COVID-19
Information on HHS's
Public Education
Campaign
Report to Congressional Committees
March 2022
GAO-22-104724
United States Government Accountability Office
United States Government Accountability Office
Highlights of GAO-22-104724 a report to
congressional committees
March 2022
COVID-19
Information on
HHS's Public Education Campaign
What GAO Found
In the summer of 2020, the Office of the Assistant Secretary for Public Affairs
(ASPA) within the Department of Health and Human Services (HHS) worked with
procurement offices within the Food and Drug Administration (FDA) and the
National Institutes of Health (NIH) to solicit proposals and make awards to two
firms in support of a COVID-19 public education campaign. The primary goals of
the campaign, according to award documents, were sharing information on
preventing the spread of COVID-19 and increasing vaccine acceptance. ASPA
officials developed and led the campaign, while FDA and NIH staff oversaw the
technical aspects of the contracting process.
• FDA awarded a nearly $15 million contract in September 2020 to Atlas
Research, a consulting firm The award focused primarily on developing
a
s
eries of public service announcements for multiple media channels. T
he
announcements were to feature members of the entertainment industry and
public health officials.
• NIH made a $250 million award in September 2020 to Fors Marsh Group,
a
c
onsulting firm, which then developed multiple messages for the public o
n
vaccine development and COVID-19 prevention. Messages were designed
for television, radio, print and social media channels. Fors Marsh Group also
designed the campaign’s theme and logo, We Can Do This (see figure).
HHS’s We Can Do This Web Page
I
n October 2020, following congressional inquiries and negative press coverage
about the campaign, the then-Secretary of Health and Human Services
convened a group of public health officials to ensure the campaign was serving
important public health purposes. FDA terminated the Atlas Research contract in
November 2020, following the HHS internal review. Fors Marsh Group has
continued to work on the campaign.
ASPA paid for the two awards and other campaign costs with COVID-19 relief
funds appropriated for the Centers for Disease Control and Prevention (CDC).
Specifically, CDC and ASPA entered into a $300 million interagency agreement,
initially funded with $100 million from the CARES Act and $200 million from the
Paycheck Protection Program and Health Care Enhancement Act. HHS budget
officials reported that the department subsequently identified a more appropriate
funding source, and CDC adjusted its budget accounts to use only its CARES
Act funds for the $300 million interagency agreement with ASPA.
View GAO-22-104724. For more information,
contact
Alyssa M. Hundrup at (202) 512-7114
or
Why GAO Did This Study
In response to the COVID
-19
pandemic
, HHS began a national
public education campaign led by
ASPA. Congressional committees and
the media raised questions about the
focus and timing of the campaign.
There were also concerns that funds
meant for CDC were used to pay for
the effort.
The CARES A
ct includes a provision
for GAO to report on the federal
response to the pandemic. In addition
,
GAO was asked to conduct a review of
the award process for the COVID
-19
public education campaign
, as well as
its source of funding.
This report describes
, among other
issues: ASPA
, FDA, and NIH’s roles in
executing the COVID
-19 public
education campaign
, and how ASPA
paid for the campaign awards.
To conduct this work
, GAO reviewed
and analyzed inter
-agency
agreements
, award files, related
funding documents
, and the products
developed for the public education
campaign; federal statutes and
regulations; applicable agency
guidance; and agency email
communications about the campaign.
GAO also interviewed relevant agency
officials and contractors
, and received
written
answers to questions regarding
the funding used for the campaign.
GAO
provided a draft of this report to
HHS for review and comment
. HHS
stated that it appreciated the
opportunity to review the draft, and had
no comments.
Page i GAO-22-104724 HHS’s COVID-19 Public Education Campaign
Letter 1
Background 5
ASPA Worked with Procurement Offices within FDA and NIH on
the COVID-19 Public Education Campaign 8
ASPA Assembled Group of HHS Officials to Review Campaign
Materials for Alignment with Public Health Recommendations 15
ASPA Used CDC COVID-19 Relief Funds for the Public Education
Campaign 15
Agency Comments 17
Appendix I GAO Contact and Staff Acknowledgments 20
Figure
Figure 1: HHS’s We Can Do This COVID-19 Public Education
Campaign Logo 13
Contents
Page ii GAO-22-104724 HHS’s COVID-19 Public Education Campaign
Abbreviations
ASFR Office of the Assistant Secretary for Financial Resources
ASPA Office of the Assistant Secretary for Public Affairs
CDC Centers for Disease Control and Prevention
COVID-19 Coronavirus Pandemic 2019
FAR Federal Acquisition Regulation
FDA Food and Drug Administration
HHS Department of Health and Human Services
NIH National Institutes of Health
PICS II Public Information and Communication Services II
PSA public service announcement
RFP request for proposals
This is a work of the U.S. government and is not subject to copyright protection in the
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without further permission from GAO. However, because this work may contain
copyrighted images or other material, permission from the copyright holder may be
necessary if you wish to reproduce this material separately.
