GAO

United States General Accounting Office

Testimony

Before the Subcommittee on National Security, Veterans 

Affairs and International Relations, Committee on 

Government Reform, House of Representatives

For Release on Delivery

2:00 p.m.

Tuesday,

May 1, 2001

COMBATING TERRORISM

Accountability Over 

Medical Supplies Needs 

Further Improvement

Statement of Linda M. Calbom

Director, Financial Management and Assurance

GAO-01-666T

Page 1 GAO-01-666T

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to discuss the status of agencies’ actions to 

establish effective internal control over the federal medical stockpiles that 

can be used to treat civilian and military victims in the event of a chemical 

or biological terrorist attack. The United States’ ability to effectively 

respond to such an incident is dependent, among other things, on the plans, 

methods, and procedures that are in place to manage the pharmaceutical 

and medical supplies. We testified before this Subcommittee in March 20001

on the need to establish effective control over the stockpiles, which was 

the subject of our October 1999 report.2

 That work resulted in several 

initiatives by the responsible agencies to correct serious control 

weaknesses we identified. It also led your office to request that we follow 

up on the status of corrective actions taken by the Department of Health 

and Human Services’ (HHS) Office of Emergency Preparedness (OEP) and 

Centers for Disease Control and Prevention (CDC), the Department of 

Veterans Affairs (VA), and the Marine Corps Chemical Biological Incident 

Response Force (CBIRF) to address our recommendations that they

1. conduct risk assessments;

2. arrange for periodic, independent inventories of the stockpiles;

3. implement a tracking system that retains complete documentation for 

all supplies ordered, received, and destroyed; and

4. rotate stock properly.

In completing our most recent work in these four areas, we found that OEP, 

CDC, VA, and CBIRF have made significant progress toward implementing 

our October 1999 recommendations. Management at each of the 

responsible agencies has given priority to and placed emphasis on 

strengthening internal control over the stockpiles. As a result, corrective 

actions have reduced inventory discrepancy rates and improved 

accountability. At the same time, we found that in all of the areas 

associated with our prior recommendations, additional steps could be 

1

Combating Terrorism: Chemical and Biological Medical Supplies Are Poorly Managed 

(GAO/T-HEHS/AIMD-00-59, Mar. 8, 2000).

2

Combating Terrorism: Chemical and Biological Medical Supplies Are Poorly Managed 

(GAO/HEHS/AIMD-00-36, Oct. 29, 1999).
Page 2 GAO-01-666T

taken to ensure that pharmaceutical and medical supplies that can be used 

to treat victims of chemical and biological terrorist incidents are current, 

accounted for, and readily available for use. Accordingly, we made 13 new 

recommendations to the responsible agencies in order that they

• minimize the risks associated with partnering with private companies 

and other entities; 

• improve accountability over pharmaceutical and medical supplies; and 

• ensure the effectiveness of supplies on hand. 

My statement will summarize the results of our recent follow-up review and 

highlight additional actions needed to further improve control over the 

stockpiles. A detailed discussion of our findings is contained in our report 

Combating Terrorism: Accountability Over Medical Supplies Needs 

Further Improvement (GAO-01-463), which is being released today. I will 

provide some background information to set the stage.

Background The United States has established a national policy for combating chemical 

and biological terrorism and managing the consequences of terrorist 

attacks. In the event of a domestic chemical or biological terrorist incident, 

local and state governments would be the first to respond in assisting 

civilian victims. If the consequences of such an incident overwhelmed state 

and local capabilities, federal assistance could be given to support their 

efforts. Critical to that assistance are the chemical and biological medical 

supplies maintained by OEP, CDC, VA, and CBIRF. 

The Federal Emergency Management Agency, through the Federal 

Response Plan, has designated HHS as the lead agency to coordinate 

medical assistance in the event of a federally declared natural or man-made 

disaster, including chemical or biological terrorist incidents. Within HHS, 

OEP is responsible for implementing and coordinating this medical 

assistance and has, among other efforts, established four National Medical 

Response Teams (NMRTs) in different regions of the country and staffed 

the teams with specially trained doctors, nurses, other health care 

providers, and emergency personnel whose mission it is to decontaminate 

and/or treat victims of a terrorist attack. Under a memorandum of 

agreement between VA and OEP, VA maintains a medical stockpile 

containing antidotes, antibiotics, and medical supplies at locations near 

each team for responding to chemical terrorist attacks. In addition, VA also 

maintains a smaller stockpile for OEP that contains only antidotes for 
Page 3 GAO-01-666T

chemical incidents. This stockpile can be loaned to local governments or 

predeployed for special events, such as the Olympic Games.

