The US must invest in fighting foodborne illness

Looking back at the news of 2018, a story broke every few days on foodborne illness. A recent outbreak, tied to E-coli-tainted romaine lettuce, sickened 59 people in 15 states. This followed several outbreaks tied to romaine and recalls of salmonella-tainted ground beef — the latest of five million pounds on Dec. 4, which totaled tens of millions of pounds of food.

In a nation with our resources, this simply shouldn’t be happening, yet outbreaks occur with increasing frequency. What causes them, and why is it so difficult to contain this persistent public-health threat?

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The issue is bigger than you may have thought. It’s a global problem, according to the World Health Organization; almost 1 in 10 people falls ill every year from eating contaminated food and 420,000 die worldwide. Our own Centers for Disease Control and Prevention (CDC) estimate that each year, roughly 1 in 6 Americans – about 48 million people — gets sick from foodborne diseases; 128,000 of these require hospitalization and 3,000 die. If it feels like you’re hearing more about foodborne illness outbreaks, you’re right; the CDC’s Foodnet notes that illness reports involving a number of infectious agents including E-coli, Listeria and Salmonella, are on the rise: reports for the last two are up 96 percent over the 2014-16 average.

But in the U.S., preventing foodborne illness is hardly straightforward, with different agencies taking on parts of the overall challenge. The U.S. Department of Agriculture's (USDA’s) Food Safety and Inspection Service oversees meat, poultry and egg products. The FDA is responsible for domestic food processing facilities, processed foods and imported processed foods and produce. The dividing lines between responsibilities aren’t straightforward. For example, the FDA inspects shelled eggs, while the USDA inspects processed eggs, including frozen and liquid; FDA inspects fish, but USDA gets catfish; and while FDA is responsible for closed sandwiches, USDA inspects open-faced sandwiches. It’s a tangle.

To bring clarity to the situation, Congress passed The Food Safety Modernization Act, (FMSA). The 2011 legislation called for state governments to take over frontline inspection and management of food safety for produce at the farm level from the USDA. The law outlines sanitation, environmental monitoring and food safety surveillance requirements aimed at decreasing the growing incidence of food recalls. FMSA also makes traceability easier, mandating each food processor increase the effectiveness of their sanitation practices and that each business ensures that the product they receive from a seller meets FMSA requirements.

But, while Congress passed the new legislation to move the U.S.’s emphasis from tracing sources of outbreaks to preventing them, progress on implementation has been disturbingly slow. FDA, which has an important role in FMSA oversight, has yet to implement science-based standards that should lead to safer produce, has not finalized rules for foreign supplier verification, and must still issue guidance that will help schools and childcare programs lower allergy risks for school-age children.

Funding is a major impediment; only about half of what the Congressional Budget Office projected would be needed has been made available. Congress and the White House have chronically underinvested in this vital component of public safety, leaving a dangerously frayed food safety net in place. That must change in 2019; the problems we face are not simply E-coli-tainted romaine lettuce. Researchers have identified more than 250 food-borne illnesses.

The CDC names the five most common as Norovirus, Salmonella, Clostridium perfringens, Campylobacter and Staphylococcus aureus. Causing 58 percent of foodborne illness annually, Norovirus is commonly passed by food preparers through leafy greens, shellfish and fresh fruits. Borne by foods including meats and eggs to grains and prepared foods, Salmonella causes about 1.2 million illnesses, 23,000 hospitalizations and 450 deaths in the U.S. annually. Found in beef, poultry, gravies and dried or pre-cooked foods, Clostridium perfringens causes nearly one-million food poisoning cases per year. Found on raw poultry, Campylobacter causes 1.3 million illnesses annually. Known as Staph or MRSA, Staphylococcus aureus is passed by preparers through foods not cooked after handling, such as sliced meats, puddings, pastries and sandwiches.

Facing scores of viruses, bacteria and parasites is daunting, but the CDC’s Four Steps to Food Safety provides consumers good general safety advice — whaturging them to clean food, separate it to avoid cross contamination, cook to the right temperature and refrigerate promptly. Consumers should be especially vigilant if they are pregnant women, elderly, have young children or are immuno-compromised.

But these are last-line defenses. How do we get ahead of disease outbreaks, fighting them far from our kitchen counters?

With passage of the Food Safety Modernization Act, we have the first move in this country to try to bring our efforts into the modern era. It called for a federal-state cooperative framework on produce inspections, created new guidance for imports, and pointed the way for the FDA to move from merely being an inspector of processed foods to becoming an agency that approaches food from a public health orientation, heading off food-borne illness with regulation and innovation.

And yet, it’s not working. In 2015, Deputy FDA Commissioner Michael R. Taylor told the New York Times “We have good plans for moving forward. The problem is that we don’t have the money.” Three years later, the situation remains the same, but with a new Congress being convened in January, that could change. Now is the time for Congress to take action before another life is lost. Now is the time for fully funding the FSMA to ensure more rigorous inspections, a safer food supply and better public health. On food safety, the U.S. can and should do better.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at University of California, Los Angeles.