What the government shutdown means for the nation’s top public health agencies

The shutdown comes amid one of the deadliest seasonal flu epidemics in recent memory.

The US Congress and the White House didn’t agree on a new budget by midnight Friday, and now the US government is shut down.

That means all “nonessential” federal employees and programs will not be able to do their jobs. What’s particularly concerning are the tens of thousands of them who work at the agencies responsible for public health — such as the Centers for Disease Control and Prevention, which tracks and responds to diseases like flu and foodborne illness.

In the case of a shutdown, 50 percent of the Department of Health and Human Services’ 80,000-member staff will likely be furloughed, cutting the federal health staff down to only 40,000 employees. That includes some of the people at the CDC who monitor outbreaks, the researchers at the National Institutes of Health who are looking for disease cures, and the inspectors at the Food and Drug Administration who look out for pharmaceutical and food safety. More than that, it means some patients won’t be able to enroll in clinical trials for potentially lifesaving procedures.

Here’s what we can expect for health and science during a shutdown. It’s making us anxious.

1) A government shutdown could mean we won’t know, as quickly, how deadly this year’s flu outbreak is

Right now, America is in the grips of one of the deadliest seasonal flu epidemics in recent memory. And the shutdown will slow down operations on its seasonal influenza program.

As Buzzfeed reports, hours before the government shutdown Friday night, the agency released a contingency plan that said flu outbreak monitoring would continue during a shutdown, but that flu reports may be published on a slower schedule.

During the 2013 shutdown, state labs continued to operate, doing the work of surveilling disease to detect outbreaks, but they weren’t able to call on CDC epidemiologists for help coordinating investigations — and any samples sent to the agency piled up. Back then, the CDC also wasn’t able to update national disease trends or disease clusters.

Tom Frieden, who was director of the agency for eight years, from 2009 to 2017, said the 2013 shutdown “was the only time I felt I couldn’t do my job of protecting Americans.”

He added: “It was the really the most anxiety-provoking time because it was like being blindfolded and having one hand tied behind your back.”

Even though the government says “activities related to the safety of human life” are supposed to continue in the event of a shutdown, Frieden added that the way shutdowns work is “very irrational.”

“Because whether people are allowed to keep working or not doesn’t actually depend on how important their jobs are,” he said. “It depends on where the sources of funding come from and whether certain legal definitions are met.”

For example, in 2013, CDC employees working on tracking foodborne illness were furloughed — and then had to be put back on the job because of a severe salmonella outbreak, caused by raw chicken products. The outbreak sickened 278 people and hospitalized 76 across 18 states.

According to the government’s 2018 contingency plan for a government shutdown, 50 percent of staff across Health and Human Services agencies would be furloughed. The retention rates at specific agencies vary, but the plan suggests only 37 percent of the CDC’s 13,600 employees would be retained. At the two other key health agencies in the department, the NIH and FDA, the numbers are only 23 percent and 58 percent, respectively.

In the 2013 shutdown, Frieden said, his agency didn’t know of any deaths that happened as a result of government public health services being shuttered — but he couldn’t be sure. “In practice it’s certainly possible,” he said. “We didn’t have our systems fully up and running to assess that.”

2) The NIH won’t be able to enroll new patients in clinical trials, and research will grind to a halt

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Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, is concerned about potentially having to turn away new patients for NIH clinical trials.

The NIH has hospital facilities to treat patients, but it’s also one of the major basic biomedical research institutions in the United States. NIH research discovers new drugs and vaccines, and works to better understand the biology of illness. And not just at its campus in Bethesda — about 80 percent of its budget goes to awarding research grants for institutions across the United States. (Same goes for the National Science Foundation, which also won’t be able to approve new research grants.)

In 2013, the NIH had to turn down hundreds of patients (many of whom were children) who could have potentially benefited from experimental procedures.

The same would happen this time around, Anthony Fauci, the head of the NIH’s infectious disease division, told the Associated Press on Thursday.

“We still take care of them,” he said of patients currently enrolled in NIH hospitals for treatment. But new patients would be turned away.

During the 2013 shutdown, 73 percent of its staff couldn’t go to work. That means research projects were put on hold at the Bethesda facility, and new grants couldn’t go out to outside scientists awaiting funding. The NIH kept on essential staff to ensure the safety of critical cell lines, and to keep research animals (mice and primates) alive.

Some research can’t survive a pause. “You have experiments that have been going on for months if not years, and then all of a sudden you’ve got to stop — you can’t do that,” Fauci told the AP. “You can’t push the pause button on an experiment when you inject an animal with a particular substance to see what the response is and then you have to go home for a week.”

The shutdown also throws a wrench into international and disciplinary science collaboration. During a shutdown, government scientists can’t attend conferences.

3) The FDA’s food inspection work would be imperiled

The Food and Drug Administration not only regulates pharmaceuticals and monitors their safety after they get on the market; it also regulates most of the food supply. And one of the scariest aspects of this looming government shutdown is that the agency would likely to have to put its food safety inspections on pause.

In the 2013 shutdown, according to Food Safety News, FDA food safety inspectors were “asked to turn in their government cell phones and not even check their work email until Congress passes a budget.”

This didn’t mean all food safety inspections in America stopped; private companies continued with their own monitoring practices, and inspectors at the US Department of Agriculture, which oversees inspections of meat, poultry, and eggs, were allowed to continue working. But the federal oversight the FDA provides — of 80 percent of the food supply — was shuttered.

In an excellent story on the 2013 government shutdown’s impact on health, STAT reported that FDA staff who worked on research that would inform public health decisions stopped, as did “the agency’s efforts to keep drug labelling information up to date and accurate.”

In addition to programs and services that are halted, we can also expect a more sluggish FDA in shutdown mode. Again, the government’s 2018 contingency plan for a government shutdown would keep only 58 percent of the FDA’s 17,000 staff members on the job. So drug approvals would slow down, for example (but they wouldn’t necessarily stop, because they are partly funded by the private sector).

So overall, the government shutdown won’t mean an apocalypse for human health. But it would mean that our government will be less able to monitor and respond to disease outbreaks.