Improved Coordination Needed for HHS’s Emergency Preparedness Programs (GAO-26-107507)
Summary
A GAO report to congressional committees, GAO-26-107507, dated February 2026, on public health preparedness. It states that the U.S. Department of Health and Human Services (HHS) leads federal public health and medical preparedness for, response to and recovery from public health emergencies. HHS awarded almost $900 million in fiscal year 2024 to states and other jurisdictions to help them prepare for a range of public health threats and emergencies. It notes ongoing risks from infectious diseases, extreme weather events and biological and chemical threats. Its title states that improved coordination is needed for HHS's emergency preparedness programs.
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United States Government Accountability Office
Report to Congressional Committees
PUBLIC HEALTH
February 2026
PREPAREDNESS
Improved
Coordination Needed
for HHS’s Emergency
Preparedness
Programs
GAO-26-107507
Public Health Preparedness
Highlights Improved Coordination Needed for HHS’s Emergency
Preparedness Programs
GAO-26-107507 February 2026
A report to congressional committees
For more information, contact: Mary Denigan-Macauley at deniganmacauleym@gao.gov
What GAO Found Why GAO Did This Study
The U.S. Department of Health and Human Services (HHS) leads the federal The United States faces ongoing risks
public health and medical preparedness for, response to, and recovery from from future public health threats, such
public health emergencies. HHS awarded almost $900 million in fiscal year 2024 as infectious diseases; extreme weather
to states and other jurisdictions to help them prepare for a range of public health events; and biological, chemical,
threats and emergencies through two programs. First, the Public Health nuclear, and radiological events. In
Emergency Preparedness (PHEP) program supports jurisdictions’ public health fiscal year 2024, HHS, through PHEP,
systems, which includes public health agencies at all government levels. Second, provided $654 million, and through
the Hospital Preparedness Program (HPP) supports health care systems, which HPP, provided $240 million, to
jurisdictions to aid preparedness for
include a community’s health care organizations such as hospitals. Jurisdictions
such threats.
distribute HPP funds to health care coalitions—made up of health care and other
entities to support preparedness. HHS requires jurisdictions and health care The CARES Act includes a provision for
coalitions to complete activities. These include exercises to help ensure that GAO to examine public health
jurisdictions are prepared to respond to public health threats, such as infectious preparedness and response efforts
diseases and extreme weather events (e.g., hurricanes). related to the COVID-19 pandemic. This
report examines, among other
Debris from Damaged Homes Following Hurricanes Helene and Milton, 2024, Florida objectives, the extent to which HHS
agencies (1) coordinate PHEP and HPP
and (2) collect and analyze information
on jurisdictions’ capabilities.
GAO reviewed HHS documentation,
including notices of funding opportunity,
templates, and examples of documents
submitted by eight selected
jurisdictions. GAO also interviewed
officials from HHS and the eight
selected jurisdictions. GAO selected
The two HHS agencies that administer these programs lack a formal mechanism, these jurisdictions to include variation
such as joint exercises, written agreements, or working groups, to coordinate among geographic location, percent of
them. Coordinating these preparedness programs could allow HHS to better the population living in a rural setting,
manage them and support jurisdictions as they prepare both their public health and public health governance structure.
and health care systems to respond to public health threats and emergencies.
Lessons learned from the COVID-19 pandemic have demonstrated the What GAO Recommends
importance of coordination between these systems, such as between state GAO is making five recommendations,
health departments and hospitals, if jurisdictions are to be effectively prepared. including that HHS establish a
Additionally, officials from selected jurisdictions said that greater interagency mechanism to coordinate PHEP and
coordination could help reduce resource inefficiencies associated with HPP; and that it collect and analyze
implementation of PHEP and HPP. information on jurisdictions’
preparedness capabilities and any
Further, HHS does not collect or analyze information on jurisdictions’ ability to
related gaps. HHS concurred with our
meet the 15 public health and four health care preparedness capabilities and any
recommendations.
related gaps. According to HHS documentation, it identified these capabilities to
serve as national guidance. The capabilities describe skills and abilities
jurisdictions need to effectively respond to, and recover from, public health
threats and emergencies. For example, they include providing mass medical care
and laboratory testing at scale for emerging pathogens. Collecting and analyzing
such information would help HHS understand the extent to which jurisdictions are
prepared to respond to public health threats and emergencies and whether any
changes are needed.
United States Government Accountability Office
Contents
Letter 1
Background 6
CDC and ASPR Lack a Mechanism to Coordinate Their
Preparedness Programs 12
CDC and ASPR Have Not Provided Information on How the
Required Activities Support the Development of the
Preparedness Capabilities 17
CDC and ASPR Do Not Collect Information on Jurisdictions’
Ability to Meet the Preparedness Capabilities 22
Conclusions 24
Recommendations for Executive Action 25
Agency Comments 25
Appendix I Additional Information on the Public Health Emergency Preparedness
Program and Hospital Preparedness Program 29
Appendix II Comments from the Department of Health and Human Services 32
Appendix III GAO Contact and Staff Acknowledgements 35
Tables
Table 1: Centers for Disease Control and Prevention’s Public
Health Preparedness and Response Capabilities 29
Table 2: Centers for Disease Control and Prevention’s Response
Readiness Framework 30
Table 3: Hospital Preparedness Program Core Functions 31
Figures
Figure 1: Example of a Biological Incident Training Exercise 8
Figure 2: Public Health Preparedness Capabilities Grouped by
Domain 10
Figure 3: Health Care Preparedness Capabilities 12
Figure 4: Leading Interagency Collaboration Practices and Key
Considerations GAO Identified 15
Figure 5: Examples of Public Health Emergency Preparedness
(PHEP) Program Required Activities and Associated
Page i GAO-26-107507 Public Health Preparedness
Program Capabilities in the 2019 Notice of Funding
Opportunity 18
Figure 6: Examples of Hospital Preparedness Program (HPP)
Required Activities and Associated Health Care
Preparedness Capabilities in the 2019 Notice of Funding
Opportunity 19
Abbreviations
ASPR Administration for Strategic Preparedness and Response
CDC Centers for Disease Control and Prevention
FEMA Federal Emergency Management Agency
HHS Department of Health and Human Services
HPP Hospital Preparedness Program
PHEP Public Health Emergency Preparedness
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Page ii GAO-26-107507 Public Health Preparedness
Letter
441 G St. N.W.
Washington, DC 20548
February 23, 2026
Congressional Committees
The United States faces risks from ongoing and future public health
threats, which include infectious disease outbreaks, extreme weather
events, radiological or nuclear incidents, and acts of terrorism. 1 We have
previously reported on the importance of preparing for, and urgently
responding to, public health threats, and on the need for significant
improvements in how the federal government supports state and local
governments during such times. 2 Not being sufficiently prepared for a
public health threat or emergency can negatively affect the time and
resources needed to achieve full recovery. 3
The Department of Health and Human Services (HHS) leads the federal
public health and medical preparedness for, response to, and recovery
from public health emergencies. We have reported that a whole-of-nation
approach is needed to effectively respond to nationally significant public
health emergencies, including ensuring coordination between public
health and health care systems. 4 A public health system includes public
health agencies at all levels of government, and a health care system
includes a community’s health care organizations such as hospitals. To
that end, HHS has provided awards to public health department recipients
in all states; territories; and freely associated states; as well as certain
localities, to help them sustain and build their medical and public health
1A public health threat is an event, disease, or disorder with significant potential to
become a public health emergency.
