FDA: The more things change, the more they stay the same – Opinion

Fifteen years ago, the Science Board of the US Food and Drug Administration (FDA) released a report in which they concluded that the agency’s scientific base had eroded, its scientific organizational structure was weak, its scientific workforce lacked sufficient capacity and capability, and its information technology (IT) structure was inadequate.

Today, the Reagan-Udall Foundation for the FDA released an Expert Panel report on the agency’s Human Food Program capabilities, in which they concluded that the program is underfunded and understaffed, IT resources are inadequate, no single individual is in overall charge of the program, and the agency is risk-averse.

Problems with organizational structure, funding, staffing and information technology. It would appear that not much has changed in fifteen years.

Expert Panel findings

In a fifty-one page report, the panel presented a damning list of deficiencies, the most glaring of which is the absence of a Deputy Commissioner of Foods, a position that was eliminated in 2019 during the Trump Administration.

Without a Deputy Commissioner, responsibility for fulfilling the FDA’s food safety and nutrition mandates is spread among the Center for Food Safety and Nutrition (CFSAN), the Center for Food Policy and Response (CFPR), and the Office of Regulatory Affairs (ORA). The Center for Veterinary Medicine (CVM) is responsible for the Animal Food Program, which includes both animal feed and companion animal food.

All four of these Centers report directly to the office of the FDA Commissioner, diluting the overall clout of the Food component of the FDA.

This lack of cohesive leadership and coordination was part of the reason for the FDA’s slow response to the Abbott Nutrition infant formula contamination crisis.

Many of the panels other findings are an inevitable consequence of the current organizational structure. Among these are:

  • Lack of a clear vision and mission
  • Absence of an ultimate decision-maker
  • A culture of indecisiveness and inaction
  • Overlapping roles and competing priorities among the various Centers
  • Over-reliance on consensus for decision-making
  • Aversion to regulatory risk-taking, resulting in reluctance to take enforcement action, including the use of mandatory recall authority
  • Funding has barely kept pace with inflation, and has fallen behind the increase in the size of the food industry
  • Critical staff have left the agency due to pay disparity with the private sector

Room at the top

The Expert Panel report does more than simply list deficiencies. It recommends a number of substantive improvements to the FDA’s organizational structure, hiring and personnel practices, budget and appropriation strategies, and information sharing.

The panel also recommends that the animal feed and companion animal food portions of the Center for Veterinary Medicine (CVM) be integrated with the Human Food Program.

But implementing the panel’s recommendations will require a strong leader–one with the courage and the clout to fight the Food Program’s battles within the FDA, with Congress, and with the food industry.

In January 2019, upon the retirement of Dr. Stephen Ostroff from the FDA, the position of Deputy Commissioner for Food disappeared from the agency’s organizational structure. Instead, the Trump Administration created a Center for Food Policy and Response (CFPR), and named Dr. Frank Yiannas as its first Deputy Commissioner.

Since then, responsibility for the Human Food Program has been parceled out among the CFPR, the CFSAN and the ORA, leading to “…overlapping roles and competing priorities that result in what is perceived as constant turmoil.”

I have long been an advocate of a single, independent Human and Animal Food Safety Agency that would take over all federal responsibility for regulating the safety of the US food supply, including most of the activities now carried out by the US Department of Agriculture’s Food Safety and Inspection Service (FSIS).

The single-agency approach has been adopted by many countries around the developed world, including Canada, the United Kingdom, a number of EU Member countries, Australia, and New Zealand.

This consolidation would, with a single stroke, eliminate significant overlap and duplication of enforcement activities, simplify the communications between regulators and the regulated (ie., food industry), and free the USDA to focus on its mandate to promote and support the agricultural industry without simultaneously trying to enforce food safety standards.

But I am, above all, a realist. I know that an independent Food Safety Agency is not even a twinkle in the Biden Administration’s eye.

In the absence of an independent agency, what the FDA needs desperately is a steady hand at the helm of the Food Program. Someone who has the authority to make tough decisions, advocate for the resources needed to ensure the safety of the food supply, and defend the Food Program against internal erosion and external pressures.

If FDA Commissioner Califf does nothing else in response to the Expert Panel report, he must act with dispatch to consolidate all of the disparate elements of the Human and Animal Food programs into a single entity headed by a Deputy Commissioner reporting directly to the Office of the Commissioner.

The gory details

If you wish to read the full report, you can download the pdf file here.

Chicken products fingered in international Salmonella outbreak

A deadly nine-nation outbreak of Salmonella Mbandaka ST413 infections is most likely due to consumption of ready-to-eat (RTE) chicken products and/or fresh chicken meat, such as those used in sandwiches and wraps.

According to the European Centre for Disease Prevention and Control,  196 cases have been reported in nine countries, including seven member states of the European Union (EU), the United Kingdom (UK), and Israel since November 8, 2022.

Nineteen outbreak victims have been hospitalized, five of them with septicemia.

One person–a resident of the UK–has died.

Outbreak cases have been reported by the following countries:

  • Czechia (Czech Republic): 5 (none confirmed as yet)
  • Estonia: 3 (all confirmed)
  • Finland: 89 (42 confirmed and 47 possible)
  • France: 10 (all confirmed)
  • Germany: 2 (all confirmed)
  • Ireland: 1 (all confirmed)
  • Netherlands: 1 (all confirmed)
  • Israel: 4 (none confirmed as yet)
  • United Kingdom: 81 (all confirmed)

The UK was the first country to detect the outbreak, reporting a cluster of 31 cases from England (25), Scotland (3) and Wales (3) on May 20, 2022. Sample collection dates ranged between September 24, 2021 and April 23, 2022. Four of the patients were hospitalized, and one has died.

