Secretary Pompeo’s Meeting with French President Macron

Office of the Spokesperson

The below is attributable to Principal Deputy Spokesperson Cale Brown:‎

Secretary of State Michael R. Pompeo met with French President Emmanuel Macron today in Paris, France.  Secretary Pompeo and President Macron discussed significant threats to global security, efforts to counter violent extremism, Iran’s destabilizing behavior, and Hizballah’s malign influence in Lebanon.  The Secretary stressed the importance of the Transatlantic alliance and NATO unity and highlighted our strong cooperation in the Indo-Pacific region, as well as efforts to counter the Chinese Communist Party.

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  • COVID-19: Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention
    In U.S GAO News
    Since November 2020, the number of COVID-19 cases in the U.S. has rapidly increased, further straining health care systems across the country. Between December 31, 2020, and January 13, 2021, new reported COVID-19 cases averaged about 225,000 per day—over 7 and 3 times higher than the surges the nation experienced during the spring and summer of 2020, respectively. (See figure.) The country also continues to experience serious economic repercussions and turmoil as a result of the pandemic. As of December 2020, there were more than 10.7 million unemployed individuals, compared to nearly 5.8 million individuals at the beginning of the calendar year. Until the country better contains the spread of the virus, the pandemic will likely remain a significant obstacle to more robust economic activity. Reported COVID-19 Cases per Day in the U.S., Through January 13, 2021 As of January 2021, 27 of GAO’s 31 previous recommendations remained unimplemented. GAO remains deeply troubled that agencies have not acted on recommendations to more fully address critical gaps in the medical supply chain. While GAO recognizes federal agencies continue to take some steps, GAO underscores the importance of developing a well-formulated plan to address critical gaps for the remainder of the pandemic, especially in light of the recent surge in cases. In addition, implementation of GAO’s recommendation concerning the importance of clear and comprehensive vaccine distribution and communication plans remains a work in progress. Moreover, slow implementation of GAO’s recommendations relating to program integrity, in particular those made to the Small Business Administration (SBA) and Department of Labor (DOL), creates risk of considerable improper payments, including those related to fraud, and falls far short of transparency and accountability expectations. See appendix III for the status of GAO’s past recommendations. GAO is pleased that the Consolidated Appropriations Act, 2021—enacted in December of 2020—requires a number of actions that are consistent with several of GAO’s prior recommendations, including those related to the medical supply chain, vaccines and therapeutics, and COVID-19 testing. GAO will monitor the implementation of the act’s requirements. GAO’s new recommendations are discussed below. COVID-19 Testing Diagnostic testing for COVID-19 is critical to controlling the spread of the virus, according to the Centers for Disease Control and Prevention. GAO found that the Department of Health and Human Services (HHS) has not issued a comprehensive and publicly available national testing strategy. HHS’s national strategy documents are not comprehensive because they only partially address the characteristics that GAO has found to be desirable in an effective national strategy. For example, testing strategy documents do not always provide consistent definitions and benchmarks to measure progress, not all documents clearly define the problem and risks, and there is limited information on the types of resources required for future needs. Furthermore, some of the documents have not been made public. While the national testing strategy is formally outlined in a publicly available document, HHS has provided only Congress with the COVID-19 Testing Strategy Reports, which detail the implementation of the testing strategy. Stakeholders who are involved in the response efforts told GAO they were unaware of the existence of a national strategy or did not have a clear understanding of the strategy. Without a comprehensive, publicly available national strategy, HHS is at risk of key stakeholders and the public lacking crucial information to support an informed and coordinated testing response. GAO is recommending that HHS develop and make publicly available a comprehensive national COVID-19 testing strategy that incorporates all six characteristics of an effective national strategy. Such a strategy could build upon existing strategy documents that HHS has produced for the public and Congress to allow for a more coordinated pandemic testing approach. HHS partially concurred with this recommendation and agreed that it should take steps to more directly incorporate some of the elements of an effective national strategy. Vaccines and Therapeutics Multiple federal agencies, through Operation Warp Speed, continue to support the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19. As of January 8, 2021, two of the six vaccines supported by Operation Warp Speed have been authorized for emergency use, and vaccine distribution and administration have begun. (See figure below). However, distribution and administration fell short of expectations set for the end of the year. As of December 30, 2020, Operation Warp Speed had distributed (shipped) about 12.4 million doses of COVID-19 vaccine and providers reported administering about 2.8 million initial doses, according to Centers for Disease Control and Prevention data. In September 2020, GAO stressed the importance of having a plan that focused on coordination and communication and recommended that HHS, with the support of the Department of Defense, establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and among other things, outline an approach for how efforts would be coordinated across federal agencies and nonfederal entities.To date, this recommendationhas not been fully implemented. GAO reiterates the importance of doing so. Effective coordination and communication among federal agencies, commercial partners, jurisdictions, and providers is critical to successfully deploying COVID-19 vaccines and managing public expectations, especially because the initial supply of vaccine has been limited. Status of Development of Six Operation Warp Speed COVID-19 Vaccine Candidates, as of January 8, 2021 Medical Supply Chain The pandemic has highlighted vulnerabilities in the nation’s medical supply chain, which includes personal protective equipment and other supplies necessary to treat individuals with COVID-19. The Strategic National Stockpile (SNS) is an important piece of HHS’s recently developed strategy to improve the medical supply chain to enhance pandemic response capabilities. However, the department has yet to develop a process for engaging about the strategy with key nonfederal stakeholders that have a shared role for providing supplies during a pandemic, such as state and territorial governments and the private sector. GAO’s work has noted the importance