Latest news with #diseasesurveillance
Medscape
15-07-2025
- Health
- Medscape
US Cuts Injure Canada's Infectious Disease Surveillance
US President Donald Trump's plans to slash discretionary and research funding to the National Institutes of Health and the Centers for Disease Control and Prevention (CDC) by as much as 53% have Canadian public health officials and experts worried. One of the most concerning challenges might be the consequent loss of invaluable surveillance efforts and data, Jasmine Pawa, MD, a public health and preventive medicine specialist physician and adjunct lecturer of clinical public health at the University of Toronto, Toronto, told Medscape Medical News. Pawa is co-author of a recently published editorial on the effects of the US federal government's dismantling of the structures that Canada has long relied on to keep its population healthy and safe. Jasmine Pawa, MD 'We wanted to focus specifically on the health data around numbers and how they relate to communicable diseases,' she said. 'In the short term, we're losing access to a lot of information on US websites that we might have referenced or used, and I'm aware that people might now be using archived or older sources.' In the long term, the ability to track pandemic threats or mitigate the spread of diseases like HIV or avian influenza will likely be impaired. 'If those data don't exist, it means that we cannot measure trends,' she said, which, in turn, affects response planning. Communicable Diseases Increasing While US surveillance and data collection have declined, Canada has been facing an infectious disease crisis. The country has seen substantial increases in the rates of preventable sexually transmitted diseases like syphilis; adult infections rose by as much as 109% and congenital syphilis by as much as 599% between 2018 and 2022. New HIV cases have also been a cause for concern, rising by almost 25% between 2021 and 2022. 'We're also seeing a surge in measles cases in Canada, which you could say is an emerging infectious disease, in the sense that it's previously been controlled,' said Zahid Butt, PhD, Canada research chair in Interdisciplinary Research for Pandemic Preparedness at the University of Waterloo in Waterloo, Ontario. Butt is especially worried about the spread of vaccine-preventable childhood diseases, including pertussis. 'We're seeing more cases because vaccine coverage is not at optimal levels,' he said. Avian flu has also been on the minds of public health officials, said Butt. Though the CDC continues to monitor confirmed human cases, reporting frequency has declined to once monthly, and the responsibility for detection in animals has been transferred to the US Department of Agriculture. 'We've seen an increase in physical cases, mostly in birds, but there's a potential to jump from birds to humans and cause outbreaks,' he said. Pawa and her coauthor wrote that they expected to see rising rates of drug-resistant tuberculosis, which has long been considered a pandemic of the 'poor.' Similar increases (especially local outbreaks) in hepatitis B and imported Oropouche are also anticipated. Widespread Misinformation The surge in health misinformation during the COVID-19 pandemic was largely attributed to social media and conservative news sources such as Fox News . In addition, US government officials during the first Trump administration sought to tamper with data sharing that other countries had long relied on. Fears about health misinformation have returned, according to the coauthors, who pointed to current deliberate efforts by Trump's cabinet to promote misinformation and publicly discredit national health institutions. 'People living in Canada are vulnerable to a cross-border bleed of not only microorganisms, but also of attitudes, health misinformation, and exposure to biased US media,' they wrote. 'In addition to the loss of data, the changes at the US Department of Health and Human Services, especially with regard to Robert F. Kennedy Jr and Make America Healthy Again, green light a lot of dis- and misinformation and falsehoods about health in general,' said Amy Kaler, PhD, professor of sociology at the University of Alberta in Edmonton. Kaler's expertise is the confluence of infectious diseases and social determinants of health. Amy Kaler, PhD 'It doesn't stop at the US-Canada border,' said Kaler, explaining that local media capacity has been dwindling, while platforms like Facebook have banned Canadian news sources. 'The availability of local, reliable, journalistically sound information has declined at the same time exposure to stuff ranging from outright crazy to just plain misinformed coming from the US has increased,' said Kaler. Though research has shown that Canadians trust their healthcare providers, Kaler also pointed out that many Canadians don't have access to primary care (a recent survey showed that more than 1 in 5 adults lacked a primary care physician). 