2See, for example, GAO, Public Health Preparedness: Building and Maintaining
Infrastructure beyond the COVID-19 Pandemic, GAO-24-105891 (Washington, D.C.: Nov.
7, 2023); Public Health Preparedness: HHS Should Address Strategic National Stockpile
Requirements and Inventory Risks, GAO-23-106210 (Washington, D.C.: Oct. 17, 2022);
and COVID-19: Significant Improvements Are Needed for Overseeing Relief Funds and
Leading Responses to Public Health Emergencies, GAO-22-105291 (Washington, D.C.:
Jan. 27, 2022).
3See GAO, Public Health Preparedness: HHS Reserve Funding for Emergencies,
GAO-23-106102 (Washington, D.C.: Aug. 15, 2023).
4GAO, Public Health: Preparedness: Critical Need to Address Deficiencies in HHS’s
Leadership and Coordination of Emergencies, GAO-23-106829 (Washington, D.C.: May
11, 2023).
Page 1 GAO-26-107507 Public Health Preparedness
emergency preparedness and response capabilities. 5 In this report we
refer to these award recipients across levels of government as
jurisdictions.
As of September 2025, HHS provided these awards through two
cooperative agreements:
1. the Public Health Emergency Preparedness (PHEP) program
administered by the Centers for Disease Control and Prevention
(CDC), and
2. the Hospital Preparedness Program (HPP) administered by the
Administration for Strategic Preparedness and Response (ASPR). 6
PHEP is a primary source of federal funding for public health
preparedness, while HPP is a primary source of federal funding for health
care preparedness. Cooperative agreements are federal awards
designed to carry out a public purpose. Cooperative agreements differ
from grants in that they provide for substantial involvement between the
federal awarding agency and non-federal entity. For example, the agency
and entity work together to carry out activities covered by the award,
which is not typical of a grant award. 7
We have previously reported on how PHEP and HPP supported
jurisdictions’ response to the COVID-19 pandemic. 8 For example, during
the COVID-19 pandemic, we found that jurisdictions used PHEP funds to
support public health laboratories, disease surveillance, and salaries for
program staff, among other uses. 9 HPP funds were used by jurisdictions,
5These localities are Chicago, Los Angeles County, New York City, and Washington,
D.C..
6For purposes of this report, we refer to PHEP and HPP as HHS’s “preparedness
programs”. In July 2022, the Secretary of Health and Human Services removed ASPR
from the HHS Office of the Secretary and created a new operating division in the
department, to be known as the Administration for Strategic Preparedness and Response.
In this report, we refer to ASPR, the organizational name in place at the time we
conducted our review.
7See 2 C.F.R. § 200.1 (2025).
8See GAO-24-105891 and GAO, Public Health Preparedness: COVID-19 Medical Surge
Experiences and Related HHS Efforts, GAO-22-105461 (Washington, D.C.: Aug. 17,
2022).
9GAO-24-105891.
Page 2 GAO-26-107507 Public Health Preparedness
for example, to help support medical surge response activities at
hospitals during the COVID-19 pandemic. 10
In fiscal year 2024, CDC awarded $654 million to jurisdictions through
PHEP and ASPR awarded $240 million to jurisdictions through HPP. As a
condition of these awards, jurisdictions must complete certain required
activities. These include drafting preparedness plans, training staff, and
conducting exercises. CDC and ASPR also release supplemental
guidance that supports the completion of requirements by jurisdictions.
They also provide additional information on the programs’ required
activities, such as guidance on effectively conducting exercises to help
ensure that jurisdictions are prepared and ready to respond to public
health threats.
Separate from the required PHEP and HPP activities, HHS also
developed 15 capabilities for public health emergency preparedness—
referred to as the public health preparedness capabilities—and four
capabilities for health care preparedness. These capabilities describe
skills and abilities needed to effectively respond to, and recover from,
public health threats and emergencies. For example, one capability is the
ability to provide mass care, which involves public health agencies
coordinating with and supporting partner agencies to provide medical
care to hundreds or thousands (depending on the size of the jurisdiction)
of individuals affected during a public health emergency.
The public health and health care preparedness capabilities serve as
national guidance for jurisdictions’ preparedness activities, according to
CDC and ASPR documentation. However, jurisdictions are not required to
meet the capabilities. Jurisdictions may also vary in their ability to meet
the capabilities.
The CARES Act includes a provision for us to examine public health
preparedness and response efforts related to the COVID-19 pandemic. 11
This report is also part of our body of work on HHS’s leadership and
10GAO-22-105461.
11Specifically, the act includes a provision for us to monitor and oversee the federal
government’s efforts to prepare for, respond to, and recover from the pandemic. Pub. L.
No. 116-136, § 19010(b), 134 Stat. 281, 580 (2020). The American Rescue Plan Act of
2021 also includes a provision for us to conduct oversight of the COVID-19 response.
Pub. L. No. 117-2, § 4002, 135 Stat. 4, 78. All of GAO’s reports related to the COVID-19
pandemic are available for no charge on GAO’s website at
https://www.gao.gov/coronavirus.
Page 3 GAO-26-107507 Public Health Preparedness
coordination of public health emergencies, which we identified as an area
of high risk in 2022. 12 This report examines the extent to which
1. CDC and ASPR coordinate PHEP and HPP;
2. CDC and ASPR have provided information on how their preparedness
programs’ required activities support the development of jurisdictions’
preparedness capabilities; and
3. CDC and ASPR collect and analyze information on jurisdictions’ ability
to meet the preparedness capabilities.
To address all three objectives, we
• reviewed relevant agency documentation, including PHEP and
HPP notices of funding opportunity from 2012 through 2024, a time
period starting after the release of the public health and health care
preparedness capabilities through the most recent notices of funding
opportunity available at the time of our review. 13 Each notice of
funding opportunity specifies the program’s priorities and
requirements, including information on activities jurisdictions must
complete, over the 5-year PHEP and HPP award period. For example,
the 2024 PHEP and HPP notices of funding of opportunity apply to the
award period 2024 through 2029. We also reviewed associated
supplemental guidance, program activity templates, and capability
guidance.
• interviewed officials from ASPR and CDC to discuss PHEP and
HPP coordination, goals, priorities, capabilities, reporting
requirements, and changes made to each program as part of the 2024
notices of funding opportunity.
12See GAO, High-Risk Series: Heightened Attention Could Save Billions More and
Improve Government Efficiency and Effectiveness, GAO-25-107743 (Washington, D.C.:
Feb. 25, 2025); High-Risk Series: Efforts Made to Achieve Progress Need to Be
Maintained and Expanded to Fully Address All Areas, GAO-23-106203 (Washington, D.C.:
Apr. 20, 2023); and appendix “New High-Risk Designation: HHS and Public Health
Emergencies” in COVID-19: Significant Improvements Are Needed for Overseeing Relief
Funds and Leading Responses to Public Health Emergencies, GAO-22-105291
(Washington, D.C.: Jan. 27, 2022).
13From 2012 through 2024, ASPR and CDC released six notices of funding opportunity for
PHEP and HPP. The joint 2012 PHEP-HPP notice of funding covered 5 years starting in
2012 through 2017. The joint 2017 PHEP-HPP notice of funding opportunity covered 2
years starting in 2017 through 2019 when ASPR took over grant administration of HPP
from CDC. The 2019 PHEP and HPP notices of funding opportunity covered 5 years
starting in 2019 through 2024. The 2024 PHEP and HPP notices of funding opportunity
will cover 5 years starting in 2024 through 2029.
