What GAO Discovered

Greater than a yr after the U.S. declared COVID-19 a public well being emergency, the pandemic continues to end in catastrophic lack of life and substantial injury to the worldwide financial system, stability, and safety. In line with knowledge from the Facilities for Illness Management and Prevention’s (CDC) Nationwide Heart for Well being Statistics, about 520,000 extra deaths occurred from all causes (COVID-19 and different causes) than could be usually anticipated from February 2020 by way of mid-February 2021, highlighting the impact of the pandemic on U.S. mortality (see determine). The pandemic additionally continues to trigger financial challenges, notably for the labor market. As of February 2021, there have been about 10 million unemployed people, in comparison with practically 5.8 million at first of 2020.

Increased-Than-Anticipated Weekly Mortality within the U.S., February 2020 by way of Mid-February 2021

Previously yr, GAO has made 44 suggestions for company actions, 6 of which have been carried out. Since taking workplace, the brand new administration has taken some motion according to GAO’s suggestions, corresponding to issuing theNationwide Technique for the COVID-19 Response and Pandemic Preparednessand issuing govt orders calling for the event of a pandemic provide chain resilience technique and offering emergency financial aid.GAO will proceed to observe the administration’s actions towards addressing GAO’s suggestions in future reporting.

On this report GAO is making 28 new suggestions within the areas of public well being, the financial system, and program integrity. Implementing these 28 suggestions, in addition to 38 of GAO’s 44 prior suggestions that haven’t been absolutely carried out from CARES Act stories issued since June 2020, would enhance the continued federal response to COVID-19.

GAO’s new suggestions are mentioned under.

Hospital and Pharmacy Views on COVID-19 Vaccine Administration and Medical Provide Availability

In February 2021, GAO surveyed hospitals and interviewed giant retail pharmacy chains and an affiliation of impartial pharmacies to achieve their views on vaccine administration and medical provide availability. Suppliers expressed issues about COVID-19 vaccine availability and limitations within the availability of sure key medical provides for administering the vaccines—notably syringes and needles. For instance, representatives from one retail pharmacy chain said that the chain has the capability to manage 25 million doses per thirty days at 9,900 areas, however the chain’s preliminary allocation of vaccines from the federal authorities was anticipated to be solely 230,000 doses at 250 areas. A number of retail pharmacy chain representatives additionally indicated that restricted vaccine availability has led to uncertainty relating to the quantity of vaccines their pharmacies can count on to obtain every week. The brand new administration has taken steps to extend certainty and vaccine availability. For instance, the White Home introduced on the finish of January 2021 that the federal authorities would start notifying states earlier about availability and shipments of vaccines, to present better certainty for planning vaccination efforts.

Of the 146 surveyed hospitals that plan to or have begun administering COVID-19 vaccines, 40 hospitals reported on the time of GAO’s survey being enormously involved about having a adequate amount of syringes within the subsequent 30 days for vaccine administration following the survey, and 43 hospitals have been enormously involved about having a adequate amount of needles. Moreover, shortages of private protecting tools (PPE) and COVID-19 testing provides additionally stay a problem for some suppliers. GAO and different entities have documented persistent and evolving provide chain challenges all through the pandemic, corresponding to shortages of key provides used for COVID-19 testing. GAO will proceed to look at the medical provide chain, together with the position of the Strategic Nationwide Stockpile, in future reporting, together with actions to answer GAO’s earlier suggestions.

Emergency Use Authorizations

Emergency use authorizations (EUA)—which permit for the momentary use of unapproved medical merchandise—have been instrumental in rising wanted provide of sure units, corresponding to PPE, through the COVID-19 pandemic response (see determine). Nevertheless, there have been cases of inconsistencies between EUAs issued by the Meals and Drug Administration (FDA) and machine steering from CDC and the Division of Labor (DOL), which led to confusion and hesitancy amongst suppliers about utilizing such units, based on supplier associations. GAO recommends that FDA, CDC, and DOL work collectively to develop a course of for sharing info to facilitate decision-making and steering consistency associated to units with EUAs. The Division of Well being and Human Companies (HHS)—which incorporates FDA and CDC—and DOL agreed with this advice.

Examples of Medical Gadgets Different Than Assessments with Emergency Use Authorizations for COVID-19

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-21-387

As well as, stakeholders—together with associations representing producers, distributors, and customers of approved units, corresponding to well being care suppliers—raised issues about what’s going to occur to units with EUAs after the declarations allowing their use for COVID-19 finish. HHS has indicated that it intends to develop draft steering for a transition plan for medical units distributed beneath EUAs for COVID-19 by the tip of fiscal yr 2021. A plan for units with EUAs that specifies an affordable timeline and course of for transitioning away from their use, considering stakeholder enter, would assist guarantee a clean transition. As HHS develops a transition plan for units with EUAs, GAO recommends that the company specify an affordable timeline and course of for transitioning approved units to clearance, approval, or acceptable disposition that takes under consideration enter from stakeholders. HHS agreed with this advice.

