CDC Scales Back Surveillance Efforts in Face of Shutdown

CDC Scales Back Surveillance Efforts in Face of Shutdown

By Rebecca Adams, CQ HealthBeat Associate Editor

The government shutdown has forced the Centers for Disease Control and Prevention to dramatically scale back its monitoring of illnesses nationally and across the globe as well as its assistance to local health departments, agency director Tom Frieden said Tuesday.

“From outside of the agency, it may be very hard to understand just how incredibly disruptive this is for our efforts to protect Americans,” Frieden told HealthBeat in an interview.

Since the government shut down on Oct. 1, House Republicans passed stand-alone continuing funding bills for the National Institutes of Health and the Food and Drug Administration. They have not yet passed a separate continuing resolution for the CDC, although some House Republicans say they want to do so.

“We do not have a commitment yet” from House GOP leadership for a floor vote on a CDC funding measure, said Rep.Jack Kingston, R-Ga., who chairs the appropriations subcommittee that oversees Department of Health and Human Services funding and is pushing for a vote on a continuing resolution for the CDC. “I hope would happen sooner rather than later. A lot of it just depends on the calendar and the evolution of discussions. So as things develop, the leadership knows of my desire to move it. I think they’re sympathetic to it but they’re looking at some mega-picture scheduling issues.”

As far as the overall budget negotiations go, Kingston said, “We’re all in a holding pattern. Once you’re past the first day or two, then the next you know it’s a few weeks. On the rank and file level, I’m not optimistic it’s going to reopen anytime soon and the issues are tremendous.”

Senate Democrats and President Barack Obama have said they won’t accept a piecemeal approach to reopening the government and there is no indication when the House may pass a comprehensive funding resolution that Democrats will accept.

More than two-thirds of CDC employees — almost 9,000 people — were furloughed because of the shutdown. Overall, 52 percent of the Department of Health and Human Services was furloughed.

One example of problems that the CDC is not able to handle as fully as usual is a recent outbreak of salmonella that started in California but spread to 18 states and has caused roughly 300 illnesses. Because of the shutdown, only a small number of the CDC food borne disease staff have been allowed to work, although CDC officials have brought some of them back.

What worries Frieden most is the uncertainty of whether the government is missing another major disease outbreak or other threat.

“We’ve got free-floating anxiety,” said Frieden, adding, “Where is there a problem that’s spreading that we’re not recognizing?”

The agency has suspended the daily updates on global outbreaks it provides to other federal officials involved in public health and emergency response.

A telephone hotline for the public to report concerns about disease that routinely fielded 100 questions a day is now closed, Frieden said.

Nine of 10 global disease detection systems around the world have shut down, said CDC spokeswoman Barbara Reynolds. In a typical year, the centers respond to about 200 outbreaks and detect 6 to 10 new pathogens. Officials are particularly concerned about threats such as Ebola and new pathogens such as MERS-CoV and H7N9 flu that are circulating around the globe. But the centers — scattered throughout Latin America, Central Asia, Southeast Asia, the Middle East, South Africa and the Western Pacific regions — are blocked from doing active surveillance during the shutdown. Only a system in the Republic of Georgia, which is funded in a different way, remains active.

At international ports within the United States, the CDC staff has dropped from five to eight officials to one. As a result, the number of cases of disease that were reported dropped in half from the week before the shutdown to the first week of the shutdown.

About 85 percent of the CDC’s officials who monitor the spread of influenza throughout the nation are furloughed. The agency will no longer be able to produce its weekly snapshots informing medical providers and government officials where the outbreak is worsening, which can affect the distribution of flu shots and other supplies.

For some of the CDC’s operations, a couple of weeks of lost data can skew the results for an entire year.

Frieden likened the problem to one of a huge ship in the ocean that loses its navigational system. A couple of days without surveillance is a manageable.

“But if you lose it for a week or two, you can get very off track and it can get dangerous,” he said.

For every day that passes, Frieden and his top officials are reassessing whether they have the legal justification to bring back some furloughed workers.

“The challenge is this balancing act,” Frieden said. “We have to obey the law and have to do everything we can to protect people’s lives at the same time.”

For instance, the CDC is scheduled to inspect some labs that work with dangerous pathogens. “Do we do that or not?” Frieden said.