Local health departments worry about government shutdown’s effects on staffing, disease outbreaks and nutrition services

By Jacqueline Howard, CNN

(CNN) — The US government’s shutdown is shaking the nation at a time when public health staffing has already been reduced, the threat of disease outbreaks looms, and both the respiratory virus season and hurricane season are upon us.

State and local health departments are now bracing for how the shutdown could affect their work to keep communities safe and healthy – and some worry about disruptions in communications with the US Centers for Disease Control and Prevention and other federal agencies in times of need.

The federal government shut down on Wednesday after a deadlocked Congress failed to reach a funding deal to keep the lights on.

“State and local health partners, along with the public, should expect delays in CDC’s ability to identify and respond to outbreaks. Specifically, CDC will maintain minimal capacity to respond to an urgent disease threat or other critical need in areas including food safety, healthcare quality and patient safety, vector-borne disease, and high consequence pathogens,” Andrew Nixon, a spokesperson for the US Department of Health and Human Services, said in an email Wednesday.

“The shutdown will also interfere with data collection and reporting to and from states, hospitals, and other facilities – data that allow State and federal partners to track, prevent, and treat respiratory virus diseases,” Nixon said. “Our critical partners, especially public health departments, may not receive guidance or up-to-date technical information for frontline programs, and CDC may not be able to support disease prevention activities.”

‘We’re in this very vulnerable period’

Depending on how long the shutdown lasts, “local health departments eventually may not get the resources or funding that were in place” before the shutdown, said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.

Federal funds cover a significant part of state and local health department budgets, including paying for some staff members.

“The other impact is on the federal staffing side,” Freeman said. “There already was a reduction in federal full-time employees across public health, and the added layer of a federal shutdown completely removes yet another number of federal workers that are supporting our public health system.”

According to the HHS shutdown plans, the CDC will continue monitoring for disease outbreaks, but its communications to the public would be “hampered.” Only about 36% of CDC staff would be considered essential and would continue their work during the shutdown.

“So all of a sudden, we’ll begin to see and have to fill these gaps in our ability to reach the federal government on really important, potentially impactful, health situations,” Freeman said.

A possible health situation, she said, could be related to a measles outbreak, as cases have continued to emerge across the country. She also emphasized that Ebola outbreaks are happening internationally. Traces of the mpox virus have been found in US wastewater, and hurricane season threatens public health in coastal US cities.

“Right now, we’re in this very vulnerable period where, if something happens where we need the federal government’s help, are we going to be able to get it? That’s my concern,” Freeman said.

“We can’t have the federal government shut down when it plays a critical role in our public health system,” she said. “We can’t have our federal government resources just go silent on us.”

Some states or local health departments may be able to continue with relatively few disruptions. “At this time, none of our services will be interrupted due to the federal government shutdown,” the Utah Department of Health and Human Services said.

Other departments have concerns about staffing at the local level. For instance, in Washington state, dozens of public health workers could be affected by the shutdown.

“The Washington State Department of Health (DOH) is closely monitoring the federal budget situation and working with state and federal partners to assess potential impacts,” spokesperson Shelby Anderson said in an email.

“In the event of a shutdown, DOH will need to temporarily lay off or reduce work hours for some employees whose positions are fully or partially funded by some federal dollars,” she said. “At this time, approximately 50 DOH employees may be directly impacted. Additionally, much of the public health work led by DOH is carried out by contractors, including private organizations, local health jurisdictions, and Tribes, some of whom may also be affected.”

The majority of those positions are in the state’s Office of Nutrition Services, which manages its Women, Infants, and Children (WIC) program, a service that provides food and nutrition support to more than 212,000 Washington residents each year. According to the department, the service is among those at highest risk of being significantly affected by the government shutdown.

“This federal shutdown will have a very real impact on families and communities in Washington state,” Brittany Tybo, director of the Office of Nutrition Services, said in a news release Wednesday. “The services that WIC provides reduce infant deaths, improve the growth of infants and children, increase immunization rates, increase access to community supports, and help ensure early prenatal care for pregnant participants. All of these benefits are at risk for WIC families, and the risk increases the longer the shutdown continues.”

Staffing challenges – either at the local level, at the federal level or both – also could play a significant role in delaying interactions between the CDC and local health departments.

“There are a few areas where the shutdown could impact that important connection across federal-state-and local public health that protects the nation’s health security,” Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials, said in an email.

“For example, there have been many updates in the vaccine policy space,” she said. “If staff are furloughed, it will be harder to get clarity when there are questions that arise.”

Can the shutdown affect vaccines?

Earlier this month, the CDC’s Advisory Committee on Immunization Practices recommended key changes to the nation’s vaccine policies, including shifting away from a broad recommendation for Covid-19 vaccines to say that people who want one must consult with a health care provider, a process known as shared clinical decision-making.

But the committee’s recommendations are not final and are still awaiting sign-off by Acting CDC Director Jim O’Neill.

Although the sign-off itself could happen at any time, there are questions about how the shutdown may affect the implementation of that sign-off of updated recommendations — especially if local or state health agencies have questions for experts at the CDC or HHS.

According to the CDC staffing plan, the Vaccines for Children program — which provides access to vaccines for children in low-income families — will continue during the shutdown. But because the CDC has not adopted its advisers’ final recommendations for Covid-19 vaccination, those shots are not yet available through the Vaccines for Children and Vaccines for Adults programs.

As time goes on, the wait could affect families on Medicaid or those that are uninsured and eligible for Vaccines for Children, since ordering and administering the vaccine under the program is contingent upon the acting CDC director’s sign-off.

“Publicly-funded COVID vaccines cannot be distributed until the Acting CDC Director signs the decision memo. It is unknown how a government shut-down will affect this,” Cadence Acquaviva, a spokesperson for the New York State Department of Health, said in an email.

In the past, shutdowns have caused “minimal disruption” to vaccine rollout plans, said Brent Ewig, the chief policy and government relations officer at the Association of Immunization Managers.

“The good news is that in past shutdowns, the disruptions to US immunization programs have been minimal, and part of the reason for that is that the funding for the Vaccines for Children program – that covers about half of all kids in the US – is mandatory funding,” Ewig said.

“The more unknowns are if there’s a lot of CDC people on furlough, states then may not be able to reach their project officers, for instance, or get quick responses on routine matters,” Ewig said. Some of those routine matters could be related to funding or the implementation of new vaccine policies or recommendations.

“Everything seems to be a new environment, and so we’ll be monitoring closely,” he said.

In Georgia, for instance, public health officials do not anticipate that immunizations will be affected by the shutdown, but they are evaluating potential impacts to other public health programs, such as WIC, the food assistance program for low-income women, infants and young children.

“We are assessing other funding sources for programs that would be affected by a shutdown,” Nancy Nydam Shirek, a spokesperson for the Georgia Department of Public Health, said in an email.

But “immunizations will not be impacted by a government shutdown,” she said. “Health departments currently have and are administering flu vaccines. Health departments place orders directly with the vaccine manufacturers.”

As for Covid-19 vaccines, she said, the department is waiting for the CDC to formally adopt the advisory committee’s recommendations before providing them.

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