Public Health Preparedness: HHS Should Address Strategic National Stockpile Coordination Challenges

What GAO Found

The Strategic National Stockpile (SNS) is a multibillion dollar inventory of drugs, vaccines, supplies, and other medical countermeasures that can be provided to jurisdictions—states, localities, territories—and Tribes during emergencies. The Department of Health and Human Services (HHS) provided four primary types of resources ahead of recent public health emergencies—COVID-19 and mpox—to help jurisdictions access and use SNS assets. This included guidance, recurring communication, trainings and exercises, and an inventory management system.

The 62 jurisdictions we surveyed reported challenges during the COVID-19 and mpox responses related to understanding the SNS inventory and coordinating on requesting and receiving SNS assets. HHS has taken steps to address some of these challenges by creating a new office focused on external coordination and developing a new system to track SNS requests. Jurisdictions also reported challenges related to understanding federal agencies' roles and navigating outdated guidance. These challenges led to jurisdictional confusion during response efforts. While HHS has taken some actions, challenges still exist regarding the lack of (1) clearly defined roles for HHS agencies that work with SNS assets; and (2) procedures for updating SNS's main guidance document. For example, the main guidance document for SNS assets has not been updated since 2014 and does not reflect the agency currently responsible for the SNS. By defining and sharing SNS roles and developing procedures for updating guidance, HHS would help jurisdictions navigate SNS processes improving response efforts.

GAO Survey Results About Strategic National Stockpile Written Guidance

Jurisdiction and tribal officials identified other coordination issues that may affect future responses. This included jurisdiction officials not seeing, or being unaware of, HHS response plans including those specific to the SNS, and federal efforts needed to help jurisdictions manage stockpiles that expanded after the COVID-19 pandemic. HHS officials said they plan to coordinate with jurisdictions on these issues by creating and sharing information about response planning and stockpile management. Also, GAO found that Tribes experienced various concerns with requesting and receiving SNS assets. In response, an HHS working group is focused on clarifying the ways Tribes can request SNS assets. However, HHS has not assessed the unique challenges—such as geography and infrastructure—that could affect Tribes' ability to receive SNS assets. By engaging with Tribes to do such an assessment, HHS and Tribes would be better equipped to deliver and receive assets, respectively, collectively strengthening preparedness and response efforts to future incidents.

Why GAO Did This Study

Recent public health emergencies have highlighted the importance of coordination across all levels of government. One key component of the nation's medical response is the SNS. In January 2022, GAO placed HHS's leadership and coordination of public health emergencies on its High Risk List, in part due to coordination issues with the SNS.

The CARES Act includes a provision for GAO to report on the federal response to the COVID-19 pandemic.

This report examines (1) SNS resources provided to jurisdictions; (2) challenges jurisdictions faced in accessing SNS assets during two recent emergencies; and (3) jurisdictional and tribal SNS coordination issues that might affect future responses.

For this work, GAO surveyed public health officials from all 62 jurisdictions nationwide and received a 100 percent response rate. GAO also interviewed officials in nine jurisdictions which were selected to obtain variation in governance structure and tribal presence, among other criteria. GAO also reviewed guidance, presentations, strategic plans, and other documentation; compared HHS actions to leading practices for collaboration and federal internal controls; and interviewed HHS and tribal officials.