Cyclospora exposes weak links in America's food safety system

The nation's largest known cyclospora outbreak is straining Americans' trust in the food safety system — and could undermine the healthy-foods messaging from the Trump administration.

Why it matters: It arrives as the administration urges Americans to eat more whole foods, even as health experts say recent cuts have weakened the public health infrastructure responsible for detecting outbreaks.

The big picture: More than 11,000 confirmed or suspected cases of infection have been linked to the parasite across more than 40 states this summer, with investigators tying some — but not all — cases to contaminated iceberg lettuce.

• That raises a broader question among public health experts: Can the government convince Americans to eat more fresh produce if confidence in the food safety system is slipping?
• "If you want people to eat more whole foods, you have to make sure you've done everything possible to maintain public confidence in the system," said Jerold Mande, former deputy undersecretary at the Department of Agriculture.

That confidence has been tested in restaurants. While in Michigan last week, where there have been more than 9,600 suspected cases and 160 hospitalizations, an Axios reporter heard diners at multiple restaurants declining salads and lettuce on sandwiches because of the outbreak.

• Sandra Eskin, CEO of Stop Foodborne Illness, said investigators shouldn't stop looking for the outbreak's root cause simply because they've identified one likely source.
• "They should not give up because there are so many people who got sick," she said. "People are freaked out."

State of play: Experts interviewed by Axios pointed to several parts of the food safety system that have been weakened in recent months, including outbreak coordination, communications and staffing.

• They pointed to fewer communications staff at the Food and Drug Administration, reduced parasitic disease expertise at the Centers for Disease Control and Prevention and strains on state and local health departments that investigate outbreaks.
• They also emphasized that many of those weaknesses predate the current administration and reflect years of underinvestment in public health.

The outbreak has underscored how nutrition policy depends on food safety policy.

• Public health officials have spent decades encouraging Americans to replace processed foods with fruits and vegetables — a message that has become central to Health Secretary Robert F. Kennedy Jr.'s Make America Healthy Again agenda.
• But outbreaks like this can push consumers in the opposite direction.
• "If I were running MAHA, I'd be working really hard to make sure people knew real food wasn't contaminated," said Megan Ranney, dean of the Yale School of Public Health.

The other side: "The Trump Administration has mounted a robust response — without interruption — to this outbreak, working closely with health departments in all 50 states and leading the public health response by promptly identifying known sources and providing Americans with the information they need to protect themselves," an HHS spokesperson told Axios in an email.

• HHS continues to encourage Americans to follow the dietary guidelines for Americans and "eat real food," including fruits and vegetables, she said.

Reality check: Richard Besser, former acting director of the CDC, said the outbreak serves as an early look at how the nation's food safety system performs under stress and how it might respond to a more dangerous threat.

• "It's saying to me that we would be pretty slow to pick up an outbreak of something, even if it was deadly," Besser said.
• Ranney pointed to the necessity of work like that done by Michigan's health department, whose painstaking interviews with patients helped identify lettuce as a likely source.

The bottom line: Consumers can't inspect fresh produce for invisible pathogens.

• "I don't have a lab in my house," Eskin said.