gao-Public Health Preparedness - HHS Reserve Funding for Emergencies-此為英文文檔

GAO-23-106102

UnitedStatesGovernmentAccountabilityOffice

ReporttoCongressionalCommittees

August2023

PUBLICHEALTHPREPAREDNESS

HHSReserve

Fundingfor

Emergencies

Highlightsof

GAO-23-106102

,areporttocongressionalcommittees

WhyGAODidThisStudy

Publichealthcanbeatsignificantriskduringemergencies,likeapandemicorhurricane.Stateandlocalgovernmentstypicallyleadthedomesticresponsetoapublichealthemergency.However,iftheircapabilitiesareoverwhelmed,HHSmayprovideadditionalsupport.Torespondimmediatelytosuchemergencies,HHShastworeservefundsdesignedtoholdfundingovermultiplefiscalyears,foruseasneeded.

ThePandemicandAll-HazardsPreparednessandAdvancingInnovationActof2019includedaprovisionforGAOtoreviewthePublicHealthEmergencyFund.Thisreportdescribes:(1)theavailableresourcesandspecificpurposesforwhichHHS’sreservefundshavebeenused;and(2)HHSofficials’perspectivesonthechallengesobtainingfundingtorespondtoimmediateneedsofpublichealththreatsoremergencies,andhowthereservefundshavehelpedaddressthesechallenges.

Toconductthiswork,GAOrevieweddocumentationandinterviewedcurrentandformeragencyofficialsabouttheiruseofthefunds,anychallengestheyfaced,andanyfundingcharacteristicsthathelpedaddresschallenges.Toidentifychallenges,GAOaskedHHSofficialsabouttheirexperiencesduringfourselectedpublichealthemergenciesthatwereinfectiousdiseasesorextremeweathereventsduringthepast20years—H1N1influenza,Zika,HurricaneMaria,andmpox.

View

GAO-23-106102

.Formoreinformation,contactMaryDenigan-Macauleyat(202)512-7114or

DeniganMacauleyM@

August2023

PUBLICHEALTHPREPAREDNESS

HHSReserveFundingforEmergencies

WhatGAOFound

TheDepartmentofHealthandHumanServices(HHS)canuseavarietyoffundingoptionstohelpaddressapublichealthemergencyorthreat.Forexample,HHSmayuseannualorsupplementalappropriationsthatweremadeforspecificagencyprogramsandactivities.HHSalsohastworeservefundstoaddressimmediateneedsthatariseinthefirstdaysorweeksofanemergency.

ThePublicHealthEmergencyFund,establishedin1983,isareservefundtohelpHHSagencies,suchastheAdministrationforStrategicPreparednessandResponseandtheCentersforDiseaseControlandPrevention(CDC),torapidlyrespondtoanykindofpublichealthemergencyorthreat.Suchthreatsincludeextremeweather;diseases;radiologicalornuclearincidents;oractsofterrorism.However,thefundhasnotreceivedappropriationsorbeenusedinover25years.

ExamplesofPossibleImmediateNeedsduringPublicHealthEmergencies

TheInfectiousDiseasesRapidResponseReserveFund,establishedin2018,isanotherreservefundtoallowCDCtorapidlyrespondtoinfectiousdiseasethreats.Thisfundreceived$800millioninappropriationsfrom2019through2023,including$600millionin2020afterthebeginningoftheCOVID-19pandemic.Fromfiscalyear2020throughMay2023,CDCused$211millionfromthefundforactivitiessuchasdiagnostictestingandairportscreeningtohelpcontrolthespreadandseverityofthreeinfectiousdiseases:COVID-19,Ebola,andmpox(formerlyknownasmonkeypox).

HHSofficialsdescribedchallengesfundingimmediateneedsduringselectedpublichealthemergencies.Forexample,priortotheinfectiousdiseasefund,HHSofficialssaidittooktimetoidentifyandsecurefundingtoaddresstheimmediateneedsoftheZikaoutbreakin2016.TheywereultimatelyabletoidentifysomefundsfromanotherprogramtousefortheZikaresponse.

HHSofficialssaidthattheInfectiousDiseasesRapidResponseReserveFundhashelpedtoaddresssomeofthesechallenges,specificallyforCDC.Inparticulartheysaidthathavingreadilyavailable,flexible,andconsistentlyreplenishedfundinghashelpedCDCrespondquicklytoemerginginfectiousdiseasethreatsbeforetheyworsen.However,HHSofficialssaidtheycontinuetofacechallengesaddressingimmediateneeds,forexamplenotingthatthefundisavailableonlyforinfectiousdiseasesandnotforotherpublichealththreats.