Page 1 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
441 G St. N.W.
Washington, DC 20548
March 29, 2022
Congressional Committees
In the summer of 2020, the Department of Health and Human Services
(HHS) initiated a $265 million public education campaign to help inform
the public about preventative measures and therapeutics related to the
COVID-19 pandemic.
1
The campaign—led by HHS’s Office of the
Assistant Secretary for Public Affairs (ASPA)—was intended to quickly
share public health information on the virus with wide audiences to
support the anticipated re-opening of businesses and the broader
economy. At the time, COVID-19 cases were on the decline and vaccines
were in development.
2
To execute the COVID-19 public education campaign, ASPA—with
assistance from procurement offices within the Food and Drug
Administration (FDA) and the National Institutes of Health (NIH)—made
awards to Atlas Research and Fors Marsh Group, both private sector
consulting firms. The Atlas Research award was a contract for nearly $15
million, and was intended to result in an “immediate surge” (up to 6
months) of information featuring public service announcements (PSA)
with discussions between celebrities and public health officials about
ways for the public to stay safe during the pandemic. The original Fors
Marsh Group award was a task order for just over $250 million, and
supported a longer-term public education effort on various strategies to
prevent the spread of COVID-19.
3
Soon after the awards were made in September 2020, congressional
committees raised concerns that monies appropriated to the Centers for
Disease Control and Prevention (CDC) were used to fund the public
education campaign, as well as questions as to the timing and intent of
the campaign, given the upcoming presidential election in November
1
The original award amounts for the COVID-19 public education campaign, before
modifications and additional awards, totaled $265 million.
2
After a spike of about 65,000 new cases per day in late July 2020, on average, the
United States had about 40,000 reported new COVID-19 cases per day in early
September 2020, according to GAO analysis of data from the Centers for Disease Control
and Prevention (CDC).
3
A task order is an order for goods or services placed against an established contract.
Letter
Page 2 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
2020.
4
Following an internal HHS review, FDA terminated the Atlas
Research contract in November 2020, while Fors Marsh Group has
continued to work on the public education campaign.
The CARES Act includes a provision for us to report on the federal
response to the COVID-19 pandemic. Specifically, the act requires us to
monitor and oversee the federal government’s efforts to prepare for,
respond to, and recover from the pandemic.
5
We also received a request
to conduct a review of HHS’s COVID-19 public education campaign,
including its source of funding. This report is part of our body of work in
response to the CARES Act.
6
In this report, we describe:
1. ASPA, FDA, and NIH’s roles in executing the COVID-19 public
education campaign;
2. ASPA’s efforts to ensure that the Fors Marsh Group campaign
materials aligned with public health recommendations; and
3. how ASPA funded the COVID-19 public education campaign.
To address the first objective, we reviewed documents comprising the
contract files for the two COVID-19 public education campaign awards to
Atlas Research and Fors Marsh Group. Specifically, we reviewed the
interagency agreements between ASPA and CDC, ASPA and FDA, and
ASPA and NIH, as well as the requests for proposals (RFP), submissions
from bidding firms, and documentation of the selection criteria and rating
process. We also reviewed products and deliverables from Atlas
Research and Fors Marsh Group, including, for example, PSAs and
4
See, Hearing entitled Review of Coronavirus Response Efforts, Subcommittee on Labor,
Health and Human Services, Education, and Related Agencies, Committee on
Appropriations, U.S. Senate, September 16, 2020, webcast available online:
https://www.appropriations.senate.gov/hearings/review-of-coronavirus-response-efforts.
Also see, Letters to the Honorable Alex M. Azar II Secretary, Department of Health and
Human Services (Sept. 10 and Oct. 28, 2020), Committee on Oversight Reform, Select
Subcommittee on the Coronavirus Crisis, and Subcommittee on Economic Consumer
Policy, U.S. House of Representatives, available online: https://oversight.house.gov/letters
(accessed 1/6/2022).
5
Pub. L. No. 116-136, § 19010, 134 Stat. 281, 579-81 (2020).
6
We have regularly issued government-wide reports on the federal response to the
COVID-19 pandemic. For the latest report, see GAO, COVID-19: Significant
Improvements Are Needed for Overseeing Relief Funds and Leading Responses to Public
Health Emergencies, GAO-22-105291 (Washington, D.C.: January 2022). Our next
government-wide report will be issued in April 2022 and will be available on GAO’s
website at https://www.gao.gov/coronavirus.
Page 3 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
interviews for television and radio, social media content, and related
market research results. Additionally, we reviewed weekly status updates
prepared by Fors Marsh Group for ASPA between December 2020 and
June 2021 to understand how initial campaign messaging was developed.
In addition, we reviewed the Federal Acquisition Regulation (FAR) and
applicable agency guidance on acquisitions from FDA and NIH.
7
To
supplement our documentation review, we interviewed agency officials
involved in developing and overseeing the campaign from ASPA, FDA,
and NIH, as well as representatives from Atlas Research and Fors Marsh
Group.