Page 4 GAO-26-107507 Public Health Preparedness
• interviewed selected jurisdiction officials in five states, two
localities, and one territory to understand their experiences
completing PHEP and HPP activities. We interviewed or received
written responses from officials from the following eight selected
jurisdictions: California, Kentucky, Los Angeles County, Missouri, New
Mexico, New York (state), New York City, and Puerto Rico. We
selected our five states to obtain variation in the following
characteristics: population size, HHS region (i.e., geographic
dispersion), percent of the population living in a rural setting, and
public health governance structure (i.e., the relationship between state
health agencies and local health departments). We selected two
localities that received PHEP and HPP awards among each selected
state. We selected Puerto Rico, because it is the U.S. territory with
the largest population. The experiences of selected jurisdiction
officials are not generalizable to other jurisdictions.
• reviewed PHEP and HPP documents submitted by each selected
jurisdiction, including project narratives, work plans, risk
assessments, multi-year integrated preparedness plans, capability
self-assessments, and exercise after-action reports. 14
To examine the extent to which CDC and ASPR coordinate PHEP and
HPP, we reviewed the HPP and PHEP documentation described above
and interviewed CDC and ASPR officials to specifically understand
actions taken to coordinate PHEP and HPP. This includes gathering
information on the rationale for changes to the 2024 notices of funding
opportunity compared to coordination of the programs in previous notices
of funding opportunity. We assessed actions taken by CDC and ASPR to
coordinate PHEP and HPP activities against leading practices for
interagency collaboration we identified in prior work. 15
To examine the extent to which CDC and ASPR provided information on
how their preparedness programs’ required activities support the
development of jurisdictions’ preparedness capabilities, we reviewed the
aforementioned PHEP and HPP documentation. We interviewed CDC
and ASPR officials to gather information on the relationship between the
PHEP activities and public health preparedness capabilities, and between
the HPP activities and health care preparedness capabilities, in the
14These documents were submitted by jurisdictions in response to the 2019 and 2024
PHEP and HPP notices of funding opportunity.
15See GAO, Government Performance Management: Leading Practices to Enhance
Interagency Collaboration and Address Crosscutting Challenges, GAO-23-105520
(Washington, D.C.: May 24, 2023).
Page 5 GAO-26-107507 Public Health Preparedness
programs’ respective 2024 notices of funding opportunity. We also
gathered information on why this relationship changed from the programs’
prior notices of funding opportunity. We assessed any information
provided about how the required activities support the development of the
capabilities against guidance in the 2024 notices of funding opportunities
and the public health and health care preparedness capability guidance
documents.
To examine the extent to which CDC and ASPR collect and analyze
information on jurisdictions’ public health and health care preparedness
capabilities, we reviewed the agency documentation described above and
interviewed CDC and ASPR officials, including to understand the
rationale for changes to the 2024 notices of funding opportunity compared
to information collected as part of previous notices of funding opportunity.
We compared CDC’s and ASPR’s actions to collect information on
jurisdictions’ public health and health care preparedness capabilities
against the relevant component of the National Preparedness System
and public health and health care preparedness capabilities guidance
documents. 16
We conducted this performance audit from April 2024 to February 2026 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.
Background
National Preparedness Following Hurricane Katrina in 2005, the Post-Katrina Emergency
Goal and National Management Reform Act of 2006 required the President to develop a
National Preparedness Goal and National Preparedness System for all
Preparedness System
16The National Preparedness System is a document including a government-wide set of
planning and policy guidance created in 2011 in accordance with the Post-Katrina
Emergency Management Reform Act of 2006. Pub. L. No. 109-295, tit. VI, §§ 642, 644,
120 Stat. 1355, 1394, 1425 (codified at 6 U.S.C. §§ 742, 744). It is designed to strengthen
national preparedness to ultimately enable the nation to meet the National Preparedness
Goal of having a secure and resilient nation. See U.S. Department of Homeland Security,
National Preparedness System (Nov. 2011).
Page 6 GAO-26-107507 Public Health Preparedness
levels of government, the private and nonprofit sectors, and the public. 17
In 2011, the White House released Presidential Policy Directive 8, which
directed the Secretary of Homeland Security to develop a National
Preparedness Goal and National Preparedness System, which the
Secretary completed that year. 18 The National Preparedness Goal and
National Preparedness System emphasize a capabilities-based approach
to emergency preparedness.
• The National Preparedness Goal. The goal is a “secure and resilient
nation with the capabilities required across the whole community to
prevent, protect against, mitigate, respond to, and recover from the
threats and hazards that pose the greatest risk.”
• The National Preparedness System. The system includes guidance
that describes actions federal agencies, jurisdictions, and others need
to take to achieve the National Preparedness Goal. The actions within
the system include completing plans and providing training to ensure
preparedness. The system also includes actions to collect and
analyze information on capabilities to identify gaps to support
preparedness efforts.
PHEP, HPP, and the public health and health care preparedness
capabilities support the National Preparedness Goal and National
Preparedness System, according to ASPR and CDC documentation.
PHEP Required Activities The PHEP program’s purpose is to strengthen the public health system’s
ability to prepare for, respond to, and recover from public health threats
and emergencies. 19 To receive funding, jurisdictions are required to
complete 34 activities, some multiple times, over the 5-year award period,
according to the 2024 PHEP notice of funding opportunity. 20
17Pub. L. 109-295, tit. VI, §§ 642, 643, 644, 120 Stat. at 1425 (codified at 6 U.S.C. §§ 742-
44).
18See White House, Presidential Policy Directive/PPD-8: National Preparedness (Mar. 30,
2011). See also U.S. Department of Homeland Security, National Preparedness Goal:
First Edition (Sept. 2011), and National Preparedness System (Nov. 2011).
19According to CDC, a public health system is defined as public health agencies at all
levels of government, such as state and local public health departments.
20Some of these activities must be completed multiple times over the 5-year award period;
therefore, the total number of required activities jurisdictions must complete is 103.
Page 7 GAO-26-107507 Public Health Preparedness
Examples of activities jurisdictions must complete to receive PHEP
funding include the following:
• Conducting biological incident exercises: Such exercises provide
opportunities for jurisdictions and others to test potential public health
roles, functions, and countermeasures—such as vaccines, antiviral
drugs, antibiotics, and masks and other protective equipment—when
responding to a large-scale biological incident, such as pandemic
influenza. 21 Jurisdictions are expected to use the Homeland Security
Exercise and Evaluation Program methodology for such exercises. 22
That program provides guidance on the completion of an after-action
report following an exercise to capture observations from the exercise,
including summarizing and analyzing performance in the exercise,
and making recommendations for post-exercise improvements. See
figure 1 below for an example of a biological incident training exercise
similar to the required PHEP biological incident exercise.
Figure 1: Example of a Biological Incident Training Exercise
21Jurisdictions are required to exercise public health risks and threats through a series of
discussion-based and operations-based exercises. Discussion-based exercises are
defined as seminars, workshops, tabletops, and games. Operations-based exercises are
defined as drills, functional exercises, and full-scale exercises.
22See U.S. Department of Homeland Security, Homeland Security Exercise and
Evaluation Program (Jan. 2020).
