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State Health Departments Need
Increased Level Of Competence

Without a doubt the most prescient person in this whole Salmonella Saintpaul outbreak is Jim Gorny at UC Davis. At an early stage in the outbreak, he wrote a piece for us which we published under the title, Tomato/Salmonella Situation Cries For Improved Epidemiology.

Dr. Gorny foresaw that the focus would move quickly to traceback, although the real problem was epidemiology:

Since September 2006, many persons have advocated for expenditure of more resources to enhance produce traceability, as they believe that enhanced traceability is the most effective means of avoiding the complete shutdown of a produce industry sector. Well, it has happened again and traceability was never the cause of these industrywide shut downs, and it is unlikely that enhanced traceability will ever prevent a future industrywide shutdown.

…painstakingly slow epidemiological investigations carried out by local, state and federal public health officials are the real cause of these industrywide shutdowns.

Dr. Gorny also cautioned about how sloppy epidemiology up front could cause massive delay:

Importantly, epidemiologists investigating the foodborne illness outbreak must be EXTREMELY careful in assuring that the link between what ill persons ate and where they purchased that food item is factually correct. If a false assumption is made early in the investigative process (i.e., wrong food product or wrong point of purchase), it leads the epidemiological investigation down the wrong distribution chain, thus wasting time, resources and ultimately delaying the identification of the true cause of the illnesses.

There has been much talk of creating one food safety agency on the federal level and, very possibly, that might help. In fact, we don’t know anyone who is opposed to it conceptually, the sticking point being whether the one federal food safety agency should be located in USDA or HHS.

Yet one of the key lessons in this outbreak has been how incompetence and lack of resources on the state level quickly become a national problem.

If Congress really wants to do something useful, it would be to launch a national initiative to bring all state health departments up to the level of top ones such as Minnesota. We would suggest retaining Michael T. Osterholm, who built the Minnesota operation and with whom we spoke frankly about this Salmonella Saintpaul outbreak in an interview we entitled, Dr. Michael Osterholm, Esteemed Authority On Public Health, Speaks Frankly About The FDA, The CDC And The Incompetent Management of the Salmonella Saintpaul Tomato Outbreak Investigation to head up this effort.

Here is how Dr. Gorny explained the situation:

The real issue regarding industrywide shutdowns is not about produce traceability (although good traceability does help), but it is about epidemiological investigations that are slow, laborious, time-consuming and resource-intensive affairs. Because multiple federal, state and local public health authorities must collaborate in these investigations, it increases the complexity of the task. This is not a criticism of public health officials trying to protect public health but merely a statement of facts regarding these investigations.

Public health agencies are currently fragmented and under-resourced to effectively monitor and respond rapidly to developing public health issues. Why did it take upwards of 6 weeks for public health officials to identify this cluster of illnesses… and then only due to the diligence of state public health officials in New Mexico?

Food industry, government and the public should be concerned about this lagging response time and its subsequent effects on public health and commerce. Since September 2006, each and every foodborne illness outbreak investigation should have been viewed as an opportunity to enhance investigation team response times to assure public health and well being. Simply put, more public health resources are needed to adequately protect public health and commerce in a timely manner or we will continue to see industrywide shutdowns in the produce industry.

Traceback is inherently limited as you can’t trace back what epidemiology has not identified as the cause. So even perfect traceback will not find you a jalapeno if epidemiology says the problem is tomatoes.

Dr. Gorny was early and he was right: Getting the epidemiology right and fast is the place for public policy to focus.

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