ZIKA 

SUPPLEMENTAL 

FUNDING

Status of HHS 

Agencies’ Obligations, 

Disbursements, and 

the Activities Funded

Report to Congressional Committees

May 2018

GAO-18-389

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-18-389, a report to 

congressional committees

May 2018

ZIKA SUPPLEMENTAL FUNDING

Status of HHS Agencies’ Obligations, Disbursements, 

and the Activities Funded

What GAO Found

As of September 30, 2017, Department of Health and Human Services’ (HHS)

agencies had obligated nearly all of the $932 million of Zika supplemental 

funding Congress appropriated in 2016 through the use of multiple funding 

mechanisms, including cooperative agreements, grants, and contracts. Four 

HHS agencies had small unobligated balances as of the September 30, 2017,

obligation deadline; these balances cannot be used to incur new obligations, but 

may be used to adjust award amounts in future years. Disbursement of the 

obligated funds was ongoing, with about 21 percent of the Zika supplemental 

funding (approximately $195.5 million) disbursed as of December 31, 2017. The 

agencies have until September 30, 2022, to disburse the remainder.

Zika Supplemental Obligations as of September 30, 2017 

HHS agency

In dollars (rounded)

Total 

supplemental 

funding

Amount 

obligated

Unobligated 

balance

Biomedical Advanced Research and Development 

Authority

245,000,000 245,000,000 0

Centers for Disease Control and Prevention 394,000,000 393,706,358 293,642

Centers for Medicare & Medicaid Services 75,000,000 74,982,493 17,508

Health Resources and Services Administration 66,000,000 65,978,442 21,558

National Institutes of Health 152,000,000 151,998,591 1,409

Total 932,000,000 931,665,883 334,117

Source: GAO analysis of Department of Health and Human Services (HHS) data. | GAO-18-389

The 12 awardees GAO interviewed—officials from 10 states and two local 

entities—funded multiple activities with their Zika supplemental funding, and had 

varying experiences applying for and managing the funds. 

• Awardees told GAO that they used their funding to support such activities as

collection of information about individuals affected by the Zika virus (human 

surveillance), mosquito control activities, laboratory capacity building, public 

outreach, and health care services. For example, Florida used Zika 

supplemental funding in its state-run laboratories to purchase materials for 

testing Zika virus-related specimens. 

• A majority of the awardees GAO spoke with reported positive experiences 

applying for and managing the Zika supplemental funding, including good 

communication with agency officials and awardees’ familiarity with the 

mechanisms used to make the awards. However, some awardees noted 

challenges, such as time frames to use the funding that varied among

multiple awards and identifying the activities that could be funded. These 

challenges added administrative burdens to applying for and managing the 

Zika supplemental funding while officials were responding to the outbreak, 

according to the awardees. In October 2017, the Centers for Disease Control 

and Prevention (CDC) issued a new notice of funding opportunity that

agency officials said is intended to help minimize the administrative burden 

on states and certain localities during emergencies—such as preparing 

applications—by pre-approving public health departments in these 

jurisdictions to be eligible to rapidly receive future awards. 

View GAO-18-389. For more information, 

contact Marcia Crosse at (202) 512-7114 or 

crossem@gao.gov.

Why GAO Did This Study

Zika—a virus primarily transmitted 

through mosquito bites—can cause 

symptoms that include fever, rash, and 

joint and muscle pain. In pregnant 

women, the Zika virus can be passed 

to the fetus and cause severe brain 

defects. In response to an outbreak in 

the United States and its territories, 

Congress appropriated $932 million in 

September 2016 through the Zika 

Response and Preparedness Act to 

HHS and its agencies to prevent, 

prepare for, and respond to the Zika 

virus and its related health conditions,

and conduct related research.

The act also included a provision that 

GAO study the activities supported 

with the appropriated funds. This report 

describes (1) the status of funds 

obligated and disbursed from the Zika 

supplemental funding appropriated to 

HHS and its agencies; and (2) how 

selected awardees used their Zika 

supplemental funding, and their 

experiences with applying for and 

managing the funding. To do this work, 

GAO reviewed agency documents on 

Zika supplemental funding and 

activities, and interviewed officials from 

the HHS agencies and selected 

awardees. To select awardees, GAO

identified states based on the amount 

of initial Zika supplemental funding 

they received from CDC, the Centers 

for Medicare & Medicaid Services, and 

the Health Resources and Services 

Administration; and selected states 

with the highest and lowest funding. In 

total, GAO selected 12 awardees: 10 

states, as well as one county and one 

city from 2 of the 10 states.

GAO provided a draft of this report to 

HHS. In response, HHS provided 

technical comments, which were 

incorporated as appropriate.
Page i GAO-18-389 Zika Supplemental Funding

Letter 1

Background 5

HHS Agencies Have Obligated Nearly All of the Zika 

Supplemental Funding; Disbursements Are Ongoing 10

Selected Awardees Undertook Multiple Activities with Zika 

Supplemental Funding, and Had Varying Experiences Applying 

for and Managing Funds 18

Agency and Third-Party Comments 30

Appendix I Biomedical Advanced Research and Development 

Authority’s Zika Supplemental Awards 31

Appendix II Centers for Disease Control and Prevention—

Epidemiology and Laboratory Capacity 

for Infectious Diseases Awardees 33

Appendix III Centers for Disease Control and Prevention—

Birth Defects Awardees 40

Appendix IV Centers for Disease Control and Prevention—

Behavioral Risk Factor Surveillance System Awardees 42

Appendix V Centers for Disease Control and Prevention—

Pregnancy Risk Assessment Monitoring 

System Awardees 43

Appendix VI Centers for Disease Control and Prevention—

Public Health Preparedness and Response Awardees 44

Contents
Page ii GAO-18-389 Zika Supplemental Funding

Appendix VII Centers for Disease Control and Prevention—

Other Cooperative Agreements’ Awardees 45

Appendix VIII Centers for Disease Control and Prevention—

Contracts and Interagency Agreements 49

Appendix IX Centers for Medicare & Medicaid Services—

Zika Health Care Services Program Awards 56

Appendix X Health Resources and Services Administration’s 

Zika Supplemental Awards 57

Appendix XI National Institutes of Health Zika Supplemental Awards 60

Appendix XII GAO Contact and Staff Acknowledgments 68

Tables

Table 1: Zika Supplemental Funding Obligations as of September 

30, 2017 11

Table 2: Examples of Activities of Selected Awardees That 

Received Direct Zika Supplemental Funding from CDC 

and CMS 19

Table 3: Biomedical Advanced Research and Development 

Authority’s Zika Supplemental Funding Contracts 31

Table 4: Epidemiology and Laboratory Capacity for Infectious 

Diseases Cooperative Agreement’s Zika Supplemental 

Funding for States and Territories, by Awardee and 

Activity Funded 33

Table 5: Epidemiology and Laboratory Capacity for Infectious 

Diseases Cooperative Agreement’s Zika Supplemental 

Funding for Local Health Departments, by Awardee and 

Activity Funded 39
Page iii GAO-18-389 Zika Supplemental Funding

Table 6: Birth Defects Cooperative Agreement Zika Supplemental 

Funding by Awardee 40

Table 7: Behavioral Risk Factor Surveillance System Cooperative 

Agreement’s Zika Supplemental Funding by Awardee 42

Table 8: Pregnancy Risk Assessment Monitoring System 

Cooperative Agreement’s Zika Supplemental Funding by 

Awardee 43

Table 9: Public Health Preparedness and Response Cooperative 

Agreement for All-Hazards Public Health Emergencies 

Cooperative Agreement’s Zika Supplemental Funding by 

Awardee 44

Table 10: Sentinel Enhanced Dengue Surveillance System Project 

Cooperative Agreement’s Zika Supplemental Funding by 

Awardee 45

Table 11: Vector-Borne Disease Regional Centers of Excellence 

Cooperative Agreement’s Zika Supplemental Funding by 

Awardee 46

Table 12: Enhancing Capacity for Vector Surveillance and Control 

to Prevent Zika, Dengue and Chikungunya Infection in 

Puerto Rico Cooperative Agreement’s Zika Supplemental 

Funding by Awardee 46

Table 13: Immunization Grants-CDC Partnership: Strengthening 

Public Health Laboratories Cooperative Agreement’s Zika 

Supplemental Funding by Awardee 47

Table 14: Building Capacity of the Public Health System to 

Improve Population Health through National, Nonprofit 

Organizations Cooperative Agreement’s Zika 

Supplemental Funding by Awardee 47

Table 15: Strengthening the Public Health System in the U.S.-

Affiliated Pacific Islands Cooperative Agreement’s Zika 

Supplemental Funding by Awardee 48

Table 16: Pan American Health Organization: Building Capacity 

and Networks to Address Emerging Infectious Diseases in 

the Americas Cooperative Agreement’s Zika 

Supplemental Funding by Awardee 48

Table 17: Global Health Security Partner Engagement: Expanding 

Efforts and Strategies to Protect and Improve Public 

Health Globally Cooperative Agreement’s Zika

Supplemental Funding by Awardee 48

Table 18: Centers for Disease Control and Prevention Zika 

Supplemental Funding Contracts by Awardee and Activity 

Funded 49
Page iv GAO-18-389 Zika Supplemental Funding

Table 19: Centers for Disease Control and Prevention Zika 

Supplemental Funding Interagency Agreements by 

Awardee and Activity Funded 55

Table 20: Centers for Medicare & Medicaid Services’ Zika Health 

Care Services Program Awardees 56

Table 21: Health Resources and Services Administration Zika 

Supplemental Funding for Health Centers by Awardee 58

Table 22: Health Resources and Services Administration Zika 

Supplemental Funding for Special Projects of Regional 

and National Significance by Awardee 59

Table 23: National Institutes of Health’s Zika Supplemental 

Funding Contracts 60

Table 24: National Institutes of Health’s Zika Supplemental 

Funding Grants 61

Table 25: National Institutes of Health’s Zika Supplemental 

Funding Intramural Awards 66

Table 26: Other National Institutes of Health Zika Supplemental 

Funding Awards 67

Figures

Figure 1: Total Zika Supplemental Funding by Agency 8

Figure 2: Examples of Vector Control Activities in Miami-Dade 

County, Florida 23

Figure 3: Examples of Zika Outreach Activities 26

Figure 4: Timeline of Florida’s Zika Supplemental Funding Awards 28
Page v GAO-18-389 Zika Supplemental Funding

Abbreviations

BARDA Biomedical Advanced Research and Development 

Authority

BRFSS Behavioral Risk Factor Surveillance System

CDC Centers for Disease Control and Prevention

CMS Centers for Medicare & Medicaid Services

ELC Epidemiology and Laboratory Capacity for 

Infectious Diseases

HHS Department of Health and Human Services 

HRSA Health Resources and Services Administration

NIH National Institutes of Health

PHPR Public Health Preparedness and Response

PHSSEF Public Health and Social Services Emergency Fund

PRAMS Pregnancy Risk Assessment Monitoring System

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Page 1 GAO-18-389 Zika Supplemental Funding

441 G St. N.W.

Washington, DC 20548

May 14, 2018

The Honorable Roy Blunt

Chairman

The Honorable Patty Murray

Ranking Member

Subcommittee on Labor, Health and Human Services, Education, and 

Related Agencies

Committee on Appropriations

United States Senate

The Honorable Tom Cole

Chairman

The Honorable Rosa DeLauro

Ranking Member

Subcommittee on Labor, Health and Human Services, Education, and 

Related Agencies

Committee on Appropriations

House of Representatives

The Zika virus outbreak in 2015 affected individuals infected with the virus 

in ways that had not been seen with other infectious disease outbreaks. 

Zika—a virus primarily transmitted through mosquito bites—can cause 

symptoms that include fever, rash, conjunctivitis (red eyes), and joint and 

muscle pain, though many infected individuals do not have symptoms or 

will only experience mild symptoms. However, in this outbreak, the Zika 

infection in pregnant women has been linked to adverse pregnancy and 

birth outcomes: the virus can be passed to the fetus and cause a birth 

defect of the brain called microcephaly and other severe brain defects, 

according to the Centers for Disease Control and Prevention (CDC).1

CDC officials note that this is the first time in more than 50 years that an 

 1

Microcephaly is a rare nervous system disorder that causes a baby’s head to be smaller 

than expected and not fully developed, which can lead to impaired thought processes, 

delayed motor function, and other adverse outcomes. A study published in December 

2017 found that 19 children ages 19 to 24 months born with microcephaly and with 

laboratory evidence of Zika virus infection experienced problems including an inability to 

sit independently, difficulties with sleeping and feeding, seizures, and hearing and vision 

problems. Ashley Satterfield-Nash et al., “Health and Development at Age 19-24 Months 

of 19 Children Who Were Born with Microcephaly and Laboratory Evidence of Congenital 

Zika Virus Infection During the 2015 Zika Virus Outbreak—Brazil, 2017,” Morbidity and 

Mortality Weekly Report, vol. 66, no. 49 (Dec. 15, 2017): 1347-1351.

Letter
Page 2 GAO-18-389 Zika Supplemental Funding

infectious pathogen has been identified as the cause of birth defects. The 

virus is also linked to other problems, such as miscarriage, stillbirth, and 

other birth defects, as well as Guillain-Barré syndrome, an uncommon 

sickness of the nervous system.2 In the western hemisphere, the first 

cases of locally transmitted Zika virus disease were confirmed in Brazil in 

May 2015; in the continental United States, the first locally transmitted 

cases were confirmed in Florida during June to August 2016.3 The World 

Health Organization declared the Zika virus a Public Health Emergency of 

International Concern from February to November 2016, and maintains 

that it is a significant, enduring public health challenge.

As of January 24, 2018, about 5,600 cases involving Zika virus disease 

have been reported in the United States and about 37,000 cases have 

been reported in the U.S. territories, primarily in Puerto Rico. In response 

to the outbreak, Congress appropriated $932 million in September 2016 

through the Zika Response and Preparedness Act to the Department of 

Health and Human Services (HHS) and its agencies for activities such as 

responding to the Zika virus, developing vaccines, and reimbursement for 

health care costs related to the Zika virus.4 Specifically, the act 

appropriated $394 million to CDC, $152 million to the National Institutes 

of Health (NIH), and $387 million to HHS’s Public Health and Social 

Services Emergency Fund (PHSSEF), of which $386 million was 

allocated to additional HHS agencies—the Biomedical Advanced 

Research and Development Authority (BARDA) within the Office of the 

Assistant Secretary for Preparedness and Response, the Centers for 

Medicare & Medicaid Services (CMS), and the Health Resources and 

Services Administration (HRSA).5 The agencies had until September 30, 

2017, to obligate the funding, for example, by awarding a contract or a 

 2

Guillain-Barré syndrome is a rare disorder in which the body’s immune system attacks 

the nervous system outside the brain and spinal cord, causing muscle weakness and in 

some cases paralysis, although most people recover.

3

While the continental United States’ first locally transmitted case was identified in Florida, 

locally transmitted Zika virus was reported in December 2015 in Puerto Rico.

4

Zika Response and Preparedness Act, Pub. L. No. 114-223, div. B, tit. I, 130 Stat. 857, 

901 (2016). For the purposes of this report, we refer to funding appropriated in the Zika 

Response and Preparedness Act as Zika supplemental funding.

5

The remaining $1 million appropriated to HHS’s PHSSEF was to be divided equally 

between HHS’s Office of Inspector General and GAO for oversight activities. Pub. L. No. 

114-223, § 104, 130 Stat. at 904. Throughout this report we use “agency” to refer to 

agencies within HHS and the Office of the Secretary, except for HHS’s Office of Inspector 

General. 
Page 3 GAO-18-389 Zika Supplemental Funding

grant to an entity (awardee). Agencies have until September 30, 2022, to 

disburse, or spend, the funding.

The Zika Response and Preparedness Act included a provision that we 

study activities supported with funds appropriated by the act. In this 

report, we describe

1. the status of obligations and disbursements of Zika supplemental 

funding by HHS agencies; and

2. how selected awardees used their Zika supplemental funding, and 

their experiences with applying for and managing the funding.

To describe the status of obligations and disbursements of Zika 

supplemental funding by HHS agencies, we analyzed BARDA, CDC, 

CMS, HRSA, and NIH obligation data as of September 30, 2017—the 

date funding had to be obligated—and disbursement data as of 

December 31, 2017—the first full quarter of data available at the time of 

our review. Each agency provided tabulated data that included 

information such as the award title, awardee name and location, award 

amount, award time frame, and the funding mechanism the agency used 

to award the funding. We interviewed officials from each agency to 

discuss the status of the agencies’ obligations and disbursements of the 

Zika supplemental funding, the different mechanisms used to award the 

funding, and the various factors that influenced the obligation and 

disbursement of the funding to awardees. We also reviewed 

documentation of the funding opportunity announcements to obtain 

information such as the activities allowed under each type of award. To 

determine the reliability of the data provided, we compared the tabulated 

award amounts received from CDC and HRSA to the actual notices of 

award provided by both agencies, and compared NIH award data to the 

amounts reported in NIH’s online database. We also obtained information 

from BARDA, CMS, and NIH officials regarding the underlying financial 

data systems used to compile the data and the controls in place for 

recording and maintaining the data. We reviewed the data from each 

agency for data discrepancies and obtained the information necessary to 

resolve the discrepancies from relevant agency officials. Furthermore, we 

interviewed officials from HHS’s Office of the Assistant Secretary for 

Financial Resources on the accuracy of the data and the steps the office 

takes to verify agencies’ obligation and disbursement data. On this basis, 

we determined that the data were sufficiently reliable for the purposes of 

our reporting objectives.
Page 4 GAO-18-389 Zika Supplemental Funding

Additionally, to describe the various factors that can affect the 

disbursement of funding after obligation, we interviewed officials 

representing selected awardees. To select awardees, we first identified 

states that were awarded Zika supplemental funding from HHS agencies 

(45 states) based on our review of the amount of initial Zika supplemental 

funding they received from CDC, CMS, and HRSA. From those 45 states, 

we judgmentally selected 10 states—5 states with the highest funding 

and 5 states with the lowest funding—which included the 2 states that 

experienced local Zika virus transmissions (Florida and Texas). Our 

selected states with the highest funding were Arizona, California, Florida, 

Louisiana, and Texas. Our selected states with the lowest funding were 

Alaska, Colorado, Iowa, Kansas, and Oklahoma.6 To obtain perspectives 

of awardees at the local level, we judgmentally selected two local 

awardees within 2 of the selected states—Houston, Texas, and Los 

Angeles County, California. For each selected state or jurisdiction, we 

interviewed state, county, or city officials who could provide information 

about their Zika supplemental funding. The perspectives of the 12 

awardees we interviewed cannot be generalized to other awardees.