UnitedStatesGovernmentAccountabilityOffice

Contents

Letter

Background

OneofHHS’sTwoReserveFundsAvailableforPublicHealthEmergenciesHasReceivedFundingandBeenUsedtoRespondtoDiseaseThreatsinRecentYears

HHSOfficialsIdentifiedChallengesObtainingFundingtoRespondtoSelectedPublicHealthEmergenciesandCharacteristicsofExistingReserveFundingThatHelped

AgencyComments

1

4

7

13

23

AppendixI

GAOContactandStaffAcknowledgments

24

RelatedGAOProducts

25

Table

Table1:Appropriations,Obligations,andEnd-of-YearBalancesfortheInfectiousDiseasesRapidResponseReserveFundbyFiscalYear,2019to2023

8

Figures

Figure1:ExamplesofPossibleImmediateNeedsduringPublic

HealthEmergencies5

Figure2:ImmediateNeedsReportedbyHHSOfficialsResulting

FromSelectedPublicHealthEmergencies17

PageiGAO-23-106102PublicHealthEmergencyFunding

Abbreviations

ASPR

CDC

Ebola

FEMA

hantavirus

HHS

InfectiousDiseasesReserveFund

StaffordAct

AdministrationforStrategicPreparednessand

Response

CentersforDiseaseControlandPreventionEbolavirusdisease

FederalEmergencyManagementAgencyhantaviruspulmonarysyndromeDepartmentofHealthandHumanServices

InfectiousDiseasesRapidResponseReserveFund

RobertT.StaffordDisasterReliefandEmergency

AssistanceAct

ThisisaworkoftheU.S.governmentandisnotsubjecttocopyrightprotectionintheUnitedStates.ThepublishedproductmaybereproducedanddistributedinitsentiretywithoutfurtherpermissionfromGAO.However,becausethisworkmaycontaincopyrightedimagesorothermaterial,permissionfromthecopyrightholdermaybenecessaryifyouwishtoreproducethismaterialseparately.

PageiiGAO-23-106102PublicHealthEmergencyFunding

Letter

441GSt.N.W.

Washington,DC20548

August15,2023

TheHonorableBernardSanders

Chair

TheHonorableBillCassidy

RankingMember

CommitteeonHealth,Education,Labor,andPensions

UnitedStatesSenate

TheHonorableCathyMcMorrisRodgers

Chair

TheHonorableFrankPallone,Jr.

RankingMember

CommitteeonEnergyandCommerce

HouseofRepresentatives

Infectiousdiseases,hurricanes,tornadoes,floods,andwildfireshaveallthreatenedpublichealthandsafetyinrecentyears,andrequiredarapidresponsetosavelives.AstheCOVID-19pandemicillustrated,theUnitedStatesfacesanongoingriskfromthesethreats.Futurepublichealthrisksinclude,forexample,newdiseaseoutbreaks;extremeweatherevents;radiological,ornuclearincidents;oractsofterrorism.

Wehavepreviouslyreportedontheimportanceofpreparingfor,andurgentlyrespondingto,publichealththreats,andontheneedforsignificantimprovementsinhowthefederalgovernmentsupportsstateandlocalgovernmentsduringsuchtimes.

1

TheDepartmentofHealthandHumanServices(HHS)takestheleadinthefederalpublichealthandmedicalresponsetothesethreats,andtheSecretaryofHealthandHumanServicesmaydeclarewhenthesethreatsbecomepublichealthemergencies.Aswehavereported,notbeingsufficientlypreparedforapublichealththreatoremergencycanalsonegativelyaffectthetimeandresourcesneededtoachievefullrecovery.Basedontheresultsofthis

1Apublichealththreatisanevent,disease,ordisorderwithsignificantpotentialtobecomeapublichealthemergency.

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pastwork,wenamedHHS’sleadershipandcoordinationofpublichealthemergenciesasahighriskissueinJanuary2022.

2

Immediateneedssuchasdiseasetestingorasurgeininjurytreatmentmayariseduringthefirstdaysorweeksfollowingapublichealththreatoremergency.Torespondtotheseneeds,HHSmayuseavarietyoffundingsources.Theseincludetworeservefunds—thePublicHealthEmergencyFundandtheInfectiousDiseasesRapidResponseReserveFund(InfectiousDiseasesReserveFund)—thataredesignedtoholdfundingovermultiplefiscalyearssothatHHScanusethemasneeded.

