US health agencies take stock after federal shutdown
Authors: Sharmila Devi
Journal: The Lancet (2013)

Federal health and science organisations are returning services to normal and assessing the damage after the US Government shutdown came to an end last week. Sharmila Devi reports. Thousands of public health workers returned to work in the USA last week after a 16-day government shutdown caused by bitter political wrangling, mostly over health-care reform, ended. However, health advocates warned that budget cuts and diminished capacity remained long-term concerns. In the short-term, America seemed to have escaped any immediate health crisis. At the Centers for Disease Control and Prevention (CDC), only about 4000 out of just under 13 000 employees were not furloughed or granted a leave of absence. However, some staff were called back to manage a salmonella outbreak in California. Tom Frieden, CDC director, wrote on his Twitter account at the start of the crisis: “CDC had to furlough 8754 people. They protected you yesterday, can't tomorrow. Microbes/other threats didn't shut down. We are less safe.” On Oct 17, a day after Republicans conceded defeat in their battle with President Barack Obama, Frieden wrote: “So relieved to have the best and brightest back to work protecting and promoting health. Hope for no lapse…” Congress approved last-minute legislation on Oct 16 to extend federal borrowing power through to Jan 15 after conservative Republicans failed in their bid to strip Obama's signature health-care law of funding. Standard & Poor's, the credit-rating agency, estimates the shutdown cost US$24 billion to the US economy and many commentators believe the bipartisan fighting will resume in January. The funding of federal health-care programmes and scientific research was already suffering from “death by a thousand cuts”, said Jeff Levi, executive director of Trust for America's Health, a non-partisan organisation working to make disease prevention a national priority based in Washington, DC. “Since the fiscal year 2010, the CDC budget has gone down 10%. At the state and local level we've lost 50 000 jobs in the last 2 to 3 years, so there's diminished capacity in day-to-day preparedness and emergency response”, he said. “The shutdown will also have had an effect on the attractiveness of government service to the best and brightest and most highly-qualified scientists. I just met a senior administration official who said it's already hard to recruit”, Levi added. The US Department of Health and Human Services, which includes the CDC, the National Institutes of Health (NIH), and the Food and Drug Administration (FDA), furloughed 52% of its staff, or 40 512 people, the department said. It had warned that the CDC's ability to prepare a response to emerging outbreaks, including the H7N9 and the Middle East respiratory syndrome outbreaks, “could be delayed”. The NIH said at its hospital, the NIH Clinical Center, only a small number of new patients with life-threatening illnesses were admitted and only one new clinical trial involving such patients was started during the shutdown. The Center had resumed its normal patient admissions process and this was “critically important since the hospital sees many seriously ill patients”, the NIH said in a statement after the shutdown. NIH research, done by some 6000 scientists in the agency's own laboratories, was severely curtailed. “While some basic and translational research projects involving large or unique investments of resources continued at a greatly reduced pace to protect these investments, the majority of research projects were placed on hold”, the NIH said. “This has resulted in a profound loss of momentum. Hundreds of experiments will require starting over, which may take many months.” The NIH told all grant applicants they would get a fair review but the funding lapse had caused delays. The agency announced new due dates for grant applications and new information on post-shutdown review timelines. The NIH-supported PubMed, which comprises more than 23 million citations for biomedical literature, was maintained with minimal staff during the shutdown, said its website. After the shutdown, the CDC said on its website that activities were returning to normal, including its weekly FluView surveillance reports but in a shorter form. The reports were shut down for 2 weeks coinciding with the start of the flu season but the CDC's latest report indicated that there was little activity. The CDC also posted an abbreviated version of its Morbidity and Mortality Weekly Report. Staffing was maintained during the shutdown under a contingency plan at the FDA and US Department of Agriculture to conduct “safety of human life” activities, such as certain inspections and high-risk recalls. But routine establishment inspections and most laboratory research needed for public health decision making were shut down.