No single federal agency has the authority to direct disease surveillance across the government, and coordination among the agencies that do it depends heavily on informal arrangements and personal relationships, according to a Government Accountability Office report released last week.
The report concludes that this fragmentation limits how quickly the United States can detect emerging infectious disease threats. It arrives as the country manages a record measles year, a large multistate cyclosporiasis outbreak, and continued H5N1 avian influenza activity in animals.
For households, the timing matters. Surveillance is what turns a scattering of illnesses into a recognized outbreak with a named source and public guidance. When that recognition is slow, families keep buying a contaminated product, keep sending children to an exposed setting, and keep making decisions without information that already exists somewhere in the system.
The Four Areas Experts Flagged
GAO convened a roundtable of 18 experts in public health, animal health, infectious diseases, medicine, and academic science, and grouped their suggested federal actions into four areas: collaboration, data, methods, and communication. The full report is available from GAO.
On collaboration, a leading recommendation was establishing a multisectoral, multidisciplinary leadership group with authority to coordinate surveillance across the agencies responsible for human, animal, and environmental health.
On data, the report describes a lack of standardized data systems, no common language across those systems, and outdated technology. In practice, this means a state laboratory result, a veterinary diagnostic finding, and a hospital record may not be comparable or linkable without manual work.
On methods, experts recommended targeting surveillance toward high-risk animal and human populations, expanding and standardizing wastewater surveillance, and drawing on more diverse data sources. Wastewater monitoring expanded substantially during the COVID-19 pandemic and can detect community spread before clinical cases are reported, but coverage remains uneven across states, and the data are not always comparable between systems.
On communication, GAO cited the 2022 mpox response, finding that the Department of Health and Human Services did not effectively communicate the significantly increased risk facing certain groups and did not adapt messaging for different communities. The report notes the same pattern in COVID-19, the 2016 Zika response, and the 2009 H1N1 pandemic, and observes that reduced public trust makes people less willing to get tested or report infections, which further degrades data quality.
The Animal-to-Human Gap
The clearest specific gap identified concerns diseases that move between animals and people. Most emerging infections in recent decades have originated in animals, which is why the report emphasizes One Health surveillance linking human, animal, and environmental data.
GAO points to the US One Health Coordination Unit, an interagency working group, and describes it as affected by disorganization during the New World Screwworm response.
Reporting on the findings by CIDRAP noted the report's framing that outbreaks have increased in incidence and impact, with global interconnectedness and animal-to-human transmission risk contributing to the threat.
The report identifies gaps in the system. It does not conclude that these gaps have already caused any particular outbreak, and readers should not read it that way.
The Accountability Record Behind the Report
This is not the first warning. HHS leadership and coordination of public health emergencies has been on GAO's High Risk List since 2022, a designation reserved for federal programs GAO considers especially vulnerable to waste, fraud, abuse, or mismanagement.
As of January of last year, 83 GAO recommendations related to public health emergency preparedness remained unimplemented, as reported alongside the new findings. The roundtable itself was convened in April and May 2025, meaning more than a year passed between the expert discussions and publication.
GAO reports are advisory. The agency cannot compel action, and the suggestions in this report came from convened experts rather than being issued as formal binding recommendations to a named agency. That distinction matters for how much weight readers should give the document. It is a structured expert consultation published by a nonpartisan congressional watchdog, not a regulatory finding, and implementation depends entirely on whether Congress or the agencies choose to act.
Where Local Health Departments Fit
Federal surveillance depends on state, county, and city health departments doing the collection. Those departments identify cases, interview patients, run laboratory confirmations, and report upward.
Their capacity varies enormously. Large metropolitan departments in New York City, Los Angeles, Chicago, and Houston maintain epidemiology staff, laboratory capability, and communications teams. Smaller and rural jurisdictions often share an epidemiologist across counties. When a national picture is assembled from uneven inputs, the weakest links determine how fast a signal appears.
For readers, the practical response is not to worry about federal organizational charts. It is to know where your own local information comes from. Your county or city health department is the source that will issue an exposure notice for your school district, a recall alert for a store in your area, or guidance during a local outbreak, and it will typically do so before a national picture is complete.
Sign up for your county health department's alerts if it offers them. Check the department's website during an active local outbreak rather than relying on social media summaries. If you or a family member has a suspected reportable illness, cooperating with a health department interview is what makes surveillance work at all.
If a clinician suspects an unusual infection, ask whether the case is being reported to the health department and whether specimens are being sent for confirmation. Reporting is a legal requirement for many conditions, but it depends on clinicians recognizing and acting on it.
Frequently Asked Questions
What did the GAO find? Federal disease surveillance is fragmented; no agency has centralized authority to coordinate it, and coordination often relies on informal arrangements.
What is One Health surveillance? An approach linking human, animal, and environmental health data, based on the fact that most emerging infections originate in animals.
Does the report say a specific outbreak was missed? No. It identifies gaps and risks. It does not conclude that these gaps caused any particular outbreak.
Who did GAO consult? Eighteen experts in public health, animal health, infectious diseases, medicine, and academic science, convened in April and May 2025.
Is HHS required to act? No. GAO reports are advisory. HHS leadership of public health emergencies has been on GAO's High Risk List since 2022.
What does this mean for my family? Indirectly, slower detection can mean later public warnings. Your county or city health department remains the fastest source of local exposure and recall information.
What can I do? Sign up for local health department alerts, check official sources during outbreaks, and cooperate with case interviews if contacted.