To address our second objective, we reviewed email communications
about the COVID-19 public education campaign messaging and products
between ASPA and a review group made up of approximately 70 public
health and public affairs officials from various HHS agencies and offices.
Within the review group, we focused on the participation of three HHS
agencies that we identified as having experience in establishing and
assessing public health recommendations—FDA, NIH, and CDC.
8
To
obtain information on the frequency and nature of those agencies’
interactions with ASPA and the input they provided on campaign
materials, we emailed a set of questions to the officials from those
agencies who served on the review group. We received responses from
18 officials—nine from CDC, five from FDA, and four from NIH which we
reviewed and summarized.
9
Lastly, we interviewed ASPA officials as well
7
The FAR is the primary regulation used by all executive agencies in their acquisition of
goods and services with appropriated funds.
8
Other HHS agencies that were part of the review group included: Administration for
Children and Families, Administration for Community Living, Agency for Healthcare
Research and Quality, Centers for Medicare & Medicaid Services, Departmental Appeals
Board, Health Resources and Services Administration, Indian Health Service, and the
Substance Abuse and Mental Health Services Administration. The review group also
include the following HHS offices: Assistant Secretary for Health, Assistant Secretary for
Planning and Evaluation, Assistant Secretary for Preparedness and Response, General
Counsel, Global Affairs, Office of the Secretary, Inspector General, Intergovernmental and
External Affairs, Medicare Hearings and Appeals, and the National Coordinator for Health
Information Technology.
9
Initially we emailed four additional officials from these agencies, however we determined
they had moved to other positions within HHS and therefore were not serving on the
review group at the time of our work.
Page 4 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
as representatives from Fors Marsh Group to gain their perspectives on
these collaborative efforts.
10
To address the third objective, we analyzed the interagency
agreements—which describe the relevant statutory authorities—as well
as funding and account information. In addition, we interviewed officials or
received written responses from ASPA, CDC, FDA, and NIH, as well as
from HHS’s Office of the Assistant Secretary for Financial Resources
(ASFR), to understand how funding decisions were made.
11
We analyzed
the information gathered to identify the amounts appropriated, the
accounts to which the appropriations were made, and the amounts
obligated. We also analyzed contract invoices to determine amounts
expended. We focused our efforts on the performance period for the Atlas
Research contract (6 months) and the first Fors Marsh Group task order
(15 months).
12
As such, our analysis covers activities for the public
education campaign from September 2020 through November 2021.
We conducted this performance audit from January 2021 to March 2022
in accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.
10
Assessing the effectiveness of the public education campaign was outside the scope of
our review.
11
ASFR is the office that oversees HHS’s activities related to budget, financial
management, and grants and acquisition management.
12
The first Fors Marsh Group task order was modified in August 2021 to extend the
performance period—originally 12 months—by 3 months. Fors Marsh Group was awarded
two additional task orders to continue work on the public education campaign. These task
orders were outside the scope of our review.
Page 5 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
Federal statutes and regulations permit agencies to procure goods and
services from each other. For example, the Economy Act authorizes an
agency to order goods or services from another agency.
13
The agency in
need of the goods or services is the “requesting” agency, and the agency
providing the purchased goods or services is the “servicing” agency. The
requesting and servicing agencies develop interagency agreements to
establish the terms and conditions of the work to be done by each. The
requesting agency may reach an agreement with the servicing agency to
pay for the purchased goods or services in advance or upon provision of
the goods or services.
14
The servicing agency may need to procure the requested goods or
services by awarding a contract or placing an order against an existing
contract. New contracts and orders are generally overseen by a servicing
agency contracting officer who has the authority to enter into, administer,
or terminate contracts and make related determinations and findings. In
addition, contracts may also have at least one contracting officer’s
representative, a requesting agency official, who provides day-to-day
oversight of the contractor’s performance and work products.
15
To procure goods or services through contracts or other acquisition
vehicles such as task orders, federal agencies may proceed through the
following four phases:
13
The Economy Act allows agencies to order goods or services from another agency if (1)
amounts are available; (2) the requesting agency decides the order is in the government’s
best interest; (3) the servicing agency is able to provide or procure the ordered goods or
services; and (4) the requesting agency decides the order cannot be provided by contract
as conveniently or cheaply by a commercial enterprise. See 31 U.S.C. § 1535. See also
FAR § 17.502-2.
14
When agencies enter into an interagency agreement under the Economy Act, the
requesting agency obligates funds for the goods or services to be performed, and
depending on the agreement, either makes a payment before or after the work is
performed. The servicing agency records the receipt of these funds as offsetting
collections.
15
The contracting officer’s representative is an individual, including a contracting officer’s
technical representative, designated and authorized in writing by the contracting officer to
perform specific technical or administrative functions.
Background
Federal Contracting and
Interagency Agreements
Page 6 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
• Pre-Solicitation. Federal agencies define the requirements—or
needs—of the award, conduct market research to assess available
goods and services, and develop an acquisition plan and an RFP,
which describes the government’s requirements, anticipated terms
and conditions of the award, and other pertinent information.
