Why the government shutdown is bad for Americans' health

On the brink of this year’s flu season, the Centers for Disease Control and Prevention (CDC) has been forced to shut down its disease-monitoring systems, significantly limiting its ability to identify and stymy outbreaks ranging from mutant seasonal flus to E. coli and more.

Shuttering of the monitoring system represents just one of several federal-government programs intended to safeguard Americans that are partially or completely out of commission as a result of the government shutdown. Food inspection, clinical trials and medical research are also on hold, possibly putting millions of Americans at risk while Republican lawmakers continue to keep all “nonessential” federal workers furloughed in their effort to delay implementation of the Affordable Care Act.

The Department of Health and Human Services, in the midst of launching the health-insurance marketplaces that are the engine of the Affordable Care Act, says its contingency plans following the shutdown account for all department activities “that involve the safety of human life and the protection of property,” but with 52 percent of its employees on furlough, residual effects of the shutdown are all but certain.

The CDC has already manufactured this year’s flu vaccine and distributed it to state and local health departments, but flu surveillance — one of the key tasks the CDC performs every year — was cut due to the shutdown. According to Barbara Reynolds, the CDC’s director of public affairs, 85 percent of the agency’s flu division has been furloughed. The CDC has retained just 32 percent of its staff.

“The longer we’re not able to collect (flu) data and analyze, the more likely it is that we’ll go into the flu season with gaps in our knowledge and blind to what’s happening on a national level,” Reynolds said. The danger is that if this season’s flu virus takes an unanticipated turn, the CDC would have no way of knowing. And it’s not an academic issue.

“Flu viruses are the most unpredictable viruses we have out there,” Reynolds said. The flu virus can mutate, and the mutations can be disastrous, particularly for those at high risk for flu-related death, such as young children, the elderly and those with compromised immune systems. The swine-flu epidemic four years ago is one recent example of how the virus can mutate in unexpected ways.

In addition to the flu, the CDC’s surveillance system, PulseNet, was tracking more than 30 different clusters of illnesses, at last count. Furloughs are hampering the CDC’s ability to monitor outbreaks. Even running at full capacity, there is typically a 20-day lag between an outbreak’s beginning and the point of discovery.

“But without these systems operating at full capacity, we don’t know what could be smoldering out there,” Reynolds said.

The CDC still has the capacity to respond to outbreaks that occur, but the agency’s ability to find those outbreaks to begin with is hampered — particularly those coming from the nation’s food supply. Food-borne illnesses typically occur across large swaths of the country, with a single food source being distributed to consumers in multiple states as the most common culprit. With PulseNet effectively down, states have nowhere to report incidences and there is no central clearinghouse responsible for testing whether specific incidences are due to genetically similar organisms or are isolated occurrences.

In other words, an outbreak may not be identified as such until it’s too late.

Not only will the CDC be unable to track this data, but the Food and Drug Administration (FDA) — the agency responsible for regulating food producers in the first place — closed down its day-to-day food-observation activities Tuesday.

The FDA is responsible for monitoring about 80 to 85 percent of the country’s food supply. The USDA will keep its meat inspectors on duty, meaning meat and poultry is safe and will continue to be inspected, but the remainder of the food supply has not been subject to inspection since Tuesday. Fruit, vegetables and seafood, for example, fall under the FDA’s domain and are being produced, imported and exported without scrutiny.

To put the implications in context, consider that the FDA typically inspects about 19,000 domestic food facilities every year — or 50 per day. Not only are FDA inspectors no longer out in the field, but laboratory research is also to be put on hold, and the agency will not be publishing any guidance documents. The last point isn’t as innocuous as it sounds; the FDA has issued more 500 warning letters to food and drug providers so far this year. The letters make up a frightening repository of violations including drug-tainted veal, infected cattle material used in pet food, and knock-off prescription flu medication sold online.

Not every violator is caught red-handed, but the threat of a surprise FDA visit is typically enough to keep most manufacturers honest, and the warning-letter system prevents most food-borne illnesses from ever taking flight, according to Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest. With the FDA’s day-to-day operations shuttered, that threat no longer exists, and the result could be more bouts of food poisoning than usual, she said.

“Some outbreaks will never be investigated and solved while others might be solved days or weeks later than they otherwise would,” Smith DeWaal said. “And each day of delay means that more consumers could be sickened from the undiscovered contaminated food.”

The furloughs may lead to public-health disasters today, and they may also result in a stymying of the medical science advancement needed to maintain the wellbeing of the country tomorrow. As of this week, the National Institutes of Health (NIH), the world’s largest source of medical-research funding, will cease reviewing or issuing new research grants. It will also stop initiating any new clinical trials or studies. As a result, the U.S. could see a significant setback in its medical-research industry.

“About 50 percent of our laboratory-based research is coming from the NIH, and all our clinical trials are funded by the NIH,” Nora Disis, director of the University of Washington’s Tumor Vaccine Group, told Al Jazeera. Due to furloughs, Disis’ clinic is unable to schedule a required visit from a federal regulator. One trial has already been placed on hold, with more likely to follow.

Beyond the potential for long-term delays in innovation, the cessation of trials also has immediate effects on the patients enrolled in those trials.

“Many of our patients have advanced-stage breast cancer and have been through all the conventional therapies, and their only next treatment would be through a clinical trial,” said Dr. Lupe Salazar, an investigator at Tumor Vaccine Group. “That’s what we can’t offer them.”

It’s no different at the NIH Clinical Center, the Bethesda, Md. hospital where patients enrolled in NIH clinical studies are treated and monitored. The center will continue to be staffed to provide ongoing treatment to those already in beds, but patients who had been anticipating enrolling in trials will be out of luck.

“We are approximating that around 200 new patients a week will be deferred until the government resumes full operations,” said Renate Myles, the NIH’s news media branch chief.

By the end of October, the NIH could be forced to turn away 1,000 patients, a relatively small number compared to the untold thousands or even millions that could sit waiting for a treatment or cure left languishing, untested, on the shelf.

Hidden Costs For At-Risk Communities

Although not as widely reported as the issues facing the CDC, FDA, and NIH, there are a few small items of note relevant to smaller, but in some cases higher-risk, groups:

• Indian Health Services, the main provider of on-reservation health services will be “unable to provide funding to Tribes and Urban Indian health programs,” pulling out the safety net from under an already-high risk population. The 176 HIS hospitals and clinics will stay open, but nutrition and other programs will be cancelled.
• VA hospitals will remain open; however, benefits claims will likely take longer to process due to a cessation of all mandatory overtime. Military commissaries, which provide service members and their families with affordable groceries, have been shuttered. In addition, if the government shutdown continues through the end of October, the VA will no longer be able to pay either pensions or disability claims.
• The 8.9 million moms and kids who survive on the health and nutrition services provided by the Special Supplemental Nutrition Program for Women, Infants and Children (also known as WIC) could soon be at serious risk; experts estimate that the program can continue to run for about one week.  
• The Federal Trade Commission, responsible for protecting consumers from deceptive marketing and advertising, has been completely shut down. Although not ostensibly a health agency, the FTC is the de facto regulator for vitamins, supplements, and other over-the-counter health products over which that the FDA technically has no jurisdiction.