GAO delivers 3 recommendations to make CDC better
Steve D. Morris is a name many may not recognize, yet he is a major national food safety decision maker. And he just writes letters with many of them addressed to Rep. Rosa DeLauro, who is more engaged on food safety than anyone else in Congress.
Morris is director of Natural Resources and Environment at the United States Government Accountability Office (GAO). When Congress wants information on food safety, the job of investigating to find answers usually goes to Morris.
And he’s usually writing to DeLauro because the Connecticut Democrat is one of the most senior members of House. She chairs the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.
His latest letter to DeLauro is part of a 60-page GAO report on how the federal Centers for Disease Control and Prevention (CDC) could “further strengthen its efforts to identify and respond to foodborne illnesses.”
In the report, the GAO makes three recommendations to Congress:
1.) The Director of the Centers for Disease Control and Prevention should develop a plan for addressing risks that the increasing use of culture-independent diagnostic tests poses to the CDC’s continued ability to identify foodborne illness outbreaks.
2) The Director of the Centers for Disease Control and Prevention should make publicly available CDC’s decision-making process for communicating about multistate foodborne illness outbreaks, including the scenarios it considers to aid in decision-making.
3.) The Director of the Centers for Disease Control and Prevention should implement a program performance assessment system for its multistate foodborne illness outbreak investigations, including setting performance goals, assessing progress toward achieving those goals with performance measures, and conducting program evaluations.
His letter to DeLauro in the latest GAO report says: “You asked us to review CDC’s response to multistate foodborne illness outbreaks.”
“This report (1) describes CDC’s roles and responsibilities in identifying and responding to multistate foodborne illness outbreaks, including collaboration with federal, state, territorial, and local partners; (2) examines challenges CDC faces in identifying and responding to multistate foodborne illness outbreaks and the steps CDC has taken to address these challenges; and (3) examines the extent to which CDC evaluates its performance in identifying and responding to multistate foodborne illness outbreaks.”
After explaining how GAO went about its investigation, the Morris letter continues with:
“CDC uses several surveillance systems to track and monitor reports of foodborne diseases in the United States, such as PulseNet and the Foodborne Diseases Active Surveillance Network (FoodNet).
“Most information in these systems comes from state and local health agencies. CDC uses data from its surveillance systems to identify outbreaks, monitor trends, and measure how well prevention programs are working.”
However, according to a 2011 CDC report, only a small proportion of foodborne illnesses are diagnosed and reported to public health agencies. Underdiagnosis occurs if a sick person does not seek medical care or does not have a specimen taken for laboratory testing.
“Underreporting occurs because not all laboratory-confirmed illnesses are reported to the CDC. According to the CDC, many steps must occur for an illness in the population to be registered in CDC’s foodborne illness surveillance systems. . .”
The GAO letter says the CDC is responsible for three key functions during a multistate foodborne illness outbreak: (1) identifying possible outbreaks using a number of pathways; (2) coordinating investigations with public health officials in affected states and territories, as well as federal regulatory partners, to determine likely food sources of outbreaks; and (3) communicating with the public about the likely food source of the outbreak and what steps can be taken to prevent further infections.
During a multistate foodborne illness outbreak, CDC serves as lead coordinator for FSIS; FDA; and state, territorial, and local health departments in identifying the possible outbreak, and in defining its size and extent, according to the GAO report.
Morris reports CDC is “balancing the competing needs for timeliness and accuracy in its outbreak communications, while also maintaining public trust.” Some say that may be an indication the agency recognizes it still falls short when it comes to transparency.
The report says CDC’s public communication framework was updated in both 2011 and 2018 “to aid in decision- making about when what, and how to communicate during a foodborne illness outbreak.”
CDC officials claim to primarily consider (1) the level of public health concern, such as the severity of the illnesses or the vulnerability of the groups affected; and (2) the specificity of the public health concern, such as whether a specific food item has been identified as the likely source. It then may respond with any one of the following:
- a “reactive” media statement, or internal talking points to be used to respond to any inquiries from the media or others;
- an Investigation Notice to provide information about an outbreak not yet linked to a specific food source, or an outbreak linked to a general type or category of food rather than to a specific food; or
- a Food Safety Alert to provide specific advice to consumers, restaurants, and retailers about foods to avoid eating or selling. This advice may include information about a recall or other warnings.
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