Federal Shutdown Causing Immediate and Lasting Damage to US Public Health, Science

Physicians fear the shutdown will have lasting negative effects on patients and US science. Image: Catherine Lane/iStockphoto.com

Physicians fear the shutdown will have lasting negative effects on patients and US science. Image: Catherine Lane/iStockphoto.com

With disease trackers from the Centers for Disease Control and Prevention (CDC) sidelined by the US government shutdown, pediatricians and other physicians are going without essential information about outbreaks of influenza, pertussis, and other infectious diseases in their area.

“If there is a pertussis outbreak, we won’t know,” said Anne Edwards, MD, a Minnesota pediatrician and chair of the American Academy of Pediatrics (AAP) committee on state government affairs. The federal public health agency “is a system we work with to respond efficiently and treat people appropriately when an outbreak occurs,” she said.

This interruption of public health efforts is a major concern as the nation enters peak seasons for influenza and other communicable diseases, and it’s only one of a string of immediate public health repercussions of the government shutdown. Wrenching stories have emerged from the hundreds of patients who cannot enroll in cancer clinical trials at the National Institutes of Health Clinical Center because new trials have been stopped and of vulnerable families who are at risk of losing their federal food aid.

But it’s not only these immediate effects that concern the medical community. Some physician leaders, who are calling for a speedy end to the shutdown, say there may be even more devastating long-term effects on public health and science.

Edwards, who just returned from meeting with Congressional leaders on Capitol Hill, said she and her colleagues raised concerns about the short- and long-term developmental effects of cutting food aid and child care programs for vulnerable children. She explained that 1 in 5 children live in poverty and that she and her colleagues at the AAP are concerned about what will happen as states exhaust their federal funding for the Head Start Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, which provide important nutritional support to pregnant and breastfeeding women and infants and young children. Children who lack adequate nutrition or access to quality care may have lasting developmental delays, she said.

“These programs are in limbo,” she said. “Some states have funding, but how long these programs continue will depend on how much money they have left.”

In addition to the potential harm to individual patients, there are hidden costs of shutting down much of the federal research enterprise. Clifford Hudis, MD, president of the American Society of Clinical Oncology and chief of the breast cancer service at Memorial Sloan-Kettering Cancer Center in New York, explained that studies have been delayed, some of which will never launch as a result of the shutdown; those that do restart will require more time and money than if they had not been interrupted.

“The price is huge and unknowable,” he said.

There have been other hard-to-quantify losses as well. For example, last week at IDWeek 2013, a major infectious diseases conference, 42  CDC employees and scientists from the US Food and Drug Administration, the National Institutes of Health, and other agencies (about 10% of the total speakers) were absent from their scheduled talks and panels. The result: attendees were denied valuable information about federal agency research and surveillance that the absent scientists had planned to share; discussions or collaborations between federal scientists and their colleagues in academia or industry that might have otherwise occurred did not take place. Additionally, Amanda Jezek, vice president for public policy and government relations for the Infectious Diseases Society of America, said government scientists were denied the chance to hear what other scientists are working on, as well.

Jezek said the shutdown has been compounding existing problems for federal scientists. “With flat funding, cuts, and sequestration, we’re really seeing a lack of adequate investment in biomedical research and public health,” she said.

Of particular concern, Jezek noted, are the shutdown’s damaging effects on multi-agency agency efforts to combat antibiotic resistance. “It’s almost the worst time for this to happen, because we had so much momentum,” she said.

Numerous other scientific meetings are planned for this fall and are likely to also suffer from the lack of federal scientists.

“You can’t quantify the loss of programs because of a lack of interactions at a meeting,” Hudis said. “We won’t know what research will never be done.”

The cumulative effects of the shutdown might slow the pace of research for the next 5 to 10 years, he said, and may also jeopardize the United States’ position as a global leader in research. Hudis explained that US investment in science has been a engine of economic growth, producing valuable patents and jobs. He speculated that an extended shutdown might discourage young people from pursuing science careers.

“We are jeopardizing a crown jewel of America’s global leadership,” he said.

Categories: Health Policy, Public Health