requirements of the Act and compares to common practices of federal agencies to increase small business participation and (2) the extent to which TSA has performance measures and data to assess the effectiveness of its initiatives. GAO compared TSA's strategy to statutory requirements and practices of comparable federal agencies; interviewed TSA and federal officials from five selected agencies responsible for small and disadvantaged business programs, and a nongeneralizable set of small businesses selected to provide various perspectives on participating in TSA's acquisition processes; and analyzed data from the Federal Procurement Data System–Next Generation. GAO is making two recommendations, including that TSA (1) develop outcome-oriented performance measures and (2) collect data, where appropriate, on small businesses' progress across TSA's acquisition phases. DHS concurred with our recommendations. For more information, contact Triana McNeil at (202) 512-8777 or McNeilT@gao.gov.
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Evidence collected during the pandemic suggests the prevalence of behavioral health conditions has increased, while access to in-person behavioral health services has decreased: Centers for Disease Control and Prevention (CDC) survey data collected from April 2020 through February 2021 found that the percentage of adults reporting symptoms of anxiety or depression averaged 38 percent. In comparison, using similar questions, CDC found that about 11 percent of U.S. adults reported experiencing these symptoms from January to June 2019. An analysis of CDC data found that the share of emergency department visits for drug overdoses and suicide attempts were 36 and 26 percent higher, respectively, for the period of mid-March through mid-October 2020 compared to the same time period in 2019. In a February 2021 survey of its members, NCBH found that in the 3 months preceding the survey, about two-thirds of the member organizations surveyed reported demand for their services increasing and having to cancel or reschedule patient appointments or turn patients away. The survey also found that during the pandemic, 27 percent of member organizations reported laying off employees, 45 percent reported closing some programs, and 35 percent decreased the hours for staff. Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services. However, most officials were not aware of published data that could confirm their concerns, and data from reports from two states on claims denials either did not support their concerns or were inconclusive. In addition, a report in one state that examined mental health parity—requirements that behavioral health benefits are not more restrictive than medical/surgical benefits—found that the rate of complaints associated with behavioral health services was notably lower than those for medical/surgical services. The lack of available data confirming stakeholder concerns could be related to potential challenges consumers and providers face in identifying and reporting mental health parity violations, as previously reported by GAO. Specifically, in 2019, GAO found that complaints were not a reliable indicator of such violations, because consumers may not know about parity requirements or may have privacy concerns related to submitting a complaint. GAO recommended that the federal agencies involved in the oversight of mental health parity requirements evaluate the effectiveness of their oversight efforts. As of March 2021, the agencies had not yet implemented this recommendation. Why GAO Did This Study Behavioral health conditions, which include mental health and substance use disorders, affect a substantial number of adults in the United States. For example, in 2019, an estimated 52 million adults in the United States were reported to have a mental, behavioral, or emotional disorder, and 20 million people aged 12 or older had a substance use disorder. Experts have expressed concerns that the incidence of behavioral health conditions would increase as a result of stressors associated with the COVID-19 pandemic. Even before the pandemic, longstanding questions have been raised about whether coverage or claims for behavioral health services are denied or delayed at higher rates than those for other health services. GAO was asked to examine several issues about the demand for behavioral health services, as well as coverage and payment for these services. GAO examined (1) what is known about the need for and availability of behavioral health services, and how these have changed during the COVID-19 pandemic; and (2) what issues selected stakeholders identified regarding the payment of claims for behavioral health services. GAO reviewed survey data and other relevant analyses focused on the need for and availability of behavioral health services prior to and during the COVID-19 pandemic. GAO also reviewed reports from two states that compared claims for behavioral health services with those of other health services; interviewed officials from NCBH; and interviewed officials from hospital associations and insurance regulators in Oregon, Pennsylvania, Texas, and Virginia. For more information, contact John E. Dicken at 202-512-7114 or dickenj@gao.gov.