Since November 1999, CDC has been building the National Pharmaceutical 

Stockpile (NPS). CDC partnered3

 with VA as the purchasing agent for the 

NPS materiel, providing CDC access to VA’s purchasing experience and 

ability to purchase medical supplies at significant discounts. The NPS is 

comprised of two types of inventories. The first is a rapid-response 

inventory of pharmaceutical and medical supplies that can be positioned at 

any location in the nation within 12 hours of a federal decision to deploy 

them. The second is a larger stock of supplies that can be deployed within 

24 to 36 hours of notification, and can be tailored to address a particular 

type of incident and augment the rapid-response inventory.4

 This second 

inventory is referred to as the vendor-managed inventory. The rapidresponse inventory comprises approximately 20 percent of the NPS; the 

vendor-managed inventory comprises the remaining 80 percent of the 

stockpile. In the event of an incident, the CDC stock is shipped in bulk and 

is accompanied by CDC technical advisors who assist state and local 

officials in organizing the medication into individual doses and implement 

plans to distribute and dispense the medication. 

CBIRF, created in April 1996 by the Commandant of the Marine Corps, is an 

incident response force and maintains a working stock of medical materiel 

to provide emergency medical care and stabilization of injured CBIRF 

personnel and a limited number of other casualties. CBIRF is also trained 

and equipped to detect and identify chemical agents as well as extract and 

decontaminate victims. 

A graphic representation of the relationships of the agencies responsible 

for chemical and biological medical supplies that could be used to treat 

victims of a terrorist incident is shown in the attachment. I will now 

discuss the results of our follow-up work.

3

 Partnering, in the context of this testimony, is the association of two or more entities in a 

business relationship.

4

These vendor-managed inventories are carried on the manufacturers’ inventory records as 

either “government owned” or “government reserved” and may be rotated with the vendor’s 

normal operating stock in order to ensure freshness.
Page 4 GAO-01-666T

Agencies Performed 

Risk Assessments but 

Did Not Recognize or 

Mitigate All Relevant 

Risks

In October 1999, we reported that neither OEP, VA, nor CBIRF had 

determined the risks that faced their stockpiles, assessed the likelihood of 

each risk’s occurrence, and established plans to detect or mitigate the risks. 

Risk assessments are an important aspect of internal control that identify 

potential internal and external risks, rank them in terms of their possible 

effect on achieving mission objectives, and include actions to mitigate the 

risks. Since our 1999 review, each agency has prepared a risk assessment. 

CBIRF not only completed a risk assessment, including a physical security 

analysis, it also implemented controls to mitigate risks identified in its 

assessment. However, for CDC and OEP we found instances where the risk 

assessments were not sufficiently comprehensive or where actions 

identified to mitigate risks had not been fully implemented. For example, 

CDC and OEP are partnering with various federal and commercial entities 

for the storage, management, and transport of their pharmaceutical and 

medical supplies. As of the completion of our fieldwork in December 2000, 

neither agency had considered all of the risks posed by delegating key 

responsibilities to other entities, nor had they taken all the necessary steps 

to mitigate those risks. 

Among CDC’s partners is a wholesale distributor of pharmaceutical and 

medical supplies, which stores and/or manages most of CDC’s rapidresponse inventories at facilities around the country. While CDC issued 

standard operating procedures in the form of a handbook to the wholesale 

distributor in November 2000, as of the end of our fieldwork there was no 

signed agreement between CDC, VA, and the distributor to cover the 

distributor’s responsibilities to CDC or to bind it to the procedures 

addressed in the handbook. In commenting on our draft report, CDC stated 

that it used existing contractual agreements between VA and its 

commercial partners. While these existing agreements are designed to 

address VA’s hospital supply needs, they do not address key 

responsibilities, requirements, and control activities specific to the NPS 

Program. CDC further stated that some of its written contractual 

agreements with the NPS Program partners had been finalized, while 

others were undergoing legal evaluation. CDC has since finalized its 

agreement with the wholesale distributor and provided us with a copy, 

which we are now reviewing.

