A congressional watchdog agency says the Trump administration failed to implement almost 90% of its recommendations for responding to the COVID-19 pandemic.
The U.S. Government Accountability Office says it is "deeply troubled" that federal agencies under the former administration did not apply 27 out of the 31 recommendations it made around fixing supply chain gaps and other areas of the pandemic that's killed more than 400,000 Americans. The agency's latest audit took place between August 2020 and Jan. 15, five days before President Biden took office.
"We're disappointed with the lack of urgency that we saw from the agencies in the fall in implementing the recommendations," said Nicole Clowers, managing director of GAO's healthcare team. The GAO's advice, if adopted quickly, can help with "mid-course corrections" to the ongoing response, she said.
It's hard to compare the current rate of implementation with past recommendations because of the accelerated pace of the current situation, but Clowers said typically about 80% of GAO's recommendations are implemented in any four-year period.
"GAO has a really good track record of having our recommendations implemented," she said.
The non-partisan federal agency does not have enforcement authority, so it can't penalize agencies for not complying.
Recommendations not carried out span multiple GAO reports. They include immediately documenting roles and responsibilities for supply chain management functions, ensuring there are enough resources to sustain and stabilize the supply chain and working with states, tribal governments and other stakeholders to fix supply chain problems.
The GAO also suggested sharing a national plan for distributing and administering COVID vaccines, developing protocols for reporting COVID cases, disclosing scientific rationale for testing guidelines, tracking COVID cases in nursing homes and veterans' homes, preventing improper CARES Act payments, among others.
"It would be hard to find people who think that the pandemic was managed well," said Julie Swann, an engineering professor at North Carolina State University and member of the Institute for Operations Research and the Management Sciences. "I think there's a lot of evidence where the previous administration did not address problems that should have been addressed."
The watchdog agency's newest report, released this week, tacks on 13 more recommendations it says would improve the federal COVID response. The Coronavirus Aid, Relief, and Economic Security Act, one of four pandemic relief laws enacted as of November, directed GAO to report on its ongoing oversight activity related to the pandemic. The newest report is the fifth such installment.
The newest report reiterates a previous recommendation that HHS and the Defense Department set timelines for vaccine distribution, administration and documentation and outline how their efforts would be coordinated across federal agencies and non-federal entities.
One of several healthcare-related executive orders President Biden signed recently expands COVID testing capacity by beefing up supply and workforce. Clowers said that appears consistent with GAO's recommendations in that area, but the agency will have to learn more.
"It was a positive development for us," she said.
GAO says HHS should immediately establish an expert committee of healthcare professionals to advise on data collection and reporting standards for key health indicators. It says FDA should ensure drugmaker data are complete and accessible and have a plan to respond to its backlog of drug inspections.
Like prior reports, the new one puts heavy emphasis on fixing the supply chain problems that have persisted throughout the pandemic: first with ventilators, then personal protective equipment, testing and now vaccines. It says HHS should regularly engage Congress and state, local and tribal governmental and private companies as it refines its supply chain strategy.
It also directs the FDA to make sure the drug manufacturing data it collects is complete and accessible in order to identify supply chain vulnerabilities. In doing so, it says the agency should work with drugmakers and other federal agencies.
Data collection is a key area where the pandemic response must improve, Swann said. As it stands currently, federal agencies don't have complete and accessible information to identify supply chain vulnerabilities, so we only learn about them once the supply is gone, she said.
"You can't expect an individual hospital or buyer to be able to have that visibility," Swann said, "and even the manufacturer itself can't have that visibility because it's across multiple manufacturers. It's only a federal agency that can address that."
A major problem that's hampering the U.S. pandemic response is that the federal government, local governments and hospitals don't have information about the availability of critical medical supply chains, said Tinglong Dai, associate professor of operations management & business analytics at Johns Hopkins University. Manufacturers aren't required to disclose how much personal protective equipment they can make, so there's no way to know what the domestic production capacity is.
"Without that information, we can't really do anything," he said.
GAO said it's concerned about potential fraud in the federal Pandemic Unemployment Assistance program, which gives money to people not otherwise eligible for unemployment insurance because they're self-employed or gig workers. States have identified more than $1.1 billion in overpayments under that program as of Jan. 11, and GAO says the U.S. Department of Labor ought to collect and report on the amount of overpayments it has recovered.