To describe how selected awardees used their Zika supplemental funding 

and gain their perspectives on applying for and managing this funding, we 

reviewed documentation from the 12 selected awardees to identify the 

activities they funded. We also interviewed officials from the selected 

awardees (state officials and officials from one county and one city) about 

their experiences with using the Zika supplemental funding and to obtain 

examples of awardees’ Zika activities. We conducted site visits to Florida 

and Texas, because at the time of our work, they alone had reported local 

Zika virus transmissions.7 Additionally, we reviewed CDC and CMS 

documents to determine the amount of funding received and the purpose 

of the funding for each of the selected awardees. We also interviewed 

 6

In determining states’ respective funding levels under the Zika Response and 

Preparedness Act, we excluded funding awarded by NIH and BARDA to entities other 

than states. We also excluded a $44 million appropriation to CDC for the Public Health 

Emergency Preparedness cooperative agreement program. The Zika Response and 

Preparedness Act specified that this amount was to restore fiscal year 2016 funds that 

HHS had reprogrammed for Zika response activities prior to its enactment, which could be 

used for purposes other than Zika-related activities. See Pub. L. No. 114-223, 130 Stat. at 

902.

7

We planned to conduct a site visit to Puerto Rico, as it was the territory with the most 

Zika disease cases and also had reported active Zika transmissions. However, we were 

not able to speak to officials in Puerto Rico due to ongoing recovery efforts following 

hurricanes Irma and Maria.
Page 5 GAO-18-389 Zika Supplemental Funding

CDC officials regarding any changes the agency has made to its plans for 

awarding funding in the future.

We conducted this performance audit from April 2017 to May 2018 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

During a disease outbreak, including the Zika virus, HHS is the lead 

federal agency for public health and medical response, and it leverages 

national public health and medical resources to prepare for and respond 

to the outbreak.8

The Zika virus is primarily transmitted to humans by infected mosquitoes, 

but can also be transmitted from mother to child during pregnancy or 

around the time of birth, or from person-to-person through sexual contact 

or blood transfusion. According to CDC, once an individual has been 

infected with the Zika virus, they are likely to be protected from future 

infections. The Aedes aegypti mosquitoes are reportedly the primary 

mosquito spreading the Zika virus, while the Aedes albopictus

mosquitoes, which share many of the same traits as Aedes aegypti, also 

have the ability to spread the virus.9 Local transmission of the virus has 

occurred in American Samoa, Florida, Puerto Rico, Texas, and the U.S. 

 8

Within HHS, the Office of the Assistant Secretary for Preparedness and Response leads 

and coordinates national preparedness and response to outbreaks in the United States. 

Within that office, BARDA coordinates and supports advanced research and development, 

manufacturing, and initial procurement of medical countermeasures, such as vaccines, 

drugs, therapies, and diagnostic tools. CDC monitors and responds to outbreaks by, for 

example, conducting studies to learn about the link between infection and health 

outcomes, monitoring and reporting cases of infection, and providing guidance to travelers 

and health care providers. According to officials, NIH funds and carries out basic and 

applied research to develop diagnostics, vaccines and therapeutics, as well as 

epidemiological studies to better understand disease progression and long-term health 

effects.

9

Edward B. Hayes, “Zika Virus Outside Africa,” Emerging Infectious Diseases, vol.15, no. 

9 (2009): 1347–50; and National Science and Technology Council, A Strategy for 

Integrating Best Practices with New Science to Prevent Disease Transmission by Aedes 

Mosquito Vectors (Washington, D.C.: December 2016). 

Background

Zika Virus Transmission 

and Prevention
Page 6 GAO-18-389 Zika Supplemental Funding

Virgin Islands. Travel-associated cases of Zika virus infection have been 

reported in every state, with the largest numbers of cases reported in 

California, Florida, New York, and Texas.10

There is no vaccine to prevent the Zika virus, so CDC guidance 

recommends preventing the spread of the virus by protecting against 

mosquito bites by wearing protective clothing, using insect repellant, and 

staying in places with air conditioning and window and door screens to 

keep mosquitoes outside, among other actions. Mosquito control in the

United States is implemented and overseen at the state and local levels 

by entities such as mosquito control districts and health agencies. Federal 

agencies support such control entities with funding and subject matter 

experts, and may regulate some control methods such as pesticides.

In April 2016, the Office of Management and Budget and the Secretary of 

Health and Human Services announced that they had identified $589 

million—$510 million of it from existing Ebola virus disease resources 

within HHS, the Department of State, and the U.S. Agency for 

International Development—that could quickly be redirected and spent on 

immediate efforts to control and respond to the spread of the Zika virus. 

According to HHS, out of the $589 million, $374 million was redirected to 

domestic Zika virus control activities. HHS reports that almost all of this 

funding ($354 million) was distributed to three HHS agencies, as follows:

• CDC received $222 million for various activities including field staff, 

state response teams, Zika virus testing, tracking of pregnant women 

who were infected with the Zika virus, and grants for mosquito control 

and other Zika prevention activities;

• BARDA received $85 million for private sector development of Zika 

vaccines, treatments, and technologies to protect the blood supply, 

and other countermeasures; and

• NIH received $47 million for Zika medical countermeasure 

development, including clinical trials on the leading Zika vaccine 

candidate.

Additionally, according to HHS officials, in August 2016, the Secretary of 

Health and Human Services notified Congress of the department’s intent 

 10CDC’s case counts for travel-associated cases of Zika virus infection, by state, also 

include cases where the Zika virus was transmitted sexually, through a laboratory, and 

person-to-person through an unknown route.

Zika Funding Prior to 

September 2016
Page 7 GAO-18-389 Zika Supplemental Funding

to redirect an additional $81 million in unobligated HHS funds for Zika 

vaccine development activities. Of this amount, $34 million was drawn 

from accounts at NIH and $47 million was drawn from funds transferred 

from other HHS agencies and reprogrammed from within PHSSEF.11

From these redirected funds, $34 million (i.e., the amount drawn from 

other NIH accounts) was to be used by NIH to continue clinical trials on 

its lead Zika vaccine candidate. The remaining $47 million was to be used 

by BARDA for continued private sector Zika vaccine development.

In September 2016, Congress appropriated $932 million to HHS and its 

agencies in the Zika Response and Preparedness Act. Of that amount, 

$394 million was appropriated directly to CDC and $152 million was 

appropriated directly to NIH. The remainder was appropriated to HHS’s 

PHSSEF, from which HHS allocated $245 million to BARDA within the 

Office of the Assistant Secretary for Preparedness and Response, $75 

million to CMS, and $66 million to HRSA. (See fig. 1.)

 11Reprogramming is the shifting of funds within an appropriation or account to use them 

for purposes other than those contemplated at the time of appropriation; it is the shifting of 

funds from one object class to another or from one program activity to another. See GAO, 

A Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP (Washington, 

D.C.: Sept. 1, 2005). 

September 2016 Zika 

Supplemental Funding
Page 8 GAO-18-389 Zika Supplemental Funding

Figure 1: Total Zika Supplemental Funding by Agency

Note: BARDA is within the Office of the Assistant Secretary for Preparedness and Response.

The Zika supplemental funding remained available for obligation until 

September 30, 2017, for the following purposes:

• CDC: to prevent, prepare for, and respond to the Zika virus, health 

conditions related to the virus, and other vector-borne diseases, 

domestically and internationally.12

• NIH: for research on the virology, natural history, and pathogenesis of 

the Zika virus infection, and preclinical and clinical development of 

vaccines and other medical countermeasures for the Zika virus and 

other vector-borne diseases, domestically and internationally.

 12Additionally, CDC was directed to use $44 million of the funding appropriated by the 

Zika Response and Preparedness Act to restore fiscal year 2016 funds that were 

reprogrammed from the Public Health Emergency Preparedness cooperative agreement 

program for Zika virus response prior to the act’s enactment.
Page 9 GAO-18-389 Zika Supplemental Funding

• PHSSEF: for various activities, including to prevent, prepare for, and 

respond to the Zika virus, health conditions related to the virus and 

other vector-borne diseases, domestically and internationally; and to 

develop necessary countermeasures and vaccines, including the 

development and purchase of vaccines, therapeutics, diagnostics, 

necessary medical supplies, and administrative activities.

• BARDA: HHS allocated funding to BARDA to support further 

development of Zika vaccine candidates, diagnostics, and 

pathogen reduction technologies initiated in fiscal year 2016 to 

advance these projects toward licensure or approval by the Food 

and Drug Administration.

• CMS: HHS allocated funding to CMS for expenses to support 

states, territories, tribes, or tribal organizations with active or local 

transmission cases of the Zika virus, as confirmed by CDC. The 

funding was allocated to reimburse the costs of health care for

health conditions related to the Zika virus, other than costs that 

are covered by private health insurance, of which not less than 

$60 million were for territories with the highest rates of Zika virus 

transmission.

• HRSA: HHS allocated $20 million for projects of regional and 

national significance in Puerto Rico and other U.S. territories, $40 

million to expand the delivery of primary health services in Puerto 

Rico and the other territories, and $6 million to be used to assign 

National Health Service Corps members to Puerto Rico and the 

other territories to provide primary health services in areas 

affected by the Zika virus or other vector-borne diseases through 

the National Health Service Corps Loan Repayment Program.13

Agencies have until September 30, 2022, to disburse the Zika 

supplemental funding appropriated by the Zika Response and 

Preparedness Act.

 13The National Health Service Corps offers financial and other support to primary care 

providers and sites in underserved communities.
Page 10 GAO-18-389 Zika Supplemental Funding

We found that as of September 30, 2017—the end of the Zika 

supplemental appropriation’s period of availability—nearly all Zika 

supplemental funding had been obligated, primarily through cooperative 

agreements, grants, and contracts.14 BARDA obligated 100 percent of its 

Zika supplemental funding, while CDC, CMS, HRSA, and NIH obligated 

over 99 percent of their funding.15 (See table 1.)

 14A cooperative agreement is an alternative assistance instrument used instead of a grant 

whenever substantial federal involvement with the recipient during performance is 

anticipated. For grants, an agency’s involvement is essentially administrative, which 

includes standard federal stewardship responsibilities, such as reviewing performance to 

ensure that the objectives, terms, and conditions of the grant are accomplished.

15These unobligated balances are not available after September 30, 2017, to incur new 

obligations. However, agencies can use unobligated balances to correct errors in 

recording obligations properly incurred during the period of availability or to cover 

legitimate cost adjustments in future years, such as those that may arise from contract 

modifications within the general scope of a prior year contract.

HHS Agencies Have 

Obligated Nearly All 

of the Zika 

Supplemental 

Funding; 

Disbursements Are 

Ongoing

Agencies Obligated Nearly 

All of Their Zika 

Supplemental Funding as 

of September 30, 2017, 

Primarily Through 

Cooperative Agreements, 

Grants, and Contracts
Page 11 GAO-18-389 Zika Supplemental Funding

Table 1: Zika Supplemental Funding Obligations as of September 30, 2017 

HHS agency

In dollars (rounded)

Total supplemental 

funding

Amount

obligated

Unobligated 

balance

Biomedical Advanced Research and Development 

Authority (BARDA)

245,000,000 245,000,000 0

Centers for Disease Control and Prevention 394,000,000 393,706,358 293,642

Centers for Medicare & Medicaid Services 75,000,000 74,982,493 17,508

Health Resources and Services Administration 66,000,000 65,978,442 21,558

National Institutes of Health 152,000,000 151,998,591 1,409

Total 932,000,000 931,665,883 334,117

Source: GAO analysis of Department of Health and Human Services (HHS) data. | GAO-18-389

Note: BARDA is within the Office of the Assistant Secretary for Preparedness and Response.

Three of the five agencies had obligated over half of their Zika 

supplemental funding by January 31, 2017, 4 months after enactment of 

the appropriation. For example, according to CDC officials, using 

cooperative agreements with application processes familiar to the 

awardees helped enable the agency to obligate its funding soon after 

receiving the appropriation.16 Some agencies began obligating later in the 

one-year obligation time frame based on their approach to obligating the 

Zika supplemental funding. For example, CMS withheld a portion of its 

supplemental funds in the event additional awardees became eligible for 

funding within the obligation time frame—eligibility included having active 

or local transmission of the Zika virus.

Agency officials told us that they used cooperative agreements, grants, 

and contracts to award Zika supplemental funding to existing and new 

awardees. The agencies also used other mechanisms to obligate the Zika 

supplemental funding, such as interagency agreements, intramural 

research awards, and funding used within the agency for travel and other 

 16Although CDC generally used existing mechanisms familiar to awardees, agency 

officials explained that the application process still needed to be completed—from creating 

and publishing notices of funding opportunities to issuing notices of award—prior to the 

obligation of funding.
Page 12 GAO-18-389 Zika Supplemental Funding

expenses.17 According to officials, agencies used these mechanisms to 

award Zika supplemental funding in the following ways.

• BARDA executed new contracts and modified existing contracts 

through the agency’s typical contracting process, officials said, for 

research in the areas of Zika clinical diagnostics and vaccine 

development. BARDA did not use any Zika supplemental funding to 

support internal administrative or personnel costs. (See app. I for the 

contracts BARDA awarded with its Zika supplemental funding.)

• CDC generally obligated Zika supplemental funding to current 

awardees through existing cooperative agreements, according to 

agency officials. (See app. II through VII for the cooperative 

agreements CDC used to award Zika supplemental funding to existing 

awardees.) CDC also awarded funding through contracts and 

interagency agreements, and obligated about $24 million for internal 

CDC expenses, such as salaries and benefits, travel, supplies, and 

equipment. (See app. VIII for the contracts and interagency 

agreements CDC awarded with its Zika supplemental funding.)

• CMS created a new program—the Zika Health Care Services 

Program—to award its Zika supplemental funding through cooperative 

agreements, according to agency officials. The purpose of the 3-year 

program is to support prevention activities and treatment services for 

women (including pregnant women), children, and men adversely or 

potentially affected by the Zika virus.18 CMS awarded funding through 

the Zika Health Care Services Program to those states, territories, 

tribes, or tribal organizations with active or local transmission of the 

Zika virus, as confirmed by CDC. CMS awarded funding to the health 

departments in American Samoa, Florida, Puerto Rico, and the U.S. 

Virgin Islands in January 2017. In June 2017, CMS awarded funding 

to the health department in Texas, the only new state or territory with 

 17Intramural research entails government scientists working in their institutes’ and centers’ 

own laboratories and clinics. An interagency agreement occurs when one agency either 

places an order directly against another agency’s contract or uses the contracting services 

of another agency to obtain supplies or services. 

18According to CMS documentation, the Zika Health Care Services Program is intended to 

address four critical components of a comprehensive response to Zika: (1) increase 

access to contraceptive services for women and men; (2) increase access to and reduce 

barriers to diagnostic testing, screening, and counseling for pregnant women and 

newborns; (3) increase access to appropriate specialized health care services for 

pregnant women, children born to mothers with maternal Zika virus infection, and their 

families; and (4) improve provider capacity and capability. Awardee needs may vary and 

some awardees may not have unmet needs across each of the four areas.
Page 13 GAO-18-389 Zika Supplemental Funding

local transmission of the Zika virus.19 In both CMS award rounds, only 

states and territories received awards, because they were the only 

areas with active or local transmission of the Zika virus. CMS retained 

about $3.6 million of the Zika supplemental funding to use for 

administrative support services, as well as for travel for monitoring 

and oversight. (See app. IX for the awards CMS made with its Zika 

supplemental funding.)

• HRSA generally obligated Zika supplemental funding through grants 

to existing awardees, according to agency officials. HRSA did not 

retain any Zika supplemental funding for internal activities. (See app. 

X for the grants HRSA awarded.)

• NIH used grants and contracts to award its Zika supplemental funding 

to new and existing awardees. NIH also used about $95 million of the 

Zika supplemental funding for internal activities—studies conducted 

by NIH researchers. According to NIH officials, the somewhat unique 

aspects of the Zika virus as an arbovirus infectious disease led NIH to 

focus on vaccines as a priority, along with development of 

diagnostics, therapeutics, vector control, and surveillance.20 (See app. 

XI for NIH’s Zika supplemental awards.)

For more information on the funding provided by CDC, CMS, and 

HRSA—the only agencies that provided funding for states and 

territories—and the number of reported Zika cases by state or territory, 

see an interactive graphic at https://www.gao.gov/products/GAO-18-389. 

Officials from all five agencies cited coordination initiatives through 

regular interagency or organizational teleconferences and participation in 

working groups. According to CMS officials, during the Zika virus

response, CDC, CMS, HRSA, and other federal partners held interagency 

Zika coordination calls to discuss ongoing developments related to the 

Zika virus. Additionally, because CMS and HRSA were both awarding 

 19According to officials, CMS issued supplemental awards to each of the five grantees in 

September 2017, using additional remaining funds.

20Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the 

bites of infected mosquitoes and ticks. 