3

ThePandemicandAll-HazardsPreparednessandAdvancingInnovationActof2019includedaprovisionforGAOtoreviewthePublicHealthEmergencyFund,includingtheresourcesavailableinthefund,andthefund’suses.

4

Inthisreport,wedescribe:

1.theavailableresourcesinandspecificpurposesforwhichHHS’sreservefundshavebeenused;

2.HHSofficials’perspectivesonthechallengesobtainingfundingtorespondtoimmediateneedsofpublichealthemergencies,andhowthereservefundshavehelpedaddressthesechallenges.

TodescribetheavailableresourcesandthespecificpurposesforwhichHHS’sreservefundshavebeenused,wereviewedlawsauthorizingandappropriatingfundstothePublicHealthEmergencyFundandtheInfectiousDiseasesReserveFund.Wealsoreviewedagencydocumentationontheamountoffundsappropriatedtoandobligatedfromthesereservefunds.

Weassessedthereliabilityofthesefundingdatabycomparingthemwithotheravailablesourcesofinformationanddiscussingthemwithagencyofficials.Basedonthisassessment,wedeterminedthatthesedataweresufficientlyreliableforthepurposesofthisengagement.WeinterviewedcurrentandformerofficialsfromHHS’sAdministrationforStrategicPreparednessandResponse(ASPR)andCentersforDiseaseControl

2SeeGAO,COVID-19:SignificantImprovementsAreNeededforOverseeingReliefFundsandLeadingResponsestoPublicHealthEmergencies,

GAO-22-105291

(Washington,D.C.:Jan.27,2022).

3Federalagenciesgenerallyreceiveannualappropriationsthatcanonlybeobligatedforaspecificfiscalyear.Certainappropriations,includingsomereservefunds,remainavailableforobligationforanindefiniteperiodoftime.

4Pub.L.No.116-22,§206,133Stat.905,926(codifiedat42U.S.C.§247d(b)(5)).

Page2GAO-23-106102PublicHealthEmergencyFunding

andPrevention(CDC)aboutthespecificactivitiesforwhichtheyusedthefunds,amongotherthings.FormerASPRandCDCofficialsweinterviewedhadexperiencewithpublichealthemergenciesthatoccurredsince2009.WeinterviewedcurrentofficialsfromHHS’sOfficeoftheAssistantSecretaryforFinancialResources,whichprovidesadviceandguidancewithinthedepartmentonfinancialmanagement.WealsointerviewedofficialsfromtheFederalEmergencyManagementAgency(FEMA)—withintheDepartmentofHomelandSecurity—thefederalagencywithprimaryresponsibilityforcoordinatingthefederalresponsetoandrecoveryfromemergenciesormajordisastersdeclaredbythePresidentundertheRobertT.StaffordDisasterReliefandEmergencyAssistanceAct(StaffordAct).FEMAalsooverseestheDisasterReliefFund,whichisavailableforsuchrecoveryandresponseefforts.

TodescribeHHSofficials’perspectivesonchallengesfundingimmediateresponseneedsofselectedpublichealthemergencies,andhowthereservefundshavehelpedaddressthesechallenges,weselectedfourofthe40publichealthemergenciesdeclaredfromAugust2005throughNovember2022:H1N1influenza(2009),Zika(2016),HurricaneMaria(2017),andmpox(previouslyknownasmonkeypox)(2022).

5

Weselectedthesefourpublichealthemergenciestoincludevarioustypesofemergencies,suchasthoseresultingfrominfectiousdiseasesandextremeweather.

6

WerevieweddocumentationaboutactionsHHSagenciestooktoaddresseachemergency,andanyfundingchallenges.WealsointerviewedcurrentandformeragencyofficialsfromASPRandCDCabouttheirexperiencesobtainingfundingtoaddressimmediateneeds,anychallengestheyfacedaddressingimmediateneeds,andtheirviewsabouthowthereservefundshavehelpedaddressthesechallenges.

WeconductedthisperformanceauditfromJune2022toAugust2023inaccordancewithgenerallyacceptedgovernmentauditingstandards.Thosestandardsrequirethatweplanandperformtheaudittoobtain

5Weinitiallyselectedafifthpublichealthemergency,the2020Californiawildfires.However,wedidnotincludeinformationonthispublichealthemergencyinthisreportbecauseCDCandASPRofficialssaidtheiragenciesdidnothaveasignificantroleinaddressingit.

