Background

Federal, state, and local government agencies have differing roles with  regard to public health emergency preparedness and response. The federal  government conducts a variety of activities, including developing  interagency response plans, increasing state and local response  capabilities, developing and deploying federal response teams, increasing  the availability of medical treatments, participating in and sponsoring  exercises, planning for victim aid, and providing support in times of  disaster and during special events such as the Olympic games. One of its  main functions is to provide support for the primary responders at the  state and local level, including emergency medical service personnel,  public health officials, doctors, and nurses. This support is critical because  the burden of response falls initially on state and local emergency  response agencies.
The President’s proposal transfers control over many of the programs that  provide preparedness and response support for the state and local  governments to a new Department of Homeland Security. Among other  changes, the proposed legislation transfers HHS’s Office of the Assistant  Secretary for Public Health Emergency Preparedness to the new  department. Included in this transfer is the Office of Emergency  Preparedness (OEP), which currently leads the National Disaster Medical  System (NDMS) in conjunction with several other agencies and the  Metropolitan Medical Response System (MMRS). The Strategic National  Stockpile, currently administered by the Centers for Disease Control and  Prevention (CDC), would also be transferred, although the Secretary of  HHS would still manage the stockpile and continue to determine its  contents. The President’s proposal would also transfer the select agent  registration enforcement program from HHS to the new department.  Currently administered by CDC, the program’s mission is the security of  those biologic agents that have the potential for use by terrorists. The  proposal provides for the new department to consult with appropriate  agencies, which would include HHS, in maintaining the select agent list.
Under the President’s proposal, the new department would also be  responsible for all current HHS public health emergency preparedness  activities carried out to assist state and local governments or private  organizations to plan, prepare for, prevent, identify, and respond to  biological, chemical, radiological, and nuclear events and public health  emergencies. Although not specifically named in the proposal, this would  include CDC’s Bioterrorism Preparedness and Response program and the  Health Resources and Services Administration’s (HRSA) Bioterrorism  Hospital Preparedness Program. These programs provide grants to states  and cities to develop plans and build capacity for communication, disease  surveillance, epidemiology, hospital planning, laboratory analysis, and  other basic public health functions. Except as otherwise directed by the  President, the Secretary of Homeland Security would carry out these  activities through HHS under agreements to be negotiated with the  Secretary of HHS. Further, the Secretary of Homeland Security would be  authorized to set the priorities for these preparedness and response  activities.
The new Department of Homeland Security would also be responsible for  conducting a national scientific research and development program,  including developing national policy and coordinating the federal  government’s civilian efforts to counter chemical, biological, radiological,  and nuclear weapons or other emerging threats. This would include  establishing priorities and directing and supporting national research and  development and procurement of technology and systems for detecting,  preventing, protecting against, and responding to terrorist acts using  chemical, biological, radiological, or nuclear weapons. Portions of the  Departments of Agriculture, Defense, and Energy that conduct research  would be transferred to the new Department of Homeland Security. For  example, the Department of Energy’s (DOE) chemical and biological  national security research and some of its nuclear smuggling and  homeland security activities would be transferred to the new homeland  security department. The Department of Homeland Security would carry  out civilian health-related biological, biomedical, and infectious disease  defense research and development through agreements with HHS, unless  otherwise directed by the President. As part of this responsibility, the new  department would establish priorities and direction for a program of basic  and applied research on the detection, treatment, and prevention of  infectious diseases to be conducted by the National Institutes of Health  (NIH).