Surveillance is the systematic and continuous collection, analysis, and interpretation of 

data, closely integrated with the timely and coherent dissemination and assessment of the 

results by those who have the right to know so that action can be taken. For more 

information about Zika disease surveillance, see GAO, Emerging Infectious Diseases: 

Actions Needed to Address the Challenges of Responding to Zika Virus Disease 

Outbreaks, GAO-17-445 (Washington, D.C.: May 23, 2017).
Page 14 GAO-18-389 Zika Supplemental Funding

funding for perinatal health care services, officials said they collaborated 

to ensure that activities available through the CMS grants complemented 

the activities available through HRSA’s Special Projects of Regional and 

National Significance. In addition, HRSA officials reported conducting joint 

site visits with CDC and CMS, as well as streamlining reporting 

requirements to reduce grantee reporting burden. Furthermore, BARDA 

officials said that they awarded and administered a contract for CDC on 

the development of a vector control product. CDC provided the funding 

and topical subject matter expertise for the award, and BARDA provided 

management services for the contract, because of BARDA’s experience 

with these types of contracts. BARDA and NIH officials also reported 

collaborating on vaccine development. BARDA officials explained that 

while the vaccine development process requires that different agencies 

support multiple vaccine development candidates, the two agencies 

coordinated to avoid redundancy.

We found that as of December 31, 2017, the HHS agencies had 

disbursed about 21 percent (approximately $195.5 million of $932 million) 

of the Zika supplemental funding. According to agency officials and 

selected awardees we spoke with, various factors can affect the 

disbursement of funding after obligation. These factors include time to 

draw down funding from the federal agencies, allowing for program 

implementation and a planning period, and awardees’ internal 

administrative processes and unique characteristics, as described below.

Drawdown procedures. CDC officials said that awardees draw down 

federal funding on their individual schedules based upon how they 

manage their federal funding. Some awardees draw down on a daily 

basis, as needed, while others draw down on a biweekly or monthly 

basis. Additionally, drawdowns for personnel costs coincide with payroll 

schedules, which could be biweekly or monthly. For example, in the case 

of monthly payroll, two awardees told us that the federal funding for a 

particular month’s expenses would be drawn down the following month. 

Furthermore, selected awardees we spoke with said that they draw down 

federal funding after they have incurred an expense, such as when they 

receive an invoice. For example, Los Angeles County officials reported 

that in order to draw down the funds for the organization that is 

responsible for servicing their vector control activities, they have to first 

receive an invoice from the organization, which the county pays with its 

own funds. Only then can the county draw down the federal funding. This 

process usually results in at least a 3-month period between receiving the 

invoice and drawing down the federal funding, officials said.

Agencies Had Disbursed 

About 21 Percent of the 

Zika Supplemental 

Funding as of December 

31, 2017
Page 15 GAO-18-389 Zika Supplemental Funding

Program implementation and planning period. According to CMS 

officials, the agency awarded funding to health departments in American 

Samoa, Florida, Puerto Rico, Texas, and the U.S. Virgin Islands from the 

Zika Health Care Services Program, which was a new collaboration 

between CMS and these specific awardees. The officials said that the 

steps awardees needed to take to stand-up new programs—such as 

budget review and approval processes, selection of key personnel to 

administer the grant, grant activities related to contracting, and hiring and 

procurement—can delay start-up and implementation of the grant 

programs.

Additionally, CMS gave awardees in the Zika Health Care Services 

Program a 3-month planning period after they received their notices of 

award to amend their activities.21 For example, Texas officials reported 

that they used the 3-month planning period to work on executing 

contracts with the local health departments in three counties bordering 

Mexico. Texas officials explained that collaborating with the local health 

departments entailed determining the greatest potential benefit of the use 

of the funds, because the award itself was not enough to cover all of the 

costs of direct health care services associated with the Zika virus.

Awardees’ processes and characteristics. Local administrative 

processes for spending federal supplemental funds can result in varied 

disbursement time frames. For example, California received Zika 

supplemental funding for an award that required an amendment to an 

administrative contract, which state officials said takes about 7 to 8 

months for internal state approval. Additionally, certain awardees’ 

characteristics affect disbursements. For example, Houston officials said 

the city was eligible for and was directly awarded a CDC cooperative 

agreement, but because it does not conduct vector control activities itself, 

the city had to negotiate a contract with the surrounding county to conduct 

these activities, adding additional time before it could begin 

disbursements.

 21CMS provided awardees with a 3-month planning period to fine tune the request for all 

specific activities funded under the award. CMS officials said that they provided this period 

because there was a limited time provided to submit an application due to the Zika virus 

being a public health emergency. According to CMS officials, the 3-month planning period 

enabled awardees to fully analyze and identify a comprehensive set of needs, to fine tune 

the request for all specific activities funded under the award; to begin the process for 

staffing, contracting, establishing reimbursement methodologies, and other procurement 

efforts; to ensure that CMS funding is coordinated with funding from other federal 

agencies; and to ensure non-duplication of funding from all sources.
Page 16 GAO-18-389 Zika Supplemental Funding

Officials also noted that awardees’ personnel hiring issues can affect 

disbursement time frames. For example, CMS officials said that some 

territories experienced delays in carrying out activities due to provider 

shortages, particularly among specialists needed to care for children with 

developmental delays and birth defects caused by the Zika virus. CMS 

officials noted that island jurisdictions, such as the U.S. territories, can 

find hiring more difficult due to a shortage of health care professionals 

available within the territory, thus requiring individuals to be recruited from 

outside the territory, which adds time to the process and raises costs. In 

addition, Florida officials in Miami-Dade County reported that the 

necessary staff surge during the Zika response was challenging to fill, 

noting that it was particularly difficult to find phlebotomists and nurses, 

because they were in high demand.22

Standard vaccine development processes also influenced the rate of 

disbursement. Due to the long duration of the vaccine development 

process, BARDA officials said, disbursements to certain awardees have 

occurred at varying intervals. For example, some contract invoices are 

received on a monthly basis, or twice a month if the company is a small 

business. The invoices are then reviewed and if deemed acceptable, they 

are processed for payment.

The 2017 hurricane season may have affected certain awardees’ use of 

their Zika supplemental funding, which prompted agencies to respond by 

approving various types of short-term relief for administrative, financial 

management, and audit requirements for awardees affected by the 

hurricanes. Three agencies—CDC, CMS, and HRSA—awarded Zika 

supplemental funding to areas affected by hurricanes Harvey, Irma, and 

Maria in 2017: Florida, Puerto Rico, Texas, and the U.S. Virgin Islands. 

CDC officials told us, for example, that because of the hurricanes they 

granted extensions at the request of the awardees for submitting financial 

and progress reports, and continuation of activities. Similarly, CMS 

offered hurricane-affected awardees of the Zika Health Care Services 

Program the option to extend the deadline for deliverables, if necessary. 

CMS officials told us that grant activities had been affected by the 

hurricanes, and all grantees had communicated the intent to fully resume 

activities as soon as they are able to do so. Due to the 3-year project 

period for grantees, CMS officials said that the affected entities can still 

 22A phlebotomist is an individual trained to draw blood for tests, transfusions, research, or 

blood donations. 
Page 17 GAO-18-389 Zika Supplemental Funding

accomplish programmatic responsibilities, even if there is a temporary 

halt in project activities. Furthermore, HRSA officials said that they 

provided Puerto Rico and the U.S. Virgin Islands with extensions on 

required program, financial, and audit reports.23

 23On October 26, 2017, the Office of Management and Budget released a memorandum 

to federal agencies with guidance for administrative relief for grantees affected by 

hurricanes Harvey, Irma, and Maria. Under certain circumstances, agencies could provide 

flexibility with application deadlines, provide no-cost extensions on expiring awards, allow 

expenditure of award funds for salaries and other project activities, and waive prior 

approval requirement waivers, among other actions.
Page 18 GAO-18-389 Zika Supplemental Funding

Selected awardees we spoke with used Zika supplemental funding for a 

variety of activities. Collectively, the activities included four primary types: 

medical surveillance, vector control, laboratory capacity building, and 

providing health care services, as described below.24

• Medical surveillance activities include identifying and reporting Zika 

virus disease cases to CDC, as well as reporting Zika virus infections 

in pregnant women and infants to the U.S. Zika Pregnancy Registry.25

• Vector control activities include detecting and monitoring Aedes

aegypti and Aedes albopictus mosquito distribution and mosquito 

control, and monitoring of insecticide resistance and management.

• Laboratory capacity building activities include developing laboratory 

capacity to perform Zika virus testing.

• Health care service activities for those selected awardees that 

received funding from CMS (Florida and Texas) included increasing 

access to contraceptive services for men and women; increasing 

access to and reducing barriers to diagnostic testing, screening, and 

 24The selected awardees we spoke with are Alaska; Arizona; California; Colorado; Florida; 

Iowa; Kansas; Louisiana; Oklahoma; and Texas; as well as Houston, Tex., and Los 

Angeles County, Calif.

25CDC collaborated with state, tribal, local, and territorial health departments to establish 

the U.S. Zika Pregnancy Registry as an enhanced national surveillance system to monitor 

pregnancy and fetal/infant outcomes among pregnancies with laboratory evidence of 

possible recent Zika virus infection. The U.S. Zika Pregnancy Registry includes data from 

all 50 states, Washington, D.C., and all U.S. territories except Puerto Rico; pregnancies in 

Puerto Rico are monitored separately by the Zika Active Pregnancy Surveillance System.

Selected Awardees 

Undertook Multiple 

Activities with Zika 

Supplemental 

Funding, and Had 

Varying Experiences 

Applying for and 

Managing Funds

Selected Awardees Used 

Zika Supplemental 

Funding for Activities 

Including Surveillance, 

Vector Control, Laboratory 

Capacity, and Health Care 

Services
Page 19 GAO-18-389 Zika Supplemental Funding

counseling for pregnant women and newborns; and increasing access 

to appropriate specialized health care services for pregnant women, 

children born to mothers with maternal Zika virus infection, and their 

families.

Table 2 provides examples of the types of activities funded by the 

selected awardees we interviewed. This table does not include a 

comprehensive list of all of the awardees’ Zika activities—see appendixes 

II through VI, and appendix IX for more information on the Zika 

supplemental funding CDC and CMS awarded to states, territories, and 

local jurisdictions.

Table 2: Examples of Activities of Selected Awardees That Received Direct Zika Supplemental Funding from CDC and CMS

Awardee

Funding received, 

in dollars, by award type

Examples of 

activities

Alaska ELC: 36,867 Alaska’s Zika activities include ensuring that procedures are in place 

to assist in the monitoring of potential Zika cases among pregnant 

women and their infants; and overseeing the development and 

dissemination of outreach materials. 

Arizona ELC: 5,161,956

Birth defects: 200,000

BRFSS: 26,000

PHPR: 388,273

Arizona’s activities include using a Zika Pregnancy Registry 

coordinator to assist the local health jurisdictions with interviewing 

patients, contacting providers, and ensuring timely follow-up for 

individuals at critical points in time for data collection, as well as 

transmitting the data to CDC in a timely fashion. Additionally, Arizona 

officials said that funding will be used for prevention efforts, including 

producing materials, such as posters, to hand out at events.

California ELC: 12,496,481

Birth defects: 360,000

PHPR: 2,658,839

California’s Zika activities include providing consultation, training, and 

operational support to detect, monitor, and control Aedes aegypti and 

Aedes albopictus mosquitoes; providing on-site technical assistance in 

the event of local transmission; and conducting field-based pesticide 

resistance testing. According to state officials, California is also 

conducting education and outreach activities. 

Colorado ELC: 230,065 Colorado’s Zika activities include using staff to build and maintain 

relationships necessary for long-term follow-up of patients and 

consistent data transmission to the U.S. Zika Pregnancy Registry.

Florida ELC: 38,298,440

Birth defects: 360,000

BRFSS: 124,976

PHPR: 4,999,979

PRAMS: 40,000

CMS: 2,991,000

Florida’s Zika activities include supporting the prevention of active 

transmission of Zika through source reduction, communication, and 

control, including the application of ground adulticide treatments, 

ground larvicide treatments, and aerial adulticide treatments. 

Additionally, staff will support Zika epidemiology and outreach 

projects, including involvement with active surveillance, response to 

any local introductions, follow-up with potentially Zika infected infants, 

as well as assistance with development and distribution of Zika and 

mosquito bite prevention outreach to targeted audiences. 
Page 20 GAO-18-389 Zika Supplemental Funding

Awardee

Funding received, 

in dollars, by award type

Examples of 

activities

Houston, Texas ELC: 2,475,899

Birth defects: 199,804

Houston’s Zika activities include providing staff to improve surveillance 

to monitor the incidence of women and infants who meet the U.S. Zika 

Pregnancy Registry case definition, identify and report all data to the 

registry in a timely manner, increase provider support and education, 

and gather follow-up clinical data on infants to identify developmental 

delays. According to city officials, Houston also will use the funding for 

education and outreach, to investigate all reports of suspected Zika 

exposure and infection, to establish and provide Zika testing for the 16 

counties served by the Houston Health Department Bureau of 

Laboratory Services, and to partner with Harris County, Texas, for 

vector control activities.

Iowa ELC: 372,847 According to state officials, Iowa’s Zika activities include surveillance 

and case follow-up.

Kansas ELC: 85,658 According to state officials, Kansas’ Zika activities include staff to work 

on submitting data to the U.S. Zika Pregnancy Registry, and to followup on pregnant women and infants.

Los Angeles County, 

California

ELC: 1,750,283

Birth defects: 360,000

PHPR: 504,855

Los Angeles County’s Zika activities include assigning staff to conduct 

Zika testing and prepare testing reports, including distinguishing Zika 

from chikungunya and dengue infections. According to county officials, 

Los Angeles County also developed hospital protocols and conducted

patient tracking and follow-up with pregnant women.

Louisiana ELC: 3,559,243

Birth defects: 200,000

BRFSS: 100,000

PHPR: 1,437,361

Louisiana’s Zika activities include staff to provide outreach to 

obstetricians and pediatricians in the state to disseminate information 

regarding the U.S. Zika Pregnancy Registry, proper diagnosis and 

clinical management of Zika, and how to participate in the registry; and 

follow-up with health care providers and patients to collect clinical 

information at designated time intervals on pregnant women and 

infants meeting the registry inclusion criteria from the point of case 

identification through 12 months after delivery. According to state 

officials, Louisiana also added Zika exposure as a risk factor for 

hearing loss to the state’s newborn hearing screening form, and added 

congenital Zika virus as a maternal risk factor on the state’s birth 

certificate application. 

Oklahoma ELC: 18,121

Birth defects: 108,262

According to state officials, Oklahoma added congenital Zika virus 

disease (including congenital Zika syndrome) as an automatic qualifier 

for the Sooner Start Early Intervention program.
Page 21 GAO-18-389 Zika Supplemental Funding

Awardee

Funding received, 

in dollars, by award type

Examples of 

activities

Texas ELC: 18,654,908

Birth defects: 360,000

BRFSS: 124,854

PHPR: 5,000,000

CMS: 2,491,000

According to state officials, Texas’ Zika activities include awareness 

and education of the state’s population about Zika risks and 

prevention; funding to local health departments for surveillance, case 

investigation, and vector control; providing education and outreach to 

health care providers to improve the quality of the data within the U.S. 

Zika Pregnancy Registry; and providing pesticide resistance training. 

Most of the laboratory funding is used by state-run or associated 

laboratories. 

Legend: 

CDC = Centers for Disease Control and Prevention

CMS = Centers for Medicare & Medicaid Services

ELC = Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement

Birth defects = Surveillance, Intervention, and Referral to Services Activities for Infants with Microcephaly or other Adverse Outcomes Linked with the 

Zika Virus cooperative agreement

BRFSS = Behavioral Risk Factor Surveillance System cooperative agreement

PHPR = Public Health Preparedness and Response Cooperative Agreement for All-Hazards Public Health Emergencies

PRAMS = Pregnancy Risk Assessment Monitoring System cooperative agreement

Source: CDC, CMS, and awardee documentation, and interviews with state, county, and city officials. | GAO-18-389

Of the awardees we spoke with, Florida and Texas were the only states 

that had experienced local mosquito-borne transmission of the Zika virus. 

Other selected awardees—which included Arizona, Los Angeles County, 

and Louisiana—were primarily responding to travel-related cases of Zika 

virus disease. The following are additional examples of activities funded 

using Zika supplemental funding. For more information on the types of 

activities authorized under each award, see appendixes II-VI and IX.

Florida. Florida, which has a centralized health department with countybased offices, used Zika supplemental funding for laboratory capacity and 

vector control activities, among other activities. According to state 

officials, funding for state-run laboratories was used for purchasing 

materials, such as those used for testing urine for the Zika virus, and 

funding staff located in counties to assist with handling Zika samples and 

testing, data entry, and result reporting to surveillance networks. 

Additionally, Florida used Zika supplemental funding for local vector 

control activities. For example, Miami-Dade County officials said that they 

purchased mosquito traps and removed mosquito breeding grounds, 

including plants, tires, and other objects that can hold standing water. 

(See fig. 2 for examples of the mosquito control activities in Miami-Dade 

County.)

Through CMS’s Zika Health Care Services Program, Florida received 
Page 22 GAO-18-389 Zika Supplemental Funding

funding for, among other things, two part-time advanced registered nurse 

practitioners to provide consultation and technical assistance in family 

planning clinics, and assist in the prescribing and management of various 

birth control methods. Florida also funded a health educator for Zika 

prevention and response duties, which included assisting local health 

care organizations in the development of educational programming to 

ensure that health care services are provided in accordance with CDC 

guidelines. The health educator’s duties also included ensuring that 

pregnant women with the Zika virus and infants with congenital Zika 

infection are referred to proper care and other available programs and 

resources.
Page 23 GAO-18-389 Zika Supplemental Funding

Figure 2: Examples of Vector Control Activities in Miami-Dade County, Florida

Texas. Texas officials said that the state used a CDC award to rapidly 

identify cases and conduct data analysis of Zika-related birth defects, to 

enhance surveillance of Zika virus-related birth defects by improving the 

Texas Birth Defects Registry database, and to facilitate remote access to 

electronic records. Texas also disseminated prevention materials and 
Page 24 GAO-18-389 Zika Supplemental Funding

interviewed mothers of children with Zika-related birth defects about their 

experience in dealing with the health system in order to help identify 

developmental outcomes of the children.