'That gap gets filled by social media nonsense,' she said. Dwindling media sources are only one part of the problem. Kaler teaches in Alberta, which has a far-right government that 'imitates some of the worst of what's happening in the US, in terms of health and infectious diseases.' 'The big problem that I see is their willingness to entertain or give more respect than should be given to the extreme voices that say things like, 'Don't get vaccinated because your DNA will mutate,'' said Kaler. 'While our minister of health has said that people should get vaccinated, it's couched in rhetoric like 'This is a personal and private decision, and every family should weigh the risks and benefits of vaccination,'' explained Kaler. 'It's not vaccine denialism; it's a soft way of encouraging hesitancy.' Strengthening National Capacity Public health experts have long called for a stronger national infrastructure that supports interoperable systems that easily share health data between provinces, territories, and the federal government. Factors that affect equity (eg, socioeconomics or demographics) should also be considered, said Pawa. This type of robust, evolving surveillance system is needed to support domestic public healthcare efforts. 'They're something that we've needed to do anyway, but being focused and pushing it forward now is really important,' she said. At the same time, 'there needs to be a higher accountability for dedicated public health services, a mechanism that requires provinces and territories to pay attention to this, as distinct from other services that they are currently providing,' said Gaynor Watson-Creed, MD, preventive medicine specialist, physician, and associate dean of medicine at Dalhousie University in Halifax. Gaynor Watson-Creed, MD Watson-Creed, a former deputy chief medical officer of health at the Nova Scotia Health Authority, Halifax, recalled that during the first severe acute respiratory syndrome outbreak, public health officials believed that they could create a 'CDC North' that would provide data and surveillance to the world just as CDC had done. 'Now that we're seeing the decline of the collaboration between CDC and its international partners, including Canada, that need is real. And it's not just the need for communicable disease surveillance but a new need for chronic disease surveillance, injury surveillance, and well-being surveillance in this country,' said Watson-Creed. 'We called for federal public health legislation [in 2017] similar to the way that we have federal legislation for acute care services (ie, the Canada Health Act), she added, citing a decline in Canada's public health systems. 'The trouble is that the provincial governments, ministers of health, etc., may not know enough about public health to even know what they don't know.' Clinicians must step up to the plate, said Watson-Creed. 'Clinicians have not stopped long enough to consider what's at the end of the spectrum after primary prevention. Now would be a good time for them to lend their voices to continued efforts to strengthen the primordial prevention end of public health,' which targets the root causes of disease. No funding for the editorial was reported. Pawa, Butt, and Kaler reported having no relevant financial relationships. Watson-Creed provides consultation services through her company, Sweetfire Consulting.
Yahoo
11-05-2025
- Health
- Yahoo
Trump health cuts create ‘real danger' around disease outbreaks, workers warn
Mass terminations and billions of dollars' worth of cuts at the Department of Health and Human Services (HHS) have gutted key programs – from child support services to HIV treatment abroad – and created a 'real danger' that disease outbreaks will be missed, according to former workers. Workers at the HHS, now led by Robert F Kennedy Jr, and in public health warned in interviews that chaotic, flawed and sweeping reductions would have broad, negative effects across the US and beyond. While Donald Trump's administration is cutting the HHS workforce from 82,000 to 62,000 through firings and buyouts, grant cuts by Elon Musk's so-called 'department of government efficiency' (Doge) have also had a stark impact on state governments – and resulted in firings at state public health agencies. At the South Carolina department of public health, for example, more than 70 staff were laid off in March due to funding cuts. 'Disease surveillance is how we know when something unusual is happening with people's health, like when there are more food-poisoning cases than usual, or a virus starts spreading in a community,' an epidemiologist at the department, whose role was eliminated, said. 'It's the system that lets us spot patterns, find outbreaks early, and respond before more people get sick.' 'When you lose public health staff, you lose time, you lose accuracy, you lose responsiveness, and ultimately that affects people's health,' they added. 'Without us, outbreaks can fly under the radar, and the response can be delayed or disorganized. That's the real danger when these roles get cut. 