In addition, while CDC had finalized the lease agreements with two private 

warehouses for the storage of three of the rapid-response inventories, as of 

the end of our fieldwork it had not developed standard operating 

procedures for those entrusted with the inventory to cover such 
Page 5 GAO-01-666T

responsibilities as granting access to the wholesale distributor for rotating 

supplies stored in the warehouses. Also, while CDC officials told us that 

they plan to use private air cargo and land transport companies to transport 

the stockpiles in the event of a terrorist incident, as of the completion of 

our fieldwork there were no standard operating procedures or signed 

agreements to cover these arrangements. Without adequate written 

procedures in place, CDC cannot be assured that mission-critical activities 

will be properly carried out by these other parties. 

Similarly, OEP did not recognize all the risks associated with delegating 

responsibility for the storage and management of its stockpiles to VA. 

Although OEP and VA jointly drafted both national and local operating 

plans5

 in accordance with their memorandum of agreement, these plans 

had not been finalized or approved by OEP as of the end of our fieldwork. 

While the draft local operating plans had been provided to the VA locations 

storing the stockpiles, security personnel at two of the locations were 

unable to provide us with a copy of the draft plan or associated training 

materials. In addition, they could not demonstrate that the plan had been 

communicated to them or that they were prepared to put it into practice. In 

commenting on our draft report, OEP stated that the national and local 

operating plans had been approved and were being transmitted to VA. 

Subsequently, OEP provided us with evidence that the plans had been 

approved and sent to VA for immediate implementation.

For CDC and OEP, we also noted instances where risks had been 

appropriately identified, but plans for mitigating these risks were not fully 

implemented. For example, CDC’s risk assessment identified physical 

security as a risk, and its handbook specified a number of actions to 

mitigate the risks, including the use of chain link fences at least 10-feet high 

with lock-secured gates around the NPS. However, the stockpiles were 

placed at four locations prior to erecting fences to segregate the CDC stock 

from that of the wholesale distributor or others sharing adjacent 

warehouse space. For up to 3 1⁄2 months, supplies at these locations were 

not segregated by fencing, and management was unable to limit or control 

5

The OEP/VA national plan addresses the responsibilities, concept of operations, and 

procedures for the procurement, storage, management and deployment of OEP’s stockpiles. 

The local plans address key responsibilities of VA personnel as they relate to each storage 

site (e.g., the amount of space and level of security to be provided and procedures to be 

followed for the controlled release of supplies when federal assistance is requested in 

response to a chemical or biological terrorist incident).
Page 6 GAO-01-666T

access to the supplies as prescribed in CDC’s standard operating 

procedures. 

In another example, one of the risks identified by OEP in its risk 

assessment was the sensitivity of the medical supplies to extreme 

temperatures, which could damage the drug or medical item. According to 

OEP’s risk assessment, should this occur, the items affected were to be 

replaced. Since our October 1999 report, OEP had installed temperature 

monitoring devices at each location to record temperature minimums and 

maximums between site visits. We noted during our November 2000 visit to 

its central location that the temperature monitoring device at that facility 

registered 95 degrees Fahrenheit, and that manufacturers of some 

pharmaceuticals stored in this facility warrant their products only if the 

items are stored at temperatures not exceeding 86 degrees. In addition, we 

noted that the OEP storage cage used to store medical supplies, including 

controlled substances, was not equipped with an alarm system, which upon 

unauthorized entry would transmit a signal to VA security or the local 

police agency, as required by Drug Enforcement Agency (DEA) 

regulations.6

 During this site visit, OEP officials told us that they planned to 

relocate the stockpile to an environmentally controlled and DEA-compliant 

facility in April 2001. At that time, OEP would replace the affected supplies. 

Inventory Accuracy 

Improved but 

Additional Actions Are 

Needed

In 1999 we reported large discrepancies between data recorded in CBIRF’s 

and OEP’s inventory systems and physical counts of their inventories. In 

our March 2001 report, we noted that while discrepancies still existed, the 

accuracy of both CBIRF and OEP inventory records had improved 

significantly. However, OEP lacked certain detailed written inventory 

procedures necessary to help ensure overall reliability of the inventory 

records. In addition, after our October 1999 report CDC began establishing 

the NPS and just recently began performing quarterly cyclical inventory 

counts, as well as quality assurance reviews. As of the end of our 

fieldwork, no unresolved discrepancies had been identified between the 

quantities of supplies recorded in its inventory system and physical counts 

taken by CDC.

