When Public Health Budgets are Cut, Someone Still Pays

We're hearing a lot of rhetoric about the need to slash government spending, so it's a good time to remind everyone that there's no such thing as a free lunch - and if you think you're getting a free lunch, it might be loaded with pathogens.

Maryn McKenna, writing at Superbug about a New England Journal of Medicine study, has an illustrative example: the Great Tomato Scare of 2008. Between May and August of 2008, 1,499 people (and probably many more) fell ill from the Saintpaul strain of Salmonella, and two people died. The Food and Drug Administration initially thought tomatoes were to blame; by the time they concluded that jalapeno and serrano peppers were the culprits, the damage to the tomoato industry was done - to the tune of more than $100 million. McKenna writes:

What could have helped? More speed, for one thing -- in identifying victims, analyzing outbreaks, and tracing the path of produce through complex, braided, multi-national system by which food is distributed and sold. And better technology, for another. For years before this outbreak, researchers had been agitating for a "FedEx system" for tracking produce; thanks to this outbreak, they got the promise of that in last autumn's Food Safety Modernization Act, though its traceability requirement will take years to implement.

And, as Michael T. Osterholm points out in an NEJM Perspective, implementing the Act will cost money that hasn't yet been appropriated:

There was no appropriation approved by the Congress for the act or authorization in the bill for the FDA to assess fees on the companies that it inspects. The Congressional Budget Office estimated that implementing this legislation would require $1.4 billion between 2011 and 2015.5 Though the bill authorizes the FDA to collect fees when a facility requires reinspection and a recall fee for mandatory recalls, these fees are expected to provide minimal resources. In short, the actual effect of this important law will at best be extremely limited if Congress and the administration don't appropriate and sign additional legislation providing the necessary funds to carry out its mandates. Recent reports in the media calling this act "historic legislation" must be tempered by the reality that without the necessary resources, requiring the FDA to carry out the law's required activities will be like trying to get blood out of a rock.

Here are a few numbers: In order to start implementing the Food Safety Modernization Act in FY 2012, FDA has requested $324 million (part of an overall $4.3 billion request for the agency as a whole). But Helena Bottemiller of Food Safety News reports that the House's continuing resolution for the remainder of FY 2011 would cut $222 million from the FDA's budget over the next eight months - and I expect the House will aim for even deeper cuts in FY 2012 appropriations. The chances of the agency being able to invest in the staff and technology to trace the source of foodborne outbreaks more quickly don't look good.

Failing to invest has a cost, though. If we don't improve our food-safety system, we'll keep paying in other ways. Thousands of people will get sick, and some will die. Growers and producers whose foods are suspected in outbreaks will lose millions of dollars and lay off workers as a result. Instead of spreading the cost of a safer system across all taxpayers, we'll let the costs of an unsafe system be borne by a much smaller number of individuals and businesses.