Addressing Foodborne Threats to Health Policies, Practices, and Global Coordination: Workshop Summary (2006) / Chapter Skim
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Summary and Assessment
Summary and Assessment
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estimates costs associated with medical expenses and losses in productivity due to missed work and premature deaths from five major types of foodborne illnesses (Campylobacter, E coli O157:H7, Shiga toxin-producing strains of E
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Workshop participants discussed the threat spectrum and burden of disease associated with foodborne illness and the role that increasing globalization of food production and distribution plays in the transmission of foodborne disease. Participants also reviewed existing research, policies, and practices concerning foodborne threats in order to identify unmet needs, challenges, and opportunities for improving food safety systems, surveillance, and emergency response.
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. Although plant pathogens do not pose a significant public health threat, their presence could trigger trade embargoes with severe 1It should be noted that not all foodborne illness is caused by an infection, not all foodborne disease causes diarrhea, and not all foodborne disease is acute.
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. Although discussions of food safety often focus on infectious disease threats, several workshop participants remarked that harmful chemicals represent an even greater risk to the food supply than those posed by biologic agents, given the huge number of potential chemical adulterants and the difficulty of detecting them in foods and/or eliminating them from the food chain (see Osterholm in Chapter 1 and Busta in Chapter 7)
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food supply offers countless opportunities for intentional harm (Osterholm, 2005) : · Prefarm inputs include cattle feed, agricultural chemicals such as fertilizers and pesticides, and water supplied for irrigation.
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. The globalization of the world's food supply will expose a greater proportion of its people to emerging and reemerging foodborne disease and contamination (Buzby, 2001)
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Workshop participants noted that the reorganization of food safety at the federal level could also benefit state and local food safety systems, many of which mirror the disorganization of federal jurisdictions. In discussion, some participants considered this a critical connection, because state and local officials perform many activities essential to food safety, such as the inspection of food-processing plants and surveillance for foodborne disease.
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The global nature of much of the world's food supply and the reality that safety cannot be "tested into" food necessitate the establishment of a coherent, risk-based, international system for preventing foodborne disease, according to speaker Jørgen Schlundt (see Chapter 2) , director of the food safety program of the WHO.
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Funding and affordability of the national food safety program Timely communication is critical to protecting the food supply, particularly at the international level. The International Food Safety Authorities Network (INFOSAN)
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The investigators now believe that imported basil, served in an upscale restaurant, harbored the parasite. Such investigations constitute the best method to identify foodborne pathogens and their sources, discover how they entered the food supply, and prevent similar outbreaks from occurring in the future, Herwaldt noted.
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food supply. Workshop participants considered accounts of intentional foodborne illness, as well as likely scenarios for food adulteration with both biological and chemical agents at vulnerable points in the U.S.
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morbidity, mortality, and socioeconomic consequences that could unfold from an intentional act of adulteration targeting the U.S. food supply chain (Breeze, 2004; Chalk, 2005)
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food supply from al-Qaeda and other foreign nonstate actors, to radical animal rights groups, to homegrown "lone wolf" perpetrators. The transient nature of the food industry workforce is particularly worrisome, according to Osterholm, who noted the ease with which members of terrorist groups could be employed within food-processing companies and obtain "insider knowledge" of the vulnerable "choke points" in the production process.
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This distinction increases the already daunting challenge of ensuring food safety, of balancing the risk of harm against the cost of protection, and of implementing and paying for cost-effective safeguards. SURVEILLANCE OF FOODBORNE THREATS TO HEALTH Two categories of tools and practices are used to detect threats to the food supply: farm-to-table food safety systems and human disease surveillance (Besser,
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Several workshop presentations discussing the benefits, limitations, and accomplishments of specific food and disease surveillance tools sparked discussion on obstacles to timely foodborne threat detection and how such challenges might be overcome. Monitoring Food Safety from Farm to Fork In framing his description of food surveillance -- which focused on microbial threat agents -- speaker Robert Buchanan noted its key role in verifying the effectiveness of food safety systems, as well as in preventing foodborne disease.