Page 8 GAO-26-107507 Public Health Preparedness
• Providing training to jurisdiction staff on public health preparedness
requirements, such as incident management. 23 Incident management
is a set of structured activities to respond to an incident, such as
communication and coordination processes among all response
personnel.
• Developing an administrative preparedness plan to enhance
administrative operations—hire staff; execute contracts; and request,
receive, and distribute federal funds—to be response ready.
• Completing a risk assessment to identify the top five risks the
jurisdiction faces based on public health consequences.
Public Health The 15 public health preparedness capabilities serve as national
Preparedness Capabilities guidance for jurisdictions’ public health emergency preparedness
activities. Although jurisdictions are not required to meet the capabilities,
the capabilities are designed to support jurisdictions’ ability to prepare for,
respond to, and recover from public health threats and emergencies.
Each public health preparedness capability is categorized into one of six
domains—areas of preparedness that state and local public health
systems can use to better prepare for emergencies that impact the
public’s health. CDC’s public health preparedness capabilities guidance
document states that the capabilities also promote collaboration by
establishing a common language among preparedness professionals. For
an overview of the 15 public health preparedness capabilities, see figure
2. Appendix I contains a detailed list and description of each public health
preparedness capability.
23An incident is an occurrence, natural or human-made, that necessitates a response to
protect life or property which includes planned events as well as emergencies and
disasters of all kinds and sizes.
Page 9 GAO-26-107507 Public Health Preparedness
Figure 2: Public Health Preparedness Capabilities Grouped by Domain
HPP Required Activities HPP’s purpose is to support health care systems within jurisdictions to
plan for, respond to, and recover from public health threats and
emergencies. 24 For example, HPP awards funds to jurisdictions’ public
health departments which, in turn, distribute funding, resources, and other
support to health care coalitions. A health care coalition is a collaborative
24According to ASPR, a health care system is defined as a community’s health care
organizations which include hospitals, long term care facilities, blood banks, and
pharmacies, among others.
Page 10 GAO-26-107507 Public Health Preparedness
network of health care, public health, and response organizations in a
defined geographic location that conduct preparedness activities to
ensure that each member has what it needs to respond to disasters and
emergencies. Health care coalition members include, for example, acute
care hospitals, public health agencies, emergency medical services, and
emergency management agencies. 25 According to ASPR, HPP prepares
the health care system within jurisdictions to save lives during
emergencies that exceed the day-to-day capacity of health care and
emergency response systems.
To receive funding, jurisdictions, or their health care coalitions, must
complete 29 required activities, some multiple times, over the 5-year
award period, according to the 2024 HPP notice of funding opportunity. 26
Examples of required HPP activities include the following:
• Conducting a patient movement exercise to improve coordination
of patient movement, access to care, and to support equity during
emergencies and disasters.
• Completing a readiness assessment to document health care
coalitions’ ability to carry out required HPP activities and address
health care readiness gaps.
• Developing a cybersecurity support plan to describe
implementation of cybersecurity practices and steps to address
cybersecurity gaps.
Health Care Preparedness Although jurisdictions are not required to meet the capabilities, the four
Capabilities health care preparedness capabilities serve as guidance for jurisdictions
along with health care system members—such as hospitals, long term
care facilities, primary care clinics, and pharmacies—to prepare for,
respond to, and recover from public health threats and emergencies. For
an overview of the four health care preparedness capabilities, see figure
3.
25The HPP 2024 notice of funding opportunity states that health care coalition
membership must, at a minimum, include membership of leaders of organizations from the
following categories: health care (e.g., hospitals, health systems, health care facilities),
emergency management, health care response incident management, emergency
medical services and patient transport services, and public health.
26Some of the 29 activities must be completed multiple times over the 5-year award
period; therefore, the total number of required activities jurisdictions must complete is 80.
Page 11 GAO-26-107507 Public Health Preparedness
Figure 3: Health Care Preparedness Capabilities
CDC and ASPR lack a formal mechanism, such as formal written
CDC and ASPR Lack agreements, working groups, or joint exercises, to coordinate PHEP and
a Mechanism to HPP. Rather, officials told us they rely on monthly meetings to discuss,
for example, program due dates, updates on supplemental guidance, and
Coordinate Their information sharing events. 27 These informal meetings do not have
Preparedness documentation, such as agendas, according to ASPR officials.
Programs In contrast, the agencies previously relied on several more formal
mechanisms to coordinate PHEP and HPP. These mechanisms, which
are no longer in effect, included the following:
• Interagency work group. CDC and ASPR participated in an
interagency work group with other federal emergency management
27Officials also said that CDC and ASPR jointly present information to provide updates on
PHEP and HPP and hear concerns from jurisdictions at national annual meetings
organized by the National Association of County and City Health Officials and Association
of State and Territorial Health Officials.
Page 12 GAO-26-107507 Public Health Preparedness
agencies, such as the U.S. Department of Homeland Security’s
Federal Emergency Management Agency (FEMA), according to the
2012 PHEP and HPP notices of funding opportunity. This work group
aimed to co-develop goals, strategies, and action plans among federal
emergency management partners to better align grants with public
health and health care preparedness components, such as PHEP and
HPP, according to the notices of funding opportunity.
• Joint PHEP and HPP grant management. From 2012 through 2018,
CDC and ASPR jointly managed PHEP and HPP. Specifically, CDC
and ASPR jointly wrote and released the PHEP and HPP notices of
funding opportunity. The notices of funding opportunity emphasized
the importance of PHEP and HPP coordination to improve community
preparedness and response nationwide, reduce awardee burden, and
increase federal efficiency. However, joint administration of these
programs ended in 2019 when ASPR became the sole grant manager
for HPP, according to CDC officials.
• Joint CDC and ASPR site visits. From 2012 through 2018, CDC and
ASPR conducted joint jurisdictional site visits to assess the activities,
progress, and challenges of awardees. Additionally, according to the
2017 PHEP and HPP notices of funding opportunity, jurisdictions were
encouraged to invite PHEP and HPP project officers and senior CDC
and ASPR staff to attend or observe events such as scheduled
exercises, regional meetings, jurisdictional conferences, senior
advisory committee meetings, and coalition meetings supported by
PHEP and HPP funding to gain insight on strengths and challenges in
preparedness planning.
• Required joint PHEP and HPP activities. In the 2012 through 2019
PHEP and HPP notices of funding opportunity, CDC and ASPR
required jurisdictions to jointly conduct and submit many program
activities, such as plans, assessments, exercises, and trainings. For
example, jurisdictions were required to complete state-wide exercises
to test for example, a surge of patients into the health care system
during a public health emergency. However, CDC and ASPR no
longer require many joint activities for PHEP and HPP recipients. In
the 2024 notices of funding opportunity, jurisdictions are required to
complete 34 PHEP and 29 HPP activities during the 5-year award
period and coordinate when completing a risk assessment. 28
Additionally, the 2024 PHEP notice of funding opportunity suggests
28Some of the 34 PHEP and 29 HPP activities must be completed multiple times over the
5-year award period; therefore, the total number of required activities jurisdictions must
complete is 103 for PHEP and 80 for HPP.
Page 13 GAO-26-107507 Public Health Preparedness
that jurisdictions include health care coalitions as participants in PHEP
exercises; however, this is not a requirement.