Appropriately maintaining supplies depends on having a complete list of 

requirements and stocking supplies in accordance with the list. During our 

6

21 CFR 1301.72 (b)(4)(v), (2000).
Page 7 GAO-01-666T

1999 review, we noted that while OEP had prepared a requirements list, 

CBIRF had not. However, we found in our 2000 review that CBIRF had 

developed a requirements list, but it did not have on hand all items included 

in the list. In addition, we found that OEP had not updated its requirements 

list to reflect changes to the composition of its stockpile. Also, we found 

that while CDC had established requirements lists for its rapid-response 

and vendor-managed inventories, the requirements for the NPS were not 

completely filled by the end of our fieldwork. These issues need to be 

addressed to help ensure inventory readiness in the event of a chemical or 

biological incident.

Since our 1999 inventory count of CBIRF’s medical supplies, the 

discrepancy rate has declined from 26 percent to approximately 10 percent. 

While this is a significant improvement, we found during counts performed 

in 2000 that the inventory system still had inaccurate or incomplete data. 

We found discrepancies in quantities, expiration dates, and lot numbers. It 

is important to note, however, that no discrepancies were found between 

the records for controlled substances and data from the physical inventory 

of controlled substances. 

In response to our 1999 report, VA began performing quarterly inventory 

counts on behalf of OEP in April 2000. As a result, the inventory 

discrepancy rate declined from approximately 11 percent, as previously 

reported, to less than 1 percent in November 2000. Not included in VA’s 

counts were certain expired controlled substances, which VA was holding 

for OEP, pending approval by the Food and Drug Administration (FDA) to 

extend the shelf life of these items. As of December 2000, 17,897 expired 

items were being held for this purpose. When we counted these expired 

items and compared the results to VA’s inventory records, we found that 

approximately 5 percent of the expired items were not listed in the system. 

VA officials told us that they attribute the higher discrepancy rate for these 

expired items to less frequent inventory counts and a lack of periodic 

reconciliation of system data to on-hand stock.

While OEP’s overall discrepancy rate had significantly improved, it had not 

provided, nor has VA established, written guidance stipulating acceptable 

discrepancy rates or the frequency of inventory counts. Sustained progress 

is dependent upon setting goals against which performance can be 

measured and conducting periodic inventories. Without these, OEP will not 

be able to measure improvement or determine the reliability of inventory 

records. In commenting on our report, OEP stated that it recently had 

established a tolerable discrepancy rate for mission-critical and 
Page 8 GAO-01-666T

nonmission-critical supplies. It further stated that VA would perform 

annual inventory counts of OEP’s medical supplies, beginning in 2001.

During our 1999 review, we also reported that OEP had a complete list of 

pharmaceutical and medical supplies and quantities required to meet its 

mission. Since then, OEP has made changes in its stockpile to increase the 

number of victims it could treat in a chemical incident. However, as of the 

end of our fieldwork, OEP had not updated and issued to VA an official 

inventory requirements list to reflect those changes. In commenting on our 

draft report, OEP stated that on February 27, 2001, it finalized the NMRT 

requirements list and asked VA to adjust the inventory at each location to 

comply with the list when it performs the June 2001 rotation of expiring 

stock. 

Another issue noted in our October 1999 report was that CBIRF did not 

have an approved list of the items that should be kept in its inventory. In 

May 2000, CBIRF’s Commanding Officer established an interim 

requirements list, pending receipt of the authorized medical allowance list 

(AMAL), programming of funds, and development of a fielding plan by the 

Marine Corps System Command. While we found that CBIRF did not have 

on hand all the items included in its interim requirements list, its officials 

told us that they did not plan to order additional stock and risk 

overstocking supplies based on the AMAL. At the end of our fieldwork, 

CBIRF officials told us that the Marine Corps System Command was 

developing/revising the AMAL, which it then planned to compare with onhand materiel to identify shortfalls or excesses and develop and implement 

a fielding plan to adjust on-hand stock to the AMAL.

Since our October 1999 report, CDC has developed an inventory 

requirements list and is using the list as a basis for making inventory 

purchases to establish the NPS. We found that CDC had developed and 

followed internal guidelines for establishing the composition and stock 

levels of the pharmaceutical and medical supplies on the list. As of the end 

of our fieldwork, approximately 47 percent of the requirements for the 

rapid-response inventories had been acquired, and the first of 

approximately five contracts for the vendor-managed inventory had been 

finalized. 
Page 9 GAO-01-666T

Current Tracking 

Systems Do Not 

Record Inventory 

Activity Over the Life 

Cycle of the Supplies

In 1999, we reported that the responsible agencies’ inventory systems were 

not adequate, and recommended that they implement tracking systems that 

retain complete documentation for all supplies that have been ordered, 

received, and destroyed. The current inventory systems used by OEP, VA, 

CDC, and CBIRF still lack certain fundamental information, which impedes 

their ability to comprehensively track their pharmaceutical and medical 

supplies. 

