INFECTIOUS DISEASES
The Rapid Closure— and Reinstatement— of Two CDC Laboratories
By Sarah Buss, PhD, D( ABMM), program manager, HIV, Viral Hepatitis, STD and TB Programs
Laboratories are essential to public health. Laboratorians work to generate data and provide results that inform public health action and treatment decisions. When laboratories are running smoothly, their work can be underappreciated. However, when laboratory work is abruptly stopped, people quickly take notice.
On April 1, two US Centers for Disease Control and Prevention( CDC) laboratories— the Division of STD Prevention’ s( DSTDP) Laboratory Reference and Research Branch and the Division of Viral Hepatitis’ s( DVH) Laboratory Branch— were suddenly closed and all employees were subject to a reduction in force. The closures were part of broader federal staffing cuts that were rationalized as elimination of tasks“ identified as either unnecessary or virtually identical to duties being performed elsewhere in the agency.” In reality, these laboratories performed essential functions that were not available elsewhere, and their absence was swiftly felt.
By April 2, the public health community was scrambling to find a laboratory that could complete molecular surveillance testing related to an ongoing hepatitis C virus( HCV) outbreak linked to a pain clinic in Florida. The DVH laboratory had been performing this work using an in-house-developed protocol and system designed specifically for hepatitis outbreak detection and transmission mapping— the Global Hepatitis Outbreak and Surveillance Technology( GHOST). The DVH laboratory had deployed the protocol to state and local public health laboratories, but data analysis was dependent upon GHOST system maintenance that the DVH laboratory routinely performed. With GHOST shut down, unmet HCV surveillance needs were reported in additional states and requests for hepatitis A surveillance testing, also previously completed by the DVH laboratory, surfaced. National surveillance for hepatitis viruses had been halted without a contingency plan.
Similarly, questions quickly arose about the ability of the United States to continue the vital work conducted by the DSTDP laboratory. Public health laboratories providing regional antimicrobial susceptibility testing and sequencing-based surveillance for drug-resistant Neisseria gonorrhoeae wondered who would provide the external performance evaluation panels, quality control strains, media and antibiotic powders, data analysis and technical consultation that they relied upon. Surveillance work conducted by the DSTDP laboratory, related to an uptick of disseminated gonococcal infection cases, abruptly stopped and there was no plan in place to move it forward.
Fortunately, on June 11, following widespread concern and mobilization by the public health community, CDC announced a policy reversal with over 400 positions reinstated, including all staff from the DVH and DSTDP laboratories. The announcement brought relief, but also questions: Would all employees return or was there a loss of institutional knowledge and expertise? Would the reinstatement of critical services survive a CDC-wide reorganization? How long would it take to bring specialized testing back online? While some questions remain unanswered, employees of both laboratories worked rapidly to bring their testing and consultative services back online, understanding that more damage would be done the longer that systems remained down.
This episode should serve as a reminder: laboratories are not optional infrastructure and skilled laboratorians are indispensable. Moreover, the functions of national reference laboratories cannot be quickly outsourced or recreated. While private laboratories can provide diagnostic testing for many diseases and conditions, surveillance testing that links cases and helps find the source of outbreaks is usually not available in the private sector.
State and local public health laboratories are highly capable and increasingly equipped with molecular surveillance tools of their own. However, working across jurisdictional boundaries presents challenges, such as facilitating payment across state lines, assuring reporting capability and establishing a common understanding of methodologies. These challenges must be mitigated before services are needed. National laboratories help bring coherence to the system, providing consistent methods, ensuring quality standards and linking data across the country. Without their central coordination and expertise, the national laboratory network begins to fragment, weakening the collective response to emerging threats.
Looking ahead, the laboratory community must advocate for sustainable investments, clear contingency planning and policies that recognize the irreplaceable role of federal public health laboratories in a functioning public health laboratory system. Because when the system shuts down, the consequences are immediate— and the recovery is never instant. g
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