Texas intends to use its CMS Zika Health Care Services Program 

funding—awarded on June 30, 2017—to increase clients’ access to 

contraceptives; for care management, including counseling on Zika virus 

testing for pregnant women and their families; and for counseling to refer 

clients for services and support. State officials provided the following 

information on some of the activities intended for the program.

1. Increasing clients’ access to contraceptives: Community health 

workers and case management staff will assist clinic providers with 

informing women and their partners about contraceptive availability 

and about the potential Zika virus risks during pregnancy. They will 

also work with the women to determine what messages work best 

with their partners regarding contraceptives.

2. Care management that includes pre- and post-test counseling on Zika 

virus testing for pregnant women and their families: Officials said that 

this activity is important because the CDC testing algorithm is 

complex, the results from various tests can be confusing, and there 

can be false positives from the tests. Generally, doctors do not have 

the time to go through the complexities of these issues with clients, 

such as how to understand the laboratory tests and results.

3. Counseling to refer clients for services and supports: This can include 

counseling about various types of resources to support clients predelivery, after delivery, and during the infant’s first year of life.

Arizona. According to state officials, Zika supplemental funding was used 

to create an action plan with counties, and increase the state’s ability to 

raise public awareness about the threat of the Zika virus, its transmission 

routes, and prevention measures. Officials stated that Arizona’s border 

with Mexico makes communicating about Zika more complex, because 

individuals frequently cross the border for a variety of reasons including 

work, school, and to visit family, and do not necessarily consider 

themselves to be travelers. Additionally, the state used funding to 

increase the amount of personal protective equipment for the vector 

surveillance staff, and set up vector control contracts that could be 

accessed if the Zika virus spread locally, and in the event that vector 

control could not be handled at the local level. However, this contracting 

mechanism was not used, because there was no local transmission of the 

Zika virus in Arizona. According to state officials, Arizona plans to ask for 
Page 25 GAO-18-389 Zika Supplemental Funding

an extension to use the funding in the next mosquito season. The state 

health department also sponsored training on mosquito identification.

Los Angeles County. County officials said that some funding was used 

to support personnel involved with Zika surveillance, testing, and case 

management. This included the detection of cases—individuals 

diagnosed with Zika infection—and also the dissemination of information 

to Los Angeles County’s Maternal and Child Health group, which follows 

pregnant women through delivery and then transfers the cases to the 

county’s Children’s Medical Services group. For example, according to 

officials, once a case is identified, information is shared with the relevant 

vector control district about the location of the case, and the vector control 

district can then conduct inspection and abatement activities to reduce 

the risk of a local outbreak. Los Angeles County officials found that this 

process takes about one week from finding out about a case to 

completion of inspection and abatement. This included 1 day to get 

information to the vector control district and 1 to 5 days for completing 

inspection and abatement. The funding was also used to provide funds to 

the vector control districts to augment Aedes mosquito detection efforts 

and support outreach activities, according to county officials.

Louisiana. Louisiana officials said they used a CDC award, in part, to 

provide equipment and mileage reimbursement for nurses, who served as 

clinical liaisons between the birth defects surveillance program and 

hospitals and physicians statewide, to help enable rapid surveillance 

activities.

Awardees also funded other activities, such as outreach campaigns. See 

figure 3 for examples of outreach funded with Zika supplemental funding.
Page 26 GAO-18-389 Zika Supplemental Funding

Figure 3: Examples of Zika Outreach Activities

While a majority of the 12 selected awardees we spoke with reported 

positive experiences with the process of applying for and managing the 

Zika supplemental funding, some awardees cited aspects of the process 

that were challenging. The awardees we spoke with received much of 

their supplemental funding from CDC and noted that the process went 

well: there was good communication with CDC officials; CDC’s 

Epidemiology and Laboratory Capacity for Infectious Diseases 

cooperative agreement process to apply for Zika supplemental funds was 

more streamlined than the regular application process; and awardees 

Selected Awardees Had 

Mixed Experiences 

Applying for and Managing 

the Zika Supplemental 

Funding
Page 27 GAO-18-389 Zika Supplemental Funding

said they were familiar with the mechanisms, which helped them navigate 

the process.26

Awardees we spoke to also cited some challenges to applying for and 

managing the Zika supplemental funding. These awardees noted that 

various time frames among multiple awards and restrictions on authorized 

activities under the awards added administrative burdens that officials 

had to deal with while responding to the outbreak. Florida officials said 

that the state received funding from different federal agencies, from 

different cooperative agreement awards, with different deadlines, and 

different rules on what the funding could be used for. For example, CDC 

distributed Zika supplemental funds to states and certain localities and 

territories through five cooperative agreements—some of which had 

multiple application rounds. Florida officials said that they had to track 

funding separately and identify the activities that could be funded under 

each award—administrative requirements that were burdensome during 

an emergency response. Figure 4 presents the period of time Florida had 

to use the Zika supplemental funding from multiple awards received from 

CDC.

 26Awardees annually apply for and receive funding through CDC’s Epidemiology and 

Laboratory Capacity for Infectious Diseases cooperative agreement. CDC provided 

additional awards through this cooperative agreement using its Zika supplemental funding.
Page 28 GAO-18-389 Zika Supplemental Funding

Figure 4: Timeline of Florida’s Zika Supplemental Funding Awards

a

The title of the birth defects award is the Surveillance, Intervention, and Referral to Services 

Activities for Infants with Microcephaly or other Adverse Outcomes Linked with the Zika Virus award. 

According to officials from the Centers for Disease Control and Prevention (CDC), Florida received a 

no-cost extension for this award, which extends the period Florida has to use the funding to July 31, 

2019.

b

The title of this award is the Epidemiology and Laboratory Capacity for Infectious Diseases award.

c

For this Epidemiology and Laboratory Capacity for Infectious Diseases award, CDC officials said that 

Florida could not begin using the funding until August 1, 2017.
Page 29 GAO-18-389 Zika Supplemental Funding

d

The title of this award is the Public Health Preparedness and Response Cooperative Agreement for 

All-Hazards Public Health Emergencies. According to CDC officials, Florida received a no-cost 

extension for this award, which extends the period Florida has to use the funding to June 30, 2018.

In addition, awardees we spoke with cited challenges with adjusting their 

plans when federal funding was more or less than anticipated. For 

example, CDC officials said that they provided average award amount 

ranges as guidance for awardees as part of the application process for 

one of CDC’s cooperative agreements.27 Los Angeles County officials 

said that they applied for an amount that was near the limit, and county 

officials said that they had to adjust the activities they planned to fund 

when they received less than what they applied for. Iowa officials said 

that without knowing exactly how much funding would be available it was 

difficult to know what to apply for and made staffing changes difficult. 

Iowa officials had to adjust their initial plan when they later received 

additional unexpected funding.

In October 2017, CDC issued a new notice of funding opportunity that, 

according to agency officials, was intended to help minimize the 

administrative burden on these awardees (e.g., preparing applications 

and other paperwork) during significant public health emergencies by preapproving public health departments in these jurisdictions to rapidly 

receive future awards.28 This new notice of funding opportunity will be 

used to establish a list of awardees, with existing emergency 

preparedness and response capacity, that would be pre-approved for 

funding by CDC when a public health threat occurs, including infectious 

disease threats.29 It requires that awardees have structures and plans in 

place to receive funding, as well as plans to respond to a public health 

threat. According to CDC officials, awards could potentially be provided 

within 2 weeks to pre-approved awardees after supplemental 

appropriations are enacted. According to CDC officials, as of February 

2018, the agency had approved all 64 applicants for the notice of funding 

 27The approximate award range provided by CDC as guidance for three activities within 

the cooperative agreement was (1) $0 to $10,000,000; (2) $0 to $6,000,000; and (3) $0 to 

$550,000.

28According to CDC officials, they began thinking about creating the notice of funding 

opportunity during the 2009 H1N1 response.

29The notice of funding opportunity is open to all of CDC’s Epidemiology and Laboratory 

Capacity for Infectious Diseases (ELC) and Public Health Emergency Preparedness 

awardees, as well as five tribes, which CDC defines as federally or state recognized 

American Indian or Alaska Native tribal governments serving a population of at least 

50,000 members. 
Page 30 GAO-18-389 Zika Supplemental Funding

opportunity.30 This means that CDC will consider these approved 

applicants for future funding if an emergency occurs and funding 

becomes available.

We provided a draft of this report to HHS for review and comment. HHS

provided technical comments, which we incorporated as appropriate.

We also provided relevant draft portions of this report to the Zika 

supplemental funding awardees we interviewed. Specifically, we provided 

the excerpts to officials in Alaska; Arizona; California; Colorado; Florida; 

Houston, Texas; Iowa; Kansas; Los Angeles County, California; 

Louisiana; Oklahoma; and Texas. All but one awardee responded. 

Awardees provided technical comments, which we incorporated as 

appropriate.

We are sending copies of this report to the appropriate congressional 

committees, the Secretary of Health and Human Services, and to other 

interested parties. In addition, the report is available at no charge on the 

GAO website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact 

me at (202) 512-7114 or crossem@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix XII.

Marcia Crosse

Director, Health Care

 30According to CDC officials, as of December 2017, all of the ELC and Public Health 

Emergency Preparedness awardees had applied, but no tribes had applied. Agency 

officials told us that they were contacting the tribes to ensure they were aware of the 

opportunity. They also said that the application process for the notice of funding 

opportunity will be reopened at a later date and eligible tribes that are interested in 

applying will have the opportunity to do so at that time.

Agency and ThirdParty Comments
Appendix I: Biomedical Advanced Research 

and Development Authority’s Zika 

Supplemental Awards

Page 31 GAO-18-389 Zika Supplemental Funding

The Biomedical Advanced Research and Development Authority 

(BARDA), within the Department of Health and Human Services’ Office of 

the Assistant Secretary for Preparedness and Response, executed 

contracts to obligate its Zika supplemental funding for research in the 

areas of (1) vaccine development, (2) diagnostic development, and (3) 

pathogen reduction systems.

Table 3 presents information for each award as it was provided to us by 

BARDA.

Table 3: Biomedical Advanced Research and Development Authority’s Zika Supplemental Funding Contracts 

Awardee Activity description

Award 

(in dollars)

Battelle Battelle will develop a passive transfer murine model to 

evaluate Zika vaccines.

1,468,809 

Battelle Battelle will conduct natural history studies for Zika infections 

in NHPs.

2,383,446 

Cerus Corpa This project will advance the INTERCEPT Blood System for 

pathogen reduction in donated red blood cells. It is already 

licensed and marketed for use platelets and plasma. The 

INTERCEPT Blood System is designed to reduce the risk of 

transfusion-transmitted infections by inactivating a broad 

range of pathogens such as viruses, bacteria, and parasites 

that may be present in donated blood. As a part of this 

project, a Phase 3 clinical study to evaluate safety and 

efficacy in acute care is being conducted in Puerto Rico.

57,421,416 

InBios International Inc. InBios is developing 2 different Zika IgM diagnostic tests 

under this contact, a semi-automated test for use in clinical 

laboratories, which is available under Emergency Use 

Authorization (EUA), and an easy-to-use lateral flow test for 

use in point of care settings. Development of both tests are 

funded through EUA to FDA 510(K) filing.

4,354,808 

Moderna Therapeutics Inca Moderna is presently conducting a Phase 1 trial at three 

different clinical sites across the U.S. (first and second 

cohorts have been fully immunized) for an investigational 

mRNA Zika vaccine. Enrollment continues, and 

immunogenicity data (unblinded) from this study is expected 

later this year. Work is also ongoing at Moderna to scale up 

manufacturing in preparation for a large Phase 2/3 trial to 

initiate soon after the Phase 1 trial is completed in 2017.

109,112,211

Orasure Technologies Inc. Orasure is developing a point of care Zika IgM diagnostic test 

for use in informing the care of pregnant women. The test is 

an easy-to-use lateral flow test. Development of data to 

support consideration by the FDA for an Emergency Use 

Authorization and continued development through FDA 

510(K) clearance is included in the contract. 

2,612,925 

Appendix I: Biomedical Advanced Research 

and Development Authority’s Zika 

Supplemental Awards
Appendix I: Biomedical Advanced Research 

and Development Authority’s Zika 

Supplemental Awards

Page 32 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

Sanofi Pasteur Incb Sanofi will complete Zika defined preclinical vaccine 

development activities. In addition, the Zika case definition 

study is being conducted in Central and South America. (As 

of 22 September 2017, 1,131 subjects have been enrolled).

7,500,000 

Siemens Healthcare Diagnostics Inc. Siemens is developing a laboratory Zika IgM blood test for 

use on 3 automated platforms in their Centaur product line. 

These are high throughput fully automated blood analysers. 

When available, this test will greatly increase the Zika testing 

capacity in the U.S. BARDA is fund work to support 

consideration of an Emergency Use Authorization by the FDA 

and continued development to FDA 510(K) approval.

8,945,785 

Takeda Vaccines Inc.a Takeda is developing a Zika whole-virus inactivated vaccine 

which will be adjuvanted with aluminum hydroxide.

51,200,600

Source: Biomedical Advanced Research and Development Authority (BARDA). | GAO-18-389

a

This awardee received more than one award and funding amounts for awards for the same awardee 

and activity were added together in this table.

b

Prior to September 30, 2017, Sanofi Pasteur decided to no longer develop a Zika vaccine. Non-Zika 

supplemental funding was de-obligated, according to BARDA officials, but the Zika supplemental 

funding was maintained by the agency to continue support of a Zika case definition study being 

conducted in Central and South America.
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory

Capacity for Infectious Diseases Awardees

Page 33 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) 

cooperative agreement. CDC awarded Zika supplemental funding for the 

ELC cooperative agreement for the following activities:

• Zika vector surveillance and control,

• Zika epidemiology and laboratory surveillance, and

• U.S. Zika Pregnancy Registry.1

The Zika supplemental funding awarded through the ELC cooperative 

agreement was to further support and strengthen activities to protect the 

public’s health, especially pregnant women, through epidemiologic 

surveillance and investigation, improving mosquito control and 

monitoring, and strengthening laboratory capacity. The funding will also 

support participation in the U.S. Zika Pregnancy Registry to monitor 

pregnant women with the Zika virus disease and their infants.

For each award, we present information as it was provided to us by CDC, 

as well as the activities funded. Table 4 provides information on ELC Zika 

supplemental funding awarded to states and territories, and table 5 

presents information on awards to local health departments.

Table 4: Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement’s Zika Supplemental Funding 

for States and Territories, by Awardee and Activity Funded

State/territory Awardee Activity funded

Award 

(in dollars)

Alabama Alabama Department of Public 

Health

Zika vector surveillance and control 343,980

Zika epidemiology and laboratory surveillance 584,738

U.S. Zika Pregnancy Registry 549,996

Total 1,478,714

Alaska Alaska State Department of 

Health & Social Services

Zika epidemiology and laboratory surveillance 14,874

U.S. Zika Pregnancy Registry 21,993

Total 36,867

American Samoa American Samoa Government Zika vector surveillance and control 180,822

Zika epidemiology and laboratory surveillance 454,563

U.S. Zika Pregnancy Registry 136,200

 1

Not all awardees received funding for each activity.

Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees

Page 34 GAO-18-389 Zika Supplemental Funding

State/territory Awardee Activity funded

Award 

(in dollars)

Total 771,585

Arizona Arizona Department of Health 

Services

Zika vector surveillance and control 1,438,817

Zika epidemiology and laboratory surveillance 3,615,719

U.S. Zika Pregnancy Registry 107,420

Total 5,161,956

Arkansas Arkansas Department of Health Zika vector surveillance and control 493,698

Zika epidemiology and laboratory surveillance 129,539

U.S. Zika Pregnancy Registry 516,579

Total 1,139,816

California Public Health Foundation 

Enterprises (California)

Zika vector surveillance and control 4,285,687

Zika epidemiology and laboratory surveillance 7,058,745

U.S. Zika Pregnancy Registry 1,152,049

Total 12,496,481

Colorado Colorado Department of Public 

Health and Environment

Zika epidemiology and laboratory surveillance 163,688

U.S. Zika Pregnancy Registry 66,377

Total 230,065

Connecticut Connecticut State Department of 

Public Health

Zika epidemiology and laboratory surveillance 175,820

U.S. Zika Pregnancy Registry 338,526

Total 514,346

Delaware Delaware Health & Social 

Services

Zika epidemiology and laboratory surveillance 12,791

U.S. Zika Pregnancy Registry 435,759

Total 448,550

Federated States of 

Micronesia

Federated States of Micronesia -

FSM

Zika vector surveillance and control 68,717

Zika epidemiology and laboratory surveillance 144,129

U.S. Zika Pregnancy Registry 120,000

Total 332,846

Florida Florida Department of Health Zika vector surveillance and control 25,590,915

Zika epidemiology and laboratory surveillance 11,411,188

U.S. Zika Pregnancy Registry 1,296,337

Total 38,298,440

Georgia Georgia Department of Public 

Health

Zika vector surveillance and control 302,612

Zika epidemiology and laboratory surveillance 319,435

U.S. Zika Pregnancy Registry 103,913

Total 725,960

Guam Guam Department of Public 

Health and Social Services

Zika vector surveillance and control 146,700

Zika epidemiology and laboratory surveillance 299,191
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees

Page 35 GAO-18-389 Zika Supplemental Funding

State/territory Awardee Activity funded

Award 

(in dollars)