6WedidnotincludetheCOVID-19pandemicinourselectionofpublichealthemergenciesbecausewehavepreviouslyissuednumerousreportsonfundingforCOVID-19responseactivities,includingfundingchallenges.See

/coronavirus-oversight-all-covid-19-reports

andtheRelatedGAOProductspageattheendofthisreport.However,weincludetheCOVID-19pandemicinthisreportwhendiscussinguseoftheInfectiousDiseasesReserveFund.

Page3GAO-23-106102PublicHealthEmergencyFunding

sufficient,appropriateevidencetoprovideareasonablebasisforourfindingsandconclusionsbasedonourauditobjectives.Webelievethattheevidenceobtainedprovidesareasonablebasisforourfindingsandconclusionsbasedonourauditobjectives.

Background

PublicHealth

Emergencies

Stateandlocalgovernmentstypicallyleadthedomesticresponsetoapublichealththreatoremergency.However,ifathreatissevereenoughthatstateandlocalcapabilitiesareoverwhelmed,stateandlocalgovernmentsmayseeksupportfromthefederalgovernment.Undersection319ofthePublicHealthServiceAct,theSecretaryofHealthandHumanServicesmaydeclareapublichealthemergencyiftheSecretarydetermines,inconsultationwithotherpublichealthofficialsasmaybenecessary,that(1)adiseaseordisorderpresentsapublichealthemergency;or(2)apublichealthemergencyotherwiseexists,includingsignificantoutbreaksofinfectiousdiseaseorbioterroristattacks.

Adeclarationofapublichealthemergencytriggerstheavailabilityofcertainauthoritiesunderfederallawthatmayallowthefederalgovernmenttoincreasesupporttoandreduceadministrativeburdensonstateandlocalgovernmentsaffectedbythepublichealthemergency.

7

ImmediateNeedsduring

PublicHealthEmergencies

Immediateneedsduringthefirstdaysorweeksfollowingapublichealththreatoremergencycanvary;forexampleparticularneedsmaydependonwhethertheemergencyresultsfromextremeweathersuchasahurricaneorflood;aninfectiousdisease;oraradiologicalornuclearincident.Figure1illustratesexamplesofpossibleimmediateneedsduringdifferenttypesofpublichealthemergencies.

7Forexample,uponrequestbyastategovernorortribalorganization,theSecretaryofHealthandHumanServicesmayauthorizethetemporaryreassignmentoffederallyfundedstateandlocalpublichealthdepartmentpersonnelfundedinwholeorinpartthroughprogramsauthorizedunderthePublicHealthServiceActtoaddresstheimmediateneedsofapublichealthemergencyinastateortribe.42U.S.C.§247d(e).

Page4GAO-23-106102PublicHealthEmergencyFunding

Figure1:ExamplesofPossibleImmediateNeedsduringPublicHealthEmergencies

FederalPublicHealth

Agencies

HHSleadsthefederalgovernment’spublichealthandmedicalresponsetoemergenciesanddisasters.

8

WithinHHS,ASPRistheleadagencyformedicalandpublichealthemergencypreparednessandresponse,policycoordination,andstrategicdirection.ASPRalsoservesastheprincipaladvisortotheSecretaryofHealthandHumanServicesonallmattersrelatedtofederalpublichealthandmedicalpreparednessandresponse.Inaddition,itmaintainsastockpileofresources,includingsuppliesimportantforrespondingtodifferenttypesofpublichealthemergencies.AnotheragencywithinHHS,CDC,alsohasaleadroleinaddressingpublichealthemergencypreparednessandresponse,includingdetectingandrespondingtonewandemergingdiseasethreats.CDCalsomaintainsexpertiseinaddressingpublichealthneedsresultingfromnaturaldisastersandsevereweather,radiationandchemical

8Specifically,HHSisrequiredtoleadallfederalpublichealthandmedicalresponsestopublichealthemergenciesandincidentscoveredbytheNationalResponseFramework.42U.S.C.§300hh(a).TheNationalResponseFrameworkestablishesanall-hazardsresponsestructuretocoordinatefederalresourcesduringemergenciesanddisastersandisdividedinto14emergencysupportfunctions,whicharefunctionalareasthataremostfrequentlyneededduringanationalresponse.

