From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Federal Response to COVID-19 Challenged by Ongoing
Supply Shortages, Vaccine Distribution Delays

Description: U.S. COVID-related infections and deaths set alarming
records in January, which further drew attention to delays in
coronavirus-vaccine efforts and a need for better planning to address
this evolving public health and economic crisis. Here at GAO, we've been
monitoring and reviewing the federal response to COVID-19, and are
issuing bimonthly reports that--among things--identify opportunities for
the federal government to improve its response and prepare for future
challenges. We talk with 3 GAO experts about our latest report. 

Related GAO Work: GAO-21-265, COVID-19: Critical Vaccine Distribution,
Supply Chain, Program Integrity, and Other Challenges Require Focused
Federal Attention

Released: January 2021 

[Intro music:]

[Nikki Clowers:] Today's report offers a number of opportunities for the
government to improve its ongoing response and recovery efforts.

[Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for
news and information from the U.S. Government Accountability
Office--celebrating 100 years of fact-based, non-partisan government
oversight. I'm Holly Hobbs.

U.S. COVID-related infections and deaths set alarming records in
January, which further drew attention to delays in coronavirus-vaccine
efforts and a need for better planning to address this evolving public
health and economic crisis. Here at GAO, we've been monitoring and
reviewing the federal response to COVID-19, and are issuing bimonthly
reports that--among things--identify opportunities for the federal
government to improve its response and prepare for future challenges.
Today, we talk with 3 GAO experts about our latest report. Joining us
are Nikki Clowers, the Managing Director of our Health Care Team; Tom
Costa, an acting director in our Education, Workforce and Income
Security Team; and Bill Shear, a director in our Financial Markets and
Community Investment Team. Thank you all for joining us!

[Nikki Clowers:] Thank you for having me, Holly.

[Tom Costa:] Thanks for having me, Holly.

[Bill Shear:] Thank you, Holly.

[Holly Hobbs:] So Nikki, let's start with questions on the government's
response as a health crisis. The COVID vaccine rollout has not met
public expectation. Operation Warp Speed--which is the government's
program for developing vaccines quickly--had a goal of producing 300
million vaccine doses, but fell significantly short of that goal. 
What's delaying distribution and use of vaccines? 

[Nikki Clowers:] First, I think we need to acknowledge the record time
that Operation Warp Speed and its partners achieved in developing
multiple vaccines. But as you noted, the rate of vaccination has fallen
quite short of the goal. And the problems, they really center around the
last mile--that is, getting the vaccine distributed and into the arms of
Americans. And this is challenging task because it involves multiple
players from all levels of government as well as the private and
non-public sectors in some cases. And this is why we had called for the
government--back in late summer--to ensure good communication and
coordination States need more visibility over how much vaccine they can
expect and when they'll be receiving it. Providers need communication in
terms of what their role is to be. And there's also a public health
campaign that's needed to educate and reassure Americans about taking
vaccines. This communication really does need to be ongoing, routine,
and very consistent. 

[Holly Hobbs:] And, for those who haven't had the vaccines, testing
remains important for controlling the spread of the virus, right? What
is the status of the federal effort to develop a national testing
strategy?

[Nikki Clowers:] The former administration did provide some strategic
documents on testing, but they were not comprehensive. They did not
include the elements that I just talked about. And they were not made
publicly available. As a result, some of the stakeholders were confused
about their roles. The new administration recently released new pandemic
strategies and plans. We are in the process of reviewing those plans and
we'll report our assessment of them in future reporting.

[Holly Hobbs:] Nikki, it feels like we have spent almost a year talking
about critical medical supply shortages. What supplies are still hard to
come by, and what could the federal government do to rectify these
shortages?

[Nikki Clowers:] You're right Holly. We have been talking about
shortages for a long time now. And there's been some shortages that have
persisted and some new shortages have emerged. If you remember early on,
it was ventilators. And then there was a shortage of PPE and gloves. And
then there was a shortage of testing supplies. And now we're hearing
about shortages of certain components needed for vaccine development and
distribution. Some of this was quite predictable and there was a warning
sign from our past experiences with pandemics or other outbreaks. And
that's why this summer, we immediately called for HHS to develop a plan
for addressing these shortages. To date, these recommendations have not
been fully implemented. 

[Holly Hobbs:] So what are we recommending in our new report?

[Nikki Clowers:] We continue to track these issues and make an
additional recommendation. The Department (of Health and Human Services)
has taken some steps to start to develop a plan to examine the medical
supply chain and for ways to strengthen that supply chain, but we think
they really need to be engaging their non-federal partners and Congress
more in doing so. 

[Holly Hobbs:] And so, some communities are getting hit harder by the
pandemic--for example Los Angeles has been in the news lately. Do we
know if or how the federal government is prioritizing health resources
to help those communities? 

