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Government closure 2018: what it means for the flu, CDC, FDA and NIH



The US Congress UU And the White House did not agree on a new budget for midnight on Friday, and now the US government. UU Is closed.

That means that all employees and federal "non-essential" programs will not be able to work. What is particularly worrying are the tens of thousands who work in agencies responsible for public health, such as the Centers for Disease Control and Prevention, which track and respond to diseases such as influenza and foodborne diseases.

In the event of a closure, 50 percent of the 80,000-member staff of the Department of Health and Human Services will likely be suspended, reducing federal health personnel to only 40,000 employees. That includes some people at the CDC who monitor outbreaks, researchers from the National Institutes of Health who are looking for cures for diseases, and inspectors from the Food and Drug Administration who take care of pharmaceutical and food safety. More than that, it means that some patients will not be able to enroll in clinical trials for potentially life-saving procedures.

This is what we can expect from health and science during a closure. It is making us anxious.

1) A government shutdown could mean we will not know, as quickly, how deadly this year's flu outbreak is

. At this moment, the United States is on the verge of one of the deadliest seasonal flu epidemics of the last times. And the shutdown will slow operations in its seasonal influenza program.

According to Buzzfeed reports, hours before the government closed on Friday night, the agency published a contingency plan that said influenza outbreak monitoring would continue during a closure, but that influenza reports may be published in a slower calendar.

During 2013 closure, state laboratories continued to operate, doing the work of monitoring diseases to detect outbreaks, but they could not turn to CDC epidemiologists to help coordinate investigations, and all samples sent to the agency were they accumulated. At that time, the CDC was also unable to update national disease trends or disease groups.

Tom Frieden, who was the agency's director for eight years, from 2009 to 2017, said that the 2013 closure "was the only time I felt I could not do my job of protecting Americans."

He added: "It was really the most distressing moment because it was like having your eyes blindfolded and having a hand tied behind your back."

Although the government says that "activities related to the safety of human life" are Assuming they continue in case of closure, Frieden added that the way the closings work is "very irrational."

"Because whether or not people can continue working does not depend on how important their jobs are," he said. "It depends on where the funding sources come from and if certain legal definitions are met."

For example, in 2013, CDC employees who worked in the monitoring of foodborne diseases were suspended and had to return to work because of a severe outbreak of salmonella, caused by raw chicken products. The outbreak sicked 278 people and hospitalized 76 in 18 states.

According to the Government's 2018 government contingency plan for the closure of the government, 50 percent of the personnel of the Health and Human Services agencies will be suspended. Retention rates at specific agencies vary, but the plan suggests that only 37 percent of the 13,600 CDC employees will be retained. In the other two key health agencies in the department, the NIH and the FDA, the figures are only 23 and 58 percent, respectively.

At the close of 2013, Frieden said, his agency did not know of any deaths that occurred as a result of the closure of the government's public health services, but he could not be sure. "In practice, it is certainly possible," he said. "We did not have our systems fully operational to evaluate that."

2) NIH will not be able to enroll new patients in clinical trials, and research will stop


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Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, is concerned about having to reject new patients for NIH clinical trials.
Paul Morigi / Getty Images

The NIH has hospital facilities to treat patients, but it is also one of the leading basic biomedical research institutions in the United States. The NIH research discovers new drugs and vaccines, and works to better understand the biology of the disease. And not only on its campus in Bethesda: approximately 80 percent of its budget goes towards granting research grants to institutions throughout the United States. (The same applies to the National Science Foundation, which may not approve new research grants either).

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

The same thing would happen this time, Anthony Fauci, the head of the infectious diseases division at the NIH, told the Associated Press on Thursday.

"We still take care of them," he said of patients currently enrolled at NIH. hospitals for treatment. But the new patients would be rejected.

During the closing of 2013, 73 percent of its personnel could not go to work. That means that the research projects were suspended at the Bethesda facility, and no new grants could be granted to outside scientists who were expecting funding. The NIH maintained the essential personnel to ensure the safety of critical cell lines and to keep the research animals alive (mice and primates).

Some investigations can not survive a pause. "You have experiments that have been going on for months, if not years, and then suddenly you have to stop, you can not do that," Fauci told the AP. "You can not press the pause button in an experiment when you inject an animal with a particular substance to see what the answer is and then you have to go home for a week."

The closure also throws a wrench into the world and disciplinary scientific collaboration. During a closure, government scientists can not attend conferences.

3) FDA food inspection work would be at risk

The Food and Drug Administration not only regulates pharmaceutical products and monitors their safety after they are placed on the market; it also regulates most of the food supply. And one of the most frightening aspects of this impending government shutdown is that the agency will probably have to put its food safety inspections on hold.

At the end of 2013, according to Food Safety News, FDA food safety inspectors were asked to hand over their government cell phones and did not even check their work email until Congress approves a budget. "

This did not mean that all food safety inspections in the United States were stopped, private companies continued with their own monitoring practices, and inspectors from the US Department of Agriculture, which oversees inspections of meat, poultry and eggs were able to continue working, but the federal oversight provided by the FDA of 80 percent of the food supply was closed.

In an excellent story about the impact of government closure on health, STAT reported that FDA staff who worked on research that would inform public health decisions were stopped, as was "the agency's efforts to Antener updated and accurate information on drug labeling. "

In addition to the programs and services that have been stopped, we can also expect a slower FDA shutdown mode." Again, the government's contingency plan for the government's closure in 2018 would maintain only 58 percent of the 17,000 FDA staff members at work, therefore, drug approvals would be reduced, for example (but not necessarily stopped because they are partly funded by the private sector).

So, in general , the closure of the government will not mean an apocalypse for human health, but it would mean that our government will be less able to monitor and respond to outbreaks of disease.


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