The Government Accountability Office (GAO) on Thursday said that for more than a decade it has found issues with how the Department of Health and Human Services’ (HHS) prepares for and responds to emergencies, including COVID-19, the H1N1 influenza pandemic, Zika, Ebola, and extreme weather events, such as hurricanes.

The GAO report—it’s ninth on COVID relief under the CARES Act—examines the federal government’s efforts to respond to and recover from the COVID-19 pandemic.

GAO said it has designated HHS coordination and leadership of public health emergencies as “high risk” due to significant, long-standing deficiencies spanning several years.

The high-risk list identifies federal programs and operations that are vulnerable to fraud, waste, abuse, and mismanagement, or needs transformation. The GAO issues the list every two years at the start of each new session in Congress.

The GAO found HHS has failed to:

  • Establish clear roles and responsibilities for the wide range of key federal, state, local, tribal, territorial, and nongovernmental partners
  • Collect and analyze complete and consistent data to inform decision-making—including any necessary midcourse changes—as well as future preparedness
  • Provide clear and consistent communication to key partners and the public
  • Establish transparency and accountability to help ensure program integrity and build public trust
  • Understand key partners’ capabilities and limitations

“As devastating as the COVID-19 pandemic has been, more frequent extreme weather events, new viruses, and bad actors who threaten to cause intentional harm loom, making the deficiencies GAO has identified particularly concerning. Not being sufficiently prepared for a range of public health emergencies can also negatively affect the time and resources needed to achieve full recovery,” the report highlights said.

GAO noted that HHS has failed to address 72 of the 115 recommendations related to leadership and coordination of public health emergencies since fiscal year 2007. For example, it has yet to address the September 2020 recommendation to work with the Federal Emergency Management Agency to develop plans to mitigate supply chain shortages for the remainder of the pandemic, thus contributing to the shortage of supplies in January 2022.

The report said GAO is adding this area to the high-risk list to ensure the executive branch and Congress continue to pay attention so HHS can strengthen its leadership and coordination role for future public health emergencies.

HHS has received approximately $484 billion in COVID-19 relief funds from the six COVID-19 relief laws. As of November 30, 2021, HHS reported that it had designated about $387 billion of the funding and spent approximately $226 billion. Although GAO has previously recommended that HHS provide projected time frames for spending the remaining COVID-relief funds, the department said it would not be able to provide specific time frames as it needs to be flexible in responding to incoming requests.

An HHS spokesperson told Politico that the department shares “GAO’s focus and urgency in battling this once-in-a-generation pandemic and desire to ensure we never again face a pandemic of this magnitude. "We’re in a much stronger position than we were a year ago."