A major reason why the United States has not prevented syphilis from killing babies – ProPublica

This op-ed was published in conjunction with The Washington Post.

In public health, a “guard post event” is a case of preventable injury so significant that it serves as a warning that the system is failing. The alarms are ringing now.

An increasing number of babies are born with syphilis after their mothers get the sexually transmitted disease and the bacteria cross the placenta. These cases can be 100% preventable: When mothers with syphilis are treated with penicillin while pregnant, babies are often born without a trace of the disease. However, when mothers are not treated, there is a 40% chance that their babies will have an abortion, be stillborn or die shortly after birth. Survivors may be born with deformed bones or damaged brains, or they may suffer from severe anemia, hearing loss or blindness.

I have spent the last few months trying to understand why countries including Belarus, Cuba, Malaysia and Sri Lanka have managed to eradicate congenital syphilis while the US is facing its highest incidence in almost three decades: Last year, 2,022 cases were reported , including 139 deaths. It’s a shocking turn from 1999, when the Centers for Disease Control and Prevention declared that the United States was on the verge of eliminating the centuries-old plague for adults as well as babies.

What went wrong here?

My reporting led me to one significant factor: the unusual and – according to various experts I spoke to, problematic – the way the CDC is funded, which has not only hampered the response to an increase in sexually transmitted diseases, but has also left us ill-prepared on the COVID-19 pandemic.

State and local health departments get a lot of their money from the federal agency, which has the best bird’s eye view of all the insects, viruses and diseases circulating in America. But CDC researchers do not have the power to decide how much money they should spend on fighting each one.

Instead, Congress dictates the CDC, in an unusually specific way, which is not seen in many other agencies, exactly how much money, per. line item it can use to combat a single threat to public health, from broad categories such as new infectious diseases and Alzheimer’s disease, to more niche conditions such as interstitial cystitis, neonatal withdrawal syndrome and Tourette’s syndrome. Although prevention tactics for HIV and other sexually transmitted diseases overlap significantly, HIV prevention has a separate line item and is allocated about six times as much money as the category of sexually transmitted infections.

Decisions can be politically driven and detached from greater health needs as lobbyists and patient advocates head down to Washington to argue to lawmakers that their specific disease of interest should get a bigger slice of the pie. Cases that do not have large armies of persuasive advocates can be ignored. Sexually transmitted diseases, which have an extra layer of stigma to contend with, have few dedicated advocate groups. The small number of lobbyists who focus on STDs can sometimes not even get a meeting with lawmakers.

“The CDC needs more money and more flexible money,” said former CDC director Dr. Tom Frieden to me. The political nature of the agency’s funding is part of what led the country to neglect virus surveillance before the coronavirus pandemic. The Ebola epidemic in 2014 was supposed to be a “global wakeup call,” but in 2018, the CDC reduced its epidemic prevention work as the money ran out.

This means that public health in the United States is constantly in what Frieden calls “a deadly cycle of panic and neglect” – struggling to throw money at the recent emergency and then losing attention and motivation to complete the task when fear ebbs. In May, President Joe Biden’s administration announced it would allocate $ 7.4 billion over the next five years to hiring and training health professionals. But some officials worry about what will happen once the five years have passed. “We’ve seen this movie before, haven’t we?” said Frieden. “Everyone gets worried when there’s an outbreak and when that outbreak stops, the headlines stop and there’s an economic downturn, the budget gets cut.”

Jo Valentine, former program coordinator for the CDC’s 1999 campaign to eliminate syphilis, says one of the reasons the campaign failed is that public health usually works “in rescue mode, parachuting and fixing things.” It is effective in emergency situations, such as stopping a new outbreak from exploding, but it does not solve long-term structural problems such as economic stability, safe housing and transportation, all of which are key factors in chronic and preventive care. The last fraction of cases in any public health effort can be the most difficult to resolve because they often involve vulnerable populations experiencing these barriers to accessing care. They are also the easiest populations to ignore.

Local health departments do not have nearly enough resources to investigate cases of syphilis with contact tracing, which involves tracing patients, inquiring about sex partners, and ensuring that everyone is treated. A disease intervention specialist I shadowed in Fresno, California, has made six trips to a rural town, driving for an hour each way, to try to prevent a single case of congenital syphilis. The patient is uninhabited and itinerant, and has so far been hesitant to visit the community clinic for treatment.

With interest in public health now at a record high, it is worth reconsidering how much money public health is making to take on these unpopular but necessary challenges, and how much authority the CDC is having to set its priorities. I hope in five or 10 years I still do not report COVID-19 hotspots left behind after the attention has waned, creating places where the disease still flares up because testing or treatment is hard to come by. And I also hope I do not still write about babies dying of syphilis.

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