GAO Report Details Zika Preparedness Shortcomings, Outlines Next Steps

The Government Accountability Office (GAO) has issued a report evaluating the continued public health response to the Zika virus in the US and detailing the remaining challenges and possible solutions. It was presented at a Congressional subcommittee hearing that served as a follow-up to the March 2016 hearing about the initial response to the emergence of the virus.

According to a press release from the Subcommittee on Oversight and Investigations, part of the House Energy and Commerce Committee, the panel invited Timothy M. Persons, PhD, chief scientist at the GAO, to share findings from his report on the challenges of responding to the outbreak.

The major highlights were that the CDC had not been adequately prepared to respond to the virus, which was relatively unknown prior to 2016, so initial surveillance efforts and research initiatives were hampered. As the outbreak progressed, knowledge about Zika’s epidemiology drastically improved, but “many unknowns remain, including the actual number of infections and the full spectrum of outcomes.”

The report also indicated that the Zika virus diagnostic tests developed and sold during the outbreak “varied in their ability to detect the virus and provide accurate results.” It found that the CDC and the FDA did not publish adequate information that would have allowed consumers to compare different tests, and that some test manufacturers reported that limited access to virus samples impaired their ability to develop tests meeting FDA requirements.

Finally, it discussed the role of mosquito control programs, which were “critical to mitigating the risks associated with the Zika virus.” Efforts like pesticide application, eliminating standing water, and personal mosquito bite prevention were enacted by state and local agencies with guidance and funding from the CDC.

Included in the report were 5 recommendations for correcting these shortcomings. Generally, they involved having the HHS secretary direct either the FDA commissioner or the CDC director to publish more information about diagnostic tests and mosquito distribution maps.

Subcommittee Chairman Rep. Tim Murphy (R-Pennsylvania) summarized the findings in terms of evaluating the government’s performance, noting that while “GAO has found that HHS was reactive in its response to outbreak prevention, preparedness, detection, and response,” it also had “shown that we were not fully prepared at the outset of the outbreak.”

Several other experts invited to speak at the hearing discussed these gaps between responsiveness and preparedness, according to the press release. Scientists from the National Institutes of Health and the Biomedical Advanced Research Development Authority discussed the progress made towards developing a Zika vaccine. In response to the outbreak, federal researchers accelerated their ongoing virus vaccine studies with a focus on preventing Zika, but full approval of an effective vaccine is likely years away.

Representatives from CDC and FDA also spoke about why a lack of preparedness made it difficult to develop accurate diagnostic tests. There were no such available at the start of the outbreak, but the agencies worked together to develop diagnostic tests rapidly. Now, 16 different tests have been approved under the FDA’s accelerated approval process, and the agencies are still working to refine these diagnostic methods.

“The experts on the panel made it quite clear that we need to stop thinking of disease preparedness and response as occasional, episodic events — a reactive approach that has left us constantly lagging in our response efforts,” said committee Chairman Rep. Greg Walden (R-Oregon) in the press statement.

“Instead, we must shift our mindsets and strategies towards a broader, more comprehensive, and proactive approach — one that considers the larger context of our preparedness for future infectious diseases and outbreaks.”