Preparing for the Next Public Health Emergency and Threat

Mary Denigan-Macauley, Director of Public Health, US Government Accountability Office

Mary Denigan-Macauley is a Director of Public Health in the Health Care Team for the U.S. Government Accountability Office (GAO), a nonpartisan and independent investigative arm of the U.S. Congress. She joined GAO in 2001, managing a diverse portfolio related to science and infectious zoonotic diseases. Her current work evaluates the effectiveness of federal programs to promote and ensure public health. Areas of focus under Mary’s direction include HHS leadership and coordination of public health emergencies; biodefense; FDA oversight of drug, biologic, and device manufacturing and safety; antimicrobial resistance; biosafety and biosecurity of high-risk pathogens; and maternal health. Before joining GAO, Mary taught public policy at Sam Houston State University in Texas and at Troy University in Japan. She was a visiting professor at the Georgian Institute of Public Affairs in Tbilisi, Georgia, promoting sound and ethical governance. Graduating from the University of Delaware with a Bachelor of Science, she attained a Master of Science from the University of Arizona and earned her Ph.D. in Public Administration from Arizona State University.

Planning for Routine and Emergency Preparedness

During peacetime, public health planning focuses on ensuring agencies have the resources and skills for routine challenges like seasonal flu, including monitoring circulating strains and sharing data. In emergencies, these activities are rapidly scaled up to address crises, with rapid data collection essential for tracking disease spread, for example. Peacetime planning strengthens capacity and resilience; emergency planning enables fast, specialized responses to immediate threats.

“The nation remains underprepared for future emergencies, highlighting the need for strong leadership and collaboration.”

Emergency response funding is cyclical—support increases during crises but drops once the threat subsides, causing loss of built-up capabilities. This leads to repeated rebuilding when new emergencies arise. GAO has identified persistent weaknesses for over a decade, limiting the U.S. in responding to health threats like COVID-19, H1N1, Zika, Ebola, and severe weather events. The nation remains underprepared for future emergencies, highlighting the need for strong leadership and collaboration across all levels of government and the private sectors for how to sustain capabilities and ramp up for such events.

Communicating Risk and Cross-Sector Health Links

Most of our work is requested by Congress or mandated by law and delivered to policymakers through briefings, reports, and/or testimony. We design our work to be fact-based and non-partisan. We use clear, actionable language to ensure our recommendations are understood and prioritized by decision-makers. Our approach allows us to effectively communicate public health risks in ways that resonate with each audience, whether we’re briefing legislators on urgent threats or providing technical details to specialized staff. We also track recommendations and monitor their implementation; for instance, when HHS was added to our high-risk list, we had made 155 recommendations since 2007, with 91 still unimplemented. By providing ongoing updates, we inform policymakers about gaps—including those identified as high priority—and emphasize critical issues, such as adding HHS’s public health emergency leadership to our high-risk list to highlight areas needing significant improvement.

Human and animal health are closely linked, making cross-sector collaboration essential for addressing emerging diseases, fighting antimicrobial resistance, and strengthening global health security. The work we do combines animal and public health to help achieve these goals and to raise this interconnectedness to Congress and emergency responders.

Addressing Gaps and Leading Future Preparedness

Based on decades of work, we have identified five critical areas where gaps exist in how governments prepare for and respond to public health emergencies and threats, especially the Department of Health and Human Services, which coordinates the federal response. These include:

1. Lack of leadership, creating confusion and risks.

2. Incomplete and inconsistent public and animal health data that hinder timely responses,

3. Unclear and inconsistent communication causing confusion,

4. Lack of transparency and accountability  eroding public trust, and

5. Not understanding partner response capabilities leading to conflict and misallocation of scarce or limited resources.

Public health leaders can address these gaps by, for example, building trust through clear communication, relying on current scientific evidence for policy decisions, justifying and explaining changes transparently, collaborating to use resources efficiently, and planning for future threats based on lessons learned so as not to repeat mistakes.