Epidemiologist Andrea Ellis, Dept. of Food Safety and Zoonoses of the World Health Organization, updates journalists on the E. coli situation in Germany and across Europe at the United Nations European headquarters in Geneva, Switzerland, June 3, 2011.
"Bobbling an Outbreak"
Op-Ed, Boston Globe
June 13, 2011
Author: Juliette Kayyem, Lecturer in Public Policy
Belfer Center Programs or Projects: International Security
DIAGNOSING THE problem is a basic tenet of medicine. That, and doing no harm. As it contends with one of the worst food-poisoning outbreaks in recent history, Germany is failing at both, and dragging down much of Europe with it.
The bacterium known as E. coli 0104 is the cause of an outbreak that has struck more than 2,400 people, killing at least 24 and leaving 600 of them in intensive care. It is the biggest E. coli epidemic in world history. This form of E. coli — a virulent strain causing bloody diarrhea, kidney failure, and anemia — clings to intestinal walls, with a potent infection rate as toxins enter the bloodstream. It is durable. It is not likely to be the last new deadly E. coli strain.
So what is unfolding now in Europe — a disastrous and confusing response by German health officials who, in a desperate pursuit of the source of the outbreak, have managed to destroy much of Europe’s agriculture economy while maligning bean sprouts, broccoli, peas, chickpeas, garlic, lentils, and radishes — is not simply some distant gastrointestinal ailment.
Since World War II, Europe has found its strength — economically, politically, and militarily — through coordination. In such an interconnected world, the E. coli outbreak is a reminder that our global system is only as strong as its weakest link. As scientists study new superbacteria, the fumbling public health response also provides lessons on what a global health network should look like.
Germany first blamed Spanish-grown cucumbers, even though no Spaniards had gotten sick. Immediately, the Spanish agriculture industry faced losses running at $300 million weekly. By the time Germany admitted its mistake, Europe was facing panic. The Russian health service has banned all vegetable imports from the entire European Union. Spanish farmers are rioting. Retailers and markets are suffering.
German officials then turned to bean sprouts, thinking they had found the culprit on a local farm. The tests, however, were inconclusive. Germans in multiple regions are now falling ill. Some scientists are hoping the E. coli outbreak has abated because fewer cases are being reported. It may be just as likely that no one in Europe is eating vegetables anymore.
German Chancellor Angela Merkel, who was feted at a White House state dinner in the midst of the crisis, should remember that small European wars have been fought over much less.
Finding the source of a deadly virus is a scientific nightmare. Clues are often thrown away with the night's trash. Contaminated farm or factory equipment may have been cleaned. Symptoms may take weeks to materialize, requiring a patient to remember what they ate and when.
But Germany's problems seem to be systemic. Germany's decentralized governance system was not fast enough to monitor early warnings of outbreaks. It took several weeks after the first reported case in early May for officials even to recognize they were in the midst of an outbreak. Local governments are likely to be the first to notice a strange illness pattern, but unless the information is compared with other jurisdictions, it will just look like a bunch of sick people.
The volume and severity of this outbreak means it should be easier, not harder, to detect the source. There are more opportunities to determine a pattern of purchases or consumption. Yet Germany's troubled history has made it a very pro-privacy nation, with public health and medical information decentralized and guarded. That is understandable for personally identifiable information, but not forgivable for a nation at the center of the European Union. There is a way to share basic information without violating a patient's rights.
Fortunately, the United States imports very little produce from Europe, though even United Natural Foods Inc., the largest distributor of organic products in the United States, has seen its stock prices fall over 5 percent since the European cases became public. We also have strong programs, such as CDC's Foodnet, which monitor foodborne diseases nationwide by accessing state and local data. The 2011 Food Safety Modernization Act essentially aims to protect food supplies by focusing federal regulatory efforts on prevention rather than responding to contamination.
What we often don't have is a commitment to our public health system. Congressional attempts to cut the FDA’s budget request by $600 million suggest that we view food safety as a low priority. Which we all probably do. Until we can't eat Spanish cucumbers anymore.
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