of directly and continuously involving key stakeholders, including Congress, in the development of successful agency reforms and helping to harness ideas, expertise, and resources. To improve the nation’s response and preparedness for pandemics, GAO recommends that HHS establish a process for regularly engaging with Congress and nonfederal stakeholders—including state, local, tribal, and territorial governments and private industry—as the agency refines and implements its supply chain strategy for pandemic preparedness, to include the role of the SNS. HHS generally concurred with this recommendation and noted that the department regularly engages with Congress and nonfederal stakeholders. GAO maintains that capitalizing on existing relationships to engage these critical stakeholders as HHS refines and implements a supply chain strategy, to include the role of the SNS, will improve a whole-of-government response to, and preparedness for, pandemics. In August 2020, the President issued an Executive Order directing agencies to take steps toward the goal of strengthening domestic drug manufacturing and supply chains. Federal agencies have started implementing the Executive Order, but expressed concerns about their ability to implement some of the provisions. In particular, GAO found that federal agencies do not have complete and accessible information to identify supply chain vulnerabilities and to report the manufacturing supply chains of drugs that were procured by the agency. To help it identify and mitigate vulnerabilities in the U.S. drug supply chain, GAO recommends that the Food and Drug Administration (FDA) ensure drug manufacturing data obtained are complete and accessible, including by working with manufacturers and other federal agencies, such as the Department of Defense and the Department of Veterans Affairs and, if necessary, seek authority to obtain complete and accessible information. HHS neither agreed nor disagreed with this recommendation. COVID-19 Data for Health Care Indicators The federal government does not have a process to help systematically define and ensure the collection of standardized data across the relevant federal agencies and related stakeholders to help respond to COVID-19, communicate the status of the pandemic with citizens, or prepare for future pandemics. As a result, COVID-19 information that is collected and reported by states and other entities to the federal government is often incomplete and inconsistent. The lack of complete and consistent data limits HHS’s and others’ ability to monitor trends in the burden of the pandemic across states and regions, make informed comparisons between such areas, and assess the impact of public health actions to prevent and mitigate the spread of COVID-19. Further, incomplete and inconsistent data have limited HHS’s and others’ ability to prioritize the allocation of health resources in specific geographic areas or among certain populations most affected by the pandemic. To improve the federal government’s response to COVID-19 and preparedness for future pandemics, GAO recommends that HHS immediately establish an expert committee comprised of knowledgeable health care professionals from the public and private sectors, academia, and nonprofits or use an existing one to systematically review and inform the alignment of ongoing data collection and reporting standards for key health indicators. HHS partially concurred with this recommendation and agreed that it should establish a dedicated working group or other mechanism with a focus on addressing COVID-19 data collection shortcomings. Drug Manufacturing Inspections FDA is responsible for overseeing the safety and effectiveness of all drugs marketed in the U.S., including those manufactured overseas, and typically conducts more than 1,600 inspections of foreign and domestic drug manufacturing establishments every year. In light of the COVID-19 pandemic, since March 2020, FDA has limited domestic and foreign inspections for the safety of its employees. (See figure below.) FDA has used alternative inspection tools to maintain some oversight of drug manufacturing quality while inspections are paused, including inspections conducted by foreign regulators, requesting and reviewing records and other information, and sampling and testing. Although FDA has determined that inspections conducted by certain European regulators are equivalent to an FDA inspection, other tools provide useful information but are not equivalent to an FDA inspection. As a result, FDA could be faced with a backlog of inspections, threatening the agency’s goal to maximize inspections prioritized by its risk-based site selection model each year. GAO recommends that FDA (1) ensure that inspection plans for future fiscal years identify, analyze, and respond to the issues presented by the backlog of inspections that could jeopardize its goal of risk-driven inspections, and (2) fully assess the agency’s alternative inspection tools and consider whether these tools or others could provide the information needed to supplement regular inspection activities or help meet the agency’s drug oversight objectives when inspections are not possible in the future. FDA concurred with both recommendations. Number of FDA-Conducted Domestic and Foreign Drug Manufacturing Establishment Inspections, Fiscal Years 2019–2020, by Month Federal Contracting Federal agencies are using other transaction agreements to respond to the pandemic, which are contracting mechanisms that can enable agencies to negotiate terms and conditions specific to a project. GAO found that HHS misreports its other transaction agreements related to COVID-19 as procurement contracts, including other transaction agreements with about $1.5 billion obligated for Operation Warp Speed and other medical countermeasures. HHS’s approach is inconsistent with federal acquisition regulations and limits the public’s insight into the agency’s contract spending. To ensure consistent tracking and transparency of federal contracting activity related to the pandemic, GAO recommends that HHS accurately report data in the federal procurement database system and provide information that would allow the public to distinguish between spending on other transaction agreements and procurement contracts. HHS concurred with this recommendation. Oversight of Worker Safety and Health GAO identified concerns about federal oversight of worker safety and health amid the COVID-19 pandemic. Specifically, the Occupational Safety and Health Administration (OSHA) has adapted its enforcement methods for COVID-19 to help protect agency employees from the virus and address resource constraints, such as by permitting remote inspections in place of on-site inspections of workplaces. However, gaps in OSHA’s oversight and tracking of its adapted enforcement methods prevent the agency from assessing the effectiveness of its enforcement methods during the pandemic, ensuring that its adapted enforcement methods do not miss violations, and ensuring that employers are addressing certain identified violations. To improve its oversight, GAO recommends that OSHA (1) develop a plan, with time frames, to implement the agency’s oversight processes for COVID-19-adapted enforcement methods, and (2) ensure that its data system includes comprehensive information on use of these enforcement methods to inform these processes. The agency neither agreed nor disagreed with these recommendations. Additionally, OSHA’s data do not include comprehensive information on workplace exposure to COVID-19. For example, OSHA does not receive employer reports of all work-related hospitalizations related to COVID-19, as disease symptoms do not appear within the required reporting time frames. Employers may also face challenges determining whether COVID-19 hospitalizations or fatalities are work-related because of COVID-19’s incubation period and the difficulties in tracking the source of exposure. GAO recommends that OSHA determine what additional datamay be neededfrom employers or other sources to better target the agency’s COVID-19 enforcement efforts. The agency neither agreed nor disagreed with this recommendation. Assistance for Fishery Participants The CARES Act appropriated $300 million in March 2020 to the Department of Commerce (Commerce) to assist eligible tribal, subsistence, commercial, and charter fishery participants affected by COVID-19, which may include direct relief payments. After administrative fees were assessed, $298 million of the $300 million appropriated was obligated for fishery participants.Widespread restaurant closures in the spring of 2020 led to a decrease in demand for seafood, adversely affecting the fisheries industry. As of December 4, 2020, all funds had been obligated and only about 18 percent ($53.9 million) of the CARES Act funding obligated for fishery participants had been disbursed, which is inconsistent with Office of Management and Budget guidance on the importance of agencies distributing CARES Act funds in an expedient manner. Commerce’s National Oceanic and Atmospheric Administration (NOAA) officials said they expect that the vast majority of funds will be disbursed to fisheries participants by early 2021. However, the agency does not have the needed information centralized to help ensure that funds are being disbursed expeditiously and efficiently. GAO recommends that NOAA develop a mechanism to track the progress of states, tribes, and territories in meeting established timelines to disburse funds in an expedited and efficient manner. NOAA concurred with this recommendation. Program Integrity GAO continues to identify areas to improve program integrity and reduce the risk of improper payments for programs funded by the COVID-19 relief laws now that federal agencies have obligated a total of $1.9 trillion and expended $1.7 trillion of the $2.7 trillion appropriated for response and recovery efforts as of November 30, 2020. Federal relief programs remain vulnerable to significant risk of fraudulent activities because of the need to quickly provide funds and other assistance to those affected by COVID-19 and its economic effects. In this report, GAO identifies concerns about overpayments and potential fraud in the unemployment insurance (UI) system, specifically in the federally funded Pandemic Unemployment Assistance (PUA) program, which provides UI benefits to individuals not otherwise eligible for these benefits, such as self-employed and certain gig economy workers. As of January 11, 2021, states that had submitted data to DOL reported more than $1.1 billion in PUA overpayments from March through December 2020. While DOL requires states to report data on PUA overpayments, as of the beginning of 2021, the agency was not tracking the amount of overpayments recovered, limiting insight into the effectiveness of states’ efforts to recoup federal funds. To better track the recovery of federal funds, GAO recommends that DOL collect data from states on the amount of PUA overpayments recovered. DOL concurred with this recommendation, and has taken the first step toward implementing it by issuing new guidance and updated instructions for states to report PUA overpayment recovery data. GAO also remains concerned about SBA’s management of internal controls and fraud risks in the Economic Injury Disaster Loans (EIDL) program. COVID-19 relief laws made qualifying small businesses and nonprofit organizations adversely affected by COVID-19 eligible for financial assistance from the EIDL program. Some approval requirements were also relaxed, such as requiring each applicant to demonstrate that it could not obtain credit elsewhere, through December 31, 2021. As of December 31, 2020, SBA officials said they had approved about 3.7 million applications for loans related to COVID-19, totaling about $200 billion. SBA rapidly processed loans and advances to millions of small businesses affected by COVID-19. GAO’s analysis of SBA data shows that the agency approved EIDL loans and advances for potentially ineligible businesses. For example, SBA approved at least 3,000 loans totaling about $156 million to potentially ineligible businesses in industries that SBA policies state were ineligible for the EIDL program, such as insurance and real estate development, as of September 30, 2020. GAO recommends that SBA develop and implement portfolio-level data analytics across EIDL loans and advances made in response to COVID-19 as a means to detect potentially ineligible and fraudulent applications. SBA neither agreed nor disagreed with this recommendation. As of January 15, 2021, the U.S. had about 23 million cumulative reported cases of COVID-19 and more than 387,000 reported deaths, according to the Centers for Disease Control and Prevention. The country also continues to experience serious economic repercussions. Four relief laws, including the CARES Act, were enacted as of November 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of November 30, 2020, of the $2.7 trillion appropriated by these four laws, the federal government had obligated a total of $1.9 trillion and expended $1.7 trillion of the COVID-19 relief funds, as reported by federal agencies. In December 2020, the Consolidated Appropriations Act, 2021, provided additional federal assistance for the ongoing response and recovery. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines the federal government’s continued efforts to respond to and recover from the COVID-19 pandemic. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials and stakeholders. GAO completed its audit work on January 15, 2021. GAO is making 13 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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    The Department of Transportation (DOT) uses a multistep, centralized process to prioritize and select research activities it will fund. DOT's modal administrations—which focus on specific modes of transportation like air, rail, and highways—conduct and manage most of DOT's research. The modal administrations GAO spoke to used a variety of methods to prioritize and select research, including soliciting stakeholders' feedback on research needs. The Office of the Assistant Secretary for Research and Technology (OST-R) is responsible for reviewing this proposed research to ensure alignment with DOT's strategic plans and to prevent duplicative research efforts, as required by statute. DOT has multiple efforts to facilitate research collaboration both externally and internally, but in guidance to promote collaboration, OST-R did not incorporate all leading practices. Specifically, OST-R established topical-research working groups on 12 multimodal subject areas in October 2018 and issued accompanying guidance. This guidance incorporated some leading collaboration practices, such as directing working groups to identify leadership roles and relevant participants. However, the guidance did not incorporate two leading practices—defining and monitoring progress toward long-term outcomes and regularly updating and monitoring written agreements. Taking steps to ensure the working groups follow these practices could provide OST-R greater assurance that the groups coordinate their efforts effectively, better plan long-term research, and better position themselves to address future transportation challenges. OST-R has taken some steps to help ensure that its public database on DOT-funded research projects (the Research Hub) contains complete and accurate information, as required by DOT's data management policy; however, data reliability issues remained. For example, as of July 2019—the latest available data at the time of GAO's analysis—36 percent of records in the database were missing research partners' contact information, hindering the research community's ability to obtain current project details. Taking additional steps, such as providing instructions to the modal administrations on how to improve the completeness and accuracy of the information they give OST-R for the Research Hub, would help ensure the database is fulfilling DOT's intended purpose that it serve as a reliable source of information on the department's research portfolio. Examples of Research Activities on Advanced Driver-Assistance Systems and Connected Vehicles Funded by the U.S. Department of Transportation DOT's research activities are critical to DOT's mission to make the nation's transportation system safer and more efficient. To meet current research needs and prepare for emerging technologies, DOT partners with public and private entities. In fiscal year 2018, DOT funded about 2,300 partners and had a research budget exceeding $1 billion. GAO was asked to review DOT's research activities. This report addresses: (1) how DOT prioritizes and selects which research activities it will undertake; (2) the extent to which DOT facilitates research collaboration with external stakeholders and across the department; and (3) the extent to which DOT ensures its Research Hub database contains complete and accurate project information. GAO reviewed documents and analyzed data from DOT; observed DOT-funded research; interviewed DOT officials from OST-R and four selected modal administrations; and used GAO's leading collaboration practices to assess the extent of collaboration. GAO also interviewed 17 DOT research partners, including universities and associations. GAO recommends that OST-R (1) take steps to ensure the topical-research working groups follow all leading collaboration practices, and (2) take additional steps to ensure the information in the Research Hub is complete and accurate. DOT concurred with GAO's recommendations. For more information, contact Elizabeth Repko at (202) 512-2834 or repkoe@gao.gov.
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    In U.S GAO News
    The Department of Defense (DOD) has taken steps to track reports of sexual harassment and sexual assault involving its federal civilian employees, but its visibility over both types of incidents is hindered by guidance and information-sharing challenges. While employees may not report all incidents for a variety of reasons, DOD also lacks visibility over those incidents that have been reported. For example, from fiscal years 2015 through 2019, DOD recorded 370 civilian employees as victims of sexual assault and 199 civilian employees as alleged offenders. However, these data do not include all incidents of sexual assault reported over this time period. Specifically, based on DOD guidance, examples of incidents that could be excluded from these data include those involving civilian employee victims (1) occurring in the continental United States, (2) employed by DOD components other than the military services, such as defense agencies, and (3) who are also military dependents. Without guidance that addresses these areas, DOD does not know the extent to which its civilian workforce has reported work-related sexual assault worldwide. Number of Department of Defense Federal Civilian Employees Recorded as Victims or Alleged Offenders in Reported Sexual Assault Incidents, Fiscal Years 2015-2019 While DOD has developed policies and procedures to respond to and resolve sexual harassment and sexual assault incidents involving federal civilian employees, gaps exist. For example, DOD issued guidance in June 2020 directing components to establish anti-harassment programs, but it lacks details regarding how such programs should be structured. Without clarifying guidance, components can establish programs that do not align with U.S. Equal Employment Opportunity Commission guidance for model anti-harassment programs. Additionally, GAO found that DOD civilian employees' ability to make restricted reports of sexual assault—confidential disclosures that do not initiate official investigations, but allow the victim to receive DOD-provided sexual assault support services—varies across components. According to DOD officials, they have not taken action to resolve this variation due to conflicts with federal statute, among other things. By reporting to and requesting any needed actions from Congress to resolve any conflicts with statute, the department can alleviate such inconsistencies and minimize legal risks for DOD components. With nearly 900,000 federal civilian employees around the world, DOD has responsibilities for preventing and responding to sexual harassment and assault within its workforce. In fiscal year 2018, DOD estimated that about 49,700 civilian employees experienced sexual harassment and about 2,500 civilian employees experienced work-related sexual assault in the prior year. House Report 116-120 included a provision for GAO to review DOD's prevention of and response to sexual harassment and assault involving DOD federal civilian employees. GAO's report examines, among other things, the extent to which DOD has (1) visibility over such reported incidents, and (2) developed and implemented policies and procedures to respond to and resolve these incidents. GAO reviewed policies and guidance; analyzed program data from fiscal years 2015 through 2019; interviewed officials at a nongeneralizable sample of five military installations; evaluated DOD training materials; and interviewed DOD, service, and civilian officials. GAO is making 19 recommendations, including that DOD issue guidance for comprehensive tracking of civilian work-related sexual assaults, enhance guidance on the structure of anti-harassment programs for civilians, and report to and request any needed actions from Congress on the ability of civilian employees to make restricted reports of sexual assault. As discussed in the report, DOD generally concurred with the recommendations. For more information, contact Brenda S. Farrell at (202) 512-3604 or farrellb@gao.gov.