HHSistheleadagencyforEmergencySupportFunction#8:PublicHealthandMedicalServicesResponse.See

/emergency-managers/national-preparedness/frameworks/response

.

Page5GAO-23-106102PublicHealthEmergencyFunding

emergencies,andbioterrorism.InadditiontoCDCandASPR,HHS’sOfficeoftheAssistantSecretaryforFinancialResourcesprovidesadviceandguidancetotheSecretaryofHealthandHumanServicesonfinancialmanagement,includingfundingforpublichealthemergencies.

HHSReserve

PublicHealthEmergencies

Fundsfor

ThePublicHealthEmergencyFundwasestablishedin1983andisavailabletoHHSanditsagencieswhentheSecretarydeclaresapublichealthemergency,orwhentheSecretarydeterminesthereisasignificantpotentialforapublichealthemergency.

9

ThepurposeofthefundistoallowtheSecretaryto“rapidlyrespondtotheimmediateneeds”resultingfromsuchemergenciesorpotentialemergencies,andauthorizedusesincludefacilitatingcoordinationamongentitiesaffectedbyapublichealththreatoremergency,facilitatingadvancedresearchanddevelopmentofcountermeasures,strengtheningbio-surveillancecapabilities,andcarryingoutotheractivitiesdeterminedtobeappropriate.

TheInfectiousDiseasesReserveFundwasestablishedin2018toprovideCDCwithfundsto“prevent,preparefor,orrespondtoaninfectiousdiseaseemergency.”

10

SimilartothePublicHealthEmergencyFund,theInfectiousDiseasesReserveFundmaybeusedwhentheSecretarydeclaresaninfectiousdiseaseemergencytobeapublichealthemergency,oriftheSecretarydeterminesthereisasignificantpotentialfortheinfectiousdiseaseemergencytoimminentlyoccurandtoaffectnationalsecurityorthehealthandsecurityofU.S.citizens.

PublicHealth

EmergenciesandFEMA’s

DisasterReliefFund

Insomecases,circumstancesgivingrisetoapublichealthemergencydeclarationmayalsoleadtoapresidentialdeclarationofanemergencyormajordisasterundertheStaffordAct.TheDisasterReliefFund—administeredbyFEMA—maybeusedtoaddresscertainpublichealthandmedicalneedsforStaffordActemergenciesandmajordisastersthroughamissionassignmenttoHHSandotheragencies.Forexample,forHurricaneMaria,FEMAtaskedHHSwithamissionassignmenttoprovideemergencymedicalandpublichealthservicesinmultiplelocalitiesinPuertoRico.

9Pub.L.No.98-49,97Stat.245(1983)(codifiedasamendedat42U.S.C.§247d(b)).

10DepartmentofDefenseandLabor,HealthandHumanServices,andEducationAppropriationsAct,2019andContinuingAppropriationsAct,2019,Pub.L.No.115-245,§231,132Stat.2981,3095(2018)(codifiedat42U.S.C.§247d-4a).

Page6GAO-23-106102PublicHealthEmergencyFunding

Page7GAO-23-106102PublicHealthEmergencyFunding

OneofHHS’sTwo

ReserveFunds

AvailableforPublic

HealthEmergencies

HasReceived

FundingandBeen

UsedtoRespondto

DiseaseThreatsin

RecentYears

ThebalanceintheInfectiousDiseasesReserveFund—$560.5millionasofMay31,2023—hasremainedrelativelyconsistentsince2020,andisavailabletorespondtocurrentandfuturediseasethreats.Thefundfirstreceivedappropriationsinfiscalyear2019,andhadreceivedacumulativetotalof$800millioninappropriationsasofMay31,2023.Themajorityoftheseappropriations—$600million—weremadein2020afterthebeginningoftheCOVID-19pandemicthroughtheCoronavirusPreparednessandResponseSupplementalAppropriationsAct,2020andtheCARESAct.

11

Theremainingamountswereaddedthroughannualappropriationsthatrangedbetween$10millionand$85million.Inaddition,HHS’scongressionalbudgetjustificationforfiscalyear2024includesarequestfor$35millionfortheInfectiousDiseasesReserveFund.(SeeTable1.)

AppropriationsforReserve

Funds

11CoronavirusPreparednessandResponseSupplementalAppropriationsAct,2020,Pub.

L.No.116-123,div.A,tit.III,134Stat.146,148($300million);CARESAct,Pub.L.No.116-136,div.B,tit.VIII,134Stat.554-55(2020)($300million).