• Solicitation. Agencies seek firms to perform work by issuing an RFP.
The solicitation may be limited to a defined set of firms, or to a single
firm, depending on the needs of the contract or task order.
16
• Selection. A panel evaluates and rates submitted proposals, and,
based on that review, selects an awardee.
• Post-award. After an award is made, agencies monitor the contract—
providing direction and oversight of contract activities and deliverables
(e.g., work products).
Three HHS agencies and offices were involved in the process to award
the contract to Atlas Research and the task order to Fors Marsh Group, to
support HHS’s COVID-19 public education campaign.
• ASPA. ASPA serves as the principal counsel on public affairs to the
Secretary of Health and Human Services and provides centralized
leadership and guidance for public affairs activities within HHS’s staff
and operating divisions and regional offices. In addition, ASPA
conducts national public affairs programs; manages HHS’s digital
communications; and leads the planning, development, and
implementation of emergency incident communications strategies and
activities for HHS. The Assistant Secretary for Public Affairs reports
directly to the Secretary of Health and Human Services.
• FDA, Office of Acquisition & Grants Services. Within FDA, the
Office of Acquisition & Grants Services awards contracts and grants
and enters into interagency agreements on behalf of FDA. For
purposes of this report, we refer to the Office of Acquisition & Grants
Services as FDA.
• NIH, Office of Logistics and Acquisitions Operations. NIH’s Office
of Logistics and Acquisition Operations administers the Public
Information and Communication Services II (PICS II) program, which
awards contracts that provide communication goods and support
services to NIH institutes and centers—as well as other HHS
16
Federal agencies procuring goods and services are generally required to do so using full
and open competition, with certain limited exceptions. See 41 U.S.C. §§ 3301 and 3304.
See also FAR §§ 6.101 and 6.301.
HHS Agencies and Offices
That Executed the COVID-
19 Public Education
Campaign Awards
Page 7 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
agencies and offices.
17
Currently, 10 firms participate in the PICS II
program. Other HHS agencies and offices can use the PICS II
program by entering into an interagency agreement with NIH. For
purposes of this report, we will refer to the Office of Logistics and
Acquisition Operations as NIH.
ASPA designed the COVID-19 public education campaign to roll out
rapidly to share critical public health information on COVID-19 across
wide audiences. Initial campaign-related documents stated that educating
the public on ways to prevent further spread of the virus supported the
goal of re-opening businesses and the broader economy. Over the course
of the pandemic, ASPA’s public education campaign evolved to respond
to changing circumstances. Contract documents noted that ASPA
expected the campaign to evolve based on new and emerging
information on the pandemic. For example, initial solicitation documents—
for both the Atlas Research and Fors Marsh Group awards—included
goals of defeating despair and inspiring hope, sharing best practices for
businesses to operate in the new normal, and instilling confidence to
return to work and restart the economy.
However, after those documents were signed in September 2020, the
United States experienced a spike in cases.
18
HHS officials confirmed
that ultimately, issues related to the economy and a return to work were
not included in the public education campaign. Additionally, initial contract
documents described the campaign approach as coordinating public
outreach efforts around prevention and treatment of the seasonal flu and
COVID-19. In winter 2020, campaign efforts included paid advertisements
on social media and YouTube highlighting CDC’s seasonal flu vaccine
messaging as well as preventative steps for stopping the spread of
COVID-19. Then, when FDA authorized the first vaccines for emergency
use in December 2020, the focus of the campaign shifted to the new
COVID-19 vaccines and away from the seasonal flu. HHS officials
confirmed that the primary goals of the campaign were to educate the
17
Requirements under the PICS II program are fulfilled through the award of task orders,
which are awarded under indefinite-delivery, indefinite-quantity contracts. An indefinite-
delivery, indefinite-quantity contract may be awarded to one or more contractors when the
exact quantities and timing for goods or services are not known at the time of the award.
18
As discussed earlier, the number of cases began increasing again in September 2020
and continued to do so into 2021. For example, between December 31, 2020, and
January 13, 2021, new reported COVID-19 cases averaged about 225,000 per day—over
7 and 3 times higher than the surges the nation experienced during the spring and
summer of 2020, respectively.
Changing Nature of the
COVID-19 Public
Education Campaign
Page 8 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
public about COVID-19 prevention and increase COVID-19 vaccine
acceptance.
Our review of contract documents shows that ASPA officials developed
and led the public education campaign, while FDA and NIH procurement
officials oversaw the technical aspects of the contracting process. HHS
officials told us ASPA led the campaign because, at the time, HHS
needed a whole of government response, and ASPA could bring
agencies together to do so. Below, we describe the roles ASPA, FDA and
NIH played in awarding and executing the Atlas Research contract and
the Fors Marsh Group task order
In August 2020, ASPA and FDA entered into an interagency agreement
under the Economy Act for the award of an “immediate surge” contract,
which was awarded in September 2020. However, FDA terminated this
contract in November 2020 after an HHS internal review.