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    In U.S GAO News
    What GAO Found The Department of Defense (DOD) has a variety of suicide prevention efforts that are implemented by the military services (Army, Navy, Air Force, and Marine Corps). These include clinical prevention efforts that are generally focused on individual patient treatment and interventions, as well as non-clinical efforts that are intended to reduce the risk of suicide in the military population. This includes, for example, training servicemembers to recognize warning signs for suicide and encouraging the safe storage of items such as firearms and medications. Officials with DOD's Defense Suicide Prevention Office (DSPO) told GAO that most ongoing non-clinical efforts are evidence based. Officials added that a suicide prevention effort is considered to be evidence based if it has been assessed for effectiveness in addressing the risk of suicide in the military population, which has unique risk factors such as a higher likelihood of experiencing or seeing trauma. These officials stated that newer efforts are generally considered to be “evidence informed,” which means that they have demonstrated effectiveness in the civilian population, but are still being assessed in the military population. DSPO officials further explained that assessments of individual prevention efforts can be challenging because suicide is a complex outcome resulting from many interacting factors. In 2020, DSPO published a framework for assessing the collective effect of the department's suicide prevention efforts by measuring outcomes linked to specific prevention strategies, such as creating protective environments. However, this framework does not provide DOD with information on the effectiveness of individual non-clinical prevention efforts. Having a process to assess individual efforts would help DOD and the military services ensure that their non-clinical prevention efforts effectively reduce the risk of suicide and suicide-related behaviors. GAO also identified impediments that hamper the effectiveness of DOD's suicide prevention efforts, including those related to the reporting of suicide data. Definitions. The military services use different definitions for key suicide-related terms, such as suicide attempt, which may result in inconsistent classification and reporting of data. These data are used to develop the department's annual suicide event report. DOD officials stated that this could negatively affect the reliability and validity of the reported data, which may impede the department's understanding of the effectiveness of its suicide prevention efforts and limit its ability to identify and address any shortcomings. Annual suicide reports. DOD publishes two yearly suicide reports through two different offices that are based on some of the same data and provide some of the same information, resulting in the inefficient use of staff. While these reports serve different purposes, improved collaboration between the two offices could help minimize duplication of effort and improve efficiency, potentially freeing resources for other suicide prevention activities. Why GAO Did This Study Suicide is a public health problem facing all populations, including the military. From 2014 to 2019, the rate of suicide increased from 20.4 to 25.9 per 100,000 active component servicemembers. Over the past decade, DOD has taken steps to address the growing rate of suicide in the military through efforts aimed at prevention. The National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's suicide prevention programs. This report examines DOD's suicide prevention efforts, including, among other objectives, (1) the extent to which non-clinical efforts are assessed for being evidence based and effective and (2) any impediments that hamper the effectiveness of these efforts. GAO examined suicide prevention policies, reports, and assessments and interviewed officials from DOD, the military services, and the Reserve components. GAO also interviewed officials at four installations and a National Guard site selected for variety in military service, location, and size.
