How a Government Shutdown Would Affect Public Health

On Monday, the Senate voted 81-18 in favor of a short-term spending bill that could end the government shutdown. If passed through the House, the bill will fund the government through February 8. The bill comes after a 3-day shutdown following Congress’ failure to agree on a new budget.

However, if a permanent budget is not agreed upon following the short-term fix, the government will face another shutdown. A shutdown will have far-reaching implications for public health, with health services halted and almost half (40,969) of HHS staff furloughed. In an updated contingency plan, HHS outlined which activities would continue during the shutdown and which would not.

National Institutes of Health (NIH)

Would continue: Throughout the shutdown, patients currently enrolled in the NIH Clinical Center would continue receiving care. In an interview with the Associated Press, Anthony Fauci, MD, infectious disease chief, NIH, assured that patients currently in NIH-run studies would not be adversely affected by a shutdown.

Would be halted: However, NIH would not admit new patients, who often turn to the institute when conventional treatments have failed, unless deemed necessary by the NIH director. NIH would not initiate new protocols or take any actions on grant applications or awards.

CDC

Would continue: While the CDC would continue to provide minimal support to protect the health and well-being of the public, its capacity to do so would be significantly reduced. Response to outbreak investigations, processing of laboratory samples, and the agency’s 24/7 emergency operations center would maintain operation. Activities supported by funding that would be unaffected by a shutdown include the US President’s Emergency Plan for AIDS Relief, CDC’s Global AIDS program, the Energy Employees Occupational Illness Compensation Program Act, and the Vaccines for Children program.

Would be halted: As the country is in the peak of a particularly severe flu season, surveillance of outbreaks would be slowed down. For disease surveillance activities not directly related to protection of life and limiting disease progression, constraints on CDC staff resources under the lapse would result in a longer time to review, analyze, and report out public health information, according to the plan. CDC would also be unable to support noncommunicable disease prevention programs, continuously update disease treatment and prevention recommendations, and provide technical assistance, analysis, and other support to state and local partners.

FDA

Would continue: The FDA’s crucial activities, such as maintaining critical consumer protection to handle emergencies, high-risk recalls, civil and criminal investigations, import entry review, and other critical public health issues, would continue. In a Twitter thread, FDA Commissioner Scott Gottlieb, MD, said that the FDA’s mission critical surveillance of adverse events for drugs, medical devices, and other medical products will not stop. Gottlieb also said the FDA will not stop working to alleviate the urgent IV saline shortage.

Would be halted: Under a shutdown, the FDA would not accept drugs for review nor conduct any plant inspections. While the government was shut down over the weekend, the FDA announced that it did not have legal authority to accept user fees assessed for the 2018 fiscal year until the budget is settled. It would also have to cease safety activities such as routine establishment inspections, some compliance and enforcement activities, monitoring of imports, notification programs, and the majority of laboratory research necessary to inform public health decision-making.