Pre-solicitation. According to officials we spoke with, ASPA—the
requesting agency—defined the requirements (or needs) of the award,
conducted market research and developed the statement of work.
Officials from FDA—the servicing agency—were the contracting officers
for the award, overseeing the regulatory and technical aspects of the
process.
According to HHS officials, the Office of the Assistant Secretary for
Administration typically handles acquisitions for ASPA, and FDA officials
told us it was atypical for FDA to provide contracting assistance to an
HHS office or agency outside of FDA. However, ASPA worked with FDA
to execute the contract awarded to Atlas Research because, in August
2020, FDA had the capacity and staff to execute a contract rapidly,
according to officials from ASPA and ASFR.
Solicitation. In August 2020, FDA oversaw and issued the RFP, which
defined the goals, scope, and expected deliverables for the award. The
award had a primary deliverable—a series of PSAs on COVID-19
prevention strategies featuring members of the entertainment industry
and public health officials, along with the purchase of advertising space
and time for the PSAs to air on multiple media platforms. The award also
had specific requirements for disseminating information on the prevention
and treatment of COVID-19 as rapidly as possible.
ASPA Worked with
Procurement Offices
within FDA and NIH
on the COVID-19
Public Education
Campaign
Atlas Research Contract
Page 9 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
According to FDA officials, ASPA initially wanted to execute a sole source
contract with Atlas Research.
19
However, at the suggestion of FDA
officials, ASPA agreed that FDA should solicit proposals from an
additional firm. According to the market research memo prepared by
FDA, Atlas Research and one additional firm had the qualifications to
perform under the expedited delivery requirements, including access to
and knowledge of the national media landscape. Ultimately, the two
identified firms prepared and submitted proposals for the award, including
items such as a projected budget and timeline for deliverables.
During the solicitation process, an ASPA official asked FDA staff to
provide the two bidding firms the names of three companies to consider
as potential subcontractors—to help perform the requirements should
they be selected for the award, according to FDA officials. FDA officials
stated that the three firms were suggested as potential subcontractors
because they had the capacity to start the work immediately upon award,
including rapid access to PSA production services. An FDA official told us
that they emailed the two bidding firms the information about the three
potential subcontractors during the solicitation period, as requested by the
ASPA official. Atlas Research representatives and FDA officials said it
was unusual for firms to be suggested as potential subcontractors during
the solicitation phase.
20
Atlas Research included the three suggested
firms as potential subcontractors in its proposal, while the other bidding
firm did not.
Evaluation and award. Prior to making the award, in August 2020 a
panel comprised of two ASPA officials and one FDA official evaluated and
rated the submitted proposals from the two bidding firms for the award.
Then, based on the scores from the reviews, the panel selected the
awardee. The contracting officers from FDA reviewed the respective
evaluations to ensure the rationale for the award was in line with federal
19
A sole source contract is a contract for the purchase of supplies or services that is
awarded after soliciting and negotiating with only one source. In March 2020, HHS issued
a class justification and approval for all HHS acquisition offices to use procedures other
than full and open competition, in order for HHS agencies and offices to have adequate
flexibility to respond to the COVID-19 pandemic.
20
In the course of our work, we became aware of a potential pre-existing business
relationship between an ASPA official involved in the public education campaign and one
of the suggested subcontractors. We have referred this matter to the Offices of Inspector
General at HHS and the Department of Justice for action they deem appropriate.
Page 10 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
contracting standards. In September 2020, FDA awarded a contract to
Atlas Research for nearly $15 million.
Post-award. After the award was made to Atlas Research, the
contracting officer’s representative (an ASPA official) monitored the
contract by providing day-to-day oversight of the contractor’s performance
and deliverables (e.g., work products, required status updates), according
to Atlas Research and an ASPA official. Atlas Research developed a list
of over 250 potential celebrity participants. Our review of contractor
documents found the list included information on the celebrities’ political
affiliations or related public statements, any arrests, and identified the
demographic groups the celebrities would most effectively reach. Atlas
Research representatives said these elements were based on vetting one
of the subcontractors had conducted for similar clients. In addition, they
said the final selection of celebrities to participate in the campaign was
based on which audience was being targeted, not on political support or
affiliation.
21
Under the Atlas Research contract, three members of the entertainment
industry filmed PSAs that featured conversations with public health
officials.
22
We reviewed footage filmed for the PSAs and found that they
contained information on topics such as preventative measures to combat
COVID-19 (e.g., hand washing, mask wearing, social distancing),
participation in COVID-19 vaccine clinical trials, and encouraging the
public to receive the flu shot.
Following congressional inquiries and media reports questioning the
timing and content of the public education campaign in September 2020,
the then-Secretary of Health and Human Services convened a review of
both the Atlas Research and Fors Marsh Group awards in October
21
According to Atlas Research documents we reviewed, targeted audiences included, for
example, Black Americans, the Latinx community, Asian Americans, women, faith-based
communities, and the elderly.
