Government Shutdown Will Have Lasting Negative Effects

The 16-day federal shutdown in October caused US public health and biomedical research systems immediate and long-term problems, according to an analysis by Kuehn published in Journal of the American Medical Association [2013;310(18):1907-1908].

The shutdown reduced staffing at the federal health agencies and cut off funding for health laboratories and other efforts that require federal support. According to the US Department of Health and Human Services (HHS) October 10, 2013, contingency plan, 54% of HHS employees were furloughed and 46% of employees were retained. However, some agency’s units were harder hit than others. See Figure for a breakdown of staff retained among HHS’ agencies and offices.

Leaders from several US physician organizations said, “The shutdown likely did lasting damage to the US public health and biomedical research enterprise, setting back research and public health programs by years.”

Lives at Risk

Interruption of public health efforts raised major concerns as the nation entered peak seasons for influenza and other communicable diseases. The multistate outbreak of antibiotic-resistant Salmonella Heidelberg in early October drew attention about the nation’s ability to respond to and prevent outbreaks of foodborne illnesses during the shutdown. The Centers for Disease Control and Prevention (CDC) had sidelined investigators who are tasked to work quickly to identify and contain foodborne epidemics. Approximately a week into the 16-day shutdown, there were reports of nearly 300 illnesses in 17 states caused by the bacterium, which had been linked to raw chicken traced to Foster Farms in California. Although the CDC recalled about 30 furloughed staff, the delayed response left more people vulnerable to becoming ill. A recent CDC update on the outbreak shows 389 individuals infected with strains of Salmonella Heidelberg have been reported in 23 states and Puerto Rico, and 40% of the cases required hospitalization.

Program Delays

Although the shutdown is over, it is expected to have repercussions. Experts foresee that a variety of programs and partnerships between institutions will be delayed or even possibly eliminated. Georges Benjamin, MD, executive director of the American Public Health Association, explained that 70% of CDC funding is earmarked for local communities and state and local health departments and that many projects involve collaboration at all levels of government.

Another consequence of the shutdown might be setbacks to multiagency efforts to curb antibiotic resistance, according to Amanda Jezak, vice president for public policy and government relations for the Infectious Diseases Society of America. She explained that fighting the emergence of antibiotic resistance is a priority for the United States, noting that several agencies have launched complementary efforts to prevent or combat antibiotic resistance. Because of the complexity of antibiotic resistance, no single agency can handle it on its own. The effects of the government shutdown may jeopardize these efforts.

Economic Burden

Apart from the possible harm to individual patients and specific programs, there are hidden costs of shutting down much of the federal research enterprise. For example, studies have been delayed, some of which will never start as result of the shutdown. Studies that do restart will require additional funding and time than if they had not been delayed, according to Clifton Hudis, MD, president of the American Society of Clinical Oncology and chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York. The shutdown also caused problems for research at some federal laboratories that use specialized and expensive mice in research on Alzheimer’s disease and cancer.

Dr. Hudis explained that cumulative effects of the shutdown might slow the pace of research for the next to 5 to 10 years. It may also put the United States’ position as a global leader in research in jeopardy. The investment in science has been a source of economic growth, producing valuable patents and employment.

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