'It's invisible work, until it's not. You may not think about it day to day, but it's protecting your drinking water, your food, your kids' schools and your community.' A spokesperson for South Carolina's public health department declined to comment on specifics, but noted employees hired through grants are temporary. 'When funding for grants is no longer available, their employment may end, as happened with some temporary grant employees who were funded by these grants,' they said. In Washington, the HHS has been cut harder by Doge than any other federal department. Hundreds of grants to state, local and tribal governments, as well as to research institutions, have been eliminated, worth over $6.8bn in unpaid obligations. The HHS receives about a quarter of all federal spending, with the majority disbursed to states for health programs and services such as Medicare and Medicaid, the insurance programs; medical research; and food and drug safety. Trump's budget proposal calls for cutting the department's discretionary spending by 26.2%, or $33.3bn. RFK Jr, who has a history of promoting conspiracy theories and medical misinformation, was nominated by Trump and approved by the Senate along party lines, with Mitch McConnell the sole Republican dissenter. Following a reduction in force of 10,000 employees on 1 April, Kennedy Jr claimed 20% of the firings were in error and that those workers would be reinstated, though that has not happened. An HHS spokesperson blamed any such errors on data-collection issues, and did not comment on any other aspects of the Guardian's reporting. At the Centers for Disease Control and Prevention, an operating division of the HHS, employees working on maternal and child health at the President's Emergency Plan for Aids Relief (Pepfar) program were shocked to be included in the reduction in force, as earlier in the administration their work had received a waiver for parts of the program from federal funding freezes. All federal experts on HIV prevention in children overseas were fired as part of the reduction in force. 'Our concern initially was that it was a mistake with the name. We hoped around that time it came out that there were 20% errors, that we would be included,' said an epidemiologist who was included in the reduction in force, but requested to remain anonymous as they are currently on administrative leave. They also noted that they were in the middle of planning and delivering a new pediatric HIV treatment medication set to be dispersed this year, and that that work was now at risk. They said 22 epidemiologists in the branch of their CDC division had been fired. Pepfar was created in 2003 by George W Bush to prevent mother-to-child HIV transmission and credited with saving 26 million lives. 'We were very shocked on April 1 that we were put immediately on admin leave,' said another epidemiologist affected by the reduction in force at the CDC. 'We really feel our branch being cut was a mistake. The state department had said services were a priority and needed to continue, but then we were cut by HHS.' They noted HIV treatment had already stopped in regions of countries that had been reliant on USAID programs, such as Zambia. 'It is one of the most successful global health programs in history, data driven with high levels of accountability and the dollars spent achieve impact. Our concern now is, yes, they are continuing Pepfar in name, but they are dismantling all the systems and structure that allowed it to succeed,' they added. 'The US made a huge investment in this program in 20 years and a lot of it is now undone. We've now disrupted those systems that could have reduced and eventually removed US investment in these programs.' Inside the HHS, the Administration for Children and Families is responsible for enforcing court-ordered child-support payments. For every dollar it receives in federal funding, ACF says it is able to collect $5 in child support. A child-support specialist with the HHS, who requested to remain anonymous for fear of retaliation, said reductions in force at the department have increased workloads on those who were not fired by multiple times, making it so state and tribal agencies have no way of ensuring they are compliant with federal requirements. 'The regional staff with direct oversight of the program are gone,' they said. 'There are entire regions that have two staff members managing a quarter of the work for the program with no management, no support, no knowledge of the program.' After the Trump administration took office, the agency was under an unofficial stop-work order, where staff were not permitted to provide guidance or support to grantees or even answer phones, until late February, the specialist said. A reduction in force followed on 1 April, when, the child-support specialist claimed, about half the ACF staff working on child support were fired. Their department is responsible for overseeing child-support programs at state, tribal and local levels. States 'could very well lose millions of dollars in funding' if ACF does not provide key training and assistance and the states do not have qualified staff, the specialist cautioned. 