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    During fiscal years 2018 and 2019, the Department of Housing and Urban Development (HUD) obligated about $421 million through two grant programs to state and local governments to help identify and control lead paint hazards in housing for low-income households. HUD also issued guidelines for evaluating and controlling lead paint hazards, generally encouraging abatement (such as replacing building components containing lead) as the preferred long-term solution. HUD has supported research on lead paint hazard control and provided education and outreach to public housing agencies, property owners, and the public through publications and training events. HUD monitors lead paint-related risks in its Project-Based Rental Assistance Program, one of HUD's three largest rental assistance programs, through management reviews and periodic physical inspections, but has not conducted a comprehensive risk assessment to identify properties posing the greatest risk to children under the age of 6. HUD's management reviews include assessing property owners' compliance with lead paint regulations—such as by reviewing lead disclosure forms, records of lead inspections, and plans to address lead paint hazards. Inspectors from HUD's Real Estate Assessment Center also assess the physical condition of properties, including identifying damaged paint that could indicate lead paint risks. According to HUD officials, they have not conducted risk assessments in project-based rental assistance housing because they believe the program has relatively few older and potentially riskier properties. However, GAO's analysis of HUD data found that 21 percent of project-based rental assistance properties have at least one building constructed before 1978 (when lead paint was banned in homes) and house over 138,000 children under the age of 6. If HUD used available program data to inform periodic risk assessments, HUD could identify which of the properties pose the greatest risk of exposure to lead paint hazards for children under the age of 6. Unless HUD develops a strategy for managing the risks associated with lead paint and lead paint hazards in project-based rental assistance housing, it may miss the opportunity to prevent children under the age of 6 from being inadvertently exposed to lead paint in those properties. Project-Based Rental Assistance Properties with at Least One Building Built before 1978 and That House Children under Age 6, as of December 31, 2019 Note: Children under the age of 6 are at the greatest risk of lead exposure because they have frequent hand-to-mouth contact, often crawl on the floor, and ingest nonfood items. Lead paint exposure in children under the age of 6 can cause brain damage, slowed development, and learning and behavioral problems. Exposure to lead paint hazards can cause serious harm to children under 6 years old. HUD is required by law to reduce the risk of lead paint hazards in HUD-assisted rental housing—including project-based rental assistance (subsidies to make privately owned multifamily properties affordable to low-income households). The 2019 Consolidated Appropriations Act Joint Explanatory Statement includes a provision for GAO to review, among other things, HUD's oversight of lead paint and related hazards in affordable rental housing. This report (1) describes how HUD programs and guidance address lead paint hazards in HUD-assisted and other low-income rental housing, and (2) examines HUD's oversight procedures for assessing risk for lead paint hazards in project-based rental assistance housing. GAO reviewed HUD and Environmental Protection Agency (EPA) lead paint regulations and documents on lead programs and methods for addressing lead paint hazards. GAO reviewed HUD oversight policies and procedures and analyzed HUD data on building and tenant age. GAO interviewed staff at HUD, EPA, and organizations that advocate for safe affordable housing. GAO recommends that HUD (1) conduct periodic risk assessments for the Project-Based Rental Assistance Program and (2) develop and implement plans to proactively manage identified lead paint risks. HUD agreed to conduct periodic risk assessments and develop and implement a plan to proactively manage risks. For more information, contact John H. Pendleton at (202) 512-8678 or pendletonj@gao.gov.
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    In U.S GAO News
    As of June 2020, the Federal Communications Commission (FCC) required consumers nationwide to use the Lifeline National Verifier (Verifier), a centralized process and data system, to check their eligibility for Lifeline. Because consumers who participate in certain federal benefits programs qualify for discounted phone and internet service through Lifeline, the Verifier checks state and federal benefits databases to verify consumers' eligibility. The Verifier also includes a manual review process for consumers to submit documents proving their eligibility if they cannot be found in a database. As of November 2020, the Verifier had connections with databases in 20 states and 2 federal agencies. GAO found that although consumers in states without state database connections had the same likelihood of actually meeting eligibility requirements as consumers in states with such connections, they were less likely to be found eligible for Lifeline through the Verifier (see figure). Average Eligibility Determination for New Lifeline Applicants in States with and without State Database Connections to the Lifeline National Verifier, June 2018 through June 2020 FCC coordinated with state and federal stakeholders to implement the Verifier. However, stakeholders told GAO that many eligible consumers are not aware of the Verifier or Lifeline. Consumers may lack this awareness because FCC's consumer education planning did not always align with key practices, such as developing consistent, clear messages and researching target audiences. As a result, eligible consumers may not apply for Lifeline. Moreover, while FCC originally envisioned tribal governments and organizations assisting residents of tribal lands with the Verifier, it has not provided them with quality information to effectively do so. Although FCC reported that the Verifier is meeting its goal of improving the consumer experience, GAO found that the manual review process, which FCC used to determine the eligibility of more than half of applicants in many states, is challenging for consumers. However, FCC does not collect complete information on consumers' experience with this process, and thus is