Table1:Appropriations,Obligations,andEnd-of-YearBalancesfortheInfectiousDiseasesRapidResponseReserveFundbyFiscalYear,2019to2023

Dollarsinmillions

FederalFiscalYear

2019

2020

2021

2022

(2023)c

Appropriations

50.0

685.0

10.0

20.0

35.0

Annual

50.0

85.0

10.0

20.0

35.0

Supplemental

0

600.0

0

0

0

Obligationsa

0

104.4

17.8

10.7

77.9

COVID-19

0

104.4

0

0

0

Ebolavirusdisease

0

0

17.8

4.7

6.8

Mpox

0

0

0

6.0

71.1

Otheradjustmentsb

0

-30.0

.6

.2

.6

CumulativeUnobligatedBalanceatEndofYearc,d

50.0

600.6

593.4

602.9

560.5

Source:AppropriationsactsandCentersforDiseaseControlandPreventioninformation.|GAO-23-106102

aIncludespriorbudgetyearupwardadjustments.

bIncludesanauthorizedtransferof$30millioninfiscalyear2020andrecoveriesofprioryearbalancesinfiscalyears2021through2023.SeeContinuingAppropriationsAct,2020,andHealthExtendersActof2019,Pub.L.No.116-59,§138,133Stat.1093,1101(2019)andFurtherContinuingAppropriationsAct,2020,andFurtherHealthExtendersActof2019,Pub.L.No.116-69,§101(4),133Stat.1134,1135(2019).

cAppropriations,obligations,andbalanceinformationforfiscalyear2023reflectpartialyeardatathroughMay31,2023.

dNumbersmaynottotalduetorounding.

InadditiontotheInfectiousDiseasesReserveFund,HHShasaccesstothePublicHealthEmergencyFund.AccordingtoHHSofficials,thefundhadabalanceofabout$57,000asofJune2023.Itreceivedappropriationsin1987and1993,andhasnotreceivedappropriationsinrecentyears.

12

HHS’scongressionalbudgetjustificationforfiscalyear

12SupplementalAppropriationsAct,1987,Pub.L.No.100-71,tit.I,101Stat.391,420;SupplementalAppropriationsActof1993,Pub.L.No.103-50,ch.V,107Stat.241,253.LegislationhasbeenintroducedinrecentyearstoappropriatefundstothePublicHealthEmergencyFund,butappropriationshavenotbeenenacted.Forexample,H.R.7614,introducedduringthe116thCongress,wouldhaveappropriated$5billiontothefund.Inaddition,S.2467,introducedduringthe117thCongress,wouldhaveamendedsection319ofthePublicHealthServiceActtoprovideforappropriationstothePublicHealthEmergencyFunduponthedeclarationofapublichealthemergencyarisingfromaninfectiousdiseaseoutbreak,abioterroristattack,oradisaster.

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2024includesarequestfor$50millionforthePublicHealthEmergencyFund.

UsesofReserveFunds

TheInfectiousDiseasesReserveFundhasbeenusedbyCDCforthreedifferentdiseasethreatssincethefundwasestablishedin2018:COVID-

19startingin2020,Ebolavirusdisease(Ebola)startingin2021,andmpoxstartingin2022.

13

?Tousethefundineachofthesecases,officialstoldusthattheyconsideredthescale,scope,andnatureofthediseaseandwhetheritposedanimminentthreattopublichealthandsecurity.

?Tohelppreservefundingforfuturethreats,officialsalsosaidtheyconsideredtheavailabilityofotherresources,andgenerallyusedthefundwhenotherfundingoptionswerenotavailable.

?Ineachcase,officialssaidthattheyidentifiedspecificresponseactivitiesexpectedtohavethelargesteffectsincontrollingthespreadorseverityofthedisease.

HHSofficialsdescribedspecificresponseactivitiessupportedbythefundforeachofthethreediseasethreats.

13TheInfectiousDiseasesReserveFundwasnotavailablefordiseasethreatsbefore2018,suchasZikaandH1N1influenza.

COVID-19

COVID-19isadiseasecausedbythevirusSARS-CoV-2.Itspreadswhenaninfectedpersonbreathesoutdropletsandverysmallparticlesthatcontainthevirus.Itcanbeverycontagiousandspreadsquickly.COVID-19mostoftencausesrespiratorysymptomsthatcanfeelmuchlikeacold,theflu,orpneumonia.