States to CDC on bird flu: ‘Back off’

May 06, 2024

Driving the Day

Cows and dairy worker

Many farmers don’t want federal health officials on their property. | Daniel Acker/Bloomberg via Getty Images | Getty

CDC WANTS MORE AVIAN FLU DATA — State agriculture officials and the dairy industry are telling public health officials they don’t want federal CDC researchers on farms, complicating efforts to track and contain an avian flu virus that’s sickened cows across the country, POLITICO’s Meredith Lee Hill, David Lim and Marcia Brown report.

“It's overreach. … They need to back off,” Texas Agriculture Commissioner Sid Miller, a former rodeo cowboy who is a possible pick to lead the USDA if Donald Trump wins the presidential election, said in an interview.

Texas, the first state where the bird flu virus was detected, hasn’t invited the CDC to conduct epidemiological field studies, even though its health department is open to the research, because “we haven’t found a dairy farm that is interested in participating,” Lara Anton, a spokesperson for the Texas Department of State Health Services, said.

Dairy farmers’ resistance is emblematic of the trust gap between key agriculture players in red and blue states and federal health officials — one that public health experts fear could hamper the nation’s ability to head off the virus’ threat to humans.

CDC officials are trying to find a middle ground as they race to determine how the outbreak spreads among dairy cows and whether it’s infected more humans than the single documented case in a Texas dairy worker.

“Discussions are underway with farms in multiple jurisdictions to participate in CDC-led epidemiological studies. In the meantime, states continue to test symptomatic farm workers and monitor those who have been exposed to infected animals,” CDC spokesperson Jason McDonald said in an email.

“One of the big open questions in my mind is whether there's only been one human case because we haven't surveyed widely enough or whether that is a true reflection of incidence,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security who was a founding associate director of the CDC’s Center for Forecasting and Outbreak Analytics.

White House chief of staff Jeff Zients has taken a personal interest in the bird flu response. Since assuming that role, the former Covid response czar has stressed to officials that the administration must closely monitor public health threats for fear of the damage another national crisis would do to the American psyche and Biden’s political standing.

State agriculture officials have pushed for interviews with farmworkers to be voluntary and conducted off the farms.

“Having CDC show up with a response team is very intimidating to the workers,” said Dr. Justin Smith, Kansas’ animal health commissioner.

— Marcia also reports on why public health officials are struggling to protect dairy workers.

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AROUND THE AGENCIES

The White House in Washington.

The White House is fast-tracking health care rules to avoid any Congressional Review Act challenges. | Daniel Slim/AFP via Getty Images

BIDEN’S REGULATORY SPRINT — The Biden administration has finalized several major health care rules in recent weeks ahead of a key congressional deadline, but we still have our eyes on these key proposals:

— Telemedicine prescribing of controlled substances is still up in the air. The Drug Enforcement Administration late last year extended pandemic rules for prescribing the drugs through the end of 2024, with hopes of finalizing new rules by this fall.

— Expanded requirements for insurers to cover mental health and substance use care like any other treatment are still yet to be finalized. The proposal has upset insurers, who say it might impede access to care and exacerbate staffing shortages.

It’s unclear whether either rule would draw a challenge under the Congressional Review Act.

LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.

Abortion

DISPATCH FROM FLORIDA — The fate of Florida’s November referendum to undo a six-week abortion ban that went into effect last week hinges on how many Republicans think abortion should be legal, even if they wouldn’t choose it for themselves, Kathy Gilsinan reports for POLITICO Magazine.

Kathy reports from Hialeah in Miami-Dade County, a heavily Republican and Cuban city with one of the state's highest concentration of abortion clinics. Backers of the referendum know its outcome will depend on places like the city, where many residents or their ancestors fled from autocracy and are Republican because they value limited government and freedom.

Polling shows Florida Latinos are divided on the issue and more conservative than in other parts of the country. The six-week ban is a dramatic shift in a state that’s had one of the nation's highest abortion rates, especially after the Dobbs decision led to many states in the South restricting access to the procedure.

But over 90 percent of the more than 84,000 women who got abortions in the state last year came from Florida.

“They may be Republicans,” a clinic administrator said, “but they still come in for services.”

In Congress

HHS REG RENEWS QALY BAN PUSH — Updated HHS regulations finalized last week preventing discrimination against people with disabilities have reinvigorated a movement to ban the use of quality-adjusted life years in federal programs.

The metric assesses a drug’s impact on health outcomes and quality of life, and some groups argue the statistic discriminates against people with disabilities by undervaluing how much treatments help them.

QALYs are banned in Medicare, but a top priority for Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, who is retiring at the end of the year, has been a bill that would bar the metric and similar measures' use in Medicaid, the VA and other federal programs. Metric supporters say it helps avert overpaying for care that doesn't give substantial benefits.

The path forward: Tucked into the new rules is language prohibiting federally funded programs from denying benefits based on measures that discount the value of life due to disability — but advocacy groups haven’t interpreted the rule as a complete ban on QALYs and similar measures.

“This only further supports the need for [the bill] and could actually eliminate the bill’s cost,” said Megan Burke, principal at the Petrizzo Group.

Kandi Pickard, president of the National Down Syndrome Society, told Pulse that the group sees the final rule as a “critical step” but said it doesn’t “fully and explicitly ban the use of similar measures.” Sara Traigle van Geertruyden, executive director of the Partnership to Improve Patient Care, also said the group still “strongly supports” the bill, which cleared the House on party lines in February.

Democrats have raised concerns that the legislation could interfere with new Medicare drug price negotiation provisions under the Inflation Reduction Act. The Affordable Care Act banned QALYs and similar measures in Medicare “as a threshold to determine coverage.”

HHS, FDA UNDER SCRUTINY — Rep. James Comer (R-Ky.), chair of the House Oversight Committee, is pushing the chair of the House Appropriations Committee, Rep. Tom Cole (R-Okla.), to slash funding for agencies he says haven’t cooperated with congressional investigations, including HHS and the FDA.

“The appropriations bills for Fiscal Year 2025 must signal to the Administration that its behavior will no longer be tolerated,” Comer and other Republicans wrote to Cole.

The lawmakers said the FDA hasn’t sufficiently complied with requests related to the agency’s infant formula crisis response and its tobacco and nicotine regulation and HHS hasn’t turned over documents requested last month related to alcohol guidelines.

Cole’s office, HHS and the FDA didn’t return requests for comment.

Names in the News

Dr. Sree Chaguturu has been named chair of the American Telemedicine Association’s board of directors. He’s executive vice president and chief medical officer at CVS Health.

Verlon Johnson of Acentra Health has been named chair of the Medicaid and CHIP Payment and Access Commission, or MACPAC. Doug Brown of COEUS Consulting and Michael Nardone, who leads an independent consulting practice, have been appointed to the commission.

WHAT WE'RE READING

The New York Times asks whether anyone is listening to the thousands who say they were harmed by Covid-19 vaccines.

Healthcare Dive reports on Walgreens’ GLP-1 clinical trial deal.

The Washington Post reports on the FDA's bid to make chemotherapy less brutal.

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