Government Shutdown Boomerangs On U.S. Health
Everyone’s thinking about the U.S. government shutdown. American media have chosen to dramatize a health official’s suggestion that children with cancer will not be able to receive advanced clinical treatments because funds are unavailable. But the kids with cancer are only a sideshow.
The most frightening health effects concern the entire nation, and by extension, the rest of the world. They are many and include these significant consequences:
• Loss of emergency medical resources and coordination,
• Increased susceptibility to foodborne illness (e.g., food poisoning),
• Current and future encroachments on our ability to prevent disease,
• Slowdown in urgent efforts to combat antibiotic resistance, and
• Stagnation of all research involving government contracts.
Also very concerning: Should [any of the tropical storms brewing in the Caribbean] transform into a major hurricane like Katrina or Sandy, the health hazards cannot be underestimated. Rainfall-induced flooding, storm surge, high winds, and related storms all accompany tropical cyclones. Without swift, coordinated, and effective emergency response, states like Louisiana, Florida, and the Carolinas risk not only massive destruction, but also widepread injury, disease, and death.
And that’s just the health/medical side. Here’s a summary of the wicked boomerangs, including highlights from my article of yesterday for examiner.com.
First, consider the shutdown’s impact on the Department of Health and Human Services, the main health, medical, and disease agency in the United States.
This federal agency aims “to protect the health of all Americans and provide essential human services, especially for those who are the least able to help themselves.”
HHS personnel involved in first response to national crises:
• Emergency support functions,
• National disaster medical system,
• Medical surge capability,
• Strategic national stockpile of medicines and vaccines,
• Federal medical stations and medical reserve corps, and
• Public health administration.
HHS has overall responsibility for three other important agencies:
• The U.S. Food and Drug Administration,
• The Centers for Disease Control and Prevention, and
• The National Institutes of Health.
Food and Drug Administration
The sequester hit FDA pretty hard. Now, almost half (45%) of the agency’s personnel are furloughed.
No food import inspections will take place during the shutdown. This leaves us vulnerable to tons of contaminated fish (91% of which are imported), bad veggies (50% imported), and toxic fruit (20% imported). The Department of Agriculture will continue monitoring meat and poultry. The National Center for Toxicological Research, food and drug product registration and listing, and critical path initiatives are also endangered.
Centers for Disease Control and Prevention
CDC personnel work 24/7 to protect the United States from health and safety threats, both foreign and domestic. CDC has had to furlough about 70% of its employees. The shutdown will affect the functioning of our national emergency operations center itself. The cuts will also end support for state and local partners with infectious disease surveillance. Lab testing has been cut back. The shutdown means no effective monitoring of multi-state disease outbreaks. CDC’s work to track and prevent HIV/STDs, tuberculosis, and MERS will be limited or postponed. The agency will not be conducting routine inspections of high-risk (BSL3 and BSL 4) labs.
The shutdown has also affected many more individuals by limiting the country’s seasonal flu program. With “Chinese bird flu,” H5N1, and H7N9, influenza has evolved into an increasingly lethal disease. The shutdown won’t affect the availability of flu shots this fall (135 to 140 million doses of vaccine are currently being produced), but it may limit CDC’s ability to warn people at high risk and respond to uneven or rogue illness. [Furthermore…], the shutdown may curtail our ability to assimilate this season’s disease results and prepare next year’s flu shot. Within a few weeks, CDC researchers are scheduled to begin analyzing this year’s viruses to determine next year’s multi-strain vaccine.
Another meaningful consequence has to do with antibiotic resistance. Three weeks ago, CDC issued a new report about working on it. The problem is said to require “urgent and immediate collaboration among public health, clinical medicine, agriculture, industry, and policy makers.” Urgency has now succumbed to lethargy.
National Institutes of Health
The National Institutes of Health handle the nation’s medical research. Not surprisingly, NIH is the hardest-hit health agency. It has had to furlough 75% of its staff because of the shutdown. (Fortunately, staff at HHS who work with lab animals are still on the job.)
The NIH Clinical Center–the world’s largest research hospital–is suffering from the cuts. More than 1,400 ongoing clinical trials of new medicines in people with serious and even mortal conditions will be able to continue, but the agency will not be able to start any new Phase 4 trials of potentially disease-reducing or life-sustaining therapies. Four clinical trials should be start next week, but they risk delay or cancellation if the shutdown continues.
Possible political ramifications
According to a longstanding and respected independent national poll released Tuesday, American voters oppose Congress shutting down the federal government to block implementation of the Affordable Care Act by a three-to-one margin. The House of Representatives has even blocked a center-right budget deal that some influential Republicans initially backed, but then turned down at roll call time. The impassioned battle cry being heard: federal government is bad for us, and Americans do not want or need governing (although, to the contrary, at least 47% of us are lazy sloths looking for handouts).
American voters also oppose blocking an increase in the nation’s debt ceiling (deadline: October 17), by well over a two-to-one margin (64-27%). The poll finds voters almost evenly divided on Obamacare and federal budget deficit issues. However, only one-third of Americans think Congress should defund the health care law. The President’s approval rating dropped to 45% [but gained 1% yesterday].
Looking at the 2014 Congressional races, voters now pick a generic Democrat over a generic Republican candidate by an 11% margin, the widest Democratic lead measured so far, according to Peter A. Brown, assistant director of the Quinnipiac University Polling Institute. “On almost all questions, voters see President Obama as more reasonable, and better able to handle the issues. But it is not because the president is beloved…. Voters are angry at almost everyone in Washington over their inability to keep the trains running, but they are madder at the Republicans than the Democrats.”