Federal funding cuts test cyclosporiasis outbreak response : NPR

Environmental health expert Bob Custard has spent 40 years working with local governments on clean water, rabies prevention, and food safety. He also leads 160 others in similar roles as the president of the West Virginia Association of Sanitarians.

In the face of the largest cyclosporiasis outbreak in nearby states, Custard, who is now a public health consultant, notes that federal funding cuts have left local food safety programs in the state severely understaffed. Health officials struggle to conduct the necessary interviews and investigations to track and contain the diarrhea-causing pathogen. Custard likens the situation to removing smoke detectors from a house.

Meanwhile, epidemiologist Susan Mayne criticizes the slow government response to the record-breaking outbreak that began in May, highlighting the inefficiencies in the nation’s federal food safety programs, including the Food and Drug Administration‘s Center for Food Safety and Applied Nutrition, now part of the Human Foods Program, which she led until three years ago.

Mayne points out that crucial teams responsible for public-awareness campaigns and crisis-response coordination with international partners were cut during the Trump administration’s sweeping reduction of federal government functions last year, particularly affecting public health.

“Now we have this outbreak with Mexico – I don’t know who’s managing that partnership, [but] those relationships obviously have been disrupted,” Mayne commented.

This summer’s cyclosporiasis outbreak is primarily linked to contaminated iceberg lettuce from Mexico, with the U.S. confirming over 15,700 cases as reported by the Centers for Disease Control and Prevention this week. The outbreak coincides with funding and staffing reductions, impacting efforts against Cyclospora from local to federal levels.

“I think that that has really pushed us into a new level of vulnerability in terms of our food safety system,” Mayne remarked.

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In a statement to NPR, the Department of Health and Human Services, which oversees the FDA and CDC, indicated that the Human Foods Program staff working with foreign regulatory counterparts had been reinstated. The FDA also stated it “continues to work with federal, state and international partners to investigate these outbreaks,” deploying personnel for the greatest public health impact.

State level cuts

Funding for most state food safety and outbreak programs comes from FDA and CDC grants. Last year, the Trump administration reduced the CDC’s grants by 40% — around $5.8 billion as of May.

States vary in how they implement these cuts.

Kentucky’s Cabinet for Health and Family Services reports a 30 to 50% decrease in food safety staff. However, the Ohio Department of Health stated that its Cyclospora response remains unaffected by staffing cuts.

Michigan, which has the highest number of cases, successfully challenged grant cuts in court, allowing ongoing disease surveillance, investigation, reporting, and public messaging, according to the Michigan Department of Health and Human Services.

In West Virginia, beyond federal cuts, other factors such as job requirements for those investigating and preventing foodborne illnesses have impacted the state’s response.

Custard, the West Virginia food safety consultant, recounted working with a county two years ago that had four full-time sanitarians, specialists in environmental health and safety. “The last time I talked to them they were down to two,” Custard said. “It’s a growing county with growing needs, so they’re pretty stressed.” The same county also lost its only epidemiologist, who handled food poisoning investigations.

Observing the state’s food safety staff organization chart, Custard noted that about half of all positions were vacant. He said the lack of funding and low pay have worsened staffing shortages, leading West Virginia lawmakers to reduce job requirements for sanitarians from four years of college to a two-year associate’s degree in March, a change Custard criticized. “These people have a tremendous amount of responsibility and because of the variety of programs they work in, they really need a really strong science foundation.”

Custard is not surprised by the recurring infections across the country, or by regulators’ struggles to understand and control the spread of Cyclospora. “At every level, the system has been weakened. If you’re not getting the reporting from the local level, it doesn’t roll up to the state level and then roll up to the national level.”

Coordination between local and federal agencies

Experts say the strain on the U.S. food safety system began long before the Trump administration’s recent cuts, and it is now impacting public health.

“Delays, lack of clarity and time in solving problems are all symptoms of this broader issue that our public health – and in particular state and local public health departments – are in crisis,” said Sarah Sorscher, director of regulatory affairs for the Center for Science in the Public Interest. She said a lack of information has left the public confused about what’s safe to eat. “That confusion itself, and the period of time it’s taken them to solve the outbreak is a real cost to public health.”