	Transfer of Certain Public Health Programs Has Potential to Improve Coordination

The transfer of federal assets and resources in the President’s proposed  legislation has the potential to improve coordination of public health  preparedness and response activities at the federal, state, and local levels.  Our past work has detailed a lack of coordination in the programs that  house these activities, which are currently dispersed across numerous  federal agencies. In addition, we have discussed the need for an  institutionalized responsibility for homeland security in federal statute.  We have also testified that one key consideration in evaluating whether  individual agencies or programs should be included or excluded from the  proposed department is the extent to which homeland security is a major  part of the agency or program mission.
The President’s proposal provides the potential to consolidate programs,  thereby reducing the number of points of contact with which state and  local officials have to contend. However, coordination would still be  required with multiple agencies across departments. Many of the agencies  involved in these programs have differing perspectives and priorities, and  the proposal does not sufficiently clarify the lines of authority of different  parties in the event of an emergency, such as between the Federal Bureau  of Investigation (FBI) and public health officials investigating a suspected  bioterrorist incident. Let me provide you with more details.
We have reported that many state and local officials have expressed  concerns about the coordination of federal public health preparedness and  response efforts. Officials from state public health agencies and state  emergency management agencies have told us that federal programs for  improving state and local preparedness are not carefully coordinated or  well organized. For example, federal programs managed by the Federal  Emergency Management Agency (FEMA), Department of Justice (DOJ),  OEP, and CDC all currently provide funds to assist state and local  governments. Each program conditions the receipt of funds on the  completion of a plan, but officials have told us that the preparation of  multiple, generally overlapping plans can be an inefficient process. In  addition, state and local officials told us that having so many federal  entities involved in preparedness and response has led to confusion,  making it difficult for them to identify available federal preparedness  resources and effectively partner with the federal government.
The proposed transfer of numerous federal response teams and assets to  the new department would enhance efficiency and accountability for these  activities. This would involve a number of separate federal programs for  emergency preparedness and response, whose missions are closely  aligned with homeland security, including FEMA; certain units of DOJ; and  HHS’s Office of the Assistant Secretary for Public Health Emergency  Preparedness, including OEP and its NDMS and MMRS programs, along  with the Strategic National Stockpile and the select agent program. In our  previous work, we found that in spite of numerous efforts to improve  coordination of the separate federal programs, problems remained, and we  recommended consolidating the FEMA and DOJ programs to improve the  coordination. The proposal places these programs under the control of  the Under Secretary for Emergency Preparedness and Response, who  could potentially reduce overlap and improve coordination. This change  would make one individual accountable for these programs and would  provide a central source for federal assistance.
The proposed transfer of MMRS, a collection of local response systems  funded by HHS in metropolitan areas, has the potential to enhance its  communication and coordination. Officials from one state told us that  their state has MMRSs in multiple cities but there is no mechanism in  place to allow communication and coordination among them. Although  the proposed department has the potential to facilitate the coordination of  this program, this example highlights the need for greater regional  coordination, an issue on which the proposal is silent.
Because the new department would not include all agencies with public  health responsibilities related to homeland security, coordination across  departments would still be required for some programs. For example,  NDMS functions as a partnership among HHS, the Department of Defense  (DOD), the Department of Veterans Affairs (VA), FEMA, state and local  governments, and the private sector. However, as the DOD and VA  programs are not included in the proposal, only some of these federal  organizations would be brought under the umbrella of the Department of  Homeland Security. Similarly, the Strategic National Stockpile currently  involves multiple agencies. It is administered by CDC, which contracts  with VA to purchase and store pharmaceutical and medical supplies that  could be used in the event of a terrorist incident. Recently expanded and  reorganized, the program will now include management of the nation’s  inventory of smallpox vaccine. Under the President’s proposal, CDC’s  responsibilities for the stockpile would be transferred to the new  department, but VA and HHS involvement would be retained, including  continuing review by experts of the contents of the stockpile to ensure  that emerging threats, advanced technologies, and new countermeasures  are adequately considered.
Although the proposed department has the potential to improve  emergency response functions, its success depends on several factors. In  addition to facilitating coordination and maintaining key relationships  with other departments, these factors include merging the perspectives of  the various programs that would be integrated under the proposal and  clarifying the lines of authority of different parties in the event of an  emergency. As an example, in the recent anthrax events, local officials  complained about differing priorities between the FBI and the public  health officials in handling suspicious specimens. According to the public  health officials, FBI officials insisted on first informing FBI managers of  any test results, which delayed getting test results to treating physicians.  The public health officials viewed contacting physicians as the first  priority in order to ensure that effective treatment could begin as quickly  as possible.

