Health
Record cyclosporiasis outbreak tests the response of a ‘weakened’ health system
August 20, 20263:54 PM ET
Rose Wong for NPR
Environmental health expert Bob Custard spent four decades working with local governments on things like clean water, rabies prevention and food safety. He also represents 160 others doing that kind of work as president of the West Virginia Association of Sanitarians
Health
What Cyclospora does inside the gut and how it gets there
With the largest-ever cyclosporiasis outbreak concentrated in nearby states, Custard – now a public health consultant – said federal funding cuts have left local food safety programs across the state grossly understaffed. Health officials are unable to keep pace with the interviews and investigations needed to track and contain the diarrhea-causing bug. “It’s like we have a house, and we decided to take smoke detectors out,” Custard said of the current approach to foodborne illness
Meanwhile, epidemiologist Susan Mayne said the government has responded slowly to the record-shattering outbreak that started in May, which demonstrates how the nation’s federal food safety programs are in disarray. That includes the Food and Drug Administration’s Center for Food Safety and Applied Nutrition (now part of the Human Foods Program), which she ran until three years ago
Mayne said teams of staff who played critical roles in public-awareness campaigns and crisis-response coordination with counterparts in other countries were eliminated in the sweeping Trump administration cuts to the federal government last year that hit public health functions particularly hard
“And now we have this outbreak with Mexico – I don’t know who’s managing that partnership, [but] those relationships obviously have been disrupted,” Mayne said
The summer’s cyclosporiasis outbreak has been mostly linked to contaminated iceberg lettuce grown in Mexico. The U.S. now has over 15,700 cases confirmed by the Centers for Disease Control and Prevention as of this week. It’s occurring in the wake of those funding and staff reductions, and Mayne echoed other scientists and food safety experts who said that is affecting the ground game against Cyclospora – from the local county levels, all the way to the federal agencies that fund nearly all of the country’s food safety programs.
“I think that that has really pushed us into a new level of vulnerability in terms of our food safety system,” Mayne said
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In a statement to NPR, the Department of Health and Human Services, which oversees the FDA and CDC, said that the Human Foods Program staff who work with foreign regulatory counterparts had been reinstated. Separately, the FDA said in a statement to NPR that it “continues to work with federal, state and international partners to investigate these outbreaks,” and that it “deploys personnel where they have the greatest public health impact.”
State level cuts
Most of the states’ food safety and outbreak programs are funded by grants from the FDA and CDC. Last year, the Trump administration slashed the CDC’s grants alone by 40% — about $5.8 billion as of May
But where states cut within those programs varies
Kentucky’s Cabinet for Health and Family Services said its food safety staff is down 30 to 50%. The Ohio Department of Health said in an emailed statement to NPR that its Cyclospora response is unaffected by staffing cuts
Michigan, with the highest caseload, successfully fought grant cuts in court. That allows disease surveillance, investigation, reporting and public service messaging to continue for now, according to an emailed statement from the Michigan Department of Health and Human Services
In West Virginia, beyond the federal cuts, other factors like job requirements for staffers who help investigate and prevent the spread of foodborne illnesses have affected the state’s response
Custard, the West Virginia food safety consultant, said he worked with a county two years ago that at the time employed four full-time sanitarians, or public health specialists who investigate environmental health and safety. “The last time I talked to them they were down to two,” he said. “It’s a growing county with growing needs, so they’re pretty stressed.” That same county also lost its only epidemiologist, he said, whose job included food poisoning investigations
In fact, when Custard looks at the state’s food safety staff organization chart – from the very top to the very bottom – about half of all positions are vacant. He said the lack of funding and low rate of pay have made staffing so bad, that in March, West Virginia lawmakers lowered the state’s job requirements for sanitarians from four years of college to a two-year associate’s degree. Custard bemoaned the change. “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.”
Because of the problems he’s observed around his own state, Custard is not surprised that cyclones of infections keep spawning and swirling around the country. Or that regulators are still struggling to understand and contain Cyclospora‘s spread. “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.”
Rose Wong for NPR
Coordination between local and federal agencies
Many experts said the divestments in the U.S. food safety system began long before the Trump administration’s recent cuts, and that strain is now manifesting as harm to the public
Health Reporting in the States
Nurses chase Cyclospora using grocery receipts, food apps and detailed interviews
“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.”
Rose Wong for NPR
