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Open Recommendations (17 total)

Zoonotic Diseases: Federal Actions Needed to Improve Surveillance and Better Assess Human Health Risks Posed by Wildlife

GAO-23-105238
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of CDC, in collaboration with other agencies, as appropriate, should comprehensively assess zoonotic disease risks related to imported wildlife to inform CDC's decisions about regulations. Such an assessment could include identifying high priority categories of wildlife and then conducting risk assessments for those particular categories. (Recommendation 5)
Open
As of November 2023, we are following up with the agency on any actions taken to implement this recommendation.

Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited

GAO-22-105276
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of the CDC should expand the scope of its analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to include the prevalence of falls and fall-related injuries among adults under age 65 who may be at higher risk of falls, including adults with disabilities, and, as appropriate, share findings with ACL and other agencies overseeing relevant programmatic efforts. For example:

  • CDC could analyze existing BRFSS data on adults aged 45 to 64 and share findings, as appropriate.
  • CDC could propose asking adults aged 18 to 44 the two BRFSS fall-related questions, as part of the survey update process.

(Recommendation 1)
Open
CDC agreed with this recommendation. As of January 2023, CDC officials said they have begun exploring options to expand the scope of the BRFSS data analysis for adults under age 65. Specifically, CDC is analyzing BRFSS data on falls among adults with disabilities aged 45 to 64. CDC will also consider how best to disseminate these findings, such as through targeted outreach to key partners, publications, and email outreach to those who subscribe to CDC updates on older adult falls prevention.

Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement

GAO-22-105018
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should implement controls for the entry of data into its Quarantine Activity Reporting System (QARS), including by providing adequate training and standard operating procedures that are documented and institutionalized for system users and by conducting consistent validation checks. (Recommendation 1)
Open
In its January 2023 180-day letter, CDC indicated that it is in the initial phase of addressing this recommendation. For example, CDC has taken steps to update data entry trainings for staff to increase understanding of the Quarantine Activity Reporting System (QARS) and data quality control. According to agency officials, CDC has also made some internal validation updates to QARS. We will continue to monitor CDC's progress implementing this recommendation.
Centers for Disease Control and Prevention The Director of CDC should re-design QARS or deploy a new data system that would allow CDC to more effectively facilitate contact tracing for air passengers and conduct disease surveillance for air travel. (Recommendation 3)
Open
In its January 2023 180-day letter, CDC indicated that it is starting to modernize the Quarantine Activity Reporting System (QARS) to ensure that the system is aligned with the overall data and system standards being implemented across the agency. CDC officials stated that the planned updates will move QARS to a cloud-based platform and improve the efficiency of data collection and data validation. The first modules of the updated system are expected to be in place by summer 2023, according to CDC. We will continue to monitor CDC's progress implementing this recommendation.

Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement

GAO-22-105018
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of CDC should assess additional opportunities to improve the quality of air passenger information it collects and manages— including opportunities to increase automation by adopting or establishing data exchange standards—and take action, as appropriate, based on this assessment. (Recommendation 2)
Open
In its January 2023 180-day letter, CDC noted that it has seen improvement in the quality of data collected from travelers since an October 2021 Order requiring airlines to collect contact information for passengers before their arrival into the United States from a foreign country. CDC stated that it considers this recommendation closed. GAO continues to believe that potential opportunities exist to enhance data quality, which the CDC needs to assess. Specifically, the requirements in the Order, which GAO reviewed at the time of its study, mostly apply to passengers traveling on inbound international flights--a small fraction of the total number of air travelers. In addition, these efforts may only be temporary. Therefore, this recommendation remains open. GAO will continue to monitor CDC's efforts to implement this recommendation.

COVID-19: Current and Future Federal Preparedness Requires Fixes to Improve Health Data and Address Improper Payments

GAO-22-105397
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention should define specific action steps and time frames for the agency's data modernization efforts. See the Public Health Data Collection and Standardization enclosure. (Recommendation 9)
Open – Partially Addressed
As of April 2023, CDC has taken steps to address this recommendation. Specifically, CDC has developed a Public Health Data Strategy (Strategy), and has established the Office of Public Health Data, Surveillance, and Technology (Office). The Office was created as an accountability mechanism for public health data and will implement the Strategy within the next 2 years. According to CDC, the Office will be responsible for core public health data systems and technology solutions to support critical public health missions and data policy. Although CDC has identified a 2 year time frame to implement its Strategy, it has not defined the specific action steps it will take to implement the Strategy. In its Strategy, CDC outlines broad actions it plans to take, but does not define the steps needed to achieve these actions. That is, the mechanisms through which CDC plans to increase engagement, collaboration, and continual feedback are unclear. GAO will continue to monitor CDC's progress on any updates to the Strategy and its implementation.
Centers for Disease Control and Prevention The Director of the Centers for Disease Control and Prevention, in coordination with state, tribal, local, and territorial jurisdiction and public health organization partners, should ensure the agency builds upon its existing surveillance approach by detailing specific objectives for how it will achieve its COVID-19 surveillance goals and describing how it will assess progress toward meeting them. See the COVID-19 Surveillance enclosure. (Recommendation 10)
Open
The Department of Health and Human Services (HHS) agreed with our recommendation, and the Centers for Disease Control and Prevention (CDC) noted that it will continue efforts to develop a document summarizing its COVID-19 surveillance goals and how it will assess progress towards meeting them. As of April 2023, CDC stated that it is preparing a report for publication that will describe COVID-19 Surveillance in the United States after the expiration of the Public Health Emergency (PHE) on May 11, 2023. CDC also stated that it is finalizing a document that summarizes the national COVID-19 surveillance framework during the emergency response phase of the pandemic that is expected to be cleared for release after the expiration of the PHE. CDC stated that it will provide supporting documentation in May 2023. Once CDC provides these documents, we will review them to determine the extent they were developed in coordination with partners and the extent they detail specific objectives for how it will achieve its COVID-19 surveillance goals and measure progress.

Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference

GAO-22-104613
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The CDC Director should ensure that procedures for reporting and addressing potential political interference in scientific decision-making are developed and documented, including adding a definition of political interference. (Recommendation 1)
Open
As of April 2023, HHS was updating its departmental scientific integrity policy and its operating divisions, including the CDC, were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference. In April 2023, HHS plans to submit its draft scientific integrity policy for review by the White House Office of Science and Technology Policy. HHS then plans to finalize its policy by February 2024 and will make the policy publicly available on its website.

Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference

GAO-22-104613
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The CDC Director should ensure that CDC employees and contractors performing scientific activities are trained on how to report allegations of political interference in scientific decision-making. (Recommendation 2)
Open
As of April 2023, HHS was updating its departmental scientific integrity policy and its operating divisions were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference. Following publication of the updated departmental scientific integrity policy by February 2024, HHS will develop scientific integrity training for employees, contractors, and other persons covered by the policy. This training will describe HHS's policies and procedures related to scientific integrity, including how to recognize, avoid, and report potential political interference.

COVID-19: HHS Agencies' Planned Reviews of Vaccine Distribution and Communication Efforts Should Include Stakeholder Perspectives

GAO-22-104457
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention As CDC finalizes its plans for an after action review related to its COVID-19 vaccine distribution and communication efforts, the Director of the Centers for Disease Control and Prevention should ensure the agency obtains feedback during the life cycle of the response from key stakeholders, including state and local health officials, and incorporates their perspectives as it conducts its review. (Recommendation 1)
Open
CDC concurred with this recommendation. As of April 2023, HHS/CDC had no updates for this recommendation. We will continue to monitor the agency's actions in this area.
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