	New Department’s Control of Essential Public Health Capacities Raises Concern

The President’s proposal to shift the responsibility for all programs  assisting state and local agencies in public health emergency preparedness  and response from HHS to the new department raises concern because of  the dual-purpose nature of these activities. These programs include  essential public health functions that, while important for homeland  security, are critical to basic public health core capacities. Therefore, we  are concerned about the transfer of control over the programs, including  priority setting, that the proposal would give to the new department. We  recognize the need for coordination of these activities with other  homeland security functions, but the President’s proposal is not clear on  how the public health and homeland security objectives would be  balanced.
Under the President’s proposal, responsibility for programs with dual  homeland security and public health purposes would be transferred to the  new department. These include such current HHS assistance programs as  CDC’s Bioterrorism Preparedness and Response program and HRSA’s  Bioterrorism Hospital Preparedness Program. Functions funded through  these programs are central to investigations of naturally occurring  infectious disease outbreaks and to regular public health communications,  as well as to identifying and responding to a bioterrorist event. For  example, CDC has used funds from these programs to help state and local  health agencies build an electronic infrastructure for public health  communications to improve the collection and transmission of  information related to both bioterrorist incidents and other public health  events. Just as with the West Nile virus outbreak in New York City, which  initially was feared to be the result of bioterrorism, when an unusual case  of disease occurs public health officials must investigate to determine  whether it is naturally occurring or intentionally caused. Although the  origin of the disease may not be clear at the outset, the same public health  resources are needed to investigate, regardless of the source.
States are planning to use funds from these assistance programs to build  the dual-purpose public health infrastructure and core capacities that the  recently enacted Public Health Security and Bioterrorism Preparedness  and Response Act of 2002 stated are needed. States plan to expand  laboratory capacity, enhance their ability to conduct infectious disease  surveillance and epidemiological investigations, improve communication  among public health agencies, and develop plans for communicating with  the public. States also plan to use these funds to hire and train additional  staff in many of these areas, including epidemiology.
Our concern regarding these dual-purpose programs relates to the  structure provided for in the President’s proposal. The Secretary of  Homeland Security would be given control over programs to be carried  out by HHS. The proposal also authorizes the President to direct that these  programs no longer be carried out through agreements with HHS, without  addressing the circumstances under which such authority would be  exercised. We are concerned that this approach may disrupt the synergy  that exists in these dual-purpose programs. We are also concerned that the  separation of control over the programs from their operations could lead  to difficulty in balancing priorities. Although the HHS programs are  important for homeland security, they are just as important to the day-to- day needs of public health agencies and hospitals, such as reporting on  disease outbreaks and providing alerts to the medical community. The  current proposal does not clearly provide a structure that ensures that the  goals of both homeland security and public health will be met.

	Transfer of Control and Priority Setting over Dual-Purpose Research and Development Raises Concern

