A U.S. Government Accountability Office (GAO) review has found that most states meet performance standards for infectious disease threats related to safety and coordination of first responders, but states reported mixed results regarding electronic lab reporting, epidemiology capacity, and laboratory capacity.
The U.S. Department of Health and Human Services (HHS) awarded to state and local governments about $21.2 billion from 2002 to 2017 through three essential preparedness and capacity building programs. Those programs included Epidemiology and Laboratory Capacity for Infectious Diseases (ELC), the Hospital Preparedness Program (HPP), and Public Health Emergency Preparedness (EHP). About $3 billion was awarded in direct response to threats like Zika, Ebola, and H1N1, and about $18 billion was awarded for general preparedness and capacity building activities.
“The combined amount of awards provided through the three programs’ annual appropriations has generally decreased, from about $1.4 billion in fiscal year 2003 (which was when the total awards were at the highest level) to about $1.0 billion in fiscal year 2017, though funding trends between the three programs have varied over time,” the GAO report stated.
ELC funding provided through annual appropriations almost doubled from fiscal year 2002 to 2017, but yearly appropriations to HPP and PHEP decreased about 54 percent and 33 percent, respectively. However, about $2.9 billion in supplemental appropriations were made to the three programs over that period. The GAO report concluded, “these awards have been a large percentage of total award amounts provided in certain years.”
The GAO review categorized 20 HHS performance metrics for the three programs into four general areas: electronic lab reporting, epidemiology capacity, laboratory capacity and responder protection. Concerning electronic lab reporting, 58 percent of awardees successfully achieved the goal of establishing two more electronic lab reporting feeds, but just 16 percent met the goal of increasing electronic laboratory reports by 10 percentage points or more.
Epidemiology capacity performance standards generated mixed results, too. While 84 percent of awardees met the single performance standard set for ELC, just 10 to 12 percent met PHEP targets, GAO found.
“The two PHEP measures in this area are key to being able to initiate timely investigations and limit the spread of disease,” GAO stated. “CDC officials stated that the nature of a disease may make it difficult for an awardee to meet the performance targets. For example, the source of foodborne diseases can be particularly difficult to track in order to implement control measures, especially when contamination may have originated outside of the United States.”
Laboratory capacity, meanwhile, refers to the ability of awardees to communicate with other laboratories and test specific pathogens. About half of awardees met the ELC performance target, and more than 75 percent of awardees met the five PHEP performance targets.
“CDC officials stated that the ELC measure in this area — turnaround time for laboratory tests — allows awardees to choose diseases for which they would like to focus on to improve the timeliness of their laboratory testing,” the GAO report stated. “…Certain circumstances may make it more difficult for an awardee to meet the target, such as implementing complex laboratory procedures, according to CDC officials. Performance varied widely among awardees that missed the target; for example, several awardees missed their selected target by one or two days, while others missed the target by a week or more.”
The GAO review found that states had widely met first responder protection performance standards. About 97 percent of awardees met both ELC and HPP performance measures.
“The responder protection performance measures apply to ELC’s and HPP’s Ebola awards from supplemental appropriations, and measure activities related to safety and coordination for laboratorians, hospital and emergency personnel, and other responders, including the coordination of these responders,” GAO reported. “The measures assess the extent to which awardees can safely respond in the event of a highly contagious infectious disease threat. Though these performance measures were designed specifically for Ebola, ASPR and CDC officials told us that these measures may also have some application to preparedness for other highly infectious diseases.”