• Formal written agreements. In 2014, ASPR and CDC signed a
memorandum of understanding—a formal agreement between two or
more federal agencies to help monitor, evaluate, and update
interagency collaboration. 29 Although no longer in effect, the
memorandum stated that the coordination of PHEP and HPP supports
national preparedness strategies for jurisdictions and the programs’
activities should be coordinated in the most cost-effective manner as
possible. Additionally, the memorandum of understanding established
a formal framework to support joint federal preparedness planning
and outcomes, according to CDC officials.
The use of such formal coordination mechanisms is consistent with
leading practices for enhancing interagency collaboration, defined as any
joint activity intended to produce more public value than could be
produced when the entities act alone (see fig. 4). These leading practices
state that coordination among agencies can help federal entities improve
management of federal efforts—in this instance, CDC’s and ASPR’s
respective management of PHEP and HPP. When utilized, these leading
practices could leverage agency-wide skills, knowledge, and resources to
improve the federal government’s overall capacity to support jurisdictions’
coordination of public health and health care systems, vital for responding
to public health emergencies to ensure timely and appropriate responses
that prevent harm. 30
29This memorandum of understanding also included FEMA, HHS’s Health Resources and
Services Administration, and the U.S. Department of Transportation.
30GAO, Public Health Preparedness: Critical Need to Address Deficiencies in HHS’s
Leadership and Coordination of Emergencies, GAO-23-106829 (Washington, D.C.: May
11, 2023).
Page 14 GAO-26-107507 Public Health Preparedness
Figure 4: Leading Interagency Collaboration Practices and Key Considerations
GAO Identified
Page 15 GAO-26-107507 Public Health Preparedness
CDC and ASPR officials told us they no longer coordinate PHEP and
HPP as they once did because the programs have distinct outcomes and
requirements. ASPR officials also stated that they aimed to provide
jurisdictions the flexibility to coordinate PHEP and HPP based on their
respective preparedness needs. However, CDC and ASPR officials
acknowledged that PHEP and HPP share the goal of strengthening the
nation’s preparedness for public health threats. This shared goal aligns
with lessons learned from the COVID-19 pandemic that we reported on in
2023, including that public health and health care systems cannot work
independently to effectively prepare for, respond to, and recover from an
emergency. 31 For example, we reported that regularly exercising
preparedness plans with all response partners is imperative to identifying
gaps in procedures, rectifying barriers to plan implementation, and
supporting a whole-of-nation preparedness approach. 32
Additionally, officials we spoke with from selected jurisdictions said
greater interagency coordination between CDC and ASPR could help
reduce resource inefficiencies associated with their implementation of
PHEP and HPP. For example, officials at six of eight jurisdictions said
CDC and ASPR could work together to better coordinate the PHEP and
HPP required activities. This would reduce jurisdictions’ administrative
burdens associated with determining how PHEP and HPP activities could
be completed to meet similar requirements of both programs.
We acknowledge that, as PHEP and HPP have evolved over time, the
specific coordination mechanisms implemented previously, such as in
2012 and 2019, may no longer be effective and may also need to evolve.
However, various mechanisms that could facilitate interagency
collaboration include developing memoranda of understanding, working
groups, or joint exercises; clearly defining common outcomes; and jointly
identifying data, funding, and resource needs. Developing a mechanism,
or mechanisms, to coordinate PHEP and HPP, for example, by taking into
consideration leading practices we identified for effective interagency
collaboration, could help CDC and ASPR better manage these
preparedness programs and their activities. They could also better
support jurisdictions as they prepare both their public health and health
care systems to respond to public health threats and emergencies.
31GAO, Public Health Preparedness: Critical Need to Address Deficiencies in HHS’s
Leadership and Coordination of Emergencies, GAO-23-106829 (Washington, D.C.: May
11, 2023).
32GAO-23-106829.
Page 16 GAO-26-107507 Public Health Preparedness
Ultimately, such action could help support a whole-of-community
preparedness approach.
CDC’s and ASPR’s PHEP and HPP documentation state that those
CDC and ASPR Have programs’ capabilities are to guide jurisdictions nationwide in effectively
Not Provided preparing for, responding to, and recovering from public health threats
and emergencies. However, CDC and ASPR do not specify how their
Information on How programs’ required activities support the development of these
the Required capabilities.
Activities Support the CDC and ASPR previously provided information on how the required
Development of the activities supported the development of public health and health care
preparedness capabilities:
Preparedness
Capabilities • CDC previously provided information on how required activities
supported the public health preparedness capabilities.
Specifically, in the 2019 PHEP notice of funding opportunity, which
covered activities through 2024, CDC provided information on how
required activities supported the public health preparedness
capabilities. 33 For example, jurisdictions were required to complete a
communications plan, which included a process for coordinating
messages among government officials, first responders, and
community leaders during highly infectious disease responses, and
CDC explained this activity supported the “information sharing” public
health preparedness capability. See figure 5 below for more examples
of the required PHEP activities that previously supported the
development of the public health preparedness capabilities in the
2019 PHEP notice of funding opportunity.
33U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Public Health Emergency Preparedness (PHEP) Cooperative Agreement
Notice of Funding Opportunity (Opportunity number: CDC-RFA-TP19-1901).
Page 17 GAO-26-107507 Public Health Preparedness
Figure 5: Examples of Public Health Emergency Preparedness (PHEP) Program Required Activities and Associated Program
Capabilities in the 2019 Notice of Funding Opportunity
• ASPR previously provided information linking required activities
to the health care preparedness capabilities. Similarly, in the 2019
HPP notice of funding opportunity which covered activities through
2024, ASPR previously provided information on how the required HPP
activities supported the development of the health care preparedness
Page 18 GAO-26-107507 Public Health Preparedness
capabilities. 34 Jurisdictions, including their health care coalitions, were
expected to develop and strengthen the four health care
preparedness capabilities through the implementation of certain
activities. For example, they were required to complete a surge
estimator tool, and ASPR explained that this supported the “medical
surge” health care preparedness capability. See figure 6 below for
more examples of the required HPP activities that previously
supported the development of the health care preparedness
capabilities in the 2019 HPP notice of funding opportunity.
Figure 6: Examples of Hospital Preparedness Program (HPP) Required Activities
and Associated Health Care Preparedness Capabilities in the 2019 Notice of
Funding Opportunity
34U.S. Department of Health and Human Services, Office of the Assistant Secretary for
Preparedness and Response, Hospital Preparedness Program Cooperative Agreement
Program (Opportunity number: EP-U3R-19-001).
Page 19 GAO-26-107507 Public Health Preparedness
CDC and ASPR officials said they did not provide information on how the
current required activities support the capabilities because they changed
the focus of these programs, along with about half of the required
activities, as part of the 2024 PHEP and HPP notices of funding
opportunity. Specifically, they moved away from capability-based
preparedness activities, which had been the focus of the prior notices of
funding opportunity. However, officials from both agencies acknowledged
that the programs’ capabilities are still important and foundational to their
programs. See appendix I for information about the new PHEP and HPP
focus areas—the Response Readiness Framework for PHEP and core
functions for HPP—which do not reference the programs’ capabilities.
Officials from all eight jurisdictions in our review said the public health and
health care preparedness capabilities remain relevant and important for
guiding their preparedness efforts. In addition, officials from five of these
jurisdictions elaborated that the public health and health care
preparedness capabilities are foundational to their preparedness work
and considered in their day-to-day operations. For example, officials from
two of these jurisdictions commented that their departments are
organized around the public health preparedness capabilities.