The proposed Department of Homeland Security would be tasked with  developing national policy for and coordinating the federal government’s  civilian research and development efforts to counter chemical, biological,  radiological, and nuclear threats. In addition to coordination, we believe  the role of the new department should include forging collaborative  relationships with programs at all levels of government and developing a  strategic plan for research and development. However, we have many of  the same concerns regarding the transfer of responsibility for the research  and development programs that we have regarding the transfer of the  public health preparedness programs. We are concerned about the  implications of the proposed transfer of control and priority setting for  dual-purpose research. For example, some research programs have broad  missions that are not easily separated into homeland security research and  research for other purposes. We are concerned that such dual-purpose  research activities may lose the synergy of their current placement in  programs. In addition, we see a potential for duplication of capacity that  already exists in the federal laboratories.
We have previously reported that while federal research and development  programs are coordinated in a variety of ways, coordination is limited,  raising the potential for duplication of efforts among federal agencies.  Coordination is limited by the extent of compartmentalization of efforts  because of the sensitivity of the research and development programs,  security classification of research, and the absence of a single  coordinating entity to ensure against duplication. For example, DOD’s  Defense Advanced Research Projects Agency was unaware of U.S. Coast  Guard plans to develop methods to detect biological agents on infected  cruise ships and, therefore, was unable to share information on its  research to develop biological detection devices for buildings that could  have applicability in this area.
The new department will need to develop mechanisms to coordinate and  integrate information on research and development being performed  across the government related to chemical, biological, radiological, and  nuclear terrorism, as well as user needs. We reported in 1999 and again in  2001 that the current formal and informal research and development  coordination mechanisms may not ensure that potential overlaps, gaps,  and opportunities for collaboration are addressed. It should be noted,  however, that the legislation tasks the new department with coordinating  the federal government’s “civilian efforts” only. We believe the new  department will also need to coordinate with DOD and the intelligence  agencies that conduct research and development efforts designed to  detect and respond to weapons of mass destruction. In addition, the first  responders and local governments possess practical knowledge about  their technological needs and relevant design limitations that should be  taken into account in federal efforts to provide new equipment, such as  protective gear and sensor systems, and help set standards for  performance and interoperability. Therefore, the new department will  have to develop collaborative relationships with these organizations to  facilitate technological improvements and encourage cooperative  behavior.
The President’s proposal could help improve coordination of federal  research and development by giving one person the responsibility for  creating a single national research and development strategy that could  address coordination, reduce potential duplication, and ensure that  important issues are addressed. In 2001, we recommended the creation of  a unified strategy to reduce duplication and leverage resources, and  suggested that the plan be coordinated with federal agencies performing  research as well as state and local authorities. The development of such a  plan would help to ensure that research gaps are filled, unproductive  duplication is minimized, and that individual agency plans are consistent  with the overall goals.
The proposal would transfer parts of DOE’s nonproliferation and  verification research and development program to the new department,  including research on systems to improve the nation’s capability to  prepare for and respond to chemical and biological attacks. However, the  legislation is not clear whether the programmatic management and dollars  only would move or the scientists carrying out the research would also  move to the new department. Because the research is carried out by  multiprogram laboratories that employ scientists skilled in many  disciplines who serve many different missions and whose research  benefits from their interactions with colleagues within the laboratory, it  may not be prudent to move the scientists who are doing the research. One  option would be rather than moving the scientists, the new department  could contract with DOE’s national laboratories to conduct the research.
The President’s proposal would also transfer the responsibility for civilian  health-related biological defense research and development programs to  the new department, but the programs would continue to be carried out  through HHS. These programs, now primarily sponsored by NIH, include a  variety of efforts to understand basic biological mechanisms of infection  and to develop and test rapid diagnostic tools, vaccines, and antibacterial  and antiviral drugs. These efforts have dual-purpose applicability. The  scientific research on biologic agents that could be used by terrorists  cannot be readily separated from research on emerging infectious  diseases. For example, NIH-funded research on a drug to treat  cytomegalovirus complications in patients with HIV is now being  investigated as a prototype for developing antiviral drugs against  smallpox. Conversely, research being carried out on antiviral drugs in the  NIH biodefense research program is expected to be useful in the  development of treatments for hepatitis C.
The proposal to transfer responsibility to the new department for research  and development programs that would continue to be carried out by HHS  raises many of the same concerns we have with the structure the proposal  creates for public health preparedness programs. Although there is a clear  need for the new department to have responsibility for setting policy,  developing a strategy, providing leadership, and overall coordinating of  research and development efforts in these areas, we are concerned that  control and priority-setting responsibility will not be vested in those  programs best positioned to understand the potential of basic research  efforts or the relevance of research being carried out in other, non- biodefense programs.
In addition, the proposal would allow the new department to direct, fund,  and conduct research related to chemical, biological, radiological, nuclear,  and other emerging threats on its own. This raises the potential for  duplication of efforts, lack of efficiency, and an increased need for  coordination with other departments that would continue to carry out  relevant research. We are concerned that the proposal could result in a  duplication of capacity that already exists in the current federal  laboratories.

