Biodefense: After-Action Findings and COVID-19 Response Revealed Opportunities to Strengthen Preparedness

GAO-21-513 Published: Aug 04, 2021. Publicly Released: Aug 04, 2021.
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Fast Facts

The COVID-19 pandemic shows how catastrophic biological incidents can cause substantial loss of life and damage the economy. The 2018 National Biodefense Strategy outlines how to prepare for and respond to such incidents.

The key federal agencies we examined prepared interagency response plans and conducted 74 interagency exercises from 2009-2019 to prepare for anthrax attacks, flu pandemics, and the like. However, we found the agencies don't routinely work together to monitor exercise results to identify potential patterns of problems.

We made 16 recommendations aimed at honing the nation's ability to respond to the next biological threat.

Participants in a Biological Incident Exercise

A biological incident exercise

 

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Highlights

What GAO Found

Key federal agencies, including the Departments of Homeland Security (DHS), Defense (DOD), Health and Human Services (HHS), and Agriculture (USDA), developed a range of interagency response plans to prepare for nationally significant biological incidents. These strategic, operational, and tactical level plans address responding to a broad spectrum of biological threats, including those that are intentional, accidental, or naturally occurring.

DHS, DOD, HHS, and USDA conducted numerous interagency exercises to help prepare for and respond to a wide variety of biological incidents, such as anthrax attacks, influenza pandemics, and diseases affecting plants and animals. Specifically, GAO identified 74 interagency biological incident exercises conducted from calendar years 2009 through 2019.

Number of Interagency Biological Incident Exercises Conducted, Calendar Years 2009 through 2019

HLP_5 - 104292

GAO's analysis of after-action reports for selected interagency biological incident exercises and real-world incidents, as well as the COVID-19 response, identified long-standing biodefense challenges. GAO found that the nation lacked elements necessary for preparing for nationally significant biological incidents, including a process at the interagency level to assess and communicate priorities for exercising capabilities. Further, it determined that agencies do not routinely work together in monitoring results from exercises and real-world incidents to identify patterns and root causes for systemic challenges. Assessing and communicating exercise priorities and routinely monitoring the results of the exercises and incidents will help ensure the nation is better prepared to respond to the next biological threat.

Why GAO Did This Study

The COVID-19 pandemic shows how catastrophic biological incidents can cause substantial loss of life, economic damage, and require a whole-of-nation response involving multiple federal and nonfederal entities. The 2018 National Biodefense Strategy outlines specific goals and objectives to help prepare for and respond to such incidents.

The CARES Act includes a provision for GAO to conduct monitoring and oversight of federal efforts to prepare for, respond to, and recover from COVID-19. This report addresses: (1) interagency plans key federal agencies developed, and exercises they conducted, to help prepare for biological incidents; and (2) the extent to which exercises and real-world incidents revealed opportunities to better achieve National Biodefense Strategy objectives.

GAO reviewed biological incident plans and after-action reports from exercises and real-world incidents from calendar years 2009 through 2019, including a non-generalizable sample of 19 reports selected based on threat scenario and other factors. GAO interviewed federal and state officials to obtain their perspectives on plans, exercises, and the COVID-19 response.