'And that is the long-term impact to vulnerable children and families in the country.' They added: 'The entire function of the program is to give economic stability to children and families, so that they do not depend on any other government program, or their reliance on these programs is lower, because the children are supported by both parents.' At the Centers for Medicare and Medicaid Services, also within the HHS, one of 300 workers terminated as part of a reduction in force claimed it had been illegal, and had not followed any proper procedures. The National Treasury Employees Union has filed a grievance over how the firings were carried out, including incorrect information on notices. They explained that, on 1 April, they received a generic letter informing them of an intent of reduction in force. Hours later, they were locked out of their government logins. 'We started emailing the management that was left, trying to get clarification on what our status was. Nobody could give us an answer,' the worker said. On 7 April, they discovered through their paystub that they had been placed on administrative leave, despite never receiving a notice. They didn't receive an RIF notice until weeks later, after requesting it. 'Based on my tenure, and as a disabled veteran, I should at least have a chance of reassignment,' they said. 'I'm not mad about losing my job. It happens. I've been laid off. The first time was in the private sector, and it was way more humane, more empathetic, and I was given different offers. 'This, on the other hand, is unbridled hate. This administration has gone out of their way to make it a living hell for all of its public servants.'
The Guardian
11-05-2025
- Health
- The Guardian
Trump health cuts create ‘real danger' around disease outbreaks, workers warn
Mass terminations and billions of dollars' worth of cuts at the Department of Health and Human Services (HHS) have gutted key programs – from child support services to HIV treatment abroad – and created a 'real danger' that disease outbreaks will be missed, according to former workers. Workers at the HHS, now led by Robert F Kennedy Jr, and in public health warned in interviews that chaotic, flawed and sweeping reductions would have broad, negative effects across the US and beyond. While Donald Trump's administration is cutting the HHS workforce from 82,000 to 62,000 through firings and buyouts, grant cuts by Elon Musk's so-called 'department of government efficiency' (Doge) have also had a stark impact on state governments – and resulted in firings at state public health agencies. At the South Carolina department of public health, for example, more than 70 staff were laid off in March due to funding cuts. 'Disease surveillance is how we know when something unusual is happening with people's health, like when there are more food-poisoning cases than usual, or a virus starts spreading in a community,' an epidemiologist at the department, whose role was eliminated, said. 'It's the system that lets us spot patterns, find outbreaks early, and respond before more people get sick.' 'When you lose public health staff, you lose time, you lose accuracy, you lose responsiveness, and ultimately that affects people's health,' they added. 'Without us, outbreaks can fly under the radar, and the response can be delayed or disorganized. That's the real danger when these roles get cut. 'It's invisible work, until it's not. You may not think about it day to day, but it's protecting your drinking water, your food, your kids' schools and your community.' A spokesperson for South Carolina's public health department declined to comment on specifics, but noted employees hired through grants are temporary. 'When funding for grants is no longer available, their employment may end, as happened with some temporary grant employees who were funded by these grants,' they said. In Washington, the HHS has been cut harder by Doge than any other federal department. Hundreds of grants to state, local and tribal governments, as well as to research institutions, have been eliminated, worth over $6.8bn in unpaid obligations. The HHS receives about a quarter of all federal spending, with the majority disbursed to states for health programs and services such as Medicare and Medicaid, the insurance programs; medical research; and food and drug safety. Trump's budget proposal calls for cutting the department's discretionary spending by 26.2%, or $33.3bn. RFK Jr, who has a history of promoting conspiracy theories and medical misinformation, was nominated by Trump and approved by the Senate along party lines, with Mitch McConnell the sole Republican dissenter. Following a reduction in force of 10,000 employees on 1 April, Kennedy Jr claimed 20% of the firings were in error and that those workers would be reinstated, though that has not happened. An HHS spokesperson blamed any such errors on data-collection issues, and did not comment on any other aspects of the Guardian's reporting. At the Centers for Disease Control and Prevention, an operating division of the HHS, employees working on maternal and child health at the President's Emergency Plan for Aids Relief (Pepfar) program were shocked to be included in the reduction in force, as earlier in the administration their work had received a waiver for parts of the program from federal funding freezes. All federal experts on HIV prevention in children overseas were fired as part of the reduction in force. 