COVID-19 Knowledge for Well being Care Indicators

Since June 2020, GAO has recognized issues with federal COVID-19 knowledge and underscored that within the midst of a nationwide public well being emergency, clear and constant communication between the federal authorities and the general public is crucial provided that efficient response requires the general public’s participation. As a part of its efforts to speak with the general public and stakeholders in regards to the pandemic, a number of specialists steered that the federal authorities ought to enhance the accessibility of its COVID-19 knowledge by making these knowledge out there from a central location on the web. HHS publishes its knowledge on COVID-19 well being indicators throughout a number of web sites. Nevertheless, the information it makes publicly out there should not all positioned on, or out there from web site hyperlinks on, one on-line location. Consequently, the general public, together with stakeholders, might not be capable of absolutely perceive the extent of the pandemic and use the information to greatest inform their decision-making.

To make the information extra simply accessible, GAO recommends that HHS make its totally different sources of publicly out there COVID-19 knowledge accessible from a centralized location on the web. HHS neither agreed nor disagreed with this advice, however agreed that COVID-19 knowledge needs to be made accessible to assist communication with the general public in regards to the pandemic.

COVID-19 Well being Disparities

GAO beforehand reported that communities of colour have been disproportionately affected by the pandemic. In line with HHS, as of February 8, 2021, knowledge collected from states and jurisdictions on COVID-19 vaccine recipients have been lacking knowledge on race and ethnicity for nearly half of recipients. With out full info on the race and ethnicity of these vaccinated, HHS might have problem figuring out whether or not vaccines are distributed equitably to communities of colour. GAO recommends that HHS take steps to make sure the whole reporting of race and ethnicity info for recipients of COVID-19 vaccinations. HHS neither agreed nor disagreed with this advice.

HHS’s July 2020 COVID-19 Response Well being Fairness Technique has a purpose to scale back well being disparities by utilizing data-driven approaches to achieve the very best stage of well being potential for all people, together with communities of colour. Nevertheless, the technique lacks vital components of an efficient nationwide technique. For instance, HHS’s technique doesn’t present particular actions that the company will take to find out whether or not or the place it wants to extend entry to testing for populations at elevated danger for COVID-19—a necessary first step earlier than taking steps to extend testing entry. GAO recommends that HHS incorporate key components of a nationwide technique to implement the company’s COVID-19 Response Well being Fairness Technique, together with figuring out how intermediate outcomesneeds to be prioritizedHHS agreed with this advice.

Nursing Houses

Amassing detailed info on vaccinations for nursing house populations is vital for monitoring and transparency, notably as a result of nursing properties have been an epicenter of the COVID-19 pandemic and HHS has beneficial precedence vaccinations for this group. HHS established a pharmacy partnership program for vaccinating employees and residents of long-term care amenities, and publicly stories the variety of vaccination doses, by state, supplied to residents and employees of all long-term care amenities taking part in this system. Nevertheless, HHS doesn’t report knowledge displaying vaccination charges particularly for nursing properties and doesn’t acquire or report knowledge for nursing properties not taking part in this system. To enhance the monitoring and transparency of nursing house vaccination efforts, GAO recommends that HHS acquire knowledge particular to COVID-19 vaccination charges in nursing properties and make these knowledge publicly out there. HHS neither agreed nor disagreed with this advice.

As well as, as of January 2021, HHS had not specified whether or not nursing properties could be required to supply COVID-19 vaccinations as they’ve with different vaccines and the way these vaccinations could be included into the company’s nursing house high quality technique. Knowledge on COVID-19 vaccinations in nursing properties may even be vital for HHS’s ongoing efforts to observe nursing house high quality. GAO recommends that HHS require nursing properties to supply COVID-19 vaccinations toresidents and employeesand design and implement related high quality measures. HHS neither agreed nor disagreed with this advice.