22
ASPA officials approved the three members of the entertainment industry—one actor
and two musicians popular in faith communities—who were filmed for the PSAs. Public
health officials included in the PSAs were the Director of NIH’s National Institute of Allergy
and Infectious Diseases; the then-Assistant Secretary for Health; and the then-Surgeon
General.
Page 11 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
2020.
23
The review was led by ASPA officials and included other public
health and communications experts within HHS, including, for example,
the then-Surgeon General, the Director of NIH’s National Institute of
Allergy and Infectious Diseases, the then-Director of NIH’s Office of
Communications and Public Liaison, and the Deputy Assistant Secretary
for Minority Health in the Office of Minority Health. According to the
meeting report we reviewed from the review group, the purpose of the
review was to ensure the work of the public education campaign served
critical public health purposes (i.e., provide concrete actions—masking,
hand washing—for the public to take to protect themselves against
infection as well as further spread of the virus). HHS officials said the
review group decided to terminate the Atlas Research contract because it
relied solely on members of the entertainment industry to promote
COVID-19 messages to the public and did not involve traditional,
evidence-based communication. According to HHS officials, the goal of
the shift in direction for the campaign was to improve the potential for,
and increase the speed of, the adoption of COVID-19 risk-reduction
behaviors and acceptance of COVID-19 vaccines among the public.
FDA terminated the Atlas Research contract in November 2020, and
before any PSAs developed by Atlas Research aired. When FDA
terminated the contract, Atlas Research had expended about $2.5 million
of the $15 million contract based on the work it had completed, our review
of contract files shows. According to HHS officials, the approximately
$12.5 million in unexpended monies were deobligated in July 2021, and,
as of December 2021, had not been obligated for another use.
In August 2020, ASPA and NIH entered into an interagency agreement
under the Economy Act for the award of a task order through NIH’s PICS
II program.
24
Pre-solicitation. According to officials we interviewed, ASPA—the
requesting agency—developed the statement of work and wrote the task
order RFP. Officials from NIH—the servicing agency—were the
23
See, for example, Letters to the Honorable Alex M. Azar II Secretary, Department of
Health and Human Services (Sept. 10 and Oct. 28, 2020), Committee on Oversight
Reform, Select Subcommittee on the Coronavirus Crisis, and Subcommittee on Economic
Consumer Policy, U.S. House of Representatives. For media reports, see, e.g., “HHS Bids
$250 Million Contract Meant to ‘Defeat Despair and Inspire Hope’ on Coronavirus,”
Politico (Aug. 31, 2020).
24
As noted above, NIH’s PICS II program offers communications and outreach support to
NIH institutes and centers—as well as other HHS agencies and offices.
Fors Marsh Group Task
Order
Page 12 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
contracting officers for the award, reviewed materials submitted by ASPA
and oversaw the technical aspects of the pre-solicitation process.
In mid-July 2020, NIH oversaw and issued a request for information to the
10 firms participating in the PICS II program. The request invited the firms
to submit capability statements demonstrating their ability to provide the
services described in the request for information. Three firms prepared
and submitted capability statements. NIH and ASPA reviewed the three
submissions and concluded that the firms could fulfill the requirements for
the task order.
NIH officials told us the process for awarding the task order was generally
typical for the PICS II program, however, due to the high dollar amount—
$250 million—an official with the highest levels of experience and training
served as the contracting officer to oversee execution of the task order,
per NIH policy.
25
It is common for NIH institutes and centers, as well as
other HHS agencies and offices, to use the PICS II program for media,
communication, information dissemination, and technology services that
cannot be fulfilled in-house.
Solicitation. In late July 2020, NIH issued a task order RFP to all PICS II
contractors. Three firms put forward proposals for the task order. The
proposals included items such as a projected budget, a timeline for
deliverables, a proposed approach, and a summary of relevant past
experience.
Evaluation and award. In August 2020, a panel comprised of two ASPA
officials and one FDA official evaluated and rated the three submitted
proposals.
26
Then, based on the scores from the reviews, the panel
recommended the awardee. NIH officials told us the contracting officer
from NIH reviewed the evaluations to ensure the rationale for the award
was in line with federal contracting standards. In September 2020, NIH
awarded a task order to Fors Marsh Group for just over $250 million.
Post-award. After the award was made, the contracting officer’s
representative (an ASPA official) monitored Fors Marsh Group’s progress
25
According to NIH policy, the contract oversight process takes the procurement level (i.e.,
the dollar amount of the award) into account when designating an official to serve as the
contracting officer.
26
The same panel of three officials reviewed the proposals submitted for the contract
awarded to Atlas Research.
Page 13 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
on the task order by providing oversight of the contractor’s performance
and deliverables (e.g., work products, required status reports), according
to officials we interviewed. The HHS review group—convened in October
2020—also assessed Fors Marsh Group’s work, and concluded that the
task order should continue.