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Public Health Surveillance As defined by speaker Robert Tauxe, public health surveillance is "the monitoring of health events in humans, linked to action." Information gained from public health surveillance is used to measure the magnitude and burden of foodborne illness, to identify outbreaks, and to evaluate the impact of prevention and control efforts. In the United States, authority to conduct public health surveillance rests with state governments.
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population; these sites are operated jointly by state health departments, the FDA, and the USDA under the aegis of the CDC Emerging Infections Program. Information derived from FoodNet is used to estimate the burden of foodborne illness and to monitor epidemiological trends in foodborne disease.
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Improving Foodborne Threat Surveillance Several opportunities for enhancing foodborne disease surveillance identified by workshop participants included the following: · Increase the capacity and resources of regulatory agencies for skilled traceback of food contaminants. · Decrease the anonymity of foods to make them more readily traceable.
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REPORTING FOODBORNE THREATS: THE CASE OF BSE Among all the resources brought to bear on the control of foodborne illness, time is perhaps the most precious. The rapid reporting of foodborne threats is therefore essential to reducing the burden of foodborne illness, but it also carries inevitable and significant costs to individuals, industry, and national economies.
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BSE Biology and Food Safety Implications A member of the family of diseases known as transmissible spongiform encephalopathies (TSEs, also known as prion diseases) , BSE was first identified in 1986 in the United Kingdom and has since been detected in 26 countries (GAO, 2005c)
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International Perspectives on BSE and vCJD Speakers Steven Collins, an Australian expert on BSE and vCJD, and Maura Ricketts, a Canadian authority on prion diseases, shared their perspectives on the response to these health threats (see Chapter 6)
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Trade-based economies resist the disclosure of threats to public health and the adoption of preventive measures due to their short-term costs, Ricketts observed. Thus government support for disease prevention and surveillance is essential; however, it is often difficult to obtain because the affected country must acknowledge that it has a foodborne disease problem.
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Additional research and policy opportunities for reducing foodborne threats were raised in subsequent workshop presentations on animal health, food defense, and food safety science. The emphasis on risk assessment in the latter presentation provides a framework for addressing several key challenges to food safety, as well as opportunities for protecting the food supply, identified by workshop participants.
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Food Safety Science Contending that food safety "is an intellectual concept, not an inherent biological property of a substance," speaker Sanford Miller noted the profound influence of such nonscientific issues as politics, economics, and social values on perceptions of risks to the food supply. The clear identification of foodborne threats and the accurate estimation of the risks they present require a new approach; Miller has collected these functions into a new academic discipline that he calls food safety science.
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. Assessing Needs and Opportunities The following summary comprises needs and policy opportunities for reducing foodborne threats to health that were most frequently mentioned by workshop participants.
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Domestic and International Perspectives. Presentation at the Forum on Microbial Threats Workshop Meeting, Foodborne Threats to Health: The Policies and Practices of Sur veillance, Prevention, Outbreak Investigations, and International Coordination, Washington, D.C., Institute of Medicine, Forum on Microbial Threats.
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Impacts on Human Health and International Trade -- BSE as a "Case Study"? Presentation at the Forum on Microbial Threats Workshop Meeting, Foodborne Threats to Health: The Policies and Practices of Surveillance, Prevention, Outbreak Investigations, and International Coordination, Washington, D.C., Institute of Medicine, Forum on Microbial Threats.
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Food Supply. Presentation at the Forum on Microbial Threats Workshop Meeting, Foodborne Threats to Health: The Policies and Practices of Surveillance, Prevention, Outbreak Investigations, and International Coordination, Washing ton, D.C., Institute of Medicine, Forum on Microbial Threats.
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. Session II: The Food Supply "Threat Spectrum." Presentation at the Forum on Microbial Threats Workshop Meeting, Foodborne Threats to Health: The Policies and Practices of Surveillance, Prevention, Outbreak Investigations, and International Coordination, Washington, D.C., Institute of Medicine, Forum on Microbial Threats.
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2005. Analyzing a bioterror attack on the food supply: The case of botulinum toxin in milk.
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