limited in its ability to identify and address the challenges consumers face. Such challenges likely contributed to eligible consumers giving up on their applications. For example, we found that more than two-thirds of applicants who underwent manual review between June 2018 and June 2020 did not complete their applications. FCC's Lifeline program discounts phone and internet service for eligible low-income consumers. In 2019, FCC authorized $982 million in support for 6.9 million eligible consumers. FCC created the Verifier with the stated goals of reducing fraud and costs and improving the consumer experience. The Verifier includes an online application, connections to state and federal benefits databases, and a standardized manual review process. GAO was asked to review FCC's implementation of the Verifier. This report examines: (1) the status of the Verifier; (2) FCC's coordination with stakeholders and efforts to educate consumers and facilitate tribal stakeholders' involvement; and (3) the extent to which the Verifier is meeting its goals. GAO reviewed FCC orders and documentation; analyzed Verifier performance and Lifeline subscriber data; interviewed FCC and other agency officials, and selected industry, state, tribal, and consumer stakeholders; and surveyed state officials. Stakeholders were selected to obtain a variety of non-generalizable viewpoints. GAO is making six recommendations, including that FCC develop a consumer education plan, provide quality information to tribal organizations, and collect information on consumers' experience with the manual review process. FCC agreed to take steps to address all of GAO's recommendations. For more information, contact Andrew Von Ah at (202)-512-2834 or vonaha@gao.gov.
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  • Arleigh Burke Class Destroyers: Observations on the Navy’s Hybrid Electric Drive Program
    In U.S GAO News
    In 2009, the Secretary of the Navy set goals to reduce fuel consumption and, 2 years later, initiated a program to install Hybrid Electric Drive (HED) systems on its fleet of Arleigh Burke class (DDG 51 Flight IIA) destroyers. The HED system draws surplus power from the ship's electric system and uses it to propel the ship. This allows the crew to turn off the propulsion engines and save fuel. Since 2011, Navy officials told us that they have spent over $100 million on the development, purchase, and upgrade of six HED systems. In October 2018, the Navy completed installation of one of the systems on the USS Truxtun (DDG 103). However, the Navy has yet to install the remaining five HED systems and now plans to use them to support another research effort. The Navy issued a January 2020 report to Congress on the HED system installed on the USS Truxtun, but did not include some requested information. For example, while the report included performance information from operations on board the USS Truxtun, it did not include sufficient information to determine the overall performance of the HED system. A comprehensive test and evaluation could have assessed the system's performance, reliability, and cyber survivability to inform program decision-making. Further, the report did not include a summary of planned investment that includes: an assessment of the costs and benefits of the HED system, or a projection of the funding needed to execute the program. The Navy stated that it did not include a summary of the planned investments in the report because the HED program was not included in the President's fiscal year 2020 budget and also due to the need for additional HED data. However, Congress appropriated $35 million in funding for the HED program in 2020, which was available to support ship installation of the five previously purchased HEDs. The Navy stated that it can only use a small portion of this funding before it expires in September 2022 since the systems cannot be upgraded and incorporated into a ship's maintenance schedule in the next 3 years. In summer 2020, Navy requirements officials informed GAO and Congress that they plan to suspend the HED program and send the five surplus HED systems to support research into a new electric motor, known as Propulsion Derived Ship Service (PDSS). Navy requirements officials identified several reasons for suspending the HED program, but these reasons differ from information GAO obtained during the course of this review. For example: Navy officials stated that it is expensive to maintain the HED system. However, the commanding officer and crew of the USS Truxtun and senior Navy engineers stated that the system requires little maintenance. Navy officials also stated that the HED is not used very often in operations. According to the Navy's January 2020 report, the system was designed for low-speed operations (speed up to 11 knots), which comprise more than one-third of a typical DDGs operating profile. GAO did not assess the Navy's decision to use the HED systems for PDSS research because the Navy did not have documentation regarding the requirements, testing, schedule, or costs of the PDSS effort. GAO could not determine the merits of suspending the HED program and using the other five HED systems for the PDSS effort because the Navy has yet to complete analysis that determines the costs, benefits, and performance necessary to support such a decision. If the Navy completes a further assessment—which has been requested by Congress—it could provide the information necessary to inform future decisions about the HED program. This report assesses the Navy's HED program. Senate Report 115-262 accompanying the John S. McCain National Defense Authorization Act for Fiscal Year 2019 asked the Navy to submit a report on the HED system installed on the USS Truxtun. GAO was asked to review the Navy's report and the Navy's recent decision to suspend the HED program to pursue the PDSS research project. This report (1) examines the extent to which the Navy's report on the USS Truxtun included information regarding the assessment areas as requested by Congress; and (2) describes the Navy's decision to suspend the HED program and use the HED systems for the PDSS research effort. To conduct this work, GAO reviewed the Navy's 2020 report on the HED system, analyzed data and documentation the Navy used to guide investments, and assessed HED performance information. GAO also interviewed relevant Navy officials, such as the commanding officer and other senior crew of the USS Truxtun, and Navy engineers. GAO is not making any recommendations. For more information, contact Shelby S. Oakley at (202) 512-4841 or oakleys@gao.gov.