	Concluding Observations

Many aspects of the proposed consolidation of response activities are in  line with our previous recommendations to consolidate programs,  coordinate functions, and provide a statutory basis for leadership of  homeland security. The transfer of the HHS medical response programs  has the potential to reduce overlap among programs and facilitate  response in times of disaster. However, we are concerned that the  proposal does not provide the clear delineation of roles and  responsibilities that is needed. We are also concerned about the broad  control the proposal grants to the new department for research and  development and public health preparedness programs. Although there is  a need to coordinate these activities with the other homeland security  preparedness and response programs that would be brought into the new  department, there is also a need to maintain the priorities for basic public  health capacities that are currently funded through these dual-purpose  programs. We do not believe that the President’s proposal adequately  addresses how to accomplish both objectives. We are also concerned that  the proposal would transfer the control and priority setting over dual- purpose research and has the potential to create an unnecessary  duplication of federal research capacity.
Mr. Chairman, this completes my prepared statement. I would be happy to  respond to any questions you or other Members of the Committee may  have at this time.

	Contact and Acknowledgments

For further information about this testimony, please contact Janet  Heinrich at (202) 512-7118. Gene Aloise, Robert Copeland, Marcia Crosse,  Greg Ferrante, Gary Jones, Deborah Miller, Roseanne Price, and Keith  Rhodes also made key contributions to this statement.

Related GAO Products

	Homeland Security

Homeland Security: Proposal for Cabinet Agency Has Merit, but  Implementation Will Be Pivotal to Success. GAO-02-886T.   Washington, D.C.: June 25, 2002.
Homeland Security: New Department Could Improve Coordination but  May Complicate Public Health Priority Setting. GAO-02-883T.  Washington, D.C.: June 25, 2002.
Homeland Security: Key Elements to Unify Efforts Are Underway but  Uncertainty Remains. GAO-02-610. Washington, D.C.: June 7, 2002.
Homeland Security: Responsibility and Accountability for Achieving  National Goals. GAO-02-627T. Washington, D.C.: April 11, 2002.
Homeland Security: Progress Made; More Direction and Partnership  Sought. GAO-02-490T. Washington, D.C.: March 12, 2002.
Homeland Security: Challenges and Strategies in Addressing Short- and  Long-Term National Needs. GAO-02-160T. Washington, D.C.:   November 7, 2001.
Homeland Security: A Risk Management Approach Can Guide  Preparedness Efforts. GAO-02-208T. Washington, D.C.: October 31, 2001.
Homeland Security: Need to Consider VA’s Role in Strengthening Federal  Preparedness. GAO-02-145T. Washington, D.C.: October 15, 2001.
Homeland Security: Key Elements of a Risk Management Approach.  GAO-02-150T. Washington, D.C.: October 12, 2001.
Homeland Security: A Framework for Addressing the Nation’s Efforts.  GAO-01-1158T. Washington, D.C.: September 21, 2001.

	Public Health

Bioterrorism: The Centers for Disease Control and Prevention’s Role in  Public Health Protection. GAO-02-235T. Washington, D.C.:   November 15, 2001.
Bioterrorism: Review of Public Health Preparedness Programs. GAO-02- 149T. Washington, D.C.: October 10, 2001.
Bioterrorism: Public Health and Medical Preparedness. GAO-02-141T.  Washington, D.C.: October 9, 2001.
Bioterrorism: Coordination and Preparedness. GAO-02-129T.  Washington, D.C.: October 5, 2001.
Bioterrorism: Federal Research and Preparedness Activities. GAO-01- 915. Washington, D.C.: September 28, 2001.
Chemical and Biological Defense: Improved Risk Assessment and  Inventory Management Are Needed. GAO-01-667.   Washington, D.C.: September 28, 2001.
West Nile Virus Outbreak: Lessons for Public Health Preparedness.  GAO/HEHS-00-180. Washington, D.C.: September 11, 2000.
Chemical and Biological Defense: Program Planning and Evaluation  Should Follow Results Act Framework. GAO/NSIAD-99-159.   Washington, D.C.: August 16, 1999.
Combating Terrorism: Observations on Biological Terrorism and Public  Health Initiatives. GAO/T-NSIAD-99-112. Washington, D.C.:   March 16, 1999.