U.S. Zika Pregnancy Registry 266,201

Total 712,092

Hawaii Hawaii State Department of 

Health

Zika vector surveillance and control 273,306

Zika epidemiology and laboratory surveillance 987,937

Total 1,261,243

Illinois Illinois Department of Public 

Health

Zika epidemiology and laboratory surveillance 598,160

U.S. Zika Pregnancy Registry 566,770

Total 1,164,930

Indiana Indiana State Department of 

Health

Zika epidemiology and laboratory surveillance 43,407

U.S. Zika Pregnancy Registry 83,111

Total 126,158

Iowa Iowa Department of Public 

Health

Zika epidemiology and laboratory surveillance 261,681

U.S. Zika Pregnancy Registry 111,166

Total 372,847

Kansas Kansas Department of Health 

and Environment

Zika epidemiology and laboratory surveillance 36,734

U.S. Zika Pregnancy Registry 48,924

Total 85,658

Kentucky Kentucky Cabinet for Health & 

Family Services

Zika epidemiology and laboratory surveillance 249,384

U.S. Zika Pregnancy Registry 164,822

Total 414,206

Louisiana Louisiana State Office of Public 

Health

Zika vector surveillance and control 1,450,246

Zika epidemiology and laboratory surveillance 1,872,956

U.S. Zika Pregnancy Registry 236,041

Total 3,559,243

Maine Maine Department of Health & 

Human Services

Zika epidemiology and laboratory surveillance 274,351

U.S. Zika Pregnancy Registry 144,876

Total 419,227

Marshall Islands Republic of the Marshall Islands 

Ministry of Health

Zika vector surveillance and control 119,610

Zika epidemiology and laboratory surveillance 91,293

U.S. Zika Pregnancy Registry 83,418

Total 294,321

Maryland Maryland Department of Health 

and Mental Hygiene

Zika vector surveillance and control 137,817

Zika epidemiology and laboratory surveillance 604,224

U.S. Zika Pregnancy Registry 453,970

Total 1,196,011
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees

Page 36 GAO-18-389 Zika Supplemental Funding

State/territory Awardee Activity funded

Award 

(in dollars)

Massachusetts Massachusetts Department of 

Public Health

Zika epidemiology and laboratory surveillance 434,761

U.S. Zika Pregnancy Registry 546,183

Total 980,944

Michigan Michigan Department of Health 

& Human Services

Zika epidemiology and laboratory surveillance 277,714

U.S. Zika Pregnancy Registry 218,757

Total 496,471

Minnesota Minnesota Department of Health Zika epidemiology and laboratory surveillance 344,105

U.S. Zika Pregnancy Registry 95,231

Total 439,336

Mississippi Mississippi State Department of 

Health

Zika vector surveillance and control 1,311,838

Zika epidemiology and laboratory surveillance 447,215

U.S. Zika Pregnancy Registry 249,701

Total 2,008,754

Missouri Missouri Department of Health & 

Senior Services

Zika epidemiology and laboratory surveillance 169,373

U.S. Zika Pregnancy Registry 124,903

Total 294,276

Montana Montana State Department of 

Public Health & Human Services

Zika epidemiology and laboratory surveillance 17,137

Nebraska Nebraska Department of Health 

and Human Services

Zika epidemiology and laboratory surveillance 21,073

U.S. Zika Pregnancy Registry 456,365

Total 477,438

Nevada Nevada Division of Public and 

Behavioral Health

Zika epidemiology and laboratory surveillance 227,645

U.S. Zika Pregnancy Registry 95,409

Total 323,054

New Hampshire New Hampshire Department of 

Health and Human Services

Zika epidemiology and laboratory surveillance 123,684

U.S. Zika Pregnancy Registry 114,811

Total 238,495

New Jersey New Jersey Department of 

Health

Zika vector surveillance and control 67,500

Zika epidemiology and laboratory surveillance 733,627

U.S. Zika Pregnancy Registry 1,080,245

Total 1,881,372

New Mexico New Mexico Department of 

Health

Zika vector surveillance and control 490,684

Zika epidemiology and laboratory surveillance 843,826

U.S. Zika Pregnancy Registry 513,799

Total 1,848,309

New York Health Research, Inc. (New York 

State)

Zika epidemiology and laboratory surveillance 1,469,169

U.S. Zika Pregnancy Registry 642,324
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees

Page 37 GAO-18-389 Zika Supplemental Funding

Total 2,111,493

North Carolina North Carolina Department of 

Health and Human Services

Zika epidemiology and laboratory surveillance 137,539

U.S. Zika Pregnancy Registry 74,359

Total 211,898

North Dakota North Dakota State Department 

of Health

Zika epidemiology and laboratory surveillance 46,648

Northern Mariana 

Islands

Commonwealth Healthcare 

Corporation 

Zika vector surveillance and control 16,882

Zika epidemiology and laboratory surveillance 93,355

U.S. Zika Pregnancy Registry 97,780

Total 208,017

Ohio Ohio State Department of Health Zika epidemiology and laboratory surveillance 411,193

U.S. Zika Pregnancy Registry 97,757

Total 508,950

Oklahoma Oklahoma State Department of 

Health

Zika epidemiology and laboratory surveillance 18,121

Oregon Oregon Health Authority, Public 

Health Division

Zika epidemiology and laboratory surveillance 134,598

U.S. Zika Pregnancy Registry 159,138

Total 293,736

Palau Republic of Palau Zika vector surveillance and control 90,000

Zika epidemiology and laboratory surveillance 21,401

U.S. Zika Pregnancy Registry 35,000

Total 146,401

Pennsylvania Pennsylvania State Department 

of Health

Zika epidemiology and laboratory surveillance 700,766

U.S. Zika Pregnancy Registry 280,035

Total 980,801

Puerto Rico Puerto Rico Department of 

Health

Zika epidemiology and laboratory surveillance 2,038,276

U.S. Zika Pregnancy Registry 741,967

Total 2,780,243

Rhode Island Rhode Island Department of 

Health

Zika epidemiology and laboratory surveillance 212,557

U.S. Zika Pregnancy Registry 140,879

Total 353,436

South Carolina South Carolina Department of 

Health and Environmental 

Control

Zika epidemiology and laboratory surveillance 136,644

U.S. Zika Pregnancy Registry 283,230

Total 419,874

South Dakota South Dakota Department of 

Health

U.S. Zika Pregnancy Registry 168,893

Tennessee Tennessee State Department of 

Health

Zika epidemiology and laboratory surveillance 497,947

U.S. Zika Pregnancy Registry 550,000

Total 1,047,947
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees

Page 38 GAO-18-389 Zika Supplemental Funding

Texas Texas Department of State 

Health Services

Zika vector surveillance and control 3,662,766

Zika epidemiology and laboratory surveillance 13,978,845

U.S. Zika Pregnancy Registry 1,013,297

Total 18,654,908

Utah Utah Department of Health Zika epidemiology and laboratory surveillance 206,704

U.S. Zika Pregnancy Registry 45,242

Total 251,946

Vermont Vermont Agency of Human 

Services

Zika epidemiology and laboratory surveillance 15,661

Virginia Virginia Department of Health Zika epidemiology and laboratory surveillance 708,799

U.S. Zika Pregnancy Registry 189,447

Total 898,246

U.S. Virgin Islands Virgin Islands Department of 

Health

Zika vector surveillance and control 984,690

Zika epidemiology and laboratory surveillance 865,970

U.S. Zika Pregnancy Registry 1,169,735

Total 3,020,395

Washington Washington State Department of 

Health

Zika epidemiology and laboratory surveillance 476,691

U.S. Zika Pregnancy Registry 118,618

Total 595,309

West Virginia West Virginia Department of 

Health and Human Services

Zika epidemiology and laboratory surveillance 168,241

U.S. Zika Pregnancy Registry 108,262

Total 276,503

Wisconsin Wisconsin Department of Health 

Services

Zika epidemiology and laboratory surveillance 443,218

U.S. Zika Pregnancy Registry 113,636

Total 556,854

Source: Centers for Disease Control and Prevention. | GAO-18-389

In addition to states and territories, six large city and county local health 

departments—Chicago, the District of Columbia, Houston, Los Angeles 

County, New York City, and Philadelphia—received ELC Zika 

supplemental awards.
Appendix II: Centers for Disease Control and 

Prevention—Epidemiology and Laboratory 

Capacity for Infectious Diseases Awardees

Page 39 GAO-18-389 Zika Supplemental Funding

Table 5: Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement’s Zika Supplemental Funding 

for Local Health Departments, by Awardee and Activity Funded

City/county Awardee Activity funded

Award 

(in dollars)

Chicago City of Chicago Department of 

Public Health

Zika epidemiology and laboratory surveillance 157,889

U.S. Zika Pregnancy Registry 182,496

Total 340,385

District of Columbia District of Columbia Department 

of Health

Zika epidemiology and laboratory surveillance 839,959

U.S. Zika Pregnancy Registry 219,113

Total 1,059,072

Houston Houston Department of Health 

and Human Services

Zika vector surveillance and control 1,250,000

Zika epidemiology and laboratory surveillance 723,104

U.S. Zika Pregnancy Registry 502,795

Total 2,475,899

Los Angeles County County of Los Angeles 

Department of Public Health

Zika vector surveillance and control 614,952

Zika epidemiology and laboratory surveillance 585,331

U.S. Zika Pregnancy Registry 550,000

Total 1,750,283

New York City New York City Department of 

Health & Mental Hygiene

Zika epidemiology and laboratory surveillance 854,650

U.S. Zika Pregnancy Registry 521,554

Total 1,376,204

Philadelphia Philadelphia Department of 

Public Health

Zika epidemiology and laboratory surveillance 237,516

U.S. Zika Pregnancy Registry 215,103

Total 452,619

Source: Centers for Disease Control and Prevention. | GAO-18-389
Appendix III: Centers for Disease Control and 

Prevention—Birth Defects Awardees

Page 40 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

the Surveillance, Intervention, and Referral to Services Activities for 

Infants with Microcephaly or other Adverse Outcomes Linked with the 

Zika Virus (birth defects) cooperative agreement.1

The Zika supplemental funding awarded through the birth defects 

cooperative agreement was to provide additional resources to better 

establish, enhance, and maintain rapid population-based surveillance of 

microcephaly and other adverse outcomes (especially central nervous 

system defects) possibly linked to Zika virus infection during pregnancy 

using an active case-finding methodology; participation in centralized 

pooled clinical and surveillance data projects; ensuring affected infants 

and families are referred to services; and assessing health and 

developmental outcomes of these children.

Table 6 presents information for each award as it was provided to us by 

CDC.

Table 6: Birth Defects Cooperative Agreement Zika Supplemental Funding by Awardee 

State/territory Awardee

Award 

(in dollars)

Alabama Alabama Department of Public Health 199,952 

American Samoa American Samoa Government 200,000 

Arizona Arizona Department of Health Services 200,000 

Arkansas Arkansas Children’s Hospital Research 200,000 

California California Department of Public Health 360,000 

California County of Los Angeles Department of Public Health 360,000 

Federated States of Micronesia Federated States of Micronesia - FSM 137,437 

Florida Florida Department of Health 360,000 

Georgia Georgia Department of Public Health 280,000 

Guam Guam Department of Public Health and Social Services 163,340 

Hawaii Hawaii State Department of Health 200,000 

Illinois City of Chicago Department of Public Health 100,000 

Illinois Illinois Department of Public Health 180,000 

 1

The birth defects award for cities and counties is the Surveillance, Intervention, and 

Referral to Services Activities for Infants with Microcephaly or other Adverse Outcomes 

Linked with the Zika Virus - High Risk Local Areas Cooperative Agreement.

Appendix III: Centers for Disease Control 

and Prevention—Birth Defects Awardees
Appendix III: Centers for Disease Control and 

Prevention—Birth Defects Awardees

Page 41 GAO-18-389 Zika Supplemental Funding

State/territory Awardee

Award 

(in dollars)

Indiana Indiana State Department of Health 200,000 

Iowa University of Iowa 100,000 

Kentucky Kentucky Cabinet for Health & Family Services 200,000 

Louisiana Louisiana State Office of Public Health 200,000 

Marshall Islands Republic of the Marshall Islands Ministry of Health 200,000 

Massachusetts Massachusetts Department of Public Health 100,000 

Minnesota Minnesota Department of Health 100,000 

Mississippi Mississippi State Department of Health 200,000 

Missouri Missouri Department of Health & Senior Services 200,000 

Nebraska Nebraska Department of Health and Human Services 77,427 

Nevada Southern Nevada Health District 200,000 

New Jersey New Jersey Department of Health 280,000 

New York Health Research, Inc. (New York State) 359,999 

New York New York City Department of Health & Mental Hygiene 352,287 

North Carolina North Carolina Department of Health and Human Services 280,000 

Northern Mariana Islands Commonwealth Healthcare Corporation 200,000 

Ohio Ohio State Department of Health 280,000 

Oklahoma Oklahoma State Department of Health 108,262 

Pennsylvania Pennsylvania State Department of Health 280,000 

Pennsylvania Philadelphia Department of Public Health 174,093 

Puerto Rico Puerto Rico Department of Health 200,000 

Rhode Island Rhode Island Department of Health 100,000 

South Carolina South Carolina Department of Health and Environmental Control 200,000 

Tennessee Tennessee State Department of Health 200,000 

Texas Houston Health Department 199,804 

Texas Texas Department of State Health Services 360,000 

U.S. Virgin Islands Virgin Islands Department of Health 199,885 

Utah Utah Department of Health 100,000 

West Virginia West Virginia Department of Health and Human Services 192,150 

Wisconsin Wisconsin Department of Health Services 100,000 

Source: Centers for Disease Control and Prevention. | GAO-18-389
Appendix IV: Centers for Disease Control and 

Prevention—Behavioral Risk Factor 

Surveillance System Awardees

Page 42 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

the Behavioral Risk Factor Surveillance System (BRFSS) cooperative 

agreement.

The Zika supplemental funding awarded through the BRFSS cooperative 

agreement was to conduct a rapid population-based assessment of 

women and couples using or in need of contraceptives in order to provide 

comprehensive contraceptive services related to Zika virus exposure.

Table 7 presents information for each award as it was provided to us by 

CDC.

Table 7: Behavioral Risk Factor Surveillance System Cooperative Agreement’s Zika Supplemental Funding by Awardee 

State/territory Awardee

Award 

(in dollars)

Alabama Alabama Department of Public Health 104,641 

Arizona Arizona Department of Health Services 26,000 

District of Columbia District of Columbia Department of Health 116,618 

Florida Florida Department of Health 124,976 

Georgia Georgia Department of Public Health 100,000 

Guam Guam Department of Public Health and Social Services 73,111 

Louisiana Louisiana State Office of Public Health 100,000 

Maryland Maryland Department of Health and Mental Hygiene 65,139 

Mississippi Mississippi State Department of Health 100,000 

New Mexico New Mexico Department of Health 125,000 

New York Health Research, Inc. (New York State) 125,000 

Puerto Rico Puerto Rico Department of Health 124,294 

Texas Texas Department of State Health Services 124,854 

U.S. Virgin Islands Virgin Islands Department of Health 50,756 

Source: Centers for Disease Control and Prevention. | GAO-18-389

Appendix IV: Centers for Disease Control 

and Prevention—Behavioral Risk Factor 

Surveillance System Awardees
Appendix V: Centers for Disease Control and 

Prevention—Pregnancy Risk Assessment 

Monitoring System Awardees

Page 43 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

the Pregnancy Risk Assessment Monitoring System (PRAMS) 

cooperative agreement.

The Zika supplemental funding awarded through the PRAMS cooperative 

agreement was to assess maternal behaviors and experiences related to 

Zika virus exposure among recently pregnant women who deliver a liveborn infant in the United States.

Table 8 presents information for each award as it was provided to us by 

CDC.

Table 8: Pregnancy Risk Assessment Monitoring System Cooperative Agreement’s Zika Supplemental Funding by Awardee 

State/territory Awardeea Award (In dollars)

Alabama Alabama Department of Public Health 29,993 

Connecticut Connecticut State Department of Public Health 40,000 

District of Columbia District of Columbia Department of Health 29,916 

Florida Florida Department of Health 40,000 

Georgia Georgia Department of Public Health 40,000 

Illinois Illinois Department of Public Health 40,000 

Indiana Indiana State Department of Health 30,000 

Massachusetts Massachusetts Department of Public Health 40,000 

Missouri Missouri Department of Health & Senior Services 30,000 

New Jersey New Jersey State Department of Health & Senior Services 40,000 

New York Health Research, Inc. (New York State) 30,000 

Pennsylvania Pennsylvania State Department of Health 29,830 

Puerto Rico Puerto Rico Department of Health 830,000 

South Carolina South Carolina Department of Health and Environmental Control 39,975 

Tennessee Tennessee State Department of Health 40,000 

Virginia Virginia Department of Health 39,953 

Wisconsin Wisconsin Department of Health Services 24,171 

Source: Centers for Disease Control and Prevention. | GAO-18-389

a

These awardees received more than one award and funding amounts for awards for the same 

awardee were added together in this table.

Appendix V: Centers for Disease Control and 

Prevention—Pregnancy Risk Assessment

Monitoring System Awardees
Appendix VI: Centers for Disease Control and 

Prevention—Public Health Preparedness and 

Response Awardees

Page 44 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

the Public Health Preparedness and Response (PHPR) Cooperative 

Agreement for All-Hazards Public Health Emergencies.

According to CDC officials, the Zika supplemental funding awarded 

through the PHPR cooperative agreement was to enable identified state, 

territorial, and local jurisdictions to address Zika virus disease planning 

and operational response gaps.

Table 9 presents information for each award as it was provided to us by 

CDC.

Table 9: Public Health Preparedness and Response Cooperative Agreement for All-Hazards Public Health Emergencies 

Cooperative Agreement’s Zika Supplemental Funding by Awardee 

State/territory Awardee

Award 

(in dollars)

Alabama Alabama Department of Public Health 522,093 

American Samoa American Samoa Government 453,009 

Arizona Arizona Department of Health Services 388,273 

Arkansas Arkansas Department of Health 212,707 

California California Department of Public Health 2,658,839 

California County of Los Angeles Department of Public Health 504,855 

Federated States of Micronesia Federated States of Micronesia - FSM 289,088 

Florida Florida Department of Health 4,999,979 

Georgia Georgia Department of Public Health 203,738 

Guam Guam Department of Public Health and Social Services 134,614 

Hawaii Hawaii State Department of Health 58,603 

Kentucky Kentucky Cabinet for Health & Family Services 428,132 

Louisiana Louisiana State Office of Public Health 1,437,361 

Marshall Islands Republic of the Marshall Islands Ministry of Health 86,300 

Maryland Maryland Department of Health and Mental Hygiene 288,558 

New Jersey New Jersey Department of Health 933,995 

New York Health Research, Inc. (New York State) 1,086,913 

New York Public Health Solutions (NYC) 1,294,244 

Northern Mariana Islands Commonwealth Healthcare Corporation 86,976 

Puerto Rico Puerto Rico Department of Health 3,931,723 

Texas Texas Department of State Health Services 5,000,000

Source: Centers for Disease Control and Prevention. | GAO-18-389

Appendix VI: Centers for Disease Control 

and Prevention—Public Health

Preparedness and Response Awardees
Appendix VII: Centers for Disease Control and 

Prevention—Other Cooperative Agreements’ 

Awardees

Page 45 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

additional cooperative agreements.