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  • COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted Actions
    In U.S GAO News
    In the government’s ongoing response to the COVID-19 pandemic, the Congress and the administration have taken action on multiple fronts to address challenges that have contributed to catastrophic loss of life and profound economic disruption. These actions have helped direct much-needed federal assistance to support many aspects of public life, including local public health systems and private-sector businesses. However, the nation faces continued public health risks and economic difficulties for the foreseeable future. Among other challenges, the public health system, already strained from months of responding to COVID-19 cases, will face the additional task of managing the upcoming flu season. At the same time, many of the federal, state, and local agencies responsible for responding to the ongoing public health emergency are called on to prepare for and respond to the current hurricane season. Timely and concerted federal leadership will be required in responding to these and other challenges. GAO has identified lessons learned and issues in need of continued attention by the Congress and the administration, including the need to collect reliable data that can drive decision-making; to establish mechanisms for accountability and transparency; and to protect against ongoing cyber threats to patient information, intellectual property, public health data, and intelligence. Attention to these issues can help to make federal efforts as effective as possible. GAO has also identified a number of opportunities to help the federal government prepare for the months ahead while improving the ongoing federal response: Medical Supply Chain The Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA), with support from the Department of Defense (DOD), have taken numerous, significant efforts to mitigate supply shortages and expand the medical supply chain. For example, the agencies have coordinated to deliver supplies directly to nursing homes and used Defense Production Act authorities to increase the domestic production of supplies. However, shortages of certain types of personal protective equipment and testing supplies remain due to a supply chain with limited domestic production and high global demand. The Food and Drug Administration (FDA) and FEMA have both identified shortages, and officials from seven of the eight states GAO interviewed in July and August 2020 identified previous or ongoing shortages of testing supplies, including swabs, reagents, tubes, pipettes, and transport media. Testing supply shortages have contributed to delays in turnaround times for testing results. Delays in processing test results have multiple serious consequences, including delays in isolating those who test positive and tracing their contacts in a timely manner, which can in turn exacerbate outbreaks by allowing the virus to spread undetected. In addition, states and other nonfederal entities have experienced challenges tracking supply requests made through the federal government and planning for future needs. GAO is making the following recommendations: HHS, in coordination with FEMA, should immediately document roles and responsibilities for supply chain management functions transitioning to HHS, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain. HHS, in coordination with FEMA, should further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate supply chain shortages for the remainder of the pandemic. HHS and FEMA—working with relevant stakeholders—should devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the COVID-19 pandemic response. HHS and the Department of Homeland Security (DHS) objected to GAO’s initial draft recommendations. GAO made revisions based on their comments. GAO maintains that implementation of its modified recommendations is both warranted and prudent. These actions could contribute to ensuring a more effective response by helping to mitigate challenges with the stability of the medical supply chain and the ability of nonfederal partners to track, plan, and budget for ongoing medical supply needs. Vaccines and Therapeutics Multiple federal agencies continue to support the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19. These efforts are aimed at accelerating the traditional timeline to create a vaccine (see figure). Traditional Timeline for Development and Creation of a Vaccine Note: See figure 5 in the report. As these efforts proceed, clarity on the federal government’s plans for distributing and administering vaccine, as well as timely, clear, and consistent communication to stakeholders and the public about those plans, is essential. DOD is supporting HHS in developing plans for nationwide distribution and administration of a vaccine. In September 2020, HHS indicated that it will soon send a report to Congress outlining a distribution plan, but did not provide a specific date for doing so. GAO recommends that HHS, with support from DOD, establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and in developing such a plan ensure that