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    In U.S GAO News
    The Missile Defense Agency (MDA) is developing a system to defend the U.S. from long-range missile attacks. As MDA continues to develop this system, called Ground-based Midcourse Defense (GMD), it has opportunities to incorporate into its approach lessons learned from over 2 decades of system development. MDA has made progress in developing and fielding elements of the GMD system. For example, MDA is constructing a new missile field to expand the fleet of interceptors. However, MDA has also experienced significant setbacks. Most recently, the Department of Defense canceled development of a key GMD element, the Redesigned Kill Vehicle, in 2019 because of fundamental problems with the system's design. Ongoing Construction of a New Ground-based Midcourse Defense Interceptor Field (July 16, 2019) Over the years, GAO has identified practices that MDA could apply to the GMD program to improve acquisition outcomes, such as: Using knowledge-based acquisition practices Involving stakeholders early and often Providing effective oversight Promoting competition Performing robust testing GAO has also made numerous recommendations to improve MDA's acquisition outcomes and reduce risk. As of July 2020, the department has concurred with most of the recommendations GAO made since MDA's inception in 2002. Although the department has implemented many of the recommendations, it has further opportunities to implement the remaining open recommendations and apply lessons learned on a major, new effort to develop a next-generation GMD interceptor. Since the late 1990s, DOD has executed the GMD program through a prime contractor responsible for developing and integrating the entire weapon system. MDA is considering taking over these responsibilities for GMD for the next phase of the program. GAO found that this approach offers potential benefits to the agency, such as more direct control over and greater insight into GMD's cost, schedule, and performance. However, the approach has some challenges that, if not addressed, could outweigh the benefits. For example, MDA may encounter challenges obtaining the technical data and staffing levels necessary to manage this complex weapon system, which could ultimately affect its availability or readiness. As of October 2020, MDA has not yet determined an acquisition strategy for the next phase of the GMD program. The GMD system aims to defend the U.S. against ballistic missile attacks from rogue states like North Korea or Iran. DOD has been developing this system since the 1990s and has spent $53 billion on the system so far. GMD is a complex system that includes interceptors and a ground system, and MDA has largely relied on a contractor, Boeing, to manage development and system integration. MDA is considering moving away from this approach as the program embarks on developing a key element of the GMD, a new interceptor. The House Armed Services Committee included a provision in a report for GAO to assess the GMD contract structure and identify potential opportunities to improve government management and contractor accountability. This report addresses (1) the lessons learned from challenges MDA encountered acquiring the GMD system and (2) the potential benefits and risks of MDA taking over system integration responsibilities for GMD. To conduct this work, GAO reviewed GMD program documentation, prior GAO reports on missile defense, GAO interviews with other DOD components, and expert panel reviews of GMD. GAO also spoke with officials from MDA and other DOD components. GAO has 17 open recommendations aimed at improving missile defense acquisition outcomes and reducing risk. Recently, DOD has taken steps to address some of these open recommendations, but further action is needed to fully implement the remaining recommendations. For more information, contact W. William Russell at (202) 512-4841 or russellw@gao.gov.
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    In U.S GAO News
    From October 2019 to March 2020, the Department of Homeland Security (DHS), in coordination with the Department of Justice's (DOJ) Executive Office for Immigration Review (EOIR), implemented expedited fear screening pilot programs. Under the Prompt Asylum Claim Review (for non-Mexican nationals) and Humanitarian Asylum Review Process (for Mexican nationals), DHS sought to complete the fear screening process for certain individuals within 5 to 7 days of their apprehension. To help expedite the process, these individuals remained in U.S. Customs and Border Protection (CBP) custody during the pendency of their screenings rather than being transferred to U.S. Immigration and Customs Enforcement (ICE). From October through December 2019, DHS implemented the programs in the El Paso, Texas, sector and expanded them to nearly all other southwest border sectors before pausing them in March 2020 due to COVID-19. DHS data indicate that CBP identified approximately 5,290 individuals who were eligible for screening under the pilot programs. About 20 percent of individuals were in CBP custody for 7 or fewer days; CBP held about 86 percent of individuals for 20 or fewer days. Various factors affect time in CBP custody such as ICE's ability to coordinate removal flights. U.S. Citizenship and Immigration Services (USCIS) data indicate that the majority of individuals (about 3,620) received negative fear determinations from asylum officers (see figure). About 1,220 individuals received positive credible fear determinations placing them into full removal proceedings where they may apply for various forms of protection such as asylum. However, as of October 2020, DHS and EOIR could not account for the status of such proceedings for about 630 of these individuals because EOIR's data system does not indicate that a Notice to Appear—a document indicating someone was placed into full removal proceedings before an immigration judge—has been filed and entered into the system, as required. Specifically, DHS and EOIR officials could not determine whether DHS components had filed the notices for these cases with EOIR, nor could they determine if EOIR staff had received but not yet entered some notices into EOIR's data system, per EOIR policy. Ensuring that DHS components file Notices to Appear with EOIR and that EOIR staff enter them into EOIR's data system in a timely manner, as required, would help ensure that removal proceedings move forward for these individuals. Outcomes of Screenings Under Expedited Fear Screening Pilot Programs, October 2019 through March 2020 (as of August 11, 2020) Note: Percentages do not total 100 due to rounding. Individuals apprehended by DHS and placed into expedited removal proceedings are to be removed from the U.S. without a hearing in immigration court unless they indicate a fear of persecution or torture, a fear of return to their country, or express an intent to apply for asylum. Asylum officers conduct such “fear screenings,” and EOIR immigration judges may review negative USCIS determinations. In October 2019, DHS and DOJ initiated two pilot programs to further expedite fear screenings for certain apprehended noncitizens. GAO was asked to review DHS's and DOJ's management of these pilot programs. This report examines (1) actions DHS and EOIR took to implement and expand the programs along the southwest border, and (2) what the agencies' data indicate about the outcomes of individuals' screenings and any gaps in such data. GAO analyzed CBP, USCIS, EOIR, and ICE data on all individuals processed under the programs from October 2019 to March 2020; interviewed relevant headquarters and field officials; and visited El Paso, Texas—the first pilot location. GAO is making two recommendations, including that DHS ensure components file Notices to Appear with EOIR for all those who received positive determinations under the programs, and that EOIR ensure staff enter all such notices in a timely manner, as required, into EOIR's case management system. DHS concurred and DOJ did not concur. GAO continues to believe the recommendation is warranted. For more information, contact at (202) 512-8777 or gamblerr@gao.gov.