Officials from four of eight jurisdictions also reported challenges with the
change in focus of the programs and movement away from the
capabilities, including the following:
• Officials from one jurisdiction said they faced challenges
understanding the Response Readiness Framework and alignment
between the required activities and capabilities due to limited
information provided by CDC. For example, the Response Readiness
Framework is a 1-page document with one sentence descriptions of
each priority area.
• Officials from three jurisdictions said they are trying to figure out how
the new focus for activities fits within the HPP core functions as well
as the health care preparedness capabilities. Officials from one of
these jurisdictions said that because the core functions are new and
ASPR has not provided additional guidance, individuals within that
jurisdiction and health care coalition faced challenges understanding
the relationship between the core functions, capabilities, and required
activities.
• Officials from three jurisdictions commented that especially with scare
resources, those resources will go to the activities required by the
Page 20 GAO-26-107507 Public Health Preparedness
programs’ new focus areas, potentially leaving capabilities
unaddressed.
Although CDC and ASPR explained that the PHEP and HPP required
activities support the programs’ new focus areas, both the PHEP and
HPP 2024 notices of funding opportunity maintain that the programs’
capabilities provide the framework to support jurisdictions to prepare for,
respond to, and recover from public health threats and emergencies. 35
Similarly, CDC’s 2018 public health preparedness capabilities guidance
document states that jurisdictions should plan activities that specifically
relate to the capabilities, and the 2024 HPP notice of funding opportunity
also states that jurisdictions are responsible for using the health care
preparedness capabilities to inform planning their activities. 36
By providing information to the jurisdictions on how PHEP and HPP
required activities support the programs’ preparedness capabilities, CDC
and ASPR would help ensure jurisdictions understand how their
completion of these activities develop their preparedness capabilities.
This information could also help CDC and ASPR ensure that the activities
they are providing funds for are indeed helping to support the
development of jurisdictions’ preparedness capabilities nationwide.
Further, providing this information would be consistent with the PHEP and
HPP 2024 notices of funding opportunity and capabilities guidance
documents that emphasize the role of the capabilities in planning and
guiding jurisdictions’ preparedness activities.
35U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Public Health Emergency Preparedness (PHEP) Cooperative Agreement
Notice of Funding Opportunity (Opportunity number: CDC-RFA-TU24-0137) and
Administration for Strategic Preparedness and Response, Hospital Preparedness
Program Cooperative Agreement Notice of Funding Opportunity (Opportunity number: EP-
U3R-24-001).
36U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Public Health Emergency Preparedness and Response Capabilities: National
Standards for State, Local, Tribal, and Territorial Public Health (Oct. 2018) and
Administration for Strategic Preparedness and Response, Hospital Preparedness
Program Cooperative Agreement Notice of Funding Opportunity (Opportunity number: EP-
U3R-24-001).
Page 21 GAO-26-107507 Public Health Preparedness
CDC and ASPR do not collect and analyze information on jurisdictions’
CDC and ASPR Do ability to meet the public health or health care preparedness capabilities
Not Collect or gaps in their ability to do so.
Information on CDC and ASPR officials provided a few reasons for not collecting and
Jurisdictions’ Ability to analyzing information on jurisdictions’ ability to meet the 15 public health
and four health care preparedness capabilities, respectively.
Meet the
Preparedness • CDC. CDC officials said their collection of information focuses on
jurisdictions’ progress completing the required activities within the
Capabilities required time frames. Further, CDC officials said collecting information
about jurisdictions’ capabilities is challenging to standardize because
of the variety of threats faced by jurisdictions.
• ASPR. Similarly, ASPR officials said they collect information on
jurisdictions’ achievements in completing the required HPP activities
rather than the capabilities. 37
Collecting information on jurisdictions’ ability to meet the capabilities and
identifying any gaps would be consistent with the National Preparedness
System. The public health and health care preparedness capabilities
guidance documents link the programs’ capabilities to this System. 38 The
National Preparedness System provides a framework for the nation to
track progress on building and improving the capabilities necessary to
prevent, protect against, mitigate the effects of, respond to, and recover
from threats. An important component of the National Preparedness
System is a mechanism to collect and analyze existing and needed
capabilities to identify gaps.
CDC and ASPR previously collected some information on jurisdictions’
ability to meet the capabilities through an annual capability self-
assessment. Through this self-assessment, required in the 2019 PHEP
and HPP notices of funding opportunity, jurisdictions reported information
37According to ASPR officials, they collect performance measures from jurisdictions and
health care coalitions organized by the activities and requirements laid out in the HPP
notice of funding opportunity.
38See U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Public Health Emergency Preparedness and Response Capabilities: National
Standards for State, Local, Tribal, and Territorial Public Health (Oct. 2018) and Assistant
Secretary for Preparedness and Response, 2017-2022 Health Care Preparedness and
Response Capabilities (Nov. 2016).
Page 22 GAO-26-107507 Public Health Preparedness
on the importance, status, challenges, and barriers for each public health
and health care preparedness capability to CDC and ASPR, respectively.
CDC and ASPR officials told us they retired the prior capability self-
Public Health Emergency Preparedness
(PHEP) Program and Hospital assessment as part of an effort to reduce reporting requirement burdens
Preparedness Program (HPP) After-Action on jurisdictions for the 2024 PHEP and HPP notices of funding
Reports
opportunity. However, instead of collecting no information, CDC and
Exercises and after-action reports are
important components of preparedness as
ASPR officials could use their past experiences with the capability self-
they provide the opportunity to shape assessments, along with feedback from jurisdictions, to develop a
planning, assess and validate capabilities, mechanism that allows them to collect and analyze information on
and address areas for improvement.
Jurisdictions are required to submit after- jurisdictions’ ability to meet the capabilities and identify related gaps.
action reports to the Centers for Disease CDC and ASPR could also use after-action reports submitted by
Control and Prevention (CDC) and the
Administration for Strategic Preparedness jurisdictions following completion of an exercise or response to an
and Response (ASPR) after completion of incident as part of, or to help inform, such a mechanism (see sidebar).
required PHEP or HPP exercises,
respectively. CDC and ASPR also require
jurisdictions to submit an after-action report CDC and ASPR could also consider how other agencies collect such
following a response to an incident—an information. See text box for an example of an agency that has a
occurrence, natural or human-made, that
necessitates a response to protect life or systematic approach to collecting and analyzing information on
property, such as an emergency or disaster. jurisdictions’ preparedness capabilities.
When completing exercises and after-action
reports, CDC and ASPR require jurisdictions
to follow the Homeland Security Exercise Example of a Federal Agency’s Collection of Preparedness Information from
and Evaluation Program methodology. This Jurisdictions
methodology provides a set of fundamental
principles for conducting exercises and Within the U.S. Department of Homeland Security, the Federal Emergency
completing after-action reports. For example, Management Agency (FEMA)—the agency that coordinates disaster preparedness,
the methodology suggests formatting of response, and recovery support at the national level—has a system to regularly
after-action reports to indicate which
capabilities were performed, if any, and any collect and analyze information from jurisdictions on their preparedness capabilities.
ratings provided on their performance. FEMA provides grants to jurisdictions to support emergency response preparedness
Source: U.S Departments of Health and Human Services
activities, and jurisdictions are required to annually report to FEMA on their capacity or
and Homeland Security information. | GAO-26-107507 ability to meet each preparedness capability. These capabilities include, for example,
mass search and rescue operations and fire management and suppression. FEMA
uses the capability information reported by jurisdictions, in part, to produce its annual
preparedness report which assesses the nation’s preparedness and provides
information on risks and capabilities that support decisions about program priorities,
resource allocations, and community actions. The 2024 National Preparedness
Report summarizes progress made toward achieving the National Preparedness Goal
and building and sustaining capabilities required to prevent, protect against, mitigate,
respond to, and recover from threats and hazards that pose the greatest risk to our
nation.