It’s not just funding that those local and state governments lost. They also historically received other support from the CDC, FDA and USAID – the now-defunct Agency for International Development – for things like scientific expertise, lab testing, and pathogen monitoring overseas. Many of those functions have been curtailed or eliminated.

Mayne, the former FDA official, said she and others at FDA often sought advice, for example, from microbiologists and epidemiologists at the CDC’s Division of Parasitic Diseases and Malaria, which researched Cyclospora and other emerging parasites. But much of the funding came from USAID, which was lost when the Trump administration shuttered the international development agency. “That has ramifications for a domestic Cyclospora response because CDC, just like FDA, shares expertise,” Mayne said.

Epidemiologist Dan Jernigan oversaw that CDC lab until resigning last summer as head of the National Center for Emerging and Zoonotic Infectious Diseases in protest of agency head Susan Monarez’s firing. Jernigan said those labs typically helped doctors identify pathogens using an online resource, or genetically sequence pathogens like Cyclospora to develop better treatments. But, he said, a majority of the funding for that work came from USAID. With at least a third of the lab’s staff missing, Jernigan said his former colleagues tell him they’re triaging, working only on the biggest cases. “They historically would help states on every outbreak where they have Cyclospora, but now they’re going to only work on those outbreaks that span multiple states,” he said.

In a statement, HHS said that the CDC continues its parasite research, saying “the CDC laboratory supporting the Cyclospora response was not affected by RIFs [reductions in force].”

The U.S. State Department, which absorbed the remaining parts of USAID, did not respond to requests for comment by the time of publication.

In addition to the CDC, the U.S. Department of Agriculture also ran two parasitology labs doing Cyclospora research in Beltsville, Md.: the Animal Parasitic Diseases Lab and the Environmental Microbial and Food Safety Lab.

According to internal emails and letters sent to lab staff and reviewed by NPR, employees were told in May to relocate to other research centers in California, Pennsylvania, or Iowa, or lose their jobs. Work in both USDA labs has effectively halted this summer, with no plans to move the specialized equipment or frozen stores of pathogens to the new locations, according to a staffer who asked NPR not to use their name because they are not authorized to speak publicly. The staffer, who said they cannot move and plans to leave the USDA, estimated at least half of their remaining colleagues are in the same position.

In an emailed statement to NPR, USDA did not respond to questions about the lab closures or requirements for staff to move, but said Cyclospora research “continues today, without disruption.” The agency did not respond to follow-up requests.

Looking ahead

Public health experts worry that, as with cyclosporiasis, foodborne illness will increase, just as they are becoming harder to prevent, harder to trace, and harder to contain.

Jernigan, the former CDC official, said that the agency last year also removed Cyclospora and 5 other pathogens it had actively tracked through a surveillance program called FoodNet. Until last year, the CDC maintained in-depth data about foodborne illness cases during outbreaks. Jernigan said FoodNet provided data that ultimately aimed to better prepare for and prevent future outbreaks. “It’s the only way that you really have a stable estimate of: Are things getting worse or not,” he said.

Mayne pointed to another factor that might have altered the course of this year’s foodborne disease. The delayed implementation of a food traceability rule enacted in 2011.

Mayne said the rule will require bar codes on every batch of produce, so contamination can be tracked within 24 hours to its source, whether that’s a specific field or washing facility. Had the rules taken effect as planned in January, she said, the lettuce from Taylor Farms in Mexico could have been caught far sooner, preventing potentially thousands of other people from getting sick. “It’s not just the trace back, it’s also the trace forward; you then have these records to say, where did all that lettuce go,” Mayne said, and knowing where other contaminated supplies traveled, would’ve helped limit spread.

Custard said, for the public, all this adds up to unacceptable risk. “We keep taking the smoke detectors out of the house, hoping that there won’t be a fire – and yet we keep seeing fires from time to time.”