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Recommendations

GAO is making four recommendations each to DHS, DOD, HHS, and USDA, including that the secretaries work through the Biodefense Steering Committee to communicate exercise priorities and conduct monitoring. The departments generally concurred but in response to comments GAO modified the recommendations to reflect that the secretaries work through the Committee identified above.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Homeland Security The Secretary of Homeland Security, should, with input from key nonfederal partners, work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team defines the set of capabilities needed to prepare for and respond to nationally significant biological incidents. (Recommendation 1)
Open
DHS concurred with our recommendation and described plans to work with the Biodefense Coordination Team to communicate inputs from DHS and nonfederal partners to identify capability gaps. As of March 2022, according to DHS officials, they are working with interagency partners to comprehensively review the U.S. Government's biopreparedness policies and plans in accordance with Executive Order 13987, "Organizing and Mobilizing the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security," which they say will include implementation of this and other recommendations in this report. Officials estimated completion of these efforts by July 29, 2022.To fully address this recommendation, DHS, working through the Biodefense Coordination Team, will need to provide a finalized set of capability descriptions and evidence of input from key nonfederal partners.
Department of Defense The Secretary of Defense, should, with input from key nonfederal partners, work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team defines the set of capabilities needed to prepare for and respond to nationally significant biological incidents. (Recommendation 2)
Open
DOD partially concurred with this recommendation and described Biodefense Coordination Team efforts to identify capabilities necessary for advancing the goals and objectives of the National Biodefense Strategy. Responding to a the draft report, DOD officials expressed concerns about the appropriateness of the Secretary of Defense's role in gathering and assessing nonfederal input and providing it to the Biodefense Coordination Team. The intent of the sixteen recommendations we make in this report-four each to the four agencies given responsibility for the National Biodefense Strategy in statute-is to ensure that all four agencies work as full partners leading this effort in the ways that are most appropriate to their particular responsibilities, authorities, and resources. In January 2022, officials from DOD stated that the process for interagency biodefense coordination was undergoing review. Officials stated that they would continue to work with the National Security Council and other interagency partners to determine the best approach to address this recommendation. To fully address this recommendation, DOD will need to work with DHS, USDA, and HHS and other agencies serving on interagency bodies responsible for strategy implementation (as of April 2022 known as the Biodefense Steering Committee and Biodefense Coordination Team) to define a set of capabilities needed to prepare for and respond to nationally significant biological incidents. These capabilities should account for the resources, responsibilities, and needs of nonfederal partners as well as the resources, responsibilities, and authorities at the federal level.
Department of Health and Human Services The Secretary of Health and Human Services, should, with input from key nonfederal partners, work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team defines the set of capabilities needed to prepare for and respond to nationally significant biological incidents. (Recommendation 3)
Open
HHS concurred with our recommendation and described Biodefense Coordination Team efforts to identify capabilities necessary for advancing the goals and objectives of the National Biodefense Strategy. As of March 2022, according to HHS officials, they continue to work with interagency partners to address this recommendation. To fully address this recommendation, HHS, working through the Biodefense Coordination Team, will need to provide a finalized set of capability descriptions and evidence of input from key nonfederal partners.
Department of Agriculture The Secretary of Agriculture, should, with input from key nonfederal partners, work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team defines the set of capabilities needed to prepare for and respond to nationally significant biological incidents. (Recommendation 4)
Open
USDA concurred with our recommendation and described Biodefense Coordination Team efforts to identify capabilities necessary for advancing the goals and objectives of the National Biodefense Strategy. In March 2022, officials from USDA reported that a prior presidential memorandum establishing processes and leadership for the biodefense enterprise, was undergoing revision. To fully address this recommendation, USDA, working through the Biodefense Coordination Team, will need to provide a finalized set of capability descriptions and evidence of input from key nonfederal partners.
Department of Homeland Security The Secretary of Homeland Security should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team establishes a process to periodically assess and communicate exercise priorities among the capabilities they identify to support nationally significant biological incidents. (Recommendation 5)
Open
DHS concurred with our recommendation and described avenues that the Biodefense Coordination Team could use to help identify and communicate exercise priorities, such as creating a dedicated working group on biological exercises. As of March 2022, according to DHS officials, they are working with interagency partners to comprehensively review the U.S. Government's biopreparedness policies and plans in accordance with Executive Order 13987, "Organizing and Mobilizing the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security," which they say will include implementation of this and other recommendations in this report. Officials estimated completion of these efforts by July 29, 2022. To fully address this recommendation, DHS, working through the Biodefense Coordination Team, will need to finalize a process that includes a means for periodic assessment to prioritize capabilities for exercises.