[Nikki Clowers:] The federal government has tried to be more agile in
responding to certain areas or the emerging risk. But one key barrier in
doing so is the lack of standardized data. The health care system is
very fragmented in the United States. At the federal level, there's
multiple federal agencies that can be involved in the health care system
and the collection of data. The same is true, there's multiple entities
at the state and local level. And then, of course, you have the private
sector. So there's a lack of comprehensive information. And as a result,
each entity or level of government may be collecting information in a
different way or using different definitions. And so this really creates
a problem in trying to assess trends of the pandemic, to make
comparisons across states, regions, or even populations, and then to
take the appropriate and quick action. And so we make a recommendation
in this report that HHS immediately bring together a group of experts to
help them determine how to align the data collection and reporting
standards. 

[Holly Hobbs:] OK Tom, we've heard from Nikki about important
recommendations for promoting comprehensive planning to ensure a faster,
more efficient response to the health crisis. Your team looked the risks
to Americans in their workplaces. Specifically you looked at how the
Occupational Safety and Health Administration, or OSHA, is protecting
workers. What can you tell us?

[Tom Costa:] Worker safety has been a really big issue during the
pandemic, especially for those workers who don't have the option to
telework. OSHA receives complaints and referrals of workplace hazards
including COVID-related ones from workers and other sources. And during
the pandemic month of February through December, OSHA received almost
13,000 of these COVID-related complain and referrals. OSHA also requires
employers to report on work-related fatalities and severe injuries and
illnesses, including hospitalizations, and tracks which of these are
related to COVID.

[Holly Hobbs:] And how many reports did OSHA get in 2020? 

[Tom Costa:] OSHA received over 900 fatality reports and over 1,700
hospitalization reports related to COVID.

[Holly Hobbs:] And how reliable are these reports?  

[Tom Costa:] Well, we found that OSHA doesn't have complete data to
inform its enforcement efforts. OSHA's regulations only require
employers to report hospitalizations that occur within 24 hours of a
worker being exposed to the virus. But COVID's symptoms don't appear for
2 to 14 days until after exposure. So employers are essentially not
required to report these hospitalization. And given the virus's
incubation period and other potential ways that workers could be
exposed, it's also really difficult for employers to determine which
COVID hospitalizations and fatalities are actually work-related. And as
a result, OSHA is missing critical information, which it could use to
inform its enforcement efforts and help keep workers safe. 

[Holly Hobbs:] Did we make any recommendations to OSHA to help improve
its oversight? 

[Tom Costa:] Yeah, we did. We recommended that OSHA determine what
additional information it needs to better target its enforcement efforts
and protect workers from COVID. For example, OSHA could explore using
public health data to identify industries or locations experiencing high
rates of COVID. We also took a look at how OSHA adapted its enforcement
methods during the pandemic. Because of resource constraints and safety
concerns for inspectors, OSHA started remotely inspecting some
workplaces instead of doing so in person. And while we understand the
needs for OSHA to adapt enforcement methods during challenging times,
OSHA hasn't been fully tracking its use of the adapted enforcement
methods or what it needs to do in order to follow through on its own
oversight plan. So, we're making two recommendations--that OSHA develop
a plan to implement the oversight processes it's already developed and
that OSHA make sure its data systems are catching the agencies use of
its methods so it's ready to perform its oversight when it's able to do
so. 

[Holly Hobbs:] Bill we've talked about the health risks of COVID and the
government's response. Now let's turn to the economy. Congress approved
the use of loans and grants to help small businesses and non-profits
affected by the pandemic under the Small Business Administration's
Economic Injury Disaster Loan Program. But there have been concerns
about payments to ineligible businesses and fraud. What can you tell us
about this? 

[Bill Shear:] Holly, SBA's Inspector General has found extensive
evidence of loans and grants going to potentially ineligible businesses.
The FBI is also heavily involved in investigating potential fraud. In
addition, we found that many loans and grants went to potentially
ineligible businesses--such as adult entertainment and casino gambling.
Finally, hundreds of financial institutions have filed thousands of
suspicious activity reports related to the program with the Financial
Crimes Enforcement Network.

[Holly Hobbs:] What is SBA doing to prevent payments from going to
ineligible or fraudulent businesses?

[Bill Shear:] SBA has contractors conducting automated reviews, followed
up with manual reviews conducted by its loan officers to identify
applicants submitting information that raises eligibility concerns. We
continue to seek information from SBA to determine how robust the
oversight is. 

[Holly Hobbs:] So Bill, did we make any recommendations to SBA?

[Bill Shear:] Yes we did. Data analytics is used to identify potentially
fraudulent activity. We are recommending that SBA develop and implement
data analytics across loans and grants made in response to COVID-19.

[Holly Hobbs:] So Nikki, last question--what's the bottom line of this
report? 

[Nikki Clowers:]  Today's report offers a number of opportunities for
the government to improve its ongoing response and recovery efforts. We
urge the new Congress and the new administration as they are setting
their priorities for the coming year to swiftly act on today's
recommendations that we're making, as well as our past recommendations
from our previous reports.

[Holly Hobbs:] That was GAO's Nikki Clowers, Tom Costa, and Bill Shear
talking about our newest report on the federal-response to COVID-19.
Thank you all for your time! 

[Nikki Clowers:] Thank you for having me, Holly.

[Tom Costa:] Thanks so much for having me, Holly.

[Bill Shear:] Thank you, Holly. It's been a pleasure.

[Holly Hobbs:] And thank YOU for listening to the Watchdog Report. To
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