COMMENTARY Improving foodborne outbreak investigations on a budget

By Craig Hedberg, PhD

Jun 17, 2009 (CIDRAP News) – The foodborne disease surveillance system seems to be under siege. A nearly continuous series of large, multistate outbreaks of Salmonella have been associated with unexpected food vehicles over the past 3 years. Several of these investigations stretched on for weeks under the glare of increasing public anxiety over uncertain identification of the source.

In response, politicians, policy makers and the public ask, "Why do these outbreaks happen?" "Why do they take so long to identify and investigate?" Calls for reform of the food safety system abound with the promise that the next time will be different.

A patchwork system
However, as Gardiner Harris pointed out in a New York Times article ("Ill from food? Investigations vary by state," Apr 20), "Uncovering which foods have been contaminated is left to a patchwork of more than 3,000 federal, state, and local health departments that are, for the most part, poorly financed, poorly trained and disconnected."

This same point is a key finding of a recent authoritative review of the food safety system conducted under the leadership of Michael Taylor and Stephanie David from the George Washington University School of Public Health and Health Services ("Stronger Partnerships for Safer Food: An Agenda for Strengthening State and Local Roles in the Nation's Food Safety System").

Taylor and David find that "obsolete food safety laws and other legal constraints, coupled with scarce resources and the lack of positive incentives to collaborate across organizational lines" are obstacles to real federal-state-local partnership in the food safety system. They argue that "food safety reform will not be complete—or successful—unless the efforts of these [state and local] agencies are strengthened and integrated more fully into the national food safety system." They call for Congress to mandate the development of a 5-year plan "for better integrating federal, state, and local food safety efforts and improving state and local capacity for that purpose."

I applaud Taylor and David's recognition that local agencies are the foundation for public health practice across most of the United States. I agree with many of their findings and endorse the spirit of their recommendations. Full implementation of their agenda would very likely lead to a better food safety system well into the future. That is also my major concern with this and other reports that evaluate the problems and potential of our food safety system: The problems are many and the potential solutions are proposals that inevitably won't bear fruit until well into the future.

Doing better with existing resources
We need to focus on which outbreaks we must be able to detect now, in the context of current budget realities. Congress can help with meaningful investments in our food safety system. It is a public good that needs support. However, we also need to do a better job with the resources we currently have.

In this regard, Gardiner Harris highlighted a key observation from Kirk Smith, supervisor of foodborne disease surveillance at the Minnesota Department of Health (MDH): "I've learned in the last few months that the real secret to our success is that we have urgency." This is important. In Minnesota, a sense of urgency is the secret to success. Across our public health system, the lack of "positive incentives" is seen as an obstacle. Kirk Smith did not say as much, but I suspect that he and his colleagues at MDH would consider that successfully identifying the source of an outbreak, and preventing others from getting ill, is a positive incentive.

A number of media reports in recent weeks have highlighted the important role of "Team Diarrhea" in foodborne disease surveillance activities. Hiring public health students to conduct interviews on a routine basis is one of the many innovations in foodborne disease surveillance to come out of Minnesota. This week, Sen. Amy Klobuchar, D-Minn., introduced legislation designed to promote the nationwide use of Minnesota-style approaches to investigating foodborne outbreaks. Establishing a network of similar Centers of Excellence will greatly enhance our nation's ability to detect and respond to outbreaks.

More important, Sen. Klobuchar's bill starts by identifying which foodborne outbreaks should cause us all to feel a sense of urgency: multi-state outbreaks that are most likely due to the commercial distribution of a contaminated food product. If we can unite ourselves with this common vision and sense of urgency, it seems we should be able to work around many other obstacles. Urgent matters draw timely responses. Our food safety system must compensate for scarce resources by focusing its efforts on the most important outbreaks.

Dr Hedberg is a professor in the Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis.

See also:

Apr 17 CIDRAP News story on food safety report by Michael Taylor and Stephanie David

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