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    In U.S GAO News
    GAO reviewed federal funding provided to various organizations that offer health-related services, such as voluntary family planning and activities related to the treatment and prevention of HIV/AIDs. In total, the organizations in our review received almost $16 billion through grants or cooperative agreements from the Department of Health and Human Services or U.S. Agency for International Development from 2016 through 2018; nearly all of this funding was received by federally qualified health centers. (See table.) Reported Amounts of Funds Received through Federal Grants or Cooperative Agreements by Organizations in GAO’s Review, 2016-2018 Dollars in millions Federal agency 2016 2017 2018 Total Department of Health and Human Services (HHS)       Federally qualified health centers (FQHC) 4,891.03 5,251.93 5,291.81 15,434.77       Planned Parenthood Federation of America (PPFA) 94.86 106.12 103.51 304.49       International Planned Parenthood Federation (IPPF) 2.30 2.05 1.20 5.55       Marie Stopes International (MSI) 0.00 0.00 0.00 0.00 Total HHS 4,988.19 5,360.10 5,396.52 15,744.81 U.S. Agency for International Development (USAID)       FQHC 0.00 0.00 0.00 0.00       PPFA 0.00 0.00 0.00 0.00       IPPF 2.13 5.48 7.80 15.41       MSI 36.64 34.20 15.62 86.46 Total USAID 38.77 39.68 23.42 101.87 Total (HHS and USAID) 5,026.96 5,399.78 5,419.94 15,846.68 Source: GAO analysis of HHS, PPFA and USAID, data. | GAO-21-188R We provided a draft of this report to the Secretary of Health and Human Services and the USAID Administrator for comment. HHS did not have any comments. USAID provided technical comments, which we incorporated as appropriate. GAO is not making any recommendations. In order to achieve their programmatic goals, federal agencies provide funding to various organizations that, in turn, use those funds to implement programs and activities aligned with those goals. For example, federal agencies may award funding through grants or cooperative agreements for programs. The organizations that are awarded the funding receive and spend the funds over a period of time. GAO was asked to report on federal funding for certain organizations that provide health-related services. This report describes the extent of federal funding through grants and cooperative agreements for federally qualified health centers, Planned Parenthood Federation of America, International Planned Parenthood Federation, and Marie Stopes International from 2016 through 2018. GAO obtained and reviewed information on federal funding from the Department of Health and Human Services and the U.S. Agency for International Development—the primary sources of federal funds to the organizations in our review. GAO also obtained available information from each of the organizations. For more information, contact James Cosgrove at 202-512-7114 or cosgrovej@gao.gov.  
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  • Crude Oil Markets: Effects of the Repeal of the Crude Oil Export Ban
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    GAO's analysis of U.S. Energy Information Administration (EIA) data and interviews with industry stakeholders shows that the repeal of the U.S. crude oil export ban is associated with increased crude oil exports—from less than half a million barrels per day in 2015 to almost 3 million barrels per day in 2019. The repeal of the ban expanded the market for U.S. crude oil to overseas buyers and, along with other market factors, allowed U.S. crude oil producers to charge higher prices relative to comparable foreign crude oil. Higher prices and an expanded market for U.S. crude oil further incentivized domestic crude oil production, which had been growing since the shale oil boom began around 2009 (see figure). During the period after the repeal, total U.S. imports of crude oil remained largely unchanged. Annual Production and Exports of U.S. Crude Oil, 2009-2019 GAO's analysis found limited effects associated with the repeal of the ban on the production, export, and import of domestic refined petroleum products, such as gasoline. However, profit margins—which are determined in part by the costs a refiner pays for the crude oil and the earnings a refiner receives from the sale of refined products—likely decreased as the prices refiners paid for domestic crude oil increased relative to international prices. Because gasoline prices are largely determined on the global market, U.S. refiners could not pass on to consumers the additional costs associated with the increase in crude oil prices, resulting in decreased profit margins for U.S. refiners. Finally, after the repeal of the crude oil export ban, the U.S. shipping industry experienced a decline as demand fell for U.S. tankers—known as Jones Act tankers—used to move domestic crude oil between U.S. ports. The increase in the relative price of domestic crude oils associated with the repeal of the export ban may have resulted in some U.S. refineries deciding to use more foreign crude oil. Foreign crude oil is typically transported by foreign tankers, reducing the demand for Jones Act tankers compared to what it would have been if the export ban had remained in place, according to six of the seven shipping industry stakeholders GAO interviewed. Between 1975 and the end of 2015, the Energy Policy and Conservation Act directed a ban on nearly all exports of U.S. crude oil. This ban was not considered a significant policy issue when U.S. oil production was declining and import volumes were increasing. However, U.S. crude oil production roughly doubled from 2009 to 2015, due in part to a boom in shale oil production made possible by advancements in drilling technologies. In December 2015, Congress effectively repealed the ban, allowing the free export of U.S. crude oil worldwide. GAO was asked to provide information on the effects of repealing the crude oil export ban. This report describes the effects of the repeal of the crude oil export ban on the domestic crude oil production, petroleum refining, and related sectors of the U.S. shipping industry. GAO analyzed data from EIA and other federal databases to determine the effects of repealing the export ban. GAO also interviewed a nongeneralizeable sample of economists, market analysts, and stakeholders from the oil and gas, refining, and shipping industries. GAO's analysis focused on the repeal of the crude oil export ban and any effects of the repeal on U.S. crude oil and related industries through March 2020. For more information, contact Frank Rusco at (202) 512-3841 or ruscof@gao.gov.