	Combating Terrorism

National Preparedness: Technologies to Secure Federal Buildings. GAO- 02-687T. Washington, D.C.: April 25, 2002.
National Preparedness: Integration of Federal, State, Local, and Private  Sector Efforts Is Critical to an Effective National Strategy for Homeland  Security. GAO-02-621T. Washington, D.C.: April 11, 2002.
Combating Terrorism: Intergovernmental Cooperation in the  Development of a National Strategy to Enhance State and Local  Preparedness. GAO-02-550T. Washington, D.C.: April 2, 2002.
Combating Terrorism: Enhancing Partnerships Through a National  Preparedness Strategy. GAO-02-549T. Washington, D.C.: March 28, 2002.
Combating Terrorism: Critical Components of a National Strategy to  Enhance State and Local Preparedness. GAO-02-548T. Washington, D.C.:  March 25, 2002.
Combating Terrorism: Intergovernmental Partnership in a National  Strategy to Enhance State and Local Preparedness. GAO-02-547T.  Washington, D.C.: March 22, 2002.
Combating Terrorism: Key Aspects of a National Strategy to Enhance  State and Local Preparedness. GAO-02-473T. Washington, D.C.:   March 1, 2002.
Chemical and Biological Defense: DOD Should Clarify Expectations for  Medical Readiness. GAO-02-219T. Washington, D.C.: November 7, 2001.
Anthrax Vaccine: Changes to the Manufacturing Process. GAO-02-181T.  Washington, D.C.: October 23, 2001.
Chemical and Biological Defense: DOD Needs to Clarify Expectations for  Medical Readiness. GAO-02-38. Washington, D.C.: October 19, 2001.
Combating Terrorism: Considerations for Investing Resources in  Chemical and Biological Preparedness. GAO-02-162T.   Washington, D.C.: October 17, 2001.
Combating Terrorism: Selected Challenges and Related  Recommendations. GAO-01-822. Washington, D.C.: September 20, 2001.
Combating Terrorism: Actions Needed to Improve DOD Antiterrorism  Program Implementation and Management. GAO-01-909.   Washington, D.C.: September 19, 2001.
Combating Terrorism: Comments on H.R. 525 to Create a President’s  Council on Domestic Terrorism Preparedness. GAO-01-555T.   Washington, D.C.: May 9, 2001.
Combating Terrorism: Accountability Over Medical Supplies Needs  Further Improvement. GAO-01-666T. Washington, D.C.: May 1, 2001.
Combating Terrorism: Observations on Options to Improve the Federal  Response. GAO-01-660T. Washington, DC: April 24, 2001.
Combating Terrorism: Accountability Over Medical Supplies Needs  Further Improvement. GAO-01-463. Washington, D.C.: March 30, 2001.
Combating Terrorism: Comments on Counterterrorism Leadership and  National Strategy. GAO-01-556T. Washington, D.C.: March 27, 2001.
Combating Terrorism: FEMA Continues to Make Progress in  Coordinating Preparedness and Response. GAO-01-15.   Washington, D.C.: March 20, 2001.
Combating Terrorism: Federal Response Teams Provide Varied  Capabilities; Opportunities Remain to Improve Coordination. GAO-01- 14. Washington, D.C.: November 30, 2000.
Combating Terrorism: Need to Eliminate Duplicate Federal Weapons of  Mass Destruction Training. GAO/NSIAD-00-64. Washington, D.C.:   March 21, 2000.
Combating Terrorism: Chemical and Biological Medical Supplies Are  Poorly Managed. GAO/T-HEHS/AIMD-00-59. Washington, D.C.:   March 8, 2000.
Combating Terrorism: Chemical and Biological Medical Supplies Are  Poorly Managed. GAO/HEHS/AIMD-00-36. Washington, D.C.:   October 29, 1999.
Combating Terrorism: Observations on the Threat of Chemical and  Biological Terrorism. GAO/T-NSIAD-00-50. Washington, D.C.:   October 20, 1999.
Combating Terrorism: Need for Comprehensive Threat and Risk  Assessments of Chemical and Biological Attacks. GAO/NSIAD-99-163.  Washington, D.C.: September 14, 1999.
Chemical and Biological Defense: Coordination of Nonmedical Chemical  and Biological R&D Programs. GAO/NSIAD-99-160. Washington, D.C.:  August 16, 1999.
Combating Terrorism: Use of National Guard Response Teams Is  Unclear. GAO/T-NSIAD-99-184. Washington, D.C.: June 23, 1999.
Combating Terrorism: Observations on Growth in Federal Programs.  GAO/T-NSIAD-99-181. Washington, D.C.: June 9, 1999.
Combating Terrorism: Analysis of Potential Emergency Response  Equipment and Sustainment Costs. GAO/NSIAD-99-151.   Washington, D.C.: June 9, 1999.
Combating Terrorism: Use of National Guard Response Teams Is  Unclear. GAO/NSIAD-99-110. Washington, D.C.: May 21, 1999.
Combating Terrorism: Observations on Federal Spending to Combat  Terrorism. GAO/T-NSIAD/GGD-99-107. Washington, D.C.: March 11, 1999.
Combating Terrorism: Opportunities to Improve Domestic Preparedness  Program Focus and Efficiency. GAO/NSIAD-99-3. Washington, D.C.:  November 12, 1998.
Combating Terrorism: Observations on the Nunn-Lugar-Domenici  Domestic Preparedness Program. GAO/T-NSIAD-99-16. Washington, D.C.:  October 2, 1998.
Combating Terrorism: Observations on Crosscutting Issues. GAO/T- NSIAD-98-164. Washington, D.C.: April 23, 1998.
Combating Terrorism: Threat and Risk Assessments Can Help Prioritize  and Target Program Investments. GAO/NSIAD-98-74. Washington, D.C.:  April 9, 1998.
Combating Terrorism: Spending on Governmentwide Programs  Requires Better Management and Coordination. GAO/NSIAD-98-39.  Washington, D.C.: December 1, 1997.