Each agency is in the process of replacing its current system with one that 

is expected to be able to track medical supplies from the time an order is 

placed until the item is consumed or otherwise disposed of. CDC’s goal was 

to have its new system in place by April 2001. In commenting on our report, 

CDC stated that it awarded a contract for a new inventory management 

system on March 1, 2001. Because OEP’s and CDC’s system needs are 

similar, OEP told us that it planned to rely on the results of CDC’s review of 

system capabilities and vendor proposals and use the same system as that 

selected by CDC. The Marine Corps has developed a new inventory 

management system, the ATLAS II +, that it expects to implement at CBIRF 

and be fully operational by June 2001. 

Rotation Policies and 

Practices at CBIRF and 

CDC Need 

Improvement

In 1999, we reported that the responsible agencies’ inventories included 

items that had expired but not been replaced and recommended that they 

properly rotate supplies. For example, we found that OEP had 2,000 amyl 

nitrite inhalants7

 on hand which had expired 8 months prior to our 1999 

visit. In response to our 1999 report, we found that all responsible agencies 

have developed policies and procedures related to rotating stock in their 

inventories. However, in some cases, planned approaches were not 

completely implemented. 

Proper rotation entails replacing pharmaceuticals and medical supplies 

that have expired or are close to their expiration dates with current stock. 

Agency policies require expired items to be segregated and destroyed, 

redistributed, or put into the shelf-life extension program. If expired items 

are not appropriately removed and replaced, there is an increased risk of 

ineffective items being deployed, an adequate supply of effective items 

being unavailable, or contemplated cost savings not being realized. 

7

An inhalation drug that is used as an antidote for cyanide poisoning. It is also a common 

recreational stimulant known as a popper.
Page 10 GAO-01-666T

During our October 2000 counts at CBIRF, we found 161 expired 

pharmaceutical and medical supplies, including 146 controlled substances, 

on hand. The senior member of the CBIRF controlled substances inventory 

board told us that CBIRF destroyed these expired controlled substances on 

December 20, 2000. However, as of January 2001, CBIRF had not replaced 

the expired items with current stock in sufficient quantities to meet the 

minimum stock levels determined by the Commanding Officer’s interim 

requirements list. As previously mentioned, CBIRF does not plan to order 

additional stock until the Marine Corps System Command provides 

program funds and the fielding plan for the CBIRF specific AMAL.

Since our 1999 report, CDC developed a unique concept for medical 

materiel management that could result in significant cost savings that could 

be funneled back into the program. Under this plan, certain expiring stock 

of CDC, for which there was a sufficient market demand, could be returned 

for full or partial credit to the pharmaceutical wholesale company. The 

wholesale company could then resell these pharmaceuticals to its other 

customers, who could use the items before they reached their expiration 

dates. The wholesale company would then replace the expiring items with 

fresher stock. Thus, it would be unnecessary to hold the CDC stock until 

expiration, dispose of it, and replace the disposed items at full cost. 

According to CDC officials, the wholesale company requires that the items 

be returned not less than 6 months prior to the expiration date to allow it to 

redistribute the supplies to its other customers with a 6-month minimum 

shelf life remaining on the items. CDC adopted a 12-month “trigger” date to 

ensure that items would be flagged and rotated in time to meet the 

wholesale company’s 6-month requirement. 

However, at the end of our fieldwork, CDC had not yet finalized an 

agreement with the wholesaler to rotate the items. Approximately $4.3 

million of CDC’s initial purchase of supplies for its rapid-response 

inventories is scheduled to expire by December 2001. If an agreement is not 

finalized so that these supplies can be redistributed by June 2001, or within 

the 6-month timeframe required by the wholesaler, CDC could lose the 

opportunity for cost savings of up to $4.3 million. Without finalized 

agreements in place, the expiring medical materiel may have to be replaced 

at full cost and the expired items destroyed.

