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Furloughed or Funded—How Are Health Care Agencies Operating During the Government Shutdown?

JAN 23, 2019 | MICHAELA FLEMING
As the partial government shutdown enters day 32, many questions continue to swirl.

These worries are not restricted to federal employees wondering how to pay their bills or questioning when they’ll be back to work; they extend to all Americans.

Without oversight from federal health care agencies, some may be pondering whether the food they’re eating is free from pathogens. Is it OK to serve a snack to a young child with a life-threatening allergen or is there an undeclared allergen that could lead to anaphylaxis? Is it safe to take my daily medication or is there an impurity or unapproved ingredient?

This shutdown marks the longest in American history and with an unknown end date, Contagion® set out to answer some of these questions and find out the facts about the shutdown’s impact on public health.

Although there is a long list of health care agencies that operate under federal funding, not all of their budgets are voted on simultaneously. The budgets of some agencies, including the Department of Health and Human Services, were voted upon prior to the shutdown in December, meaning that some entities are open and operating.

While it is good that some health care-related agencies are not experiencing major disruptions, interagency work is suffering, and the long-term effects are unknown.

Here is a breakdown of the operating status of health care-related agencies:

US Department of Agriculture (USDA):

The Department of Agriculture is a separate budget that is voted upon by Congress; the department does not fall under the US Department of Health and Human Services. As a result, the department is seeing significant disruption of regular activities.

According to a news release, following January 1, 2019, USDA activity would be limited to: conducting meat, poultry, and egg inspections; grain and commodity inspection; and inspections for import and export activities to prevent dissemination of pests in and out of the mainland United States.

One roadblock includes disruption to the monitoring of pesticide residue in agricultural products, which can create issues for children who consume the products.

Additionally, it has been reported that research being collaborated on by USDA employees and external investigators is being halted until employees are no longer furloughed. One notable example was publicized by Kevin Lahmers, DVM, PhD, a veterinary pathologist who first identified the Asian longhorned tick in Virginia.

The Asian longhorned tick has been identified as a public health threat by the CDC, and little is known about the dangers of the pathogen.
 
“Collaborations with USDA ARS in Pullman, Washington, are shutdown at this crucial time,” said Dr. Lahmers in a press release. “We are ready to start determining if the longhorned tick can transmit Theileria orientalis, another recently identified disease in Virginia, from calf to calf. However, because of the delay, we cannot begin this process to determine the risk this poses to cattle and how we might manage this risk. Delays will handicap our understanding of the disease dynamic and control strategies for the coming year.”

US Food and Drug Administration (FDA):

The entirety of the FDA’s budget was not approved prior to December 21, 2018, when the shutdown began. Part of the agency’s funding falls under both the US Department of Health and Human Services and the USDA, therefore the agency is not operating at full capacity.

On Friday January 11, 2019, the Office of Management and Budget and the Department of Health and Human Services authorized the agency to bring infectious disease inspectors back to work. The inspectors operating under the Office of Regulatory Affairs returned to work beginning on January 15, 2019.

According to a series of tweets issued by Scott Gottlieb, MD, commissioner of the FDA, on January 22, 2019, current ongoing activities include: foodborne illness surveillance and investigations, monitoring of imported and high-risk foods, and execution of high-risk recalls.

The agency conducts approximately 160 food inspections per week when the agency is fully operational. At this time, inspections will only occur at high-risk facilities, which can include those producing both food and medical products that have a history of contamination or safety issues. Food products include meats, seafood, and soft cheeses.

On January 21, Dr. Gottlieb indicated that under the Office of Human and Animal Food Operations there are currently approximately 200 food investigators working out of the total 550 professionals on staff. At this time the working staff are not receiving pay and traveling using personal funds

Dr. Gottlieb also reported via Twitter that an additional 450 staff members are working during the shutdown at international mail facilities and ports of entry under the Office of Import and Enforcement Operations.

US Centers for Disease Control and Prevention (CDC):

The CDC’s budget is included in the Department of Health and Human Services’; therefore, the agency is fully funded during the shutdown.

Despite the status as a fully funded office, the CDC still depends on other agencies to conduct outbreak investigations and tracebacks.

According to Reuters, CDC spokesperson Tom Skinner said that investigation, communication, and coordination about new and ongoing outbreaks may be delayed as a result of the shutdown.

Further, Skinner reported that the timeliness of the information is dependent on the available resources of partner agencies that may be impacted. Outbreak investigations are typically coordinated with the USDA and FDA, both of which are operating in limited capacity due to the shutdown.

While outbreak investigations have been updated, there have been no new outbreaks declared by the CDC since the beginning of the shutdown.

National Institutes of Health (NIH):

The NIH is operating as a fully funded agency at this time, as the budget was approved by Congress earlier in 2018 under the Department of Health and Human Services.

As Monica V. Mahoney, PharmD, BCPS-AQ ID, BCIDP, clinical pharmacy coordinator -infectious diseases, at Beth Israel Deaconess Medical Center, told Contagion®, as the NIH is still operational, the burden is different from previous shutdowns.

These burdens included disruptions to PubMed, which prevented clinicians from searching for primary literature, and Clinicialtrials.gov, which affected availability for trial enrollment and funding. In addition to enrollment, funding and grants from NIH were inaccessible, hampering the research of academic and private-sector researchers, and scientific employees employed by federal agencies, and preventing employees from attending scientific conferences.

Bottom Line:

From these findings it is clear that the government shutdown is anything but simple to understand. The intertwined budgets have left some agencies partially funded, and others with access to all of their resources.

While clinicians are relieved to still have access to resources that are necessary to treat patients, uncertainty still remains.
 
“One of the larger concerns we have from the health care/infection control standpoint is the capacity of the FDA to alert us of drug recalls and contamination, etc.,” Saskia Popescu, MPH, MA, CIC, an infection preventionist and Contagion® contributor, said. “While food inspections have been a big topic of concern, and rightfully so, I also worry about the capacity to notify healthcare providers of drug shortages, recalls, etc.” 

And now we return to the question—how long will this last and what will the long-term consequences be?

The answer? Only time will tell.
 

Are you an infectious disease clinician who wants to share your insight on how the government shutdown is affecting ID? Email me (mfleming@contagionlive.com).
 
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