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  • Commercial Shipping: Information on How Intermodal Chassis Are Made Available and the Federal Government’s Oversight Role
    In U.S GAO News
    What GAO Found Containerized shipping—performed by oceangoing vessels using standardized shipping containers—accounted for approximately 60 percent of all world seaborne trade, which was valued at approximately $12 trillion in 2017. At a port, shipping containers are placed on "intermodal chassis" (chassis), standardized trailers that carry shipping containers and attach to tractors for land transport. Multiple entities are involved in the movement of shipping containers, including intermodal equipment providers (IEP) (which own and provide chassis for a fee); ocean carriers (which transport cargo over water); and motor carriers (which transport shipping containers over land via chassis). Four distinct models are used in the U.S. to make chassis available to motor carriers (see table), each with benefits and drawbacks according to the entities GAO interviewed. While chassis are generally provided to motor carriers using one of these four models, more than one model may be available at a port. Chassis Provisioning Models Model 1: Single chassis provider An individual intermodal equipment provider (IEP) owns chassis that are directly provided to shippers or motor carriers. Model 2: Motor carrier-controlled A motor carrier owns or is responsible for a chassis that it has procured under a long-term lease. Model 3: Gray pool A single manager, often a third party, oversees the operations of a pool that is made up of chassis contributed by multiple IEPs. Model 4: Pool-of-pools Each IEP manages its respective chassis fleet, but each allow motor carriers to use any chassis among the fleets and to pick up and drop off chassis at any of the IEPs’ multiple locations. Source: GAO.  |  GAO-21-315R Entities GAO interviewed identified multiple benefits and drawbacks to each of the chassis provisioning models. Regarding benefits, for example, both the single chassis provider model and the motor carrier-controlled model allow IEPs and motor carriers to have direct control over the maintenance and repair of their chassis, something these entities potentially lose under other chassis provisioning models. Further, the gray pool and the pool-of-pools models can resolve many of the logistical concerns regarding the availability of chassis, leading to operational efficiencies for port operators and the ability of motor carriers to choose whatever chassis they wish. Regarding drawbacks, cost considerations were identified in some cases. For example, under the single chassis provider model, two IEPs told us that while an expected part of the business, repositioning chassis to ensure there is a sufficient supply of chassis where they are needed can be costly to the IEPs. The federal government provides oversight of chassis safety but has a limited economic oversight role regarding chassis. The Federal Motor Carrier Safety Administration (FMCSA) employs several inspection methods to help oversee chassis safety and compliance with regulations. For example, inspectors perform roadside inspections on commercial vehicles, including chassis, in operation. FMCSA also performs investigations of individual IEPs to oversee chassis safety. While one stakeholder GAO spoke with stated that FMCSA should consider maintaining safety ratings for IEPs—as is currently done for motor carriers—FMCSA officials told us that the current processes provide sufficient information to select IEPs for investigation. The Federal Maritime Commission (FMC) oversees ocean carriers that provide service to and from the U.S. and works to ensure a competitive and reliable ocean transportation supply system. Entities may file complaints with FMC to allege violations of the Shipping Act of 1984, as amended. One such complaint was filed in August 2020, in which the complainants allege, among other things, that although ocean carriers do not own chassis, they still control the operation of chassis pools at ports. An initial decision on this complaint is expected in August 2021. None of the entities GAO spoke with identified additional actions they would like for FMC to take regarding chassis. Why GAO Did This Study Senate Report 116-109—incorporated by reference into the explanatory statement accompanying the Further Consolidated Appropriations Act, 2020—contained a provision for GAO to study intermodal chassis. Within the U.S., some entities have expressed concerns about chassis, including limited availability of chassis in some circumstances, as well as the age and safety of chassis. This report describes selected stakeholders' views on: (1) the ways in which chassis are made available for the movement of shipping containers and the benefits and drawbacks of those models, and (2) the federal government's role in the chassis market. To address these objectives, GAO reviewed relevant reports on chassis provisioning and federal oversight. GAO interviewed representatives from FMC, FMCSA, five industry associations, and the three largest intermodal equipment providers. GAO also interviewed three ocean carriers, five port operators, and a motor carrier selected, in part, for their large number of container movements. The information obtained from these interviews provides a broad perspective of relevant issues but is not generalizable to all entities. For more information, contact Andrew Von Ah at (202) 512-2834 or vonaha@gao.gov.
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