Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”
So, this is what happens when people don’tpay attention toevery little detail. I was intrigued by the title (and certainly suspected something else.) It certainly never occurred to me that the answer would lie in obscure budget practices and requlations.
I’m not allowed to republish phpts from ProPublica, and the ones I could find on Google were too gruesome to even consider … so no pictures.j
================================================================
One Major Reason the U.S. Hasn’t Stopped Syphilis From Killing Babies
by Caroline Chen
ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Series:
A Closer Look
Examining the News
In public health, a “sentinel event” is a case of preventable harm so significant that it serves as a warning that the system is failing. The alarms are now blaring.
A growing number of babies are being born with syphilis after their mothers contract the sexually transmitted disease and the bacteria crosses the placenta. These cases are 100% preventable: When mothers who have syphilis are treated with penicillin while pregnant, babies are often born without a trace of the disease. But when mothers go untreated, there is a 40% chance their babies will be miscarried, be stillborn or die shortly after birth. Those who survive can be born with deformed bones or damaged brains, or can suffer from severe anemia, hearing loss or blindness.
I’ve spent the past few months trying to understand why countries including Belarus, Cuba, Malaysia and Sri Lanka have managed to wipe out congenital syphilis while the United States faces its highest incidence in nearly three decades: Last year, 2,022 cases were reported, including 139 deaths. That’s a shocking reversal from 1999, when the Centers for Disease Control and Prevention declared that the United States was on the verge of eliminating the centuries-old scourge for adults as well as babies.
What went wrong here?
My reporting led me to one major factor: the unusual and — according to various experts I spoke with, problematic — way that the CDC is funded, which has not only hampered the response to a rise in sexually transmitted diseases, but also has left us ill-prepared for the COVID-19 pandemic.
State and local health departments get much of their money from the federal agency, which has the best birds-eye view of all of the bugs, viruses and illnesses circulating in America. But CDC scientists don’t have the power to decide how much money to spend fighting each one.
Instead, Congress dictates to the CDC, in an uncommonly specific manner not seen with many other agencies, exactly how much money, by line item, it can spend to combat any single public health threat, from broad categories like emerging infectious diseases and Alzheimer’s disease, to more niche conditions like interstitial cystitis, neonatal abstinence syndrome and Tourette syndrome. Though prevention tactics for HIV and other STDs significantly overlap, HIV prevention has a separate line item and is allocated about six times as much money as the category for sexually transmitted infections.
The decisions can be politically driven and detached from bigger-picture health needs, as lobbyists and patient advocates descend on Washington to make the case to lawmakers that their specific disease of interest should get a bigger piece of the pie. Causes that don’t have large armies of compelling spokespeople can get ignored. Sexually transmitted diseases, which have an extra layer of stigma to contend with, have few dedicated advocacy groups. The small number of lobbyists focused on STDs sometimes can’t even get a meeting with lawmakers.
“The CDC needs to have more money and more flexible money,” former CDC director Dr. Tom Frieden told 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 2014 Ebola epidemic was supposed to be a “global wakeup call,” yet in 2018, the CDC scaled back its epidemic prevention work as money ran out.
That means public health in the U.S. is constantly in what Frieden calls “a deadly cycle of panic and neglect” — scrambling to throw money at the latest emergency, then losing the attention and motivation to finish the task once fear ebbs. In May, President Joe Biden’s administration announced it would set aside $7.4 billion over the next five years to hire and train public health workers. But some officials worry about what will happen when those five years are up. “We’ve seen this movie before, right?” Frieden said. “Everyone gets concerned when there’s an outbreak, and when that outbreak stops, the headlines stop, and an economic downturn happens, the budget gets cut.”
Jo Valentine, former program coordinator for the CDC’s 1999 push to eliminate syphilis, says one of the reasons the campaign failed is because public health is usually working “in rescue mode, parachuting in and fixing things.” That’s effective in acute situations, like stopping a new outbreak from exploding, but it doesn’t address long-term structural issues like economic stability, safe housing and transportation, which are all key factors in chronic and preventive care. The last fraction of cases in any public health effort can be the hardest to solve because they often involve vulnerable populations experiencing these barriers to accessing care. They are also the easiest populations to ignore.
Local health departments don’t have nearly enough resources to investigate cases of syphilis with contact tracing, which involves tracking down patients, inquiring about sex partners and making sure everyone is treated. One disease intervention specialist I shadowed in Fresno, California, has made six trips to a rural town, driving an hour each way, trying to prevent a single case of congenital syphilis. The patient is unhoused and itinerant, and so far has been hesitant to visit the community clinic for treatment.
With interest in public health now at an all-time high, it is worth reexamining how much money public health gets to take on these unpopular but necessary challenges, and how much authority the CDC gets to set its priorities. I hope that, five or 10 years from now, I’m not still reporting about COVID-19 hot spots left behind after attention wanes, creating places where the disease still flares because testing or treatment is hard to come by. And I also hope I’m not still writing about babies dying from syphilis.
================================================================
AMT, It’s hard enough – next to impossible, I would say – to get people to pay attention even to the biggest of governmental trends. I really have no clue how to get people to pay attention to something like this. We really need any help whatsoever you can give us. Particularly when safe and legalabortions are becoming harder and harder to obtain, we do not need a problem like this one.
The Furies and I will be back.
5 Responses to “Everyday Erinyes #293”
Sorry, the comment form is closed at this time.
Sadly, like so much in this country tis politics and lobbyists that create policy rather than the doctors and scientists in the know.
So true. And while some progress can generally be made by a determined froup of progressives banding together, it really requires a group for each issue, and we re already worn thin.
I couldn’t help but think of Henrik Ibsen’s play “Ghosts,” which I think I read in high school (but it might have been college) – a play in which the symptoms arrived very late indeed – the victim was a young adult – but whem they did arrive were devastating.
Thanks Joanne.
In addition, with Covid more pregnant women, especially those without insurance or on Medicaid, did not get prenatal care. We also have more political interference again with high school sex education courses, where information about preventing and treating STDs is covered in places without such interference and school nurses would often help when classes are in person. Planned Parenthood often was where younger women and teens would turn for this kind of help just like older women do for mamograms and those that opted out of federal funding due to abortion restrictions in last administration would be serving fewer women for all reasons.
One things we all can do is share this article with our senators and representatives (forgiveable to exclude rabid right-wing, tea partiers, etc.) to ask that they provide at least some funding that gives CDC the flexibility to provide where most needed without having to wait a year as the problem snowballs until next budget.
Syphilis is on the rise here in Oz too, with some questioning this has something to do with COVID and fewer people reaching out to their doctor or hospital for treatment. But Syphilis was also on the rise in The Netherlands when I left more than three years ago, so long before COVID could play a role.
I think Caroline Chen has put her finger on s sore spot prevalent in too many countries: the deadly cycle of panic and neglect. When Syphilis or any other STD rears its ugly head again, it takes a while before healthcare workers who fight STDs on a daily basis get heard again and point out that funding has become a major problem in fighting the STD. Other STDs may not get the same response from governments because their effects on the unborn are less disastrous but after the first panic ebbs away, all STD prevention and treatment get a boost in attention and money until the incidence rate is back to “normal”. And then it starts all over again, eradication impossible because of open borders combined with a lack of attention and funding.
Comment from Mitch –
Unbelievable!Exceptional!
We re-act, we do not pro-act, we do not keep things safe, we go after the shiniest target.
Mitch