it is consistent with best practices for project planning and scheduling and outlines an approach for how efforts will be coordinated across federal agencies and nonfederal entities. DOD partially concurred with the recommendation, clarifying that it is supporting HHS in developing plans for nationwide distribution and administration of vaccine. HHS neither agreed nor disagreed with the recommendation, but noted factors that complicate the publication of a plan. GAO maintains that a time frame is necessary so all relevant stakeholders will be best positioned to begin their planning.On September 16, 2020, HHS and DOD released two documents outlining a strategy for any COVID-19 vaccine. GAO will evaluate these documents and report on them in future work.GAO will also continue to conduct related work, including examining federal efforts to accelerate the development and manufacturing of COVID-19 vaccines and therapeutics. COVID-19 Data Data collected by the Centers for Disease Control and Prevention (CDC) suggest a disproportionate burden of COVID-19 cases, hospitalizations, and deaths exists among racial and ethnic minority groups, but GAO identified gaps in these data. To help address these gaps, on July 22, 2020, CDC released a COVID-19 Response Health Equity Strategy. However, the strategy does not assess whether having the authority to require states and jurisdictions to report race and ethnicity information is necessary to ensure CDC can collect such data. CDC’s strategy also does not specify how it will involve key stakeholders, such as health care providers, laboratories, and state and jurisdictional health departments. GAO recommends that CDC (1) determine whether having the authority to require the reporting of race and ethnicity information for cases, hospitalizations, and deaths is necessary for ensuring more complete data, and if so, seek such authority from Congress; (2) involve key stakeholders to help ensure the complete and consistent collection of demographic data; and (3) take steps to help ensure its ability to comprehensively assess the long-term health outcomes of persons with COVID-19, including by race and ethnicity. HHS agreed with the recommendations. In addition, HHS’s data on COVID-19 in nursing homes do not capture the early months of the pandemic. HHS’s Centers for Medicare & Medicaid Services (CMS) began requiring nursing homes to report COVID-19 data to CDC by May 17, 2020, starting with information as of May 8, 2020, but made reporting prior to May 8, 2020 optional. By not requiring nursing homes to submit data from the first 4 months of 2020, HHS is limiting the usefulness of the data in helping to understand the effects of COVID-19 in nursing homes. GAO recommends that HHS, in consultation with CMS and CDC, develop a strategy to capture more complete data on COVID-19 cases and deaths in nursing homes retroactively back to January 1, 2020. HHS partially agreed with this recommendation by noting the value of having complete data, but expressed concern about the burden of collecting it. GAO maintains the importance of collecting these data to inform the government’s continued response and recovery, and HHS could ease the burden by incorporating data previously reported to CDC or to state or local public health offices. Economic Impact Payments The Department of the Treasury’s (Treasury) Internal Revenue Service (IRS) has issued economic impact payments (EIP) to all eligible individuals for whom IRS has the necessary information to do so; however, not everyone eligible was able to be initially identified. To help ensure all eligible recipients received their payments in a more timely manner, IRS took several actions to address challenges GAO reported on in June, including a policy change—reopening the Non-Filers tool registration period for federal benefit recipients and extending it through September 30—that should allow some eligible recipients to receive supplemental payments for qualifying children sooner than expected. However, Treasury and IRS lack updated information on how many eligible recipients have yet to receive these funds. The lack of such information could hinder outreach efforts and place potentially millions of individuals at risk of missing their payment. GAO recommends that Treasury, in coordination with IRS, (1) update and refine the estimate of eligible recipients who have yet to file for an EIP to help target outreach and communications efforts and (2) make estimates of eligible recipients who have yet to file for an EIP, and other relevant information, available to outreach partners to raise awareness about how and when to file for EIP. Treasury and IRS neither agreed nor disagreed with the recommendations and described actions they are taking in concert with the recommendations to notify around 9 million individuals who may be eligible for an EIP. Coronavirus Relief Fund The Coronavirus Relief Fund (CRF) is the largest program established in the four COVID-19 relief laws that provides aid to states, the District of Columbia, localities, tribal governments, and U.S. territories. Audits of entities that receive federal funds, including CRF payments, are