'Our concern initially was that it was a mistake with the name. We hoped around that time it came out that there were 20% errors, that we would be included,' said an epidemiologist who was included in the reduction in force, but requested to remain anonymous as they are currently on administrative leave. They also noted that they were in the middle of planning and delivering a new pediatric HIV treatment medication set to be dispersed this year, and that that work was now at risk. They said 22 epidemiologists in the branch of their CDC division had been fired. Pepfar was created in 2003 by George W Bush to prevent mother-to-child HIV transmission and credited with saving 26 million lives. 'We were very shocked on April 1 that we were put immediately on admin leave,' said another epidemiologist affected by the reduction in force at the CDC. 'We really feel our branch being cut was a mistake. The state department had said services were a priority and needed to continue, but then we were cut by HHS.' They noted HIV treatment had already stopped in regions of countries that had been reliant on USAID programs, such as Zambia. 'It is one of the most successful global health programs in history, data driven with high levels of accountability and the dollars spent achieve impact. Our concern now is, yes, they are continuing Pepfar in name, but they are dismantling all the systems and structure that allowed it to succeed,' they added. 'The US made a huge investment in this program in 20 years and a lot of it is now undone. We've now disrupted those systems that could have reduced and eventually removed US investment in these programs.' Inside the HHS, the Administration for Children and Families is responsible for enforcing court-ordered child-support payments. For every dollar it receives in federal funding, ACF says it is able to collect $5 in child support. A child-support specialist with the HHS, who requested to remain anonymous for fear of retaliation, said reductions in force at the department have increased workloads on those who were not fired by multiple times, making it so state and tribal agencies have no way of ensuring they are compliant with federal requirements. 'The regional staff with direct oversight of the program are gone,' they said. 'There are entire regions that have two staff members managing a quarter of the work for the program with no management, no support, no knowledge of the program.' After the Trump administration took office, the agency was under an unofficial stop-work order, where staff were not permitted to provide guidance or support to grantees or even answer phones, until late February, the specialist said. A reduction in force followed on 1 April, when, the child-support specialist claimed, about half the ACF staff working on child support were fired. Their department is responsible for overseeing child-support programs at state, tribal and local levels. States 'could very well lose millions of dollars in funding' if ACF does not provide key training and assistance and the states do not have qualified staff, the specialist cautioned. 'And that is the long-term impact to vulnerable children and families in the country.' They added: 'The entire function of the program is to give economic stability to children and families, so that they do not depend on any other government program, or their reliance on these programs is lower, because the children are supported by both parents.' At the Centers for Medicare and Medicaid Services, also within the HHS, one of 300 workers terminated as part of a reduction in force claimed it had been illegal, and had not followed any proper procedures. The National Treasury Employees Union has filed a grievance over how the firings were carried out, including incorrect information on notices. They explained that, on 1 April, they received a generic letter informing them of an intent of reduction in force. Hours later, they were locked out of their government logins. 'We started emailing the management that was left, trying to get clarification on what our status was. Nobody could give us an answer,' the worker said. On 7 April, they discovered through their paystub that they had been placed on administrative leave, despite never receiving a notice. They didn't receive an RIF notice until weeks later, after requesting it. 'Based on my tenure, and as a disabled veteran, I should at least have a chance of reassignment,' they said. 'I'm not mad about losing my job. It happens. I've been laid off. The first time was in the private sector, and it was way more humane, more empathetic, and I was given different offers. 'This, on the other hand, is unbridled hate. This administration has gone out of their way to make it a living hell for all of its public servants.'