Department of Defense The Secretary of Defense should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team establishes a process to periodically assess and communicate exercise priorities among the capabilities they identify to support nationally significant biological incidents. (Recommendation 6)
Open
DOD partially concurred with this recommendation and noted that opportunities exist to coordinate and communicate exercise priorities with interagency partners. In it's partial concurrence, DOD objected to wording in our draft recommendations that did not include the Biodefense Steering Committee. Prior to final publication, modified the recommendations to include the Committee. In January 2022, officials from DOD stated that the process for interagency biodefense coordination was undergoing review. Officials stated that they would continue to work with the National Security Council and other interagency partners to determine the best approach to address this recommendation. To fully address this recommendation, DOD will need to work with DHS, USDA, and HHS and other agencies serving on interagency bodies responsible for strategy implementation (as of April 2022 known as the Biodefense Steering Committee and Biodefense Coordination Team) establish a process to periodically assess and communicate exercise priorities among the capabilities they have identified as necessary to support nationally significant biological incidents.
Department of Health and Human Services The Secretary of Health and Human Services should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team establishes a process to periodically assess and communicate exercise priorities among the capabilities they identify to support nationally significant biological incidents. (Recommendation 7)
Open
HHS concurred with our recommendation and described avenues that the Biodefense Coordination Team could use to help identify and communicate exercise priorities. As of March 2022, according to HHS officials, they continue to work with interagency partners to address this recommendation. To fully address this recommendation, HHS, working through the Biodefense Coordination Team, will need to finalize a process that includes a means for periodic assessment to prioritize capabilities for exercises.
Department of Agriculture The Secretary of Agriculture should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team establishes a process to periodically assess and communicate exercise priorities among the capabilities they identify to support nationally significant biological incidents. (Recommendation 8)
Open
USDA concurred with our recommendation and described avenues that the Biodefense Coordination Team could use to help identify and communicate exercise priorities, such as creating an exercise working group. In March 2022, officials from USDA reported that a prior presidential memorandum, which established processes and leadership for the biodefense enterprise, including the coordination team, was undergoing revision. To fully address this recommendation, USDA, working through the Biodefense Coordination Team, will need to finalize a process that includes a means for periodic assessment to prioritize capabilities for exercises.
Department of Homeland Security The Secretary of Homeland Security should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team provides guidance for federal and nonfederal partners for how to report on capabilities in after-action reports for exercises and real-world incidents in a consistent manner. (Recommendation 9)
Open
DHS concurred with our recommendation and described mechanisms that could be used for reporting capabilities in after-action reports. As of March 2022, according to DHS officials, they are working with interagency partners to comprehensively review the U.S. Government's biopreparedness policies and plans in accordance with Executive Order 13987, "Organizing and Mobilizing the United States Government To Provide a Unified and Effective Response To Combat COVID-19 and To Provide United States Leadership on Global Health and Security," which they say will include implementation of this and other recommendations in this report. Officials estimated completion of these efforts by July 29, 2022. To fully respond to this recommendation, DHS, working through the Biodefense Coordination Team, will need to provide guidance for reporting on capabilities in after-action reports.
Department of Defense The Secretary of Defense should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team provides guidance for federal and nonfederal partners for how to report on capabilities in after-action reports for exercises and real-world incidents in a consistent manner. (Recommendation 10)
Open
DOD partially concurred with this recommendation. In it's partial concurrence, DOD agreed that the Biodefense Coordination Team should be tasked to provide reporting guidance, but objected to wording in our draft recommendations that did not include the Biodefense Steering Committee. Prior to final publication, we modified the recommendations to include the Committee, which directs the work of the Biodefense Coordination Team. In January 2022, officials from DOD stated that the process for interagency biodefense coordination was undergoing review. Officials stated that they would continue to work with the National Security Council and other interagency partners to determine the best approach to address this recommendation. To fully address this recommendation, DOD will need to work with DHS, USDA, and HHS and other agencies serving on interagency bodies responsible for strategy implementation (as of April 2022 known as the Biodefense Steering Committee and Biodefense Coordination Team) to provide guidance to federal and nonfederal partners for reporting after-action findings in a consistent manner across various exercise and real-world event after-action reporting efforts.
Department of Health and Human Services The Secretary of Health and Human Services should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team provides guidance for federal and nonfederal partners for how to report on capabilities in after-action reports for exercises and real-world incidents in a consistent manner. (Recommendation 11)
Open
HHS concurred with our recommendation and described mechanisms that could be used for reporting capabilities in after-action reports. As of March 2022, according to HHS officials, they continue to work with interagency partners to address this recommendation. To fully respond to this recommendation, HHS, working through the Biodefense Coordination Team, will need to provide guidance for reporting on capabilities in after-action reports.