Tables 10-17 present information for each award as it was provided to us 

by CDC.

The Zika supplemental funding awarded through the Sentinel Enhanced 

Dengue Surveillance System Project cooperative agreement was to 

support sites working to provide new information on dengue and other 

acute febrile illnesses in Puerto Rico, which is located in the subtropics 

and where dengue epidemiology is similar to dengue endemic areas 

worldwide. The Zika supplemental funding was for two studies: (1) 

pregnant women with Zika infection, and (2) postnatal Zika infection by 

following 0-5 year old children.

Table 10: Sentinel Enhanced Dengue Surveillance System Project Cooperative 

Agreement’s Zika Supplemental Funding by Awardee 

State/territory Awardee

Award 

(in dollars)

Puerto Rico Ponce School of Medicine 500,000

Source: Centers for Disease Control and Prevention. | GAO-18-389

The Zika supplemental funding awarded through the Vector-Borne 

Disease Regional Centers of Excellence cooperative agreement is to 

establish regional centers of excellence aimed at building the capacity to 

address the problem of emerging and exotic vector-borne diseases in the 

United States, including Zika virus infection.

Appendix VII: Centers for Disease Control 

and Prevention—Other Cooperative 

Agreements’ Awardees

Administrative Support for 

the Zika Supplemental for 

Sentinel Enhanced 

Dengue Surveillance 

System Project

Vector-Borne Disease 

Regional Centers of 

Excellence
Appendix VII: Centers for Disease Control and 

Prevention—Other Cooperative Agreements’ 

Awardees

Page 46 GAO-18-389 Zika Supplemental Funding

Table 11: Vector-Borne Disease Regional Centers of Excellence Cooperative 

Agreement’s Zika Supplemental Funding by Awardee 

State/territory Awardee

Award 

(in dollars)

California University of California – Davis 8,000,000 

Florida University of Florida 9,999,628 

New York Cornell University 9,999,936 

Texas University of Texas Medical Branch, 

Galveston

9,995,253 

Wisconsin University of Wisconsin 9,999,491 

Source: Centers for Disease Control and Prevention. | GAO-18-389

The Zika supplemental funding awarded through the Enhancing Capacity 

for Vector Surveillance and Control to Prevent Zika, Dengue and 

Chikungunya Infection in Puerto Rico cooperative agreement is to fund 

activities to increase the surveillance and control of vectors, specifically 

Aedes aegypti mosquitoes (the vector of dengue, chikungunya, and Zika). 

The purpose of the program is to establish a vector control unit to oversee 

and implement comprehensive vector control activities in Puerto Rico.

Table 12: Enhancing Capacity for Vector Surveillance and Control to Prevent Zika, 

Dengue and Chikungunya Infection in Puerto Rico Cooperative Agreement’s Zika 

Supplemental Funding by Awardee 

State/territory Awardee

Award 

(in dollars)

Puerto Rico Puerto Rico Science, Technology & Research 

Trust

14,000,000

Source: Centers for Disease Control and Prevention. | GAO-18-389

The Zika supplemental funding awarded through the Immunization 

Grants-CDC Partnership: Strengthening Public Health Laboratories 

cooperative agreement is to promote quality and safe public health 

laboratory practice, improve public health laboratory infrastructure,

strengthen the public health laboratory system, and develop a well-trained 

public health laboratory workforce.

Enhancing Capacity for 

Vector Surveillance and 

Control to Prevent Zika, 

Dengue and Chikungunya 

Infection in Puerto Rico

Immunization Grants-CDC 

Partnership: Strengthening 

Public Health Laboratories
Appendix VII: Centers for Disease Control and 

Prevention—Other Cooperative Agreements’ 

Awardees

Page 47 GAO-18-389 Zika Supplemental Funding

Table 13: Immunization Grants-CDC Partnership: Strengthening Public Health 

Laboratories Cooperative Agreement’s Zika Supplemental Funding by Awardee 

Awardee

Award 

(in dollars)

Association of Public Health Laboratories (APHL) 250,000

Source: Centers for Disease Control and Prevention. | GAO-18-389

According to CDC officials, the Zika supplemental funding awarded 

through the Building Capacity of the Public Health System to Improve 

Population Health through National, Nonprofit Organizations cooperative 

agreement is to ensure national capacity for responding to the Zika 

outbreak and meeting the needs of those affected, such as by reaching 

out to specialized constituents to ensure they were informed on 

epidemiology and practice guidelines.

Table 14: Building Capacity of the Public Health System to Improve Population 

Health through National, Nonprofit Organizations Cooperative Agreement’s Zika 

Supplemental Funding by Awardee 

Awardee

Award 

(in dollars)

American Academy of Pediatrics 740,000 

Association of State & Territorial Health Officials (ASTHO) 1,150,000 

Council of State & Territory Epidemiologists (CSTE) 500,000 

March of Dimes Birth Defects Foundation 914,757 

National Association of City & County Health Officials (NACCHO)a 900,000 

National Indian Health Board (NIHB) 500,000 

Source: Centers for Disease Control and Prevention. | GAO-18-389

a

This awardee received more than one award and funding amounts for these awards were added 

together in this table.

The Zika supplemental funding awarded through the Strengthening the 

Public Health System in the U.S.-Affiliated Pacific Islands cooperative 

agreement is to provide capacity building assistance through a regional, 

nonprofit organization to strengthen the U.S.-Affiliated Pacific Islands’ 

public health leadership, workforce, and public health systems and 

infrastructure in response to Zika virus within the U.S. Pacific territories.

Building Capacity of the 

Public Health System to 

Improve Population Health 

through National, 

Nonprofit Organizations

Strengthening the Public 

Health System in the U.S.-

Affiliated Pacific Islands
Appendix VII: Centers for Disease Control and 

Prevention—Other Cooperative Agreements’ 

Awardees

Page 48 GAO-18-389 Zika Supplemental Funding

Table 15: Strengthening the Public Health System in the U.S.-Affiliated Pacific 

Islands Cooperative Agreement’s Zika Supplemental Funding by Awardee 

Awardee

Award 

(in dollars)

Pacific Island Health Officers Association (PIHOA)a 400,000 

Source: Centers for Disease Control and Prevention. | GAO-18-389

a

This awardee received more than one award and funding amounts for these awards were added 

together in this table.

The Zika supplemental funding awarded through the Pan American 

Health Organization: Building Capacity and Networks to Address 

Emerging Infectious Diseases in the Americas cooperative agreement is 

for various activities including technical assistance, such as to develop 

standard operating procedures for diagnostic and integrated surveillance 

activities, as well as to support the development, implementation, and 

evaluation of diagnostic and surveillance guidelines.

Table 16: Pan American Health Organization: Building Capacity and Networks to 

Address Emerging Infectious Diseases in the Americas Cooperative Agreement’s 

Zika Supplemental Funding by Awardee 

Awardee

Award 

(in dollars)

Pan American Health Organization 500,000 

Source: Centers for Disease Control and Prevention. | GAO-18-389

According to CDC officials, the Zika supplemental funding awarded 

through the Global Health Security Partner Engagement: Expanding 

Efforts and Strategies to Protect and Improve Public Health Globally 

cooperative agreement is for enhanced surveillance for pregnant women 

in Colombia, including laboratory testing and case investigations.

Table 17: Global Health Security Partner Engagement: Expanding Efforts and 

Strategies to Protect and Improve Public Health Globally Cooperative Agreement’s 

Zika Supplemental Funding by Awardee 

Awardee

Award 

(in dollars)

Vysnova Partners, Inc. 999,790

Source: Centers for Disease Control and Prevention. | GAO-18-389

Pan American Health 

Organization: Building 

Capacity and Networks to 

Address Emerging 

Infectious Diseases in the 

Americas

Global Health Security 

Partner Engagement: 

Expanding Efforts and 

Strategies to Protect and 

Improve Public Health 

Globally
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 49 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Disease Control and Prevention (CDC) through 

additional contracts and interagency agreements.

Tables 18 and 19 present information for each award as it was provided 

to us by CDC, as well as the activity funded.

Table 18: Centers for Disease Control and Prevention Zika Supplemental Funding Contracts by Awardee and Activity Funded

Awardee Activity funded

Award 

(in dollars)

AB Sciex Laboratory Capacity, Acceleration, Equipment 21,403.00 

ABT Associatesa Public Health Outreach and Control 10,658,187.99 

ABT Associatesb Public Health Emergency Preparedness (1,082,005.00)

Agilent Technologies Laboratory Capacity, Acceleration, Equipment 32,440.49 

Air Science USA Laboratory Capacity, Acceleration, Equipment 7,355.99 

Alivepromo, Inc Public Health Emergency Preparedness 728,736.08 

All Business Machines, Inc Laboratory Capacity, Acceleration, Equipment 66,823.20 

Altus Technical Solutions Laboratory Capacity, Acceleration, Equipment 108,000.00 

Amdex Corporation Public Health Emergency Preparedness 261,424.80 

American Toner & Ink Public Health Emergency Preparedness 3,827.25 

AP&G Co, Inc Vector Surveillance and Control 32,505.80 

Applied Medical Technologies, Inc. Laboratory Capacity, Acceleration, Equipment 7,889.16 

Aprisa Technology Vector Surveillance and Control 8,671.23 

Arist Medical Sciences University Laboratory Capacity, Acceleration, Equipment 52,800.00 

Aspen Commercial Group Vector Surveillance and Control;

Surveillance, Epidemiology, and Public Health Investigations

818,731.41 

Aspen Commercial Group Laboratory Capacity, Acceleration, Equipment 71,139.96 

Atlanta Biologicals Laboratory Capacity, Acceleration, Equipment 6,173.82 

AUS Marketing Research Systems, 

Inc.

Surveillance, Epidemiology, and Public Health Investigations 100,000.00 

Battelle Memorial Institute Laboratory Capacity, Acceleration, Equipment 187,952.00 

Becton, Dickson & Co.a Laboratory Capacity, Acceleration, Equipment 404,651.87 

BioAnalytical Instrumentsa Laboratory Capacity, Acceleration, Equipment 450,766.67 

BioAnalytical Instruments Surveillance, Epidemiology, and Public Health Investigations 25,200.00 

Biocare Medical Laboratory Capacity, Acceleration, Equipment 55,366.00 

Biocold Environmental, Inc Laboratory Capacity, Acceleration, Equipment 15,025.00 

Bio-Nuclear Laboratory Capacity, Acceleration, Equipment 149,951.19 

Bio-Rad Laboratories Laboratory Capacity, Acceleration, Equipment 24,950.00 

Bio-Rad Laboratories Vector Surveillance and Control 3,741.00

Appendix VIII: Centers for Disease Control 

and Prevention—Contracts and Interagency 

Agreements
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 50 GAO-18-389 Zika Supplemental Funding

Awardee Activity funded

Award 

(in dollars)

Biotek Instrumentsa Laboratory Capacity, Acceleration, Equipment 75,486.93 

Booz Allen Hamiltona Laboratory Capacity, Acceleration, Equipment 452,966.45 

Booz Allen Hamilton Public Health Emergency Preparedness 1,145,449.43 

Booz Allen Hamilton Vector Surveillance and Control 3,500.00 

Bruker Daltonics Laboratory Capacity, Acceleration, Equipment 20,281.00 

Caduceus Healthcarea Laboratory Capacity, Acceleration, Equipment 1,949,351.04 

Caduceus Healthcare Vector Surveillance and Control;

Laboratory Capacity, Acceleration, Equipment;

Public Health Outreach and Control

374,336.60 

Caduceus Healthcare, Inc Public Health Outreach and Control 249,956.60 

Caduceus Healthcare, Inc Laboratory Capacity, Acceleration, Equipment 483,573.33 

Canona Public Health Emergency Preparedness 69,526.24 

Carl Zeiss Microscopy, LLC Laboratory Capacity, Acceleration, Equipment 194,126.64 

Carter Consulting Surveillance, Epidemiology, and Public Health Investigations 120,497.00 

CDI Laboratories, Inc. Vector Surveillance and Control 16,800.00 

Certified Technical Expertsa Laboratory Capacity, Acceleration, Equipment 229,142.00 

Chenega Government Consulting, 

LLCa Laboratory Capacity, Acceleration, Equipment 132,902.62 

Chickasaw Health Consulting Public Health Emergency Preparedness 31,820.00 

Chickasaw Management Services, 

LLC

Public Health Outreach and Control 193,477.20 

CNI Advantage, LLCa Public Health Emergency Preparedness 2,068,011.79 

CNI Advantage, LLC Public Health Emergency Preparedness;

Surveillance, Epidemiology, and Public Health Investigations

89,403.31 

CNI Advantage, LLCa Surveillance, Epidemiology, and Public Health Investigations 7,893,052.52 

Communications Professionals, Inc. Vector Surveillance and Control 15,620.00 

Crimson Imaging Supplies, LLC Public Health Emergency Preparedness 11,073.34 

CTG Associates Public Health Emergency Preparedness 75,699.00 

Davis, James Public Health Emergency Preparedness 6,689.85 

Deloitte Consulting Surveillance, Epidemiology, and Public Health Investigations 1,381,711.80 

Diagger Scientific, Inc.a Laboratory Capacity, Acceleration, Equipment 21,687.00 

Digital Video Group, Inc Public Health Emergency Preparedness 96,389.90 

DOC Development, Inca Laboratory Capacity, Acceleration, Equipment 12,395.72 

Eagle Medical Services Public Health Emergency Preparedness;

Surveillance, Epidemiology, and Public Health Investigations

931,963.19

Eagle Medical Services Surveillance, Epidemiology, and Public Health Investigations 1,999,961.12

Elsevier Limited Laboratory Capacity, Acceleration, Equipment 5,000.00 
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 51 GAO-18-389 Zika Supplemental Funding

Awardee Activity funded

Award 

(in dollars)

EMD Millipore Corporation Laboratory Capacity, Acceleration, Equipment 22,972.80 

Entomological Society of America Vector Surveillance and Control 151,000.00 

Environmental Systems Research 

Institute

Public Health Emergency Preparedness 49,391.00 

Evolution Management, Inc Public Health Outreach and Control 300,526.00 

FedEx Public Health Emergency Preparedness 37,429.17 

Fisher Scientific Companya Laboratory Capacity, Acceleration, Equipment 306,124.39 

Fisher Scientific Company Surveillance, Epidemiology, and Public Health Investigations 16,669.48 

Fisher Scientific Company Vector Surveillance and Control 10,125.85 

Fitzgerald Industries International, 

Inc

Laboratory Capacity, Acceleration, Equipment 23,850.00 

G2S Corporation Public Health Emergency Preparedness 39,200.00 

G2S Corporation Public Health Emergency Preparedness;

Surveillance, Epidemiology, and Public Health Investigations

3,918,687.12 

G2S Corporationa Surveillance, Epidemiology, and Public Health Investigations 3,391,153.86 

G2S Corporation Vector Surveillance and Control 1,509,787.25 

GAP Solutions, Inc.a Public Health Emergency Preparedness 626,343.67 

GAP Solutions, Inc. Public Health Outreach and Control 60,408.00 

Gem Laser Express, Inc. Public Health Emergency Preparedness 16,136.82 

Geographic Mapping Technologies 

Corp.

