Lab Matters Winter 2020 | Page 14

FEATURE The kind of changes that are needed aren’t going to happen within a single funding cycle.” Frances Pouch Downes, DrPH Gone too are the laboratory’s programs for rotavirus testing, arbovirus testing and Bordetella speciation. Significant budget cuts also threatened DCLS’s culture-independent diagnostic testing and testing for carbapenem-resistant bacteria—a class of drug-resistant microbes that commonly cause infections in healthcare settings—but aggressive outreach resulted in state funds to replace lost ELC monies. Last year, DCLS lost a critical laboratory liaison position responsible for tracking grant spending and pulling together testing statistics and outbreak status reports for state epidemiologists. Now, any requests for data fall back on the scientists and technicians doing the testing, “if it’s [provided] at all.” Another hard-hit area is foodborne disease testing, funded partly through the Food Emergency Response Network (FERN), coordinated by the US Food and Drug Administration (FDA) and the US Department of Agriculture. Any reduction in funding, said Toney, “impacts the amount of work we can do and the timeliness with which we can do it, because our capability and capacity for food testing is directly aligned with our funding. When our budget is reduced, we accept fewer samples [for testing].” Just in the past few years, FERN support contributed to the resolution of several Virginia outbreaks, including clusters of illness linked to Listeria-tainted sprouts, Salmonella Javiana-tainted clam chowder and Salmonella Weltevreden-tainted kratom (an unregulated supplement reputed to have psychotropic effects). The last of these triggered FDA’s first mandatory product recall. Toney’s food-testing staff also provided FERN surge capacity testing for a multistate outbreak of Salmonella Braenderup tied to shell eggs used at a national chain restaurant. With decreased FERN support, Toney said, the state has had to cut back on FERN training and to prioritize implementation of new methods based on state needs rather than federal surveillance needs. On a national level, she said, “I think the amount of data we have is going to be less than we’ve had in the past and may negatively impact our understanding of the outbreaks we’re investigating. ...I definitely think it is going to slow our ability to identify contaminated food. And anytime we have a slow response, it means there is a source of contamination that is still out there causing disease.” Microbiologist Joseph Hancock speciates and sorts mosquitoes received as part of the vector borne mosquito surveillance program. Photo: TX DSHS Arbovirus Lab “This is really important work.” The rapid dissemination of novel coronavirus from China is a stark reminder that disease control cannot be limited to the United States. Although the FY2020 CDC budget includes a $75 million boost for the GHSA—a multinational effort focused on building capacity for infectious disease control worldwide—this gain must be balanced against the loss of over $100 million/year from supplemental federal funding for Ebola control. Frances Pouch Downes, DrPH, a public health professor at Michigan State University and former head of the Michigan Public Health Laboratory, said “We don’t think strategically when we make these development investments; when you whittle away the funding, you open up gaps or fail to fill gaps.” She said, “When something scary happens we throw money at it. But when the emergency subsides the need [for global public health capacity] doesn’t subside. There will be a next infectious disease.” Downes, who has been involved in the development of a national laboratory network in Indonesia, said every piece of the GHSA is “relevant, important work”— things like safety training to assure proper containment of biohazards, quality laboratory systems to assure the accuracy of test results and rapid data transfer to inform public health decision-making. Yet, on a visit to Capitol Hill last year, Downes said many of the Congressional Scientist Lenard Mendoza performs mass spectrometry testing in the Newborn Screening Laboratory. Photo: DCLS 12 LAB MATTERS Winter 2020 PublicHealthLabs @APHL