Veterans Well being Care

In line with the Division of Veterans Affairs (VA), many veterans enrolled in VA’s well being care system are at a better danger of an infection or extreme illness from COVID-19 on account of their age or underlying well being circumstances. GAO recognized a number of areas the place VA can enhance its vaccination efforts:

  • VA doesn’t have metrics associated to employees and veterans who don’t present (no-shows) for his or her vaccination appointments. With out knowledge on no-shows, VA could also be in danger for not having the ability to decide the extent to which employees and veterans should not displaying up for appointments for his or her second vaccinations, and will miss alternatives to higher goal outreach to people not displaying up for appointments.
  • VA lacks targets for when it should transfer from one vaccination section to a different or inside one section for when the company will transfer from one group of veterans to a different, making it tough for the division to evaluate progress.
  • VA is using a phased vaccine rollout; nonetheless, VA’s present metrics don’t seize vaccine knowledge by phases. Consequently, VA is just not in a position to decide which amenities could also be at an earlier section than others and direct assets or help to these amenities.

GAO recommends that VA (1) acquire knowledge on the variety of employees and veterans who don’t present up for a vaccination appointment to higher monitor for completion of the second dose of the vaccine; (2) develop preliminary vaccination targets for when it should transfer from one vaccination section to a different; or inside one section, from one group of veterans to a different; and (3) develop metrics to evaluate the variety of vaccines administered by vaccine rollout section to higher assess progress and make any essential changes. VA agreed with the primary and third suggestions and agreed in precept with the second advice.

Diet Help

The U.S. Division of Agriculture (USDA) administers numerous federal vitamin help applications to weak populations. Latest legislative and govt actions made a number of modifications to those applications because the detrimental financial results of the COVID-19 pandemic have continued. Nevertheless, till just lately, USDA had launched minimal knowledge about participation in these applications through the pandemic, and when the division launched knowledge in late January 2021, it didn’t publicly share adequate details about knowledge high quality. In August 2020, USDA introduced it had recognized vital points with the standard of state-reported knowledge on two applications. Because it labored to determine the foundation causes of the problems, USDA opted to not launch participation knowledge for any of its different vitamin help applications from July 2020 till late January 2021. When USDA launched the information, the division didn’t clarify the way it resolved the information high quality points it beforehand disclosed, nor did it share essential context to assist stakeholders and the general public perceive and interpret the information.

Consequently, stakeholders and the general public lack adequate info and acceptable context to interpret key program knowledge and perceive the consequences of the pandemic on the applications. GAO recommends that USDA (1) present adequate context to assist stakeholders and the general public perceive and interpret knowledge on federal vitamin help applications through the pandemic and (2) disclose potential sources of error which will have an effect on knowledge high quality through the pandemic, corresponding to guide processing. USDA usually agreed with these suggestions.

Catastrophe Reduction Fund and Help to Tribal Governments

Accessible knowledge from HHS point out that tribes are amongst communities of colour bearing a disproportionate burden of COVID-19 constructive assessments, circumstances, hospitalizations, and deaths. The Federal Emergency Administration Company (FEMA), throughout the Division of Homeland Safety (DHS), performs a key position within the ongoing COVID-19 pandemic response effort, together with utilizing the Catastrophe Reduction Fund to supply Public Help grants to reimburse tribal governments, amongst others, for pandemic prices, corresponding to testing provides, PPE, and vaccine distribution.

A number of tribal organizations reported challenges associated to finishing administrative necessities to request and obtain Public Help. For instance, two tribal officers advised GAO that when requesting technical help from FEMA to assist with catastrophe actions corresponding to creating a Public Help Administrative Plan, FEMA didn’t have employees to help. FEMA’s preliminary evaluation report of its response to the pandemic famous challenges and beneficial that FEMA develop a tribal nation engagement technique that features offering the assets and personnel all through every area required to assist program supply for all tribal nations. Nevertheless, as of March 2021, FEMA had not developed this technique.

GAO recommends that FEMA present well timed and constant technical help to assist tribal governments’ efforts to request and obtain Public Help as direct recipients, together with offering further personnel, if essential, to make sure that tribal nations are in a positionto successfully replyto COVID-19. DHS agreed with this advice.

FEMA’s 2019 Tribal Session Coverage specifies the method for consulting with tribes all through the 4 phases that information the company in learn how to conduct common and significant collaboration with tribes (see determine). Nevertheless, GAO discovered that FEMA didn’t observe the tribal session course of whereas creating an interim coverage detailing eligible gadgets for reimbursement beneath the Public Help program. If tribes had been formally consulted earlier within the course of, they might have been in a greater place to supply significant enter to FEMA on how its coverage may impression tribes. Additional, there might have been much less confusion on which gadgets have been thought of eligible for reimbursement through the early months of the pandemic, and tribes might have made extra knowledgeable choices. GAO recommends that FEMA adhere to the company’s protocols listed within the up to date 2019 Tribal Session Coverage by acquiring tribal enter by way of the 4 phases of the tribal session course of when creating new insurance policies and procedures associated to COVID-19 help. DHS agreed with this advice.