Vector Surveillance and Control 14,850.00 

Georgia State University Research 

Foundation, Inc

Laboratory Capacity, Acceleration, Equipment 1,530,000.00 

Government Scientific Sourcea Laboratory Capacity, Acceleration, Equipment 212,643.83 

Helmer Scientific Laboratory Capacity, Acceleration, Equipment 11,679.85 

Hyclone Laboratories, Inc Laboratory Capacity, Acceleration, Equipment 2,716.36 

ICF Incorporateda Public Health Outreach and Control 2,304,697.14 

IHRC Laboratory Capacity, Acceleration, Equipment 1,356,070.32 

Illumina, Inca Laboratory Capacity, Acceleration, Equipment 101,132.07 

Illumina, Inc Public Health Emergency Preparedness;

Vector Surveillance and Control;

Public Health Outreach and Control

189,732.00

Impres Technology Solutions Surveillance, Epidemiology, and Public Health Investigations 59,675.94 

InBios Internationala Laboratory Capacity, Acceleration, Equipment 323,184.00 

InBios International Surveillance, Epidemiology, and Public Health Investigations 6,963.00 

InBios International Surveillance, Epidemiology, and Public Health Investigations;

Vector Surveillance and Control

18,731.00 

JC Gonzalez, Inc.a Vector Surveillance and Control 40,970.70 
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 52 GAO-18-389 Zika Supplemental Funding

Awardee Activity funded

Award 

(in dollars)

Johns Hopkins University Vector Surveillance and Control 500,000.00 

Karna Laboratory Capacity, Acceleration, Equipment 35,668.42 

Karna Public Health Emergency Preparedness 115,000.00 

Karnab Surveillance, Epidemiology, and Public Health Investigations (16,568.10)

Karna Surveillance, Epidemiology, and Public Health Investigations;

Public Health Outreach and Control

2,138,919.00

Leica Microsystems Laboratory Capacity, Acceleration, Equipment 34,442.52 

Leidos, Inc Surveillance, Epidemiology, and Public Health Investigations 621,000.00 

Life Technologies Corporationa Laboratory Capacity, Acceleration, Equipment 79,918.85 

Life Technologies Corporation Vector Surveillance and Control 45,776.40 

Lonza Walkersville, Inc. Laboratory Capacity, Acceleration, Equipment 6,483.30 

Luminex Corporation Laboratory Capacity, Acceleration, Equipment 28,086.80 

Madison Cloud IT Solutions, LLC Public Health Emergency Preparedness 14,471.06 

Mapbox Inc Public Health Emergency Preparedness 25,000.00 

McKing Consulting Corporation Surveillance, Epidemiology, and Public Health Investigations 894,403.64 

Microptics Service, Inc Laboratory Capacity, Acceleration, Equipment 6,384.35 

Molecular Devicesa Laboratory Capacity, Acceleration, Equipment 154,923.70 

Mosquito Mate Inc Vector Surveillance and Control 999,994.02 

Multisystems, Inc Laboratory Capacity, Acceleration, Equipment 10,031.80 

Nexcelom Bioscience Laboratory Capacity, Acceleration, Equipment 139,400.00 

Nightingale Corp Laboratory Capacity, Acceleration, Equipment 3,637.40 

Nikon Inca Laboratory Capacity, Acceleration, Equipment 150,978.71 

Northrop Grummana Public Health Outreach and Control 835,000.00 

Northrop Grumman Surveillance, Epidemiology, and Public Health Investigations 175,000.00 

Northrop Grummana Vector Surveillance and Control 729,436.00 

NuAire, Inc. Laboratory Capacity, Acceleration, Equipment 8,698.40 

OAG Aviation Worldwide LLC Public Health Outreach and Control 147,000.00 

Onset Computer Corporation Vector Surveillance and Control 4,500.00 

Pacific Biosciences of California Public Health Emergency Preparedness;

Laboratory Capacity, Acceleration, Equipment;

Vector Surveillance and Control;

Surveillance, Epidemiology, and Public Health Investigations

168,889.71 

Pacific Link International, Corpa Public Health Emergency Preparedness 34,374.00 

Panasonic Healthcare Corporation 

of North America

Laboratory Capacity, Acceleration, Equipment 9,334.00 

Premier & Companies Laboratory Capacity, Acceleration, Equipment 4,653.94 

P3S Corporation Laboratory Capacity, Acceleration, Equipment 115,000.00 
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 53 GAO-18-389 Zika Supplemental Funding

Awardee Activity funded

Award 

(in dollars)

Qiagen, Inca Laboratory Capacity, Acceleration, Equipment 175,958.27 

Red River Computer Co., Inc Laboratory Capacity, Acceleration, Equipment 2,473.19 

Rentokil North America, Inc Surveillance, Epidemiology, and Public Health Investigations;

Public Health Emergency Preparedness;

Public Health Outreach and Control;

Vector Surveillance and Control

1,382,575.00

Rentokil North America, Inca Vector Surveillance and Control 4,700,097.00 

Roche Diagnostics Corporationa Laboratory Capacity, Acceleration, Equipment 602,679.70 

Roche Diagnostics Corporationa Surveillance, Epidemiology, and Public Health Investigations 98,987.30 

RTI International Surveillance, Epidemiology, and Public Health Investigations 67,948.00 

Rumph & Associatesa Laboratory Capacity, Acceleration, Equipment;

Surveillance, Epidemiology, and Public Health Investigations

2,377,501.00 

SBC Technology Partners, Inc Public Health Emergency Preparedness 3,748.75 

SDL Government, Inc.a Public Health Outreach and Control 25,155.25 

Sheknows LLC Public Health Outreach and Control 15,000.00 

Siemens Healthcare Diagnosticsa Laboratory Capacity, Acceleration, Equipment 357,540.66 

Sigma-Aldrich Laboratory Capacity, Acceleration, Equipment 5,317.62 

Smith Travel Research, Inc Public Health Outreach and Control 4,950.00 

Southland Instruments, Inc. Laboratory Capacity, Acceleration, Equipment 10,909.00 

Springstara Vector Surveillance and Control 551,294.30 

SRA International Public Health Emergency Preparedness;

Public Health Outreach and Control;

Vector Surveillance and Control;

Laboratory Capacity, Acceleration, Equipment;

Surveillance, Epidemiology, and Public Health Investigations

500,000.00

SRA International Public Health Outreach and Control 1,344,852.00 

Steris Corporation Laboratory Capacity, Acceleration, Equipment 51,836.58 

Steris Corporationa Vector Surveillance and Control 52,586.58 

Strategic Communications, LLC Laboratory Capacity, Acceleration, Equipment 2,067.96 

Synergy Americaa Public Health Emergency Preparedness 203,000.00 

Synergy Group Public Health Emergency Preparedness 48,020.29 

Tanaq Government Services Public Health Outreach and Control 284,990.00 

Texas A&M Agrilife Research Vector Surveillance and Control 1,200,923.00 

The Cresston Company, LLC Public Health Outreach and Control 40,194.00 

Thermo Electron North America Public Health Outreach and Control 990,122.21 

Thomson Reuters (Scientific) LLC Public Health Outreach and Control 23,588.00 

Three Wire Systems, LLC Public Health Emergency Preparedness 1,970.00 
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 54 GAO-18-389 Zika Supplemental Funding

Awardee Activity funded

Award 

(in dollars)

Three Wire Systems, LLC Vector Surveillance and Control 19,339.77

Total Solutions Surveillance, Epidemiology, and Public Health Investigations 550,184.67

Total Solutions Surveillance, Epidemiology, and Public Health Investigations;

Laboratory Capacity, Acceleration, Equipment

1,001,674.00

Triad Technology Partners, LLC Public Health Outreach and Control 3,564.00 

TWD Tradewinds, Inc Laboratory Capacity, Acceleration, Equipment 145,569.00 

Unicom Surveillance, Epidemiology, and Public Health Investigations 140,158.00 

University of Arizona Vector Surveillance and Control 1,250,000.00 

University of New Mexico Vector Surveillance and Control 1,301,000.00 

University of North Carolina at 

Chapel Hill

Laboratory Capacity, Acceleration, Equipment 3,279,000.00 

Veterans4you Corporation Public Health Emergency Preparedness 3,620.00 

VWR International Laboratory Capacity, Acceleration, Equipment 84,490.13 

VWR International Vector Surveillance and Control 19,203.93 

Vysnova Surveillance, Epidemiology, and Public Health Investigations 7,281,151.00 

Westat, Inc Public Health Outreach and Control 94,026.00 

Wright Line, LLC Laboratory Capacity, Acceleration, Equipment 11,072.98 

3M Company Laboratory Capacity, Acceleration, Equipment 4,918.40 

Source: Centers for Disease Control and Prevention (CDC). | GAO-18-389

Note: Awards that included a change in the funding amount are reflected in the table, unless the 

change resulted in a zero balance. For example, CDC provided funding to one company, but later 

rescinded the same amount. Therefore, this award does not appear in the table as the resulting 

award is $0. CDC officials said that these types of actions are standard, particularly in an emergency 

situation when the needs of the response are rapidly evolving. Changes to awards can occur because 

there is a change in need for services, a vendor not having the needed items in stock, a reduction in 

the price of the contract, changes after the contract was awarded, and administrative corrections of a 

funding source.

a

This awardee received more than one award and funding amounts for awards for the same awardee 

and activity were added together in this table.

b

This awardee had funding that was rescinded. The rescinded funding was not combined with the 

awardee’s other awards because it was for a different activity.
Appendix VIII: Centers for Disease Control and 

Prevention—Contracts and Interagency 

Agreements

Page 55 GAO-18-389 Zika Supplemental Funding

Table 19: Centers for Disease Control and Prevention Zika Supplemental Funding 

Interagency Agreements by Awardee and Activity Funded

Awardee Activity funded

Award 

(in dollars)

BARDA Vector Control 9,000,000.00 

NIHa Laboratory Capacity, 

Acceleration, Equipment

450,000.00 

U.S. Department 

of Commerce

Public Health Outreach 

and Control

8,574.72 

U.S. Department 

of Energya Laboratory Capacity, Acceleration, Equipment

779,856.91

U.S. Department 

of Energya Public Health Emergency Preparedness

134,278.80

U.S. Department 

of Energya Surveillance, Epidemiology, and Public Health Investigations

821,452.78 

Verizon Business 

Services

Public Health Emergency 

Preparedness

112,000.00 

Source: Centers for Disease Control and Prevention (CDC). | GAO-18-389

Note: Awards that included a change in the funding amount are reflected in the table, unless the 

change resulted in a zero balance. For example, CDC provided $550,000 to the Health Resources 

and Services Administration, but later rescinded the same amount. Therefore, this award does not 

appear in the table as the resulting award is $0. CDC officials said that these types of actions are 

standard, particularly in an emergency situation when the needs of the response are rapidly evolving. 

Changes to awards can occur because there is a change in need for services, a vendor not having 

the needed items in stock, a reduction in the price of the contract, changes after the contract was 

awarded, and administrative corrections of a funding source.

a

This awardee received more than one award and funding amounts for awards for the same awardee 

and activity were added together in this table.
Appendix IX: Centers for Medicare & Medicaid 

Services—Zika Health Care Services Program 

Awards

Page 56 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Centers for Medicare & Medicaid Services (CMS) through 

the Zika Health Care Services Program. The Zika Health Care Services 

Program is aimed at supporting prevention activities and treatment 

services for women (including pregnant women), children, and men 

adversely or potentially affected by the Zika virus. According to CMS 

documentation, the Zika Health Care Service Program is intended to 

address four critical components of a comprehensive response to Zika:

1. Increase access to contraceptive services for women and men.

2. Increase access to and reduce barriers to diagnostic testing, 

screening, and counseling for pregnant women and newborns.

3. Increase access to appropriate specialized health care services for 

pregnant women, children born to mothers with maternal Zika virus 

infection, and their families.

4. Improve provider capacity and capability.

CMS awarded funding through the Zika Health Care Services Program, in 

two award rounds, to states, territories, tribes, or tribal organizations with 

active or local transmission of the Zika virus, as confirmed by the Centers 

for Disease Control and Prevention. In January 2017, CMS awarded 

funding to American Samoa, Florida, Puerto Rico, and the U.S. Virgin 

Islands. In June 2017, CMS awarded funding to Texas, the only new area 

with local transmission of the Zika virus. Table 20 presents the awards 

CMS made through its Zika Health Care Services Program.

Table 20: Centers for Medicare & Medicaid Services’ Zika Health Care Services Program Awardees

State/territory Awardee

Award 

Amount

American Samoa American Samoa Government Department of Health 1,791,000

Florida Florida Department of Health 2,991,000 

Puerto Rico Puerto Rico Department of Health 61,291,000 

Texas Texas Department of State Health Services 2,491,000 

U.S. Virgin Islands U.S. Virgin Islands Department of Health 2,791,000 

Source: Centers for Medicare & Medicaid Services. | GAO-18-389

Appendix IX: Centers for Medicare & 

Medicaid Services—Zika Health Care 

Services Program Awards
Appendix X: Health Resources and Services 

Administration’s Zika Supplemental Awards

Page 57 GAO-18-389 Zika Supplemental Funding

This appendix presents information on Zika supplemental funding awards 

made by the Health Resources and Services Administration (HRSA) to 

health centers and for Special Projects of Regional and National 

Significance.1

• Health centers: HRSA provided awards to health centers through 

supplemental grant awards to support existing health centers in 

Puerto Rico and other territories in their efforts to expand the delivery 

of health care services, including the prevention of Zika and 

prevention and treatment of Zika-related illness. HRSA also provided 

supplemental grant awards to existing Health Center Program 

cooperative agreement awardees for efforts to provide training and 

technical assistance for Zika-related health center expansion 

activities.

• Special Projects of Regional and National Significance: HRSA 

provided awards for Special Projects of Regional and National 

Significance to support public health departments and other entities in 

Puerto Rico and other territories in efforts to ensure access to 

recommended services for pregnant women, infants, and children 

infected by the Zika virus in the prenatal, perinatal, and neonatal 

period. Activities include early identification through developmental 

screening, regular assessments and monitoring, telemedicine, care 

coordination, enabling services, family engagement and family-tofamily support; purchasing of diagnostic equipment and health 

information technology; and the training of health care providers, care 

coordinators, and other health care and public health professionals to 

ensure delivery of comprehensive, interdisciplinary health and social 

services for this population.

Tables 21 and 22 present information for each award as it was provided 

to us by HRSA.

 1

HRSA also provided student loan repayment to qualified health professionals through the 

National Health Services Corps. We do not present this information by awardee in this 

appendix, as that data contains personal information.

Appendix X: Health Resources and Services 

Administration’s Zika Supplemental Awards
Appendix X: Health Resources and Services 

Administration’s Zika Supplemental Awards

Page 58 GAO-18-389 Zika Supplemental Funding

Table 21: Health Resources and Services Administration Zika Supplemental Funding for Health Centers by Awardee 

State/territory Awardee

Award 

(in dollars)

American Samoa American Samoa Government Dept of Health 2,336,253 

Hawaii Pacific Islands Primary Care Association 250,000 

Puerto Rico Asociacian de Salud Primaria de Puerto Rico, Inc 750,000 

Puerto Rico Municipality of San Juan (HOMIS) 1,058,362 

Puerto Rico Consejo de Salud de Puerto Rico, Inc. 2,556,580 

Puerto Rico Centro de Servicios Primarios de Salud Inc 1,555,327 

Puerto Rico Concilio de Salud Integral de Loiza, Inc 1,577,352 

Puerto Rico Centro de Salud Familiar (PALMIERI) 1,563,775 

Puerto Rico Corporacion de Servicos Medicos Primarios y Prevencion de Hatillo 1,895,792 

Puerto Rico Centro de Salud de Lares, Inc. 1,668,179 

Puerto Rico Castaner General Hospital 1,428,258 

Puerto Rico Costa Salud Community Health Centers Inc 1,517,755 

Puerto Rico Corporacion de Servicios de Salud y Medicina Avanzada - COSSMA 1,938,143 

Puerto Rico Morovis Community Health Center, Inc. 1,482,153 

Puerto Rico Barceloneta Primary Health Services, Inc. 1,540,884 

Puerto Rico Camuy Health Services, Inc. 1,542,118 

Puerto Rico Salud Integral en la Montana, Inc. 2,089,258 

Puerto Rico Migrant Health Center, Western Region, Inc. 1,821,303 

Puerto Rico NeoMed Center Inc 2,285,262 

Puerto Rico HPM Foundation, Inc. 1,590,023 

Puerto Rico PryMed Medical Care, Inc. 1,532,746 

Puerto Rico Patillas Community Governing Board 1,868,331 

Puerto Rico Corporacion SANOS 1,266,725 

U.S. Virgin Islands Frederiksted Health Care Inc. 1,459,507 

U.S. Virgin Islands St. Thomas East End Medical Center Corporation 1,425,914 

Source: Health Resources and Services Administration. | GAO-18-389

Note: The Zika Response and Preparedness Act required that $40 million be used to expand the 

delivery of primary health services in Puerto Rico and other territories. According to officials from the 

Health Resources and Services Administration, the Pacific Islands Primary Care Association in 

Hawaii was funded to support health centers within the Pacific Basin based on their Zika-related 

needs.
Appendix X: Health Resources and Services 

Administration’s Zika Supplemental Awards

Page 59 GAO-18-389 Zika Supplemental Funding

Table 22: Health Resources and Services Administration Zika Supplemental Funding for Special Projects of Regional and 

National Significance by Awardee 

State/territory Awardee

Award 

(in dollars)

American Samoa Dept of Healtha 923,142

California Children’s Hospital of Los Angeles 333,333 

Florida University of Miami 333,333 

Illinois American Academy of Pediatrics 250,000 

Indiana Indiana University 333,333 

New Mexico Family Voices, Inc 250,000 

Puerto Rico Parents Training Parents 150,000 

Puerto Rico Puerto Rico Department of Healtha 16,202,850

U.S. Virgin Islands Virgin Islands Advocacy, Inc 150,000 

U.S. Virgin Islands Virgin Islands Department of Health Groupa 1,074,008

Source: Health Resources and Services Administration. | GAO-18-389

Note: The Zika Response and Preparedness Act required that $20 million be awarded for projects of 

regional and national significance in Puerto Rico and other territories. The projects located in 

California, Florida, Illinois, Indiana, and New Mexico focus on the territories.

a

This awardee received more than one award and funding amounts for these awards were added 

together in this table.
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 60 GAO-18-389 Zika Supplemental Funding

The National Institutes of Health (NIH) awarded Zika supplemental 

funding to support research to better understand Zika and its 

complications, and inform the development of new interventions. The 

three primary activities of funding include (1) vaccine development; (2) 

Zika in Infants and Pregnancy study; and (3) diagnostics, therapeutics, 

vector control, and other interventions.1 NIH used contracts, grants, 

intramural research awards, and other awards to provide funding for 

research on the Zika virus and its complications.

Tables 23-26 present information for each award as it was provided to us 

by NIH.

Table 23: National Institutes of Health’s Zika Supplemental Funding Contracts 

Awardee Activity description

Award 

(in dollars)

Advanced Bioscience Laboratories Support the production and development of a recombinant 

subunit vaccine consisting of a portion of the Zika virus 

envelope protein developed by Hawaii Biotech.

455,190.00 

Advanced Bioscience Laboratories PCSs to develop a vaccine production master cell bank for 

MVA-CHIK/Zika vaccine (Sementis).

445,190.00 

American Type Culture Collection Reagent purchases to support ZIP studies in various 

countries.

1,370,000.00 

Battelle Support the development of virus neutralizing assay for the 

assessment of Zika Vaccines.

880,000.00 

Baylor College of Medicine Conduct an epidemiological trial in Guatemala to study the 

prevalence of microcephaly in a newborn population, viral 

transmission of Zika and to follow patients diagnosed with 

ZIKV infection for the development of neurologic 

manifestations of disease. 

5,702,861.00 

Deloitte Consulting LLP Enhance the U.S. Government’s partners’ (NIH, BARDA, 

CDC, WRAIR (DoD) and FDA) capabilities in developing 

vaccine candidates and advancing the most promising to 

licensure. The ultimate objective is to accelerate the process 

and reduce costs, not only for Zika but for other vaccines for 

emerging or reemerging vector borne infectious diseases.