Fors Marsh Group activities in support of the COVID-19 public education
campaign included the development of multiple messages for the public,
to be distributed through different media platforms (television, radio, print,
and digital). In addition, Fors Marsh Group secured placements for these
messages in both paid and earned media; and conducted market
research to apply to campaign products.
27
Fors Marsh Group also
designed the campaign’s theme and logo, We Can Do This (see fig. 1).
Figure 1: HHS’s We Can Do This COVID-19 Public Education Campaign Logo
27
Paid media efforts include outreach for which an entity must pay a fee (e.g., buying
airtime on the radio). The campaign also included earned—or unpaid—media, which is
content shared at no cost.
Page 14 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
Total expenditures for the task order—from September 2020 through
November 2021—were nearly $295 million, according to invoices Fors
Marsh Group submitted to NIH.
28
Invoices indicated that Fors Marsh
Group spent the majority (nearly 80 percent) of funds on media efforts,
such as:
• PSAs in television, radio, print, out-of-home (i.e., billboards), and
digital (i.e., social media) formats.
• Interviews and outreach featuring HHS spokespeople and trusted
messengers—targeting media outlets that reach individuals who were
disproportionately affected by the COVID-19 pandemic (e.g., specific
racial and ethnic groups).
• Social media engagement across official HHS platforms.
• Engagement in conferences, seminars, expert panels, and webinars
on topics such as vaccine development and COVID-19 prevention.
• Campaign efforts also included sub-campaigns, such as:
• Slow the Spread, which provided information about how to combat
COVID-19 and flu; and
• Building Vaccine Confidence, which used public education to help
build vaccine confidence in people who were hesitant about COVID-
19 vaccines.
In July 2021, NIH awarded Fors Marsh Group a new $150 million task
order to continue work on the campaign from August 2021 through
January 2022.
28
The costs above the original award amount of $250 million were covered by a
modification approved on June 16, 2021, that raised the task order ceiling by $50 million.
Page 15 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
In November 2020, following the HHS review of the public education
campaign and the termination of the Atlas Research contract, ASPA
assembled a group of approximately 70 federal officials from across HHS
agencies to obtain their review of and input on COVID-19 public
education campaign materials developed by Fors Marsh Group. Many
group members were health communications or public affairs officials,
according to documentation we reviewed. An ASPA official told us they
provided the members with campaign materials for review and input
before approving them for use.
While our review of award documents did not find specific requirements
that campaign materials be aligned with public health recommendations,
the statement of work NIH issued noted that awardees should develop
their messaging approach with the guidance of scientific expertise and
HHS leadership. Similarly, HHS officials said it is standard HHS practice
to have relevant professionals from across the department review any
education materials being provided to the public.
According to the review group members we contacted from CDC, FDA,
and NIH, they were asked to provide a review of, and input into, proposed
campaign materials, such as talking points and scripts for videos and
radio ads. Additionally, some members said that ASPA asked them to
review materials to ensure the content aligned with any updates to public
health guidance (e.g., changes to indoor masking guidance). Many
members we contacted said they communicated with ASPA officials at
least weekly. In addition, many members said they provided input on
some aspect of the campaign—either directly or through subject matter
experts.
According to documentation provided by ASFR, ASPA used COVID-19
relief funds appropriated for CDC to pay for the public education
campaign, including both the Atlas Research and Fors Marsh Group
awards. Specifically, in July 2020, CDC entered into an interagency
agreement under the Economy Act with ASPA to procure $300 million of
services for the COVID-19 public education campaign. According to the
interagency agreement, the funds were to support the development and
implementation of PSAs—$100 million for flu-related messaging, and
$200 million for COVID-19-related messaging. The interagency
agreement stated that the estimated cost—$300 million—was based on
public education initiatives of similar size and scope—national, with
multiple audiences and multiple communication channels—such as the
FDA youth tobacco use prevention campaign. The two original awards for
the public education campaign, before modifications, totaled
ASPA Assembled
Group of HHS
Officials to Review
Campaign Materials
for Alignment with
Public Health
Recommendations
ASPA Used CDC
COVID-19 Relief
Funds for the Public
Education Campaign
Page 16 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
approximately $265 million. According to ASFR, ASPA used almost all of
the remaining $35 million for additional funding for the initial Fors Marsh
Group award, as well as for other public education campaign costs, such
as staffing and operational costs.
According to ASFR, the monies for this interagency agreement came
from appropriations for CDC under two laws:
1. The CARES Act appropriated $4.3 billion to CDC “to prevent, prepare
for, and respond to coronavirus, domestically or internationally,” of
which CDC used $100 million to fund the interagency agreement with
ASPA.
29
2. The Paycheck Protection Program and Health Care Enhancement Act
appropriated $25 billion to the Public Health and Social Services
Emergency Fund, with a required $1 billion transfer to CDC, “for
surveillance, epidemiology, laboratory capacity expansion, contact
tracing, public health data surveillance and analytics infrastructure
modernization, disseminating information about testing, and workforce
support necessary to expand and improve COVID-19 testing.”