Conclusion We are encouraged by the actions taken by the responsible agencies to 

improve accountability over the medical supplies designated to treat 

victims of chemical or biological terrorism. However, ensuring that 
Page 11 GAO-01-666T

supplies are current, accounted for, and readily available for use is 

dependent in large part on successful collaboration with other entities. 

Until CDC and OEP formalize certain ad hoc arrangements with other 

entities covering the storage, management, stock rotation, and transport of 

supplies, they will face the risk that, should a chemical or biological 

incident occur, the appropriate supplies will not be available when needed. 

Also, unless the agencies’ inventory requirements lists are up to date and 

reflective of their own identified needs, the agencies are limited in assuring 

that they have the supplies needed to fulfill their mission. We understand 

that since the completion of our review some additional steps have been 

taken by the agencies to address these issues.

Recommendations For 

Executive Action

We have included in our March 2001 report the following 13 actions that the 

Secretary of Health and Human Services and the Commandant of the 

Marine Corps should take to address the issues that I have discussed here 

today.

We recommended that the Secretary of Health and Human Services require 

the Director of the Centers for Disease Control and Prevention to 

• execute written agreements as soon as possible with all CDC’s partners 

covering the storage, management, stock rotation, and transport of 

medical supplies designated for treatment of biological or chemical 

terrorism victims; 

• issue written guidance on security to private warehouses that store 

stockpiles, addressing such issues as granting access to the wholesale 

distributor for stock rotation; and

• to the extent practical, install proper fencing prior to placing inventories 

at storage locations.

In addition, we recommended that the Secretary of Health and Human 

Services require the Director of the Office of Emergency Preparedness to

• finalize, approve, and issue an inventory requirements list;

• improve physical security at its central location to comply with DEA 

regulations, or move the supplies as soon as possible to a location that 

meets these requirements;

• issue a written policy on the frequency of inventory counts and 

acceptable discrepancy rates;
Page 12 GAO-01-666T

• finalize and implement approved national and local operating plans 

addressing VA’s responsibilities for the procurement, storage, 

management, and deployment of OEP’s stockpiles; 

• train VA personnel and conduct periodic quality control reviews to 

ensure that national and local operating plans are followed; 

• immediately contact FDA or the pharmaceutical and medical supply 

manufacturers of items stored at its central location to determine the 

impact of exposure to extreme temperatures on these items;

• replace those items deemed no longer usable; and

• either add environmental controls to the current location or move the 

supplies as soon as possible to a climate-controlled space.

We recommended that the Commandant of the Marine Corps require the 

Marine Corps System Command to program funding and complete the 

fielding plan for the CBIRF-specific authorized medical allowance list and 

require the Commanding Officer of the Chemical Biological Incident 

Response Force to

• adjust its stock levels to conform with the authorized medical allowance 

list; and

• remove expired items from its stock and replace them with current 

pharmaceutical and medical supplies.

In commenting on our report, the responsible agencies generally agreed 

with our recommendations and agreed to take corrective actions.

Mr. Chairman, this completes my prepared statement. I would be happy to 

respond to any questions you or other Members of the Subcommittee may 

have at this time.

Contact and 

Acknowledgments

For further information regarding this testimony, please contact Linda M. 

Calbom, Director, Financial Management and Assurance, at (202) 512-9508. 

Individuals making key contributions to this testimony included Louise 

Beck, Cary Chappell, David Grindstaff, Bronwyn Hughes, Charles Norfleet, 

Alana Stanfield, McCoy Williams, and Maria Zacharias. 
Page 13 GAO-01-666T
Page 14 GAO-01-666T

Attachment

Agencies Responsible for Chemical

and Biological Medical Supplies

Used to Combat Terrorism

 Agencies and entities within those agencies directly responsible for the medical supplies

 Inventory of medical supplies used to combat terrorism

Agreements

 Business partner with delegated responsibility for the medical supplies

Vendormanaged 

inventories

(80%)

Working

stock of

medical

supplies

Eight rapidresponse 

inventories

(20%)

Centers for

Disease Control

and Prevention

National Medical 

Response Teams

(NMRT)

1 special

events

inventory

4 NMRT

inventories

Health and Human

Services

Coordinates

medical assistance

Office of

Emergency

Preparedness

Department of

Veterans Affairs

Department of 

Defense

Marine Corps

Chemical

Biological Incident

Response Force

National Pharmaceutical Stockpile (NPS)

Source: GAO analysis based on the review of HHS’s and CDC’s NPSP Operating Plans and CBIRF documents.

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