Source: GAO summary of FEMA documentation. | GAO-26-107507
Collecting and analyzing information on jurisdictions’ ability to meet the
public health and health care preparedness capabilities and related gaps,
in partnership with jurisdictions, would help CDC and ASPR track the
Page 23 GAO-26-107507 Public Health Preparedness
progress made by jurisdictions in building public health and health care
preparedness capabilities—a foundational aspect of PHEP and HPP. In
addition, collecting information on jurisdictions’ capabilities would help
ASPR and CDC measure the extent to which federal government
investments through PHEP and HPP contribute to building and sustaining
capabilities nationwide and whether changes to improve preparedness
are needed. They could also use the information on capability gaps to
focus their resources in overseeing the two programs and thereby
maximize their effectiveness in achieving the aims of the programs.
Information on jurisdictions’ capabilities is crucial to help understand how
prepared jurisdictions are, as a whole-of-nation, to respond to public
health emergencies and threats. Further, obtaining and understanding
capability information is important for federal government planning,
because when an effective emergency response is beyond the
capabilities of jurisdictional governments, those governments can request
federal assistance, including from CDC and ASPR.
Effectively preparing for public health threats, such as hurricanes and
Conclusions wildfires, is essential to saving lives during emergencies. CDC and ASPR
play a key role by providing funding to jurisdictions to complete
activities—plans, exercises, assessments, and trainings—to build and
sustain jurisdictions’ preparedness capabilities through PHEP and HPP.
These activities are crucial to support jurisdictions and their health care
system partners to prepare for and respond to public health threats.
Coordinating PHEP and HPP—taking into consideration leading practices
we have identified for effective interagency collaboration—could help
CDC and ASPR better manage these preparedness programs and
support jurisdictions as they prepare their public health and health care
systems to coordinate during an emergency.
By providing information to the jurisdictions on how PHEP and HPP
required activities support the programs’ preparedness capabilities, CDC
and ASPR would help ensure jurisdictions understand how their
completion of these activities develop their preparedness capabilities.
This information would also help CDC and ASPR ensure that the
activities they are providing funds for are indeed helping to support the
development of jurisdictions’ preparedness capabilities nationwide.
Lastly, collecting and analyzing information specific to jurisdictions’ ability
to meet the public health and health care preparedness capabilities and
identifying any related gaps, would help CDC and ASPR track the
Page 24 GAO-26-107507 Public Health Preparedness
progress made by jurisdictions in building the preparedness capabilities.
Obtaining such information is crucial for CDC and ASPR, in part because
when an effective emergency response is beyond the capabilities of
jurisdictional governments, those governments can request federal
assistance, including from CDC and ASPR. In addition, collecting
information on jurisdictions’ capabilities would help ASPR and CDC
measure the extent to which federal government investments through
PHEP and HPP contribute to building and sustaining capabilities
nationwide.
We are making the following five recommendations to HHS:
Recommendations for
Executive Action The Assistant Secretary for Preparedness and Response and the Director
of CDC should develop a mechanism, or mechanisms, to coordinate
PHEP and HPP by, for example, taking into consideration GAO’s Leading
Practices to Enhance Interagency Collaboration and Address
Crosscutting Challenges. (Recommendation 1)
The Director of CDC should provide information to jurisdictions on how
the required PHEP activities support the development of the public health
preparedness capabilities. (Recommendation 2)
The Assistant Secretary for Preparedness and Response should provide
information to jurisdictions on how the required HPP activities support the
development of the health care preparedness capabilities.
(Recommendation 3)
The Director of CDC should collect and analyze information on
jurisdictions’ ability meet the public health preparedness capabilities and
identify any related gaps in partnership with jurisdictions.
(Recommendation 4)
The Assistant Secretary for Preparedness and Response should collect
and analyze information on jurisdictions’ ability to meet health care
preparedness capabilities and identify any related gaps in partnership
with jurisdictions. (Recommendation 5)
We provided a draft of this report to the Department of Homeland Security
Agency Comments and HHS for review and comment. HHS provided written comments,
which are reproduced in appendix II. HHS concurred with our five
recommendations. HHS also provided technical comments, which we
incorporated as appropriate. The Department of Homeland Security did
not provide any comments on the draft report.
Page 25 GAO-26-107507 Public Health Preparedness
We are sending copies of this report to the appropriate congressional
committees, the Secretary of Health and Human Services, the Secretary
of the Homeland Security, and other interested parties. In addition, the
report is available at no charge on the GAO website at
http://www.gao.gov.
If you or your staff have any questions about this report, please contact
me at DeniganMacauleyM@gao.gov. Contact points for our Offices of
Congressional Relations and Media Relations may be found on the last
page of this report. GAO staff who made key contributions to this report
are listed in appendix III.
Mary Denigan-Macauley,
Director, Health Care
Page 26 GAO-26-107507 Public Health Preparedness
List of Committees
The Honorable Susan Collins
Chair
The Honorable Patty Murray
Vice Chair
Committee on Appropriations
United States Senate
The Honorable Mike Crapo
Chairman
The Honorable Ron Wyden
Ranking Member
Committee on Finance
United States Senate
The Honorable Bill Cassidy, M.D.
Chair
The Honorable Bernard Sanders
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate
The Honorable Rand Paul, M.D.
Chairman
The Honorable Gary C. Peters
Ranking Member
Committee on Homeland Security and Governmental Affairs
United States Senate
The Honorable Tom Cole
Chairman
The Honorable Rosa DeLauro
Ranking Member
Committee on Appropriations
House of Representatives
The Honorable Brett Guthrie
Chairman
The Honorable Frank Pallone, Jr.
Ranking Member
Committee on Energy and Commerce
House of Representatives
Page 27 GAO-26-107507 Public Health Preparedness
The Honorable Andrew Garbarino
Chairman
The Honorable Bennie G. Thompson
Ranking Member
Committee on Homeland Security
House of Representatives
The Honorable James R. Comer
Chairman
The Honorable Robert Garcia
Ranking Member
Committee on Oversight and Government Reform
House of Representatives
The Honorable Jason Smith
Chairman
The Honorable Richard E. Neal
Ranking Member
Committee on Ways and Means
House of Representatives
Page 28 GAO-26-107507 Public Health Preparedness
Appendix I: Additional Information on the Appendix I: Additional Information on the
Public Health Emergency Preparedness
Public Health Emergency Preparedness
Program and Hospital Preparedness Program
Program and Hospital Preparedness
Program
According to the 2024 Public Health Emergency Preparedness (PHEP)
Public Health Program notice of funding opportunity, capabilities provide the framework
Emergency to support advancement of preparedness, response, and recovery
operations. 1 The 15 public health preparedness capabilities are designed
Preparedness to support jurisdictions capacity or ability to prepare for, respond to, and
Program recover from public health threats and emergencies. For an overview of
the 15 public health preparedness capabilities, see table 1 below.
Table 1: Centers for Disease Control and Prevention’s Public Health Preparedness and Response Capabilities
Capability Description
Community preparedness Ability to prepare for, withstand, and recover from public health incidents in both the short and long
term.
