Zika Supplemental Funding: Status of HHS Agencies' Obligations, Disbursements, and the Activities Funded

Fast Facts

The Zika virus outbreak that began in 2015 sickened adults, but also had another particularly tragic result—brain defects and other problems in infected fetuses. It represented the first time in more than 50 years that an infectious pathogen had been found to cause birth defects. As the virus spread into the United States, Congress appropriated $932 million to address the growing threat.

We reviewed how agencies have used this money. We found that they attacked the problem on a variety of fronts, including researching the virus, controlling mosquito populations, and raising public awareness about Zika and its prevention.

Biologists sort and examine mosquitoes to help monitor for Zika in Florida

Photograph of mosquitoes under a microscope

Highlights

What GAO Found

As of September 30, 2017, Department of Health and Human Services’ (HHS) agencies had obligated nearly all of the $932 million of Zika supplemental funding Congress appropriated in 2016 through the use of multiple funding mechanisms, including cooperative agreements, grants, and contracts. Four HHS agencies had small unobligated balances as of the September 30, 2017, obligation deadline; these balances cannot be used to incur new obligations, but may be used to adjust award amounts in future years. Disbursement of the obligated funds was ongoing, with about 21 percent of the Zika supplemental funding (approximately $195.5 million) disbursed as of December 31, 2017. The agencies have until September 30, 2022, to disburse the remainder.

Zika Supplemental Obligations as of September 30, 2017

	In dollars (rounded)
HHS agency	Total supplemental funding	Amount obligated	Unobligated balance
Biomedical Advanced Research and Development Authority	245,000,000	245,000,000	0
Centers for Disease Control and Prevention	394,000,000	393,706,358	293,642
Centers for Medicare & Medicaid Services	75,000,000	74,982,493	17,508
Health Resources and Services Administration	66,000,000	65,978,442	21,558
National Institutes of Health	152,000,000	151,998,591	1,409
Total	932,000,000	931,665,883	334,117

Source: GAO analysis of Department of Health and Human Services (HHS) data. | GAO-18-389

The 12 awardees GAO interviewed—officials from 10 states and two local entities—funded multiple activities with their Zika supplemental funding, and had varying experiences applying for and managing the funds.

Awardees told GAO that they used their funding to support such activities as collection of information about individuals affected by the Zika virus (human surveillance), mosquito control activities, laboratory capacity building, public outreach, and health care services. For example, Florida used Zika supplemental funding in its state-run laboratories to purchase materials for testing Zika virus-related specimens.

A majority of the awardees GAO spoke with reported positive experiences applying for and managing the Zika supplemental funding, including good communication with agency officials and awardees’ familiarity with the mechanisms used to make the awards. However, some awardees noted challenges, such as time frames to use the funding that varied among multiple awards and identifying the activities that could be funded. These challenges added administrative burdens to applying for and managing the Zika supplemental funding while officials were responding to the outbreak, according to the awardees. In October 2017, the Centers for Disease Control and Prevention (CDC) issued a new notice of funding opportunity that agency officials said is intended to help minimize the administrative burden on states and certain localities during emergencies—such as preparing applications—by pre-approving public health departments in these jurisdictions to be eligible to rapidly receive future awards.

Why GAO Did This Study

Zika—a virus primarily transmitted through mosquito bites—can cause symptoms that include fever, rash, and joint and muscle pain. In pregnant women, the Zika virus can be passed to the fetus and cause severe brain defects. In response to an outbreak in the United States and its territories, Congress appropriated $932 million in September 2016 through the Zika Response and Preparedness Act to HHS and its agencies to prevent, prepare for, and respond to the Zika virus and its related health conditions, and conduct related research.

The act also included a provision that GAO study the activities supported with the appropriated funds. This report describes (1) the status of funds obligated and disbursed from the Zika supplemental funding appropriated to HHS and its agencies; and (2) how selected awardees used their Zika supplemental funding, and their experiences with applying for and managing the funding. To do this work, GAO reviewed agency documents on Zika supplemental funding and activities, and interviewed officials from the HHS agencies and selected awardees. To select awardees, GAO identified states based on the amount of initial Zika supplemental funding they received from CDC, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration; and selected states with the highest and lowest funding. In total, GAO selected 12 awardees: 10 states, as well as one county and one city from 2 of the 10 states.

GAO provided a draft of this report to HHS. In response, HHS provided technical comments, which were incorporated as appropriate.

For more information, contact Marcia Crosse at (202) 512-7114 or crossem@gao.gov.