Overview of FEMA’s Tribal Session Coverage Course of

Figure described in preceding paragraph. For additional information about this figure, refer to contacts listed at http://www.gao.gov/products/GAO-21-387

Ok-12 Training

The Division of Training (Training) has taken steps to trace state and faculty district spending of sure COVID-19 aid funds, however the knowledge give an incomplete image of the standing of funds and understate the speed at which funds are getting used. In line with knowledge collected by Training, as of February 28, 2021, states and territories have spent about $6.1 billion of the roughly $75 billion appropriated by way of the Training Stabilization Fund for states’ and territories’ schooling wants. Nevertheless, federal spending knowledge alone present an incomplete image of states’ and faculty districts’ spending, as there are a number of components that affect the speed at which funds seem like spent. For instance, there’s typically a major hole between when a district “makes use of” the funds (i.e., orders, contracts for, installs, and pays for items or companies, corresponding to info expertise tools) and when these funds are reported as “spent” in state and federal reporting techniques, as is frequent in federal grants administration processes.

In line with Training officers, states award relevant funds to high school districts in order that the varsity districts can obligate these funds for particular functions. The state doesn’t switch funds to the district till the district requests fee for companies or deliverables acquired. Training officers don’t take into account the funds spent till the state requests fee for bills. Given this hole between when a district makes use of funds and funds are recorded as spent, absent info on obligations, policymakers won’t have full info on how these funds are getting used to deal with the pandemic-related schooling wants of America’s schoolchildren. GAO recommends that Training repeatedly acquire and publicly report info on college districts’ monetary commitments (obligations), in addition to outlays (expenditures) so as to extra fully mirror the standing of their use of federal COVID-19 aid funds. For instance, Training might modify its annual report on state and faculty district spending knowledge to incorporate obligations knowledge in subsequent reporting cycles. Training agreed with this advice.

Small Enterprise Help Applications

The Consolidated Appropriations Act, 2021, appropriated further funding for the creation of the Focused Financial Harm Catastrophe Mortgage (EIDL) Advance program and approved further Paycheck Safety Program (PPP) loans, amongst different issues, highlighting the continued want for making certain program integrity. Since March 2020, the Division of Justice has publicly introduced expenses in quite a few fraud-related circumstances related to loans made by way of these applications. Because of issues about program integrity, GAO has added Small Enterprise Administration (SBA) loans to GAO’s Excessive Threat Checklist. SBA has taken some steps to mitigate fraud dangers to EIDL and PPP, nevertheless it has not taken a strategic method to managing fraud dangers to each applications. GAO recommends that SBA (1) implement a complete oversight plan to determine and reply to danger within the EIDL program to make sure program integrity, obtain program effectiveness, and handle potential fraud; (2) conduct and doc a fraud danger evaluation for the EIDL program and PPP; (3) develop a technique that outlines particular actions to deal with assessed fraud dangers within the EIDL program; and (4) define particular actions to observe and handle fraud dangers in PPP on a steady foundation. SBA agreed with these suggestions.

Unemployment Insurance coverage Applications

GAO continues to have issues about overpayments and potential fraud within the unemployment insurance coverage (UI) system, together with the federally funded Pandemic Unemployment Help (PUA) program, which authorizes UI advantages to sure people not in any other case eligible for these advantages, corresponding to self-employed and sure gig financial system staff. As of March 15, 2021, DOL reported that states had recognized greater than $3.6 billion in PUA overpayments from March 2020 by way of February 2021. In response to a advice in GAO’s January 2021 report, DOL has taken steps to gather knowledge on states’ restoration of PUA overpayments. Nevertheless, the Consolidated Appropriations Act, 2021, enacted in December 2020, supplied states with authority to waive sure PUA overpayments. Thus, further knowledge on the quantities of PUA overpayments states have waived are additionally wanted to successfully monitor the restoration of overpayments. GAO recommends that DOL acquire knowledge from states on the quantity of overpayments waived within the PUA program, much like the common UI program. DOL agreed with this advice.

This report incorporates further suggestions associated to transparency and accountability within the following areas: aid for well being care suppliers, financial impression funds, federal contracts and agreements, audits of nonfederal entities receiving federal pandemic help, and employer tax aid and payroll tax deferrals.

GAO can also be inspecting the federal authorities’s COVID-19 vaccine efforts, which would be the focus of an upcoming report. Lastly, GAO will evaluate actions federal businesses have taken in response to the American Rescue Plan of 2021 in future reporting.

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