Community recovery Ability to identify critical assets, facilities, and other services within public health, emergency
management, health care, human services, mental and behavioral health, and environmental health
sectors that can guide and prioritize recovery operations.
Emergency operations Ability to coordinate with emergency management and to direct and support an incident or event with
coordination public health or health care implications by establishing a standardized, scalable system of oversight,
organization, and supervision.
Emergency public information Ability to develop, coordinate, and disseminate information, alerts, warnings, and notifications to the
and warning public and incident management personnel.
Fatality management Ability to coordinate with organizations and agencies (e.g., medical examiner) to provide fatality
management services, such as recovery and identification of human remains.
Information sharing Ability to exchange health-related information and situational awareness data among federal, state,
local, tribal, and territorial levels of government and the private sector.
Mass care Ability to coordinate with and support partner agencies to address, within a congregate location, the
public health, health care, mental and behavioral health, and human services needs of those impacted
by an incident.
Medical countermeasure Ability to provide medical countermeasures (e.g., vaccines and antiviral drugs) to prevent, mitigate, or
dispensing and administration treat the adverse health effects of a public health incident.
Medical materiel Ability to acquire, manage, transport, and track medical materiel (e.g., pharmaceuticals and
management and distribution ventilators) during and after a public health incident.
Medical surge Ability to provide adequate medical evaluation and care during events that exceed the limits of the
normal medical infrastructure of an affected community.
Nonpharmaceutical Actions that people and communities can take to help slow the spread of illness or reduce the adverse
interventions impact of public health emergencies, such as restrictions on movement and travel advisories or
warnings.
1U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Public Health Emergency Preparedness (PHEP) Cooperative Agreement
Notice of Funding Opportunity (Opportunity number: CDC-RFA-TU24-0137).
Page 29 GAO-26-107507 Public Health Preparedness
Appendix I: Additional Information on the
Public Health Emergency Preparedness
Program and Hospital Preparedness Program
Capability Description
Public health laboratory Ability to implement and perform methods to detect, characterize, and confirm public health threats.
testing
Public health surveillance and Ability to create, maintain, support, and strengthen routine surveillance and detection systems and
epidemiological investigation epidemiological investigation processes.
Responder safety and health Ability to protect public health and other emergency responders during pre-deployment, deployment,
and post-deployment.
Volunteer management Ability to coordinate with emergency management and partner agencies to identify, recruit, register,
verify, train, and engage volunteers to support the jurisdictional public health agency’s preparedness,
response, and recovery activities during pre-deployment, deployment, and post-deployment.
Source: GAO summary of Centers for Disease Control and Prevention information. | GAO-26-107507
In 2023, the Centers for Disease Control and Prevention (CDC)
established the Response Readiness Framework to serve as an
organizing framework for response readiness activities and included the
framework as part of the 2024 PHEP notice of funding opportunity. The
Response Readiness Framework includes priority areas that define state,
local, and territorial response readiness; identify essential components of
response readiness; and serve as an organizing framework for response
readiness activities, according to CDC documentation. See table 2 below
for an overview of the 10 Response Readiness Framework priority areas.
Table 2: Centers for Disease Control and Prevention’s Response Readiness Framework
Priority area Description
Prioritize a risk-based approach All-hazards planning that addresses evolving threats and supports medical countermeasures
logistics.
Enhance partnerships To effectively support community preparedness efforts by enhancing partnerships with federal and
nongovernmental organizations.
Expand local support Improve jurisdictional readiness to effectively manage public health emergencies by expanding local
support.
Improve administrative and Ensure timely access to resources for supporting jurisdictional responses.
budget preparedness system
Build workforce capacity Meet jurisdictional surge management needs and support staff recruitment, retention, resilience,
and mental health.
Modernize data collection and Improve situational awareness and information sharing with health care systems and other partners.
systems
Strengthen risk communications Improve proficiency in disseminating critical public health information and warnings and address
activities misinformation and disinformation.
Incorporate health equity Enhance preparedness and response support for communities experiencing differences in health
practices status due to structural barriers.
Advance capacity and capability Characterize emerging public health threats through testing and surveillance.
of public health laboratories
Page 30 GAO-26-107507 Public Health Preparedness
Appendix I: Additional Information on the
Public Health Emergency Preparedness
Program and Hospital Preparedness Program
Priority area Description
Prioritize community recovery Support health department reconstitution and incorporate lessons learned from public health
efforts emergency responses.
Source: GAO summary of Centers for Disease Control and Prevention information. | GAO-26-107507
As part of the 2024 Hospital Preparedness Program (HPP) notice of
Hospital funding opportunity, the Administration for Strategic Preparedness and
Preparedness Response (ASPR) established the nine core functions (see table 3
below). 2 Every jurisdiction and their health care coalitions must perform
Program the core functions as part of the required activities in the HPP cooperative
agreement according to the 2024 HPP notice of funding opportunity.
According to ASPR, jurisdictions and health care coalitions will perform
the core functions to support health care readiness.
Table 3: Hospital Preparedness Program Core Functions
Core function Description
Assessment and risk mitigation Anticipate challenges and mitigate risks to support decision-making that meets community or
jurisdiction health care needs during a disaster or emergency.
Information sharing Collect and share near real-time information to provide multidirectional health care situational
awareness during an emergency or disaster.
Specialty care planning and Incorporate necessary expertise to support health care readiness planning, disaster and incident
coordination management, including for specialty care delivery, and/or to address specific hazards or events.
Respond Coordinate and support the implementation of plans, policies, and procedures among recipients,
health care coalitions and their members, and their partners to address patient care needs during
an emergency or disaster.
Health care workforce support Equip, protect, and support the health care workforce by providing access to health care
readiness resources, training, and exercises.
Resource management Facilitate resource management and planning among recipients, health care coalitions and their
members, and their partners to mitigate shortfalls, maintain operations, and sustain delivery of
patient care services during an emergency or disaster.
Training, exercise, and evaluation Conduct trainings, exercises, and evaluations that incorporate input from assessments, plans,
policies, and previous trainings and exercises to evaluate, validate, and improve readiness and
response processes.
Continuity and recovery Support the improvement of processes and systems that promote continuity of health care
operations and aid in recovery.
Organizational development Create and carry out strategies to sustain and grow health care coalitions and their partnerships.
Source: GAO summary of Administration for Strategic Preparedness and Response information. | GAO-26-107507
2U.S. Department of Health and Human Services, Administration for Strategic
Preparedness and Response, Hospital Preparedness Program Cooperative Agreement
Notice of Funding Opportunity (Opportunity number: EP-U3R-24-001).
Page 31 GAO-26-107507 Public Health Preparedness
Appendix II: Comments from the Department
Appendix II: Comments from the Department
of Health and Human Services
of Health and Human Services
Page 32 GAO-26-107507 Public Health Preparedness
Appendix II: Comments from the Department
of Health and Human Services
Page 33 GAO-26-107507 Public Health Preparedness
Appendix II: Comments from the Department
of Health and Human Services
Page 34 GAO-26-107507 Public Health Preparedness
Appendix III: GAO Contact and Staff
Appendix III: GAO Contact and Staff
Acknowledgements
Acknowledgements
Mary Denigan-Macauley, Director, Health Care,
GAO Contact DeniganMacauleyM@gao.gov
In addition to the contact named above, Deirdre Brown (Assistant
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Page 35 GAO-26-107507 Public Health Preparedness
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