Department of Agriculture The Secretary of Agriculture should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team provides guidance for federal and nonfederal partners for how to report on capabilities in after-action reports for exercises and real-world incidents in a consistent manner. (Recommendation 12)
Open
USDA concurred with our recommendation. In March 2022, officials from USDA reported that a prior presidential memorandum, which established processes and leadership for the biodefense enterprise, including the coordination team, was undergoing revision. To fully implement this recommendation, USDA will need to work with the agencies that comprise the Biodefense Steering Committee to make sure the interagency working-level group (as of April 2022 known as the Biodefense coordination team) to routinely monitor, identify causes of, and report on after action findings from exercises and real-world events. The reporting should make recommendations and assign responsibilities for addressing identified root causes.
Department of Homeland Security The Secretary of Homeland Security should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team routinely monitors the results of interagency biological exercises and real-world incidents to identify patterns of challenges and potential root causes of identified challenges, and reports these to the Biodefense Steering Committee along with recommendations for addressing the root causes that also identify the responsible agencies. (Recommendation 13)
Open
DHS concurred with this recommendation and described ways in which interagency partners could communicate about challenges and their root causes. In January 2022, officials from DHS stated that the process for interagency biodefense coordination was undergoing review. Officials stated that they would continue to work with the National Security Council and other interagency partners to determine the best approach to address this recommendation. To fully respond to this recommendation, DHS, working with its federal biodefense partners, will need to put in place the means to routinely monitor incidents, to identify challenges and their root causes, and to make recommendations to the Biodefense Steering Committee for addressing those root causes.
Department of Defense The Secretary of Defense should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team routinely monitors the results of interagency biological exercises and real-world incidents to identify patterns of challenges and potential root causes of identified challenges, and reports these to the Biodefense Steering Committee along with recommendations for addressing the root causes that also identify the responsible agencies. (Recommendation 14)
Open
DOD partially concurred with this recommendation. In it's partial concurrence, DOD agreed that the Biodefense Coordination Team should be tasked to monitor results of interagency exercises and real-world incidents, but objected to wording in our draft recommendations that did not include the Biodefense Steering Committee. Prior to final publication, we modified the recommendations to include the Committee, which directs the work of the Biodefense Coordination Team. In January 2022, officials from DOD stated that the process for interagency biodefense coordination was undergoing review. Officials stated that they would continue to work with the National Security Council and other interagency partners to determine the best approach to address this recommendation. To fully address this recommendation, DOD will need to work with DHS, USDA, and HHS and other agencies serving on interagency bodies responsible for strategy implementation (as of April 2022 known as the Biodefense Steering Committee and Biodefense Coordination Team) identify challenges and their root cause across after-action reporting for exercises and real-world events, and then, report on the challenges including recommendations and roles and responsibilities for addressing them.
Department of Health and Human Services The Secretary of Health and Human Services should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team routinely monitors the results of interagency biological exercises and real-world incidents to identify patterns of challenges and potential root causes of identified challenges, and reports these to the Biodefense Steering Committee along with recommendations for addressing the root causes that also identify the responsible agencies. (Recommendation 15)
Open
HHS concurred with this recommendation and described ways in which interagency partners could communicate about challenges and their root causes, including as topics for discussion in Biodefense Steering Committee meetings. To fully respond to this recommendation, HHS, working through the Biodefense Coordination Team, will need to put in place the means to routinely monitor incidents, to identify patterns of challenges and their root causes, and to make recommendations to the Biodefense Steering Committee for addressing those root causes. As of March 2022, according to HHS officials, they continue to work with interagency partners to address this recommendation.
Department of Agriculture The Secretary of Agriculture should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team routinely monitors the results of interagency biological exercises and real-world incidents to identify patterns of challenges and potential root causes of identified challenges, and reports these to the Biodefense Steering Committee along with recommendations for addressing the root causes that also identify the responsible agencies. (Recommendation 16)
Open
USDA concurred with our recommendation. In March 2022, officials from USDA reported that a prior presidential memorandum, which established processes and leadership for the biodefense enterprise, including the coordination team, was undergoing revision. To fully implement this recommendation, USDA will need to work with the agencies that comprise the Biodefense Steering Committee to make sure the interagency working-level group (as of April 2022 known as the Biodefense coordination team) to routinely monitor, identify causes of, and report on after action findings from exercises and real-world events. The reporting should make recommendations and assign responsibilities for addressing identified root causes.

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