64,589.70 

Emory University - Vaccine Trial 

and Evaluation Units (VTEU)

To Support study of U.S. travelers infected with Zika virus 

while abroad.

980,000.00 

Emory University Support T-cell assays of samples from 16-0033/34 trials to 

assess vaccine response.

258,122.01 

 1

The Zika in Infants and Pregnancy study aims to improve understanding of the health 

effects of Zika virus infection in pregnant women and infants by following 10,000 pregnant 

women for the duration of their pregnancies and their infants at several intervals for at 

least one year after birth.

Appendix XI: National Institutes of Health 

Zika Supplemental Awards
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 61 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

Saint Louis University - Vaccine Trial 

and Evaluation Units (VTEU)

Support Phase 1 ZPIV Clinical Trials. 2,479,304.00 

Southern Research Institute Support the testing of vaccine candidates against Zika virus 

infection in the Indian Rhesus macaque model.

1,319,631.00 

Southern Research Institute Southern Research Institute to manufacture and test 

monoclonal antibody and synthetic compounds as 

therapeutics against Zika infection.

400,000.00 

St. Jude Children’s Research Hospital To continue support the Zika in Infants and Pregnancy (ZIP) 

study in Colombia.

962,066.00 

The Emmes Corporation Data management and support for clinical studies with 

NIAID developed Inactivated Zika Vaccine.

3,000,000.00 

University of Alabama at Birmingham Support the Zika in Infants and Pregnancy (ZIP) study in 

Peru.

997,527.00 

Source: National Institutes of Health. | GAO-18-389

Table 24: National Institutes of Health’s Zika Supplemental Funding Grants 

Awardee Activity description

Award 

(in dollars)

Beth Israel Deaconess Medical Center To support the development of Biocryst drug (BCX4430) against Zika 

virus.

599,666

Boston University Medical Campus Study effects of pre-existing dengue virus immunity on Zika virus 

infection.

246,750

Boston University Medical Campus Study innate placental defense against Zika infection. 258,196

Colorado State University Study how different cells contribute to sexual and mosquito transmission 

of Zika.

227,250

Colorado State University Predicting genetic determinants of Zika virus emergence. 227,875

Colorado State University Support the study of Zika virus urogenital tropism, pathogenesis and 

sexual transmission.

211,838

Colorado State University Support the development of a rapid assay for Zika virus in biofluids and 

insect vectors.

222,546

Colorado State University Study virus-host interactions and mechanisms of viral pathogenesis 

which will provide insights to identify novel targets for antiviral drug 

development or virus attenuation for vaccine production. 

222,436

Columbia University Health Sciences Support the development of point of care molecular diagnostics 

differentiating Zika virus from other arbovirus.

434,850

Duke University Support the Generation of Zika virus-specific recombinant antibodies for 

the development of Zika Assays.

198,750

Duke University Study Zika virus infections related birth defects in pregnant rabbit 

models.

235,406

Emory University Continue study of Dengue-Zika cross reactivity in vaccine development. 286,546
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 62 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

Emory University Support the repurposing of drugs to prevent and inhibit Zika virus 

inflections.

234,000

Fred Hutchinson Cancer Research Center Supplement to develop novel designs and methods of analysis for 

upcoming Zika vaccine trials.

99,635

Fundacao Oswaldo Cruz Continue support natural history study (ZIP) study in pregnant women in 

Brazil.

1,322,941

George Washington University Examine genes participating in innate immune response to ZIKV and 

identify and characterize effector mechanisms involved in controlling 

ZIKV.

8,576

Georgia Institute of Technology To develop Zika Virus Vaccines based on Nanoscale Constructs 

Presenting the Envelope Protein.

250,187

Harvard Medical School Development of small molecule inhibitors against enveloped virus entry 

as potential Zika therapeutics.

500,867

Harvard Medical School Manufacture a VSV vaccine for efficacy studies in mice and NHPs. 

Conduct efficacy studies in mice against lethal challenge and congenital 

disease. 

299,999

Icahn School of Medicine at Mount Sinai To study the infection mechanism of Zika virus. 254,250

Icahn School of Medicine at Mount Sinai Study host determinants in resistance to Zika virus infection. 254,250

Infectious Disease Research Institute Development of an Innovative, Effective, RNA-based Vaccine for Zika 

Virus.

178,600

JHU To construct a protein-protein interaction (PPI) network between the Zika 

virus (ZIKV) and the human proteome in order to identify host proteins 

that play roles in ZIKV life cycle. 

245,282

Johns Hopkins University Methods for Reducing Spatial Uncertainty and Bias in Zika Disease 

Surveillance.

938,706

Johns Hopkins University Development of novel Zika vaccine platform using virus-derived 

chemokine-like molecules.

286,125

Mayo Clinic Rochester Development of mucosal Single-Cycle Vaccines against Zika Virus. 198,750

Mount Sinai School of Medicine Study the enhancement of Zika virus infection caused by antibodies to 

West Nile virus.

252,993

Mount Sinai School of Medicine Study Zika virus envelop protein mutations. 274,277

New York State Univ Support Structure-based Design of Zika Virus Inhibitors Targeting 

Envelope Glycoprotein.

199,089

New York State University, Stony Brook Study of Zika virus pathogenesis in endothelial cells. 235,543

Nirmidas Biotech, Inc. Develop a Nanoscale Plasmonic-Gold diagnostic platform to differentiate 

Zika virus infection from other Flavivirus infections.

190,525

Ohio State University Develop plant-derived, resistance-breaking mosquitocides. 193,125

Oregon Health & Science University Determining the role of host lipids in Zika virus infection. 231,000

Pennsylvania State University-Univ Park To investigate the potential role of native and introduced mosquito taxa 

in the United States to mediate Zika virus invasion and transmission.

235,800

Purdue University To Study the structure of the Zika virus epitope involved in virus 

neutralization, which will improve the design of Zika vaccines.

373,831
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 63 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

Research Triangle Institute Continue clinical data center support for the ZIP studies. 400,000

Rockefeller University Continued development of a therapeutic mAb for Zika virus. This 

supplement focuses on developing an expression cell line and evaluating 

mAb in NHPs.

699,999

South Dakota State Develop a Zika virus capsid dimerization assay that will be the platform 

to screen libraries for inhibitors of Zika virus infection. 

179,239

Stanford University Support Nucleotide library (Roche) screening for potential antiviral 

activity against Zika.

305,080

Stanford University Study the diagnostic signatures of Zika virus infection. 219,762

State University of New York at Albany Study the role of Post-transcription RNA Modifications on Zika Virus 

Gene Expression.

226,813

Texas A&M Agrilife Research Study social-ecological factors influencing receptivity to Zika virus and 

the efficacy of interventions in communities along the Texas-Mexico 

border.

222,750

Texas Tech University Health SCIS 

Center 

To study Zika virus infection in individuals previously exposed to West 

Nile Virus.

191,250

Texas Tech University Health SCIS 

Center

Identify ZIKV host factors with an improved CRISPR-based genomewide knockout screen.191,250

UC Davis Develop a novel platform for rapid generation of therapeutic and 

prophylactic antibody against Zika virus, by site-specific ligation of the 

virus-capturing ligands to clinical grade intravenous-immunoglobulins. 

196,250

University of Alabama at Birmingham Support the development of high throughput screening (HTS) against 

ZIKV, using approach developed for screening Dengue.

157,657

University of Alabama at Birmingham Support the study of Zika virus in semen, as part of ZIP study in Brazil. 457,241

University of California at Davis Imaging and study of trafficking of Neurotropic Virus in Maternal/Fetal 

Nonhuman Primates.

193,000

University of California San Diego To study Zika Virus Pathogenesis and Selective Autophagy Induction to 

Inhibit Virus Production.

232,500

University of California, Berkeley Continue operations of the Zika in Infants and Pregnancy (ZIP) study in 

Nicaragua.

830,000

University of California, Davis Supplement Zika natural history study in Peru, including simulation 

models to systematic assess different strategies for controlling and 

mitigating ZIKV disease burden.

356,436

University of California, Davis Develop a nonhuman primate model of fetal Zika virus infection and 

disease.

308,800

University of California, Davis Support the development of Zika fetal infection models in non-human 

primate (Rhesus macaque) for therapeutic testing.

1,478,154

University of California, Davis To study the potential of Culex quinquefasciatus as a vector of the Zika 

virus.

171,750

University of California, Los Angel Study the viral kinetics, immunity and transmission of Zika Virus. 201,907

University of California, San Francisco Support the identification of diagnostic and prognostic biomarkers for 

Zika infection. 

198,125

University of California, San Francisco Study the role of Zika infection in human pregnancy. 197,523
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 64 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

University of California, San Francisco Support the study of maternal and fetal cell receptors susceptible to Zika 

infection and geographical virulence.

397,293

University of California, San Francisco To study antiviral immunity in the Zika virus mosquito vector. 237,750

University of Colorado, Denvera To continue support the Zika in Infants and Pregnancy (ZIP) study in 

Guatemala.

589,999

University of Colorado, Denver Study noncoding RNA production in Zika virus infection. 229,125

University of Connecticut Storrs To support the rapid development and testing of Zika virus vaccine 

candidates.

192,254

University of Hawaii at Manoa Study the modulation of the blood-testis barrier by Zika virus. 231,000

University of Kentucky Develop novel formulations of double-stranded RNA molecules as tool to 

further study RNA interference (RNAi) as potential vector control.

210,000

University of Maryland Baltimore Rapid Phenotyping of the ZIKV Genome. 231,750

University of Miami School of Medicine Continue support effort to develop point-of-care Zika diagnostic. 167,617

University of Michigan To elucidate the molecular mechanisms of the flaviviral nonstructural 

protein 1 (NS1), a multi-functional virulence protein. 

673,901

University of North Carolina Chapel Hill Support the development and testing of nanoparticle planform for 

vaccine and adjuvant delivery.

529,300

University of North Carolina Chapel Hill Study Zika virus in the human genital tract and implications for 

transmission.

207,868

University of North Carolina Chapel Hill Study viral and host determinants of Zika virus tissue tropism. 228,000

University of North Carolina Chapel Hill Structure based design of recombinant Zika virus antigens for 

serodiagnosis.

233,250

University of North Texas Hlth Sci Ctr Prevention of Zika transmission with novel Aedes personal protective 

measures.

276,530

University of Oklahoma Hlth Sciences Ctr Support development of olive baboon animal model for the study of Zika 

virus biology and pathogenesis.

222,000

University of Pennsylvania Support the study of host factors impacting Zika infection via genetic 

screening.

235,388

University of Pennsylvania To study mechanisms of Zika virus infection and anti-viral innate 

immunity.

40,240

University of Pittsburgh at Pittsburgh Support the development of a Novel, Sensitive ZIKV-Specific Serodiagnostic Assay Utilizing Biologically Inspired Synthetic Molecules.703,978

University of Pittsburgh at Pittsburgh Pre-clinical evaluation of a Zika virus vaccine. 193,332

University of Puerto Rico Med Sciences To continue support the Zika in Infants and Pregnancy (ZIP) study in 

Puerto Rico.

830,284

University of Rochester Support the study of Single-cycle infectious Zika viruses for the 

development of a live-attenuated vaccine.

180,457

University of Southern California To study the role autophagy for Zika virus lifecycle. 247,500

University of Texas To understand the mechanisms that mediate Zika virus replication in 

specific tissues by manipulating the host ubiquitin system, and identify 

host factors that can potentially be targeted for therapeutic intervention. 

193,750
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 65 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

University of Texas Med Br Galveston Preclinical development of candidate Zika virus vaccines using mouse 

models.

196,250

University of Texas Med Br Galveston To study microbial interplay between ZIKA virus and the native 

microbiome in mosquitoes.

235,500

University of Texas Medical Br Galveston Develop a novel system using human fetal brain neural stem cell to 

model ZIKV infection.

228,650

University of Texas Medical Br Galveston Develop second generation platforms to deliver zika vaccines, and 

characterize newly collected zika virus strains in tissue culture, mosquito 

vectors and animal models for transmission and pathogenesis. 

163,282

University of Washington Support the development of a rapid and specific diagnostic for 

immunoglobulin response to Zika Virus exposure.

188,696

University of Washington Study mechanisms of sexual Zika virus transmission and early 

immunopathogenesis.

232,063

University of Washington Targeting Zika Virus infection with Chloroquine and related Drugs. 232,625

University of Wisconsin To support the study of Zika virus using systems biology to better 

understand the host-pathogen response.

190,106

University of Wisconsin To study evolution of biological transmission for ZIKV including 

determining whether or not Wolbachia biocontrol is a sustainable method 

for ZIKV control and prevention.

229,500

University of Wisconsin Examine the impact of DENV immunity on pregnancy in ZIKV infected 

rhesus macaques.

753,026

University of Wisconsin Define South American Zika virus susceptibility and pathogenicity in 

adult and neonatal nonhuman primates, and testing of hyperimmune 

sera as potential Zika therapeutic.

1,569,399

University of Wisconsin-Madison To perform functional analysis of Zika virus induced birth defects. 229,500

University of Wisconsin-Madison Development of nonhuman Primate Model to Assess Fetal Zika Virus 

Infection Complications.

221,550

UTMB Accelerate development and acquisition of reagents (cDNA clone, 

serum, antibodies), small animal model development and 

characterization of virus and mosquito vectors for Zika research.

499,999

Vanderbilt Universitya Support efforts to establish a stable cell line for the optimized production 

of human monoclonal antibody-based prophylaxis.

1,327,897

Wadsworth Center Study the efficiency of repurposed therapeutics against Flavivirus in 

mouse models.

238,240

Wadsworth Center Study the efficiency of repurposed therapeutics against Zika. 235,470

Wadsworth Center Develop a high throughput screen assay for the identification of 

orthosteric inhibitors of the critical viral protease consisting of NS2B and 

NS3 proteins of flaviviruses. As the NS2B-NS3 interactive segments are 

conserved, an inhibitor would have a broad spectrum of antiviral activity. 

523,552

Wadsworth Center Identifying genetic correlates of Zika virus infection and transmission in 

U.S. mosquitoes.

181,504

Washington University in St. Louis Development of Zika vaccine in gorilla adenovirus platform. 190,625
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 66 GAO-18-389 Zika Supplemental Funding

Awardee Activity description

Award 

(in dollars)

Washington University in St. Louis Support the development of mAb that can discriminate between Zika and 

Dengue virus.

530,000

Weill Medical Coll of Cornell Univ Mapping the RNA modification N6-methyladenosine during Zika virus 

infection.

263,750

Yale University Continue studies of Aedes aegypti and Aedes albopictus as Zika virus 

vector.

252,460

Yale University Study mechanisms of innate host defense against sexual Zika virus 

transmission.

251,250

Yale University Support the Zika in Infants and Pregnancy (ZIP) study in Brazil. 891,134

Yale University Support neurological evaluation in adults in Salvador, Brazil as part of 

the ZIP study.

315,063

Source: National Institutes of Health. | GAO-18-389

a

These awardees received more than one award and funding amounts for awards for the same 

awardee and activity were added together in this table.

Table 25: National Institutes of Health’s Zika Supplemental Funding Intramural Awards

Awardee Activity description

Award 

(in dollars)

Battelle To perform PCR testing of clinical studies to evaluate 

vaccine efficacy.

8,135,441.00

Bioqual Conduct preclinical studies of Zika vaccine in nonhuman 

primate models.

1,464,000.00

Johns Hopkins University Conduct clinical evaluation and data management of NIAID 

DIR developed Dengue-Zika Chimera Vaccine studies in 

normal and immunocompromised adults.

4,099,000.00

Leidos Biomedical Research, Inc. To conduct clinical trials for NIAID VRC developed DNA 

Vaccine.

48,635,750.00

Leidos Biomedical Research, Inc. Manufacturing and clinical evaluation of NIAID DIR 

developed live attenuated Dengue-Zika Chimera Vaccine in 

Brazil.

11,664,304.09

The Emmes Corporation To provide clinical data management and monitoring 

support for phase 2 DNA Vaccine studies.

11,390,893.00

Various Labor, material, and supplies to support the preclinical 

development and testing of Zika vaccines at NIAID 

intramural laboratories.

9,593,809.09

Source: National Institutes of Health. | GAO-18-389
Appendix XI: National Institutes of Health Zika 

Supplemental Awards

Page 67 GAO-18-389 Zika Supplemental Funding

Table 26: Other National Institutes of Health Zika Supplemental Funding Awards

Awardee Activity description

Award 

(in dollars)

AI Biosciences, Inc. Support the development of rapid and low-cost point-ofcare assay for Zika virus diagnosis.224,955

Crosslife Technologies, Inc. Development of a rapid paper strip nucleic acid test for the 

point-of-care detection of Zika virus.

299,574

L2 Diagnostics, LLC Support the development of rapid, low-cost point of care 

diagnostic for detection of Zika virus RNA.

225,000

Springstar, Inc. To modify the CDC autocidal gravid ovitrap (AGO) into a 

design amenable to large-scale, low cost production for 

development of improved vector control strategies.

618, 531

United States Dept. of Agriculture Zika workshop support in collaboration with USDAScientific consultation on Zika Virus Vaccine Development.75,000

United States Dept. of Agriculture Zika workshop support in collaboration with USDAConsultation on the Ethics of ZikV Human Challenge Trials.75,000

University of Oxford, The Printing of Zika-specific supplement in the JOURNAL OF 

INFECTIOUS DISEASES to disseminate research findings.

83,250

Source: National Institutes of Health. | GAO-18-389
Appendix XII: GAO Contact and Staff 

Acknowledgments

Page 68 GAO-18-389 Zika Supplemental Funding

Marcia Crosse, (202) 512-7114, crossem@gao.gov

In addition to the contact named above, Karen Doran (Assistant Director), 

Sarah Resavy (Analyst-in-Charge), and Hannah Grow made key 

contributions to this report. Also contributing were Muriel Brown, Christine 

Davis, and Drew Long.

Appendix XII: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments

(101928)
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