30
Of
that $1 billion, CDC used $200 million to fund the interagency
agreement with ASPA.
Our review of the work products produced by Atlas Research and Fors
Marsh Group raised questions about whether the expenditures for the
public education campaign were consistent with the purposes of the
appropriation in the Paycheck Protection Program and Health Care
Enhancement Act.
31
We asked ASFR about the use of funds appropriated
by the Paycheck Protection Program and Health Care Enhancement Act
for the public education campaign. In response, ASFR stated that, after
further review of expenditures for the campaign, “HHS determined a more
appropriate funding source was and continued to be available and has
adjusted its accounts accordingly.” Specifically, CDC adjusted its
accounts to instead use only its CARES Act funds for the $300 million
29
Pub. L. No. 116-136, div. B, tit. VIII, 134 Stat. at 554.
30
Pub. L. No. 116-139, div. B, tit. I, 134 Stat. 620, 624 (2020). The Public Health and
Social Services Emergency Fund is an HHS emergency fund that supports HHS’s efforts
to improve the nation’s preparedness against naturally occurring and man-made health
threats and threats to the ability of HHS to carry out such missions.
31
Under the purpose statute, appropriated funds are available only for the purposes
authorized by Congress. 31 U.S.C. § 1301(a).
Page 17 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
interagency agreement with ASPA.
32
According to ASFR, funds
appropriated by the Paycheck Protection Program and Health Care
Enhancement Act are no longer being used for the public education
campaign since sufficient balances were available from the CARES Act to
fund the interagency agreement.
33
We provided a draft of this report to HHS for review and comment. HHS
stated that it appreciated the opportunity to review the draft, and had no
comments.
We are sending copies of this report to the appropriate congressional
committees, the Secretary of Health and Human Services, and other
interested parties. In addition, the report is available at no charge on the
GAO website at http://www.gao.gov.
If you or your staff have any questions about this report, please contact
Alyssa M. Hundrup at (202) 512-7114 or [email protected]. Contact
points for our Offices of Congressional Relations and Public Affairs may
be found on the last page of this report. GAO staff who made major
contributions to this report are listed in the appendix.
Alyssa M. Hundrup
Director, Health Care
32
An agency can adjust its accounts by charging obligations and expenditures previously
incurred in one account to a different account.
33
In addition to the $300 million in CARES Act funds for the interagency agreement, ASPA
also used appropriations provided by the American Rescue Plan Act of 2021 to fund
additional work on the public education campaign performed by Fors Marsh Group. See
Pub. L. No. 117-2, § 2302, 135 Stat. 4, 38-39 (appropriating funds to HHS, acting through
CDC, for vaccine confidence activities, among other activities).
Agency Comments
Page 18 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
List of Addressees
The Honorable Patrick Leahy
Chairman
The Honorable Richard Shelby
Vice Chairman
Committee on Appropriations
United States Senate
The Honorable Ron Wyden
Chairman
The Honorable Mike Crapo
Ranking Member
Committee on Finance
United States Senate
The Honorable Patty Murray
Chair
The Honorable Richard Burr
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate
The Honorable Gary C. Peters
Chairman
The Honorable Rob Portman
Ranking Member
Committee on Homeland Security and Governmental Affairs
United States Senate
The Honorable Rosa L. DeLauro
Chair
The Honorable Kay Granger
Ranking Member
Committee on Appropriations
House of Representatives
The Honorable Frank Pallone, Jr.
Chairman
The Honorable Cathy McMorris Rodgers
Republican Leader
Committee on Energy and Commerce
House of Representatives
Page 19 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
The Honorable Bennie G. Thompson
Chairman
The Honorable John Katko
Ranking Member
Committee on Homeland Security
House of Representatives
The Honorable Carolyn B. Maloney
Chairwoman
The Honorable James Comer
Ranking Member
Committee on Oversight and Reform
House of Representatives
The Honorable Richard Neal
Chairman
The Honorable Kevin Brady
Republican Leader
Committee on Ways and Means
House of Representatives
The Honorable Patty Murray
Chair
Subcommittee on Labor, Health and Human Services, Education and
Related Agencies
Committee on Appropriations
United States Senate
The Honorable Angus S. King, Jr.
United States Senate
The Honorable Jeanne Shaheen
United States Senate
Appendix I: GAO Contact and Staff
Acknowledgments
Page 20 GAO-22-104724 HHS’s COVID-19 Public Education Campaign
In addition to the contact named above, Lori Achman (Assistant Director),
Kristeen McLain (Analyst in Charge), Sam Amrhein, Kaitlin Farquharson,
and Lillian Riehl Schultze made key contributions to this report. Other
contributors to this report were Sandra George, Teague Lyons, Vikki
Porter, and Miranda Riemer.
Appendix I: GAO Contact and Staff
Acknowledgments
GAO Contact
Staff
Acknowledgments
(104724)
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