A resident of Washington State died last week after contracting the H5N5 avian influenza, according to the Washington State Department of Health (DOH). This was the first reported human infection with the H5N5 strain of the influenza virus. Public health officials are now monitoring everyone who had contact with the patient or the infected flock, but so far there is no evidence that the virus is spreading between people.
H5N5 influenza viruses are a type of avian influenza (bird flu) — an influenza A virus that infects birds. Bird flu viruses are classified as either “high pathogenicity” or “low pathogenicity” based on the severity of symptoms they cause in poultry (their severity also varies in other bird species). This H5N5 strain, like the widespread and much-reported-on H5N1 strain, is one of the highly pathogenic forms.
While the good news is that the infection and its origins were quickly identified and follow-on actions taken, the case underscores how important it is to have the necessary expertise, as well as collaboration between state and local health agencies, and the Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) which, if needed, can coordinate a national response and tailor interventions appropriate for different communities.
At this point there are legitimate concerns as to whether the EIS will be staffed, funded and therefore able to effectively play its part.
Death from Bird Flu in Washington State Heightens One Health Awareness
There are many known and unknown zoonotic diseases which link wildlife, domestic animals, and humans, best described as One Health.
It is useful to recall recent history with bird influenza-to-human transmission because of past challenges for epidemiology, disease management, and the human and financial costs generated.
The first known human case of H5N1 occurred in 1997 in Hong Kong. Following an outbreak in poultry, 18 people were infected, and one died. This marked a critical point that alerted the world to the threat of avian influenza. H5N1 outbreaks in countries like Vietnam, Thailand, and Egypt saw sporadic human infections, with high mortality rates, raising concern about a potential pandemic. Prevention measures focused on culling infected poultry and implementing biosecurity in farms. More recently, in 2013 there has been the emergence of H7N9 in China.
Bird Flu is but one example of other instances underscoring the critical need for having a One Health approach to the interconnectedness between wildlife, domestic animals, and humans, highlighting the importance of preparedness and vigilance in addressing zoonotic threats, and links to changing environments.
For the United States, the Epidemic Intelligence Service Is Key
For many years the EIS has been the core American entity with its mission to conduct research, identify, understand, and provide surveillance of infectious disease outbreaks and epidemics. It is highly respected and frequently consulted by other countries and international institutions.
That said, EIS management and operations within the CDC have been significantly affected. The effects of such actions taken to date by the Administration are several.
EIS Firing/Rehiring Impact
Morale and Work Environments
Staffing changes and firings within the CDC, including the EIS, potentially led to a decline in morale among public health officials. Employees may have felt insecure about their positions due to the political climate, which could undermine their effectiveness in addressing health threats.
Loss of Institutional Knowledge
Firing and/or rehiring of highly qualified experts potentially means loss of continuity, valuable institutional knowledge, and expertise that EIS officers have to bring to public health crises. EIS professionals typically have extensive training and experience that can take years to develop. When experienced personnel are let go (and do not choose to return), the result is severed ties to critical networks and local health expertise.
Recruitment Challenges
Uncertainty regarding the EIS’s future dissuades potential recruits from joining the EIS. Talented public health professionals may be hesitant to apply for positions within an organization perceived as politically compromised or lacking in vital resources.
Effects of the Administration’s Other Actions
Budgetary Constraints
The Administration’s fiscal policies have affected the funding for public health programs, including the EIS. Budget cuts have led to concerns about its ability to maintain its workforce and respond to emergent health threats effectively, to have sufficient personnel to conduct epidemiological investigations, form rapid response teams, and liaise with state and local health authorities.
CDC Reorganization
The Administration has been contemplating reorganizing the EIS, leading to confusion and diminishing the cohesion necessary for an effective public health response.
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Importance of Coordination With State and Local Health Authorities
Partnership Dynamics
The EIS traditionally works closely with state and local health authorities to manage disease outbreaks, investigate health threats, and implement response strategies. Coordination with these entities was crucial, especially during the COVID-19 pandemic, and in the future.
However, the current Administration’s approach has complicated these relationships, with differing priorities emerging between federal authorities and local health departments.
Communication Barriers
Communication breakdowns occur when there is conflicting messaging from federal and state offices. EIS relies heavily on local health departments for data and resources essential for outbreak response. When federal guidance diverged from local strategies or when local authorities felt undermined by federal actions, this created obstacles to effective communication and collaboration.
Effectiveness of Interventions
Public health interventions’ success often hinges on EIS’s ability to translate data and findings into actionable plans in concert with local health departments. The administration’s strategies that either neglected or hindered local collaboration risked implementing solutions that did not account for the unique needs of communities.
Legislative Backing
Legislative efforts to support state and local health departments are critical, in particular, those which bolster the capacity of state agencies to have them facilitate EIS’s ability to coordinate effectively at the national level. Conversely, when federal budgetary cuts or policy shifts undo these partnerships, then state health departments which rely on federal funding to sustain their operations are also affected.
Unless Things Change, We Are in for Hard Times
Administrative policies regarding the staffing and funding of the Epidemic Intelligence Service have significant implications for public health in the U.S. Decisions related to hiring, firing, and coordination shape the landscape of epidemic response, with effects felt across various layers of health governance.
The interplay between federal and local jurisdictions highlights the need for cohesive and collaborative public health leadership to address public health challenges. The central and critical role of the EIS needs to be recognized and supported by the Administration and Congress. The unfortunate death of a man in the State of Washington from a heretofore bird flu not known to be deadly is an early warning of why we need a competently managed and funded EIS.
This is indeed a crisis for the U.S. public health infrastructure’s survival.
Editor’s Note: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com — In the Cover Photo: Chickens in battery cages at a chicken parent farm begin vigorously eating after a worker poured feed into a plastic trough along the row. The facility breeds and hatches chicks to supply local farms, operating a fully controlled environment, including light, temperature and airflow. Undisclosed, Jhajjar, Haryana, India, 2024. Cover Photo Credit: Shatabdi Chakrabarti / Open Wing Alliance / We Animals.
