COVID-19: Lessons Can Help Agencies Better Prepare for Future Emergencies

PLANNING IN ADVANCE

Advanced plans-including national-level strategies and department- and agency-level plans-provide vision for how the federal government will respond to public health emergencies and are critical to the nation's preparedness and ability to implement a timely response. Agencies can further enhance their preparedness by

• clearly defining their roles and responsibilities and those of their response partners in response plans, and exercising these plans prior to emergencies;
• understanding their capabilities and limitations and those of their response partners, and reflecting these capabilities and limitations in response plans; and
• building their capacity and collecting lessons to inform and update plans.

GAO found instances where federal agencies could improve their preparedness by taking such steps. For example, the Department of the Treasury has not incorporated lessons GAO identified from the COVID-19 assistance programs to the aviation industry into its efforts to compile resources to prepare for future financial disasters. Taking such steps could help Treasury make timely decisions and avoid encountering past challenges when responding to future emergencies.

Further, GAO has made recommendations to federal agencies to improve their emergency response plans. For example, GAO recommended that the Department of Health and Human Services develop plans outlining steps to mitigate shortages in needed medical supplies, develop a comprehensive testing strategy, and develop an approach for assessing and addressing known challenges and future risks associated with advanced development and manufacturing of medical countermeasures, including vaccines.

COLLABORATING WITH RESPONSE PARTNERS

Collaborating with response partners-including federal and nonfederal partners-before and during public health emergencies can help agencies efficiently implement response activities and continue operations. Federal agencies can facilitate this collaboration by identifying partners key to implementing the response, regularly coordinating with identified partners, and ensuring partners understand their roles and responsibilities in implementing the response.

GAO has made recommendations to agencies across the federal government to improve their collaboration with response partners. For example, GAO recommended that the Department of Health and Human Services share its plans to mitigate medical supply shortages with response partners and maintain up-to-date guidance for partners on requesting and receiving assets from the Strategic National Stockpile.

PROVIDING CLEAR AND TIMELY COMMUNICATIONS

Federal agencies can enhance their efforts to effectively administer relief funds, vaccines, and other critical resources during a public health emergency by providing clear and timely information to

• applicants and eligible entities of federal relief funds,
• recipients of federal relief funds, and
• the public.

GAO has made recommendations to federal agencies to improve their communications during public health emergencies. For example, GAO recommended that the Small Business Administration develop a comprehensive strategy for communicating with potential and actual program applicants in the event of an emergency. GAO stated that its strategy should include guidelines for the types of information and timing of information to be provided to program participants throughout an emergency.

MANAGING PROGRAM INTEGRITY RISKS

Establishing controls and processes can help federal agencies manage program integrity risks when they must disburse emergency relief funds quickly during an emergency. Specifically, prepayment controls and processes can help agencies minimize the likelihood of improper payments and fraud. Further, postpayment controls and processes can help agencies identify and recover improper and fraudulent payments when the quick disbursement of funds makes prepayment controls difficult to apply fully.

GAO has made recommendations to federal agencies to better manage program integrity risks in emergency assistance programs. For example, GAO recommended that the Department of Labor design and implement an antifraud strategy for unemployment insurance programs that is consistent with leading practices outlined in GAO's Fraud Risk Framework.

COLLECTING AND SHARING DATA

Collecting and sharing data can help federal agencies

• effectively manage response activities, evaluate performance in meeting response program goals, and make midcourse adjustments as needed;
• target and administer relief fund programs; and
• enhance the early detection of public health emergencies.

GAO has made recommendations to federal agencies to enhance their ability to collect and share data before and during public health emergencies. For example, GAO recommended that the Department of Health and Human Services develop a plan to establish an electronic nationwide public health situational awareness network and identify measurable steps for completing this network.

LEVERAGING EXISTING INFRASTRUCTURE

Leveraging the existing infrastructure-including programs, partnerships, and systems-can help federal agencies implement timely activities to respond to a public health emergency and efficiently manage them. Specifically, federal agencies can use existing infrastructure to facilitate the delivery of services, distribute federal relief funds, and manage and oversee response programs.

GAO identified instances during the COVID-19 pandemic where federal agencies successfully leveraged the existing infrastructure. For example, the Department of the Interior and the Indian Health Service leveraged existing program mechanisms to efficiently distribute COVID-19 relief funds to tribal recipients during the pandemic. GAO has made recommendations to federal agencies to seek such opportunities. Further, GAO suggested that Congress consider enacting automatic increases in federal Medicaid spending during economic downturns to increase federal Medicaid support in a more timely and targeted fashion.

IMPLEMENTING PROGRAM FLEXIBILITIES

Implementing flexibilities-such as telehealth and telework-during a public health emergency can help federal agencies

• deliver services to program beneficiaries,
• maintain activities to support critical operations, and
• promote the safety of workers and the public.

GAO has recommended that federal agencies examine the extent to which flexibilities utilized during the COVID-19 pandemic could be incorporated in standard operations or used during future emergencies. For example, GAO recommended that the Food and Drug Administration fully assess whether and how alternative tools could help meet drug oversight objectives when in-person inspections are not possible in the future.