critical to the federal government’s ability to help safeguard those funds. Auditors that conduct single audits follow guidance in the Single Audit Act’s Compliance Supplement, which the Office of Management and Budget (OMB) updates and issues annually in coordination with federal agencies. OMB issued the 2020 Compliance Supplement in August 2020, but the Compliance Supplement specified that OMB is still working with federal agencies to identify the needs for additional guidance for auditing new COVID-19-related programs, including the CRF payments, as well as existing programs with compliance requirement changes. According to OMB, an addendum on COVID-19-related programs, including the CRF payments, will be issued in the fall of 2020. Further delays in issuing this guidance could adversely affect auditors’ ability to issue consistent and timely reports. GAO recommends that OMB, in consultation with Treasury, issue the addendum to the 2020 Compliance Supplement as soon as possible to provide the necessary audit guidance, as many single audit efforts are underway. OMB neither agreed nor disagreed with the recommendation. Guidance for K-12 Schools State and local school district officials tasked with reassessing their operating status and ensuring their school buildings are safe are generally relying on guidance and recommendations from federal, state, and local public health and education officials. However, portions of CDC’s guidance on reopening K-12 schools are inconsistent, and some federal guidance appears misaligned with CDC’s risk-based approach on school operating status. Based on GAO’s review, Education has updated the information and CDC has begun to do so. GAO recommends that CDC ensure that, as it makes updates to its guidance related to schools’ operating status, the guidance is cogent, clear, and internally consistent. HHS agreed with the recommendation. Tracking Contract Obligations Federal agencies are tracking contract actions and associated obligations in response to COVID-19 using a National Interest Action (NIA) code in the Federal Procurement Data System-Next Generation. The COVID-19 NIA code was established in March 2020 and was recently extended until March 31, 2021, while a draft of this report recommending that DHS and DOD extend the code beyond September 30, 2020, was with the agencies for comment. GAO has identified inconsistencies in establishing and closing these codes following previous emergencies, and has continued concerns with the criteria that DHS and DOD rely on to determine whether to extend or close a code and whether the code meets long-term needs. GAO recommends that DHS and DOD make updates to the 2019 NIA Code Memorandum of Agreement so as to enhance visibility for federal agencies, the public, and Congress on contract actions and associated obligations related to disaster events, and to ensure the criteria for extending or closing the NIA code reflect government-wide needs for tracking contract actions in longer-term emergencies, such as a pandemic. DHS and DOD did not agree, but GAO maintains implementation of its recommendation is essential. Address Cybersecurity Weaknesses Since March 2020, malicious cyber actors have exploited COVID-19 to target organizations that make up the health care and public health critical infrastructure sector, including government entities, such as HHS. GAO has identified numerous cybersecurity weaknesses at multiple HHS component agencies, including CMS, CDC, and FDA, over the last 6 years, such as weaknesses in key safeguards to limit, prevent, and detect inappropriate access to computer resources. Additionally, GAO’s March 2019 high-risk update identified cybersecurity and safeguarding the systems supporting the nation’s critical infrastructure, such as health care, as high-risk areas. As of July 2020, CMS, FDA, and CDC had made significant progress by implementing 350 (about 81 percent) of the 434 recommendations GAO issued in previous reports to address these weaknesses. Based on the imminent cybersecurity threats, GAO recommends that HHS expedite implementation of GAO’s prior recommendations regarding cybersecurity weaknesses at its component agencies. HHS agreed with the recommendation. As of September 10, 2020, the U.S. had over 6.3 million cumulative reported cases of COVID-19 and over 177,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted as of September 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of July 31, 2020, the federal government had obligated a total of $1.6 trillion and expended $1.5 trillion of the COVID-19 relief funds as reported by federal agencies on USAspending.gov. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This third report examines key actions the federal government has taken to address the COVID-19 pandemic and evolving lessons learned relevant to the nation’s response to pandemics. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials, as well as industry representatives. GAO is making 16 new recommendations for agencies that are detailed in this Highlights and in the report. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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