	Disaster Assistance

Disaster Assistance: Improvement Needed in Disaster Declaration  Criteria and Eligibility Assurance Procedures. GAO-01-837.   Washington, D.C.: August 31, 2001.
Chemical Weapons: FEMA and Army Must Be Proactive in Preparing  States for Emergencies. GAO-01-850. Washington, D.C.: August 13, 2001.
Federal Emergency Management Agency: Status of Achieving Key  Outcomes and Addressing Major Management Challenges. GAO-01-832.  Washington, D.C.: July 9, 2001.

	Budget and Management

Budget Issues: Long-Term Fiscal Challenges. GAO-02-467T.   Washington, D.C.: February 27, 2002.
Results-Oriented Budget Practices in Federal Agencies. GAO-01-1084SP.  Washington, D.C.: August 2001.
Managing for Results: Federal Managers’ Views on Key Management  Issues Vary Widely Across Agencies. GAO-01-592. Washington, D.C.:   May 25, 2001.

Summary:
What GAO Found

Since the terrorist attacks on September 11, 2001, and the subsequent anthrax incidents, there has been concern about the ability of the federal government to prepare for and coordinate an effective public health response given the broad distribution of responsibility for that task at the federal level. More then 20 federal departments and agencies carry some responsibility for bioterrorism preparedness and response. The President's proposed Homeland Security Act of 2002 would bring many of these federal entities with homeland security responsibilities--including public health preparedness and response--into one department to mobilize and focus assets and resources at all levels of government. The proposed reorganization has the potential to assist in the coordination of public health preparedness and response programs at the federal, state, and local levels. There are concerns, however, about the proposed transfer of control of public health assistance programs that have both basic public health and homeland security functions from Health and Human Services to the new department. Transferring control over these programs, including priority setting, to the new department has the potential to disrupt some programs critical to basic public health responsibilities. The President's proposal is unclear on how both the homeland security and the public health objectives would be accomplished.