Title: Public Health Preparedness--Building and Maintaining
Infrastructure Beyond the COVID-19 Pandemic

Description: At the beginning of the pandemic, we heard a lot about
shortages of hospital beds, ventilators, testing supplies, as well as
doctors and nurses. GAO has reported heavily on the impacts of not being
prepared for a pandemic. But in a new report, we look at the actions
being taken to make sure we're more prepared next time. We'll learn more
from GAO's Mary Denigan-Macauley.

Related GAO Work: GAO-24-105891, Public Health Preparedness: Building
and Maintaining Infrastructure Beyond the COVID-19 Pandemic

Released: November 2023

[MUSIC]

[Mary Denigan-Macauley:] If we are not as prepared for the next event,
that means that our recovery and our response is going to be slower.

[Holly Hobbs:] Hi and welcome to GAO's Watchdog Report. Your source for
fact-based, nonpartisan news and information from the U.S. Government
Accountability Office. I'm your host, Holly Hobbs. At the beginning of
the pandemic, we heard a lot about shortages of hospital beds, and
ventilators, testing supplies, as well as doctors and nurses. GAO has
reported heavily on the impacts of not being prepared for the pandemic.
But in a new report, we look at the actions being taken to make sure
we're ready and more prepared the next time. Joining us to talk about
our new report is GAO's Mary Denigan-Macauley, an expert on health care
policy. Thanks for joining us.

[Mary Denigan-Macauley:] Hi, Holly. Thanks for having me.

[Holly Hobbs:] So, Mary, maybe we can start with--when it comes to things
like public health infrastructure, who or what entity is responsible for
ensuring we're prepared for things like a pandemic?

[Mary Denigan-Macauley:] Well, preparing for the next pandemic really
requires all hands on deck. It's not just at the federal level or the
state or local, or even the jurisdictional level. Everyone needs to be
prepared. No one can do this alone. That said, the Centers for Disease
Control, from the Department of Health and Human Services, does have
funding that they provide to those jurisdictions to help them to
prepare.

[Holly Hobbs:] How much money are we talking about? And how was it
spent? 

[Mary Denigan-Macauley:] So we're talking millions. There was about $845
million that went to jurisdictions to be prepared. And most of that come
from what we call an all-hazards so as to be prepared for any kind of
public health event. It could be radiological, it could be chemical,
could be biological. And we previously reported that the money that was
going out was declining. In the recent years we saw that it pretty much
remained at a steady state . And they used the funds to hire staff, to
be able to get equipment. For example, you need epidemiologists to help
track and trace during infectious disease. So that's how they're using
the money.

[Holly Hobbs:] And so these funding mechanisms, they pre-dated COVID.
But did the funding change at all as a result of COVID or in the wake of
COVID?

[Mary Denigan-Macauley:] Yes. We have past work in 2018, where we had
reported that these funds actually were going down over the years. But,
we saw a massive infusion of a one-time funding in light of COVID to be
able to get these states and other jurisdictions to be able to ramp up
and respond. And they got over $7 billion for these activities.

[Holly Hobbs:] So when you have a situation like COVID, it seems like
you would need to scale up quickly, right? You would to need to hire a
lot of health care workers temporarily for example, and you need to
build facilities for things like mass testing. Right? Did that create
any problems for state and local folks?

[Mary Denigan-Macauley:] So you're absolutely right. The money came in.
They had to ramp up. Again, all hands on deck. What it did do was it
provided for the massive amount of money upfront to be able to respond
to COVID. But the challenge is that they then it was a temporary or
one-time or what we call a supplemental funding. And so you can go ahead
and you can hire staff, you can buy a piece of laboratory equipment, for
example. But now can you maintain that staff? Can you maintain that
equipment? And so that's the challenge that they're currently having, is
once that funding runs out, how are they going to be able to continue to
maintain all of those gains that they made?

{Music}

[Holly Hobbs:] So it sounds like prior to COVID, funding for public
health preparedness was declining. And then there was a massive infusion
of cash to help respond to COVID, but that also came with challenges
like maintaining efforts once the money was gone. So, Mary, we're going
to keep looking at this issue of public health preparedness. Could you
tell us a little bit about our ongoing work?

[Mary Denigan-Macauley:] Yes, absolutely. And I'm glad you asked the
question because we recently placed HHS, the Health and Human Services,
on what we call our High Risk List for their oversight and coordination
of handling of public health emergencies. And we put it on there because
we believe that it's in need of major transformation. Not only did we
see problems with the COVID response, but we looked at decades worth of
work, and we saw the same some of the same mistakes were being repeated,
and some of them were very basic--understanding, coordination and
basically being able to be prepared for an event and responding
effectively the first time. And so we will continue to look at this
issue, not only looking at infrastructure broadly like we did on this
one, but we're going to zero in. We have a report coming out that's
looking at workforce specifically. We also have a report looking at our
response to Monkeypox, which is now known as Mpox and looking at that
response. And how did it compare to COVID, and how are we making any of
the same mistakes? Are we doing better? Are we better prepared? So, yes,
we will continue to look at this issue for many years to come. 

[Holly Hobbs:] Last question, what's the bottom line of this report?

[Mary Denigan-Macauley:] So, being prepared is what the goal is. And the
question becomes what level of preparedness are we willing to provide to
be able to hit the road running if something like COVID--or goodness
forbid, something worse than COVID--comes along could be something more
highly infectious that could kill people more rapidly? We saw that we
have a steady state of funding recently, but that funding is not even
keeping up with the current times. And so when that supplemental funding
comes in, it's a boom or bust. If we are not as prepared for the next
event, that means that our recovery and our response is going to be
slower. And so really, the nation needs to decide, with all the
competing priorities, do we want to be better prepared for the next
event? And if so, how can we keep that infrastructure prepared and ready
to hit the road for when it comes?

[Holly Hobbs:] That was Mary Denigan-Macauley talking about GAO's new
report on public health preparedness. Thanks for your time, Mary. 

[Mary Denigan-Macauley:] Thanks for having me, Holly.

[Holly Hobbs:] And thank you for listening to the Watchdog Report. To
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