Finland followed on the UK’s heels with a report of nine cases on June 16, 2022.

The Finnish food safety authority has linked suspect products to an Estonian company, but this link could not be verified by traceback identification or microbiological analysis.

The European Centre for Disease Control (ECDC) is encouraging its member countries to sequence the genomes of Salmonella Mbandaka isolated from human sources and to interview those patients whose isolates match the outbreak strain.

Salmonella Mbandaka was first reported in 1948 in the Belgian Congo, where it was recovered from a patient suffering from salmonellosis.

The ST413 strain entered the Polish feed and poultry sector in the 1990s, and has been circulating in Poland and other EU countries since then.

The ECDC warns that new cases are likely to occur until the source of the outbreak has been identified and controlled.

Jif Salmonella outbreak much larger than reported by CDC

In the weeks and months following the May 20, 2022, recall of Jif peanut butter products, the US Food and Drug Administration (FDA) received more than 200 reports from consumers complaining of illness after consuming the recalled products.

This information was supplied to eFoodAlert by the FDA in response to a Freedom of Information Act request.

In comparison, the US Centers for Disease Control and Prevention (CDC) reported just twenty-one confirmed cases of Salmonella Senftenberg linked to consumption of Jif peanut butter.

It is usual for an outbreak of foodborne illness to be significantly larger than indicated by CDC statistics. Indeed, the CDC reminded the public of this in its investigation report, saying, “The true number of sick people in this outbreak was likely much higher than the number reported. This is because many people recover without medical care and are not tested for Salmonella.”

By the numbers

The CDC tally

The CDC received lab-confirmed reports of outbreak cases in 21 individuals from 17 different states. Four people were hospitalized.

  • The first victim (“Patient Zero”) became ill on February 19, 2022.
  • The 21st victim became ill on May 23, 2022.
  • The youngest victim was less than one year old.
  • The oldest victim was 85 years old.
  • The median age of the victims was 59 years.
  • 75% of the victims were female.
  • 100% of the victims interviewed reported having consumed Jif peanut butter in the days before becoming ill.

The FDA tally

From January 1, 2022, through October 11, 2022, the FDA fielded a total of 320 queries and complaints relating to Jif peanut butter. Of these, 319 were specifically related to products manufactured at the Lexington, Kentucky, manufacturing plant linked to the outbreak.

  • 235 of the complainants reported having suffered an illness after consuming Jif peanut butter
  • 204 of the complainants reported specific symptoms; the remaining 31 reports mentioned “illness” or “adverse events”
  • Most of the individuals who reported symptoms suffered from multiple ill effects, including:
    • diarrhea: 166
    • cramps or abdominal pain: 124
    • vomiting: 80
    • nausea: 67
    • fever or chills: 63
    • Weakness, lethargy or fatigue: 33
    • headache: 31
    • Fainting, disorientation, dizziness, brain fog: 10
  • 8 reported bloody diarrhea
  • 4 reported a confirmed Salmonella diagnosis
  • 2 suffered from colitis
  • 2 suffered sepsis (a potentially serious, more generalized infection)
  • 1 individual reported a perforated bowel and peritonitis
  • 1 reported kidney failure

The recall

On May 20, 2022, The J.M. Smucker Co. announced a voluntary recall of peanut butter manufactured at its Lexington, Kentucky, production facility during a period of several months, up to and including the recall date.

The recall notice listed a variety of products and packaging formats from individual serving size packets weighing less than one ounce to 96-ounce twin packs, including:

As of October 21, 2022, the recall has not been completed.

The takeaways

CDC versus FDA reporting

The differences between the data reported by the FDA and the CDC are a function of how the two agency systems operate.

The CDC relies on reports of lab-confirmed cases of foodborne illness, and reports only on those cases, whereas the FDA receives and tabulates complaints from consumers, regardless of whether or not there was lab confirmation of an infection.

Both systems provide useful and complementary information that enables epidemiologists to determine the scope of an outbreak and–with a bit of luck thrown in to season the pot–trace it to its source.

In fact, it is likely that the number of people affected by the contaminated peanut butter was far larger even than the 200+ individuals reported by the FDA. There is no way of knowing how many people suffered mild symptoms and either didn’t realize they were linked to a Jif product or didn’t bother making a report.

The consequences for the company

In 2006, Peter Pan peanut butter manufactured by ConAgra was responsible for an outbreak of 425 Salmonella infections. An FDA inspection revealed that the company had been aware of a Salmonella contamination problem in their production plant, but did not reveal this information to the FDA investigation team. The government laid charges against ConAgra and entered into a plea agreement with the company in 2015. ConAgra pled guilty to a criminal misdemeanor, was fined $8 million, and had to forfeit an additional $3.2 million in assets.

In 2009, Peanut Corporation of America was responsible for a deadly outbreak of Salmonella infections that sickened 714 people and killed nine of them. Company management had knowingly shipped contaminated peanut butter to its customers. Once again, the government brought criminal charges. This time, the owners received prison sentences.

In 2012, Sunland Inc., the largest producer of organic peanut butter in the USA, was the source of a Salmonella outbreak that sickened 42 people. Again, the coupany was found to have knowingly shipped contaminated product. The FDA suspended Sunland’s food facility registration, effectively shutting down the company’s operations, but no charges were laid.

Earlier today, the FDA declined eFoodAlert’s request for a copy of the Jif Establishment Inspection Report on the basis that, “…disclosure could reasonably be expected to interfere with enforcement proceedings.”

The FDA has a range of possible enforcement proceedings at its disposal, ranging from a simple Warning Letter all the way up to referring the case to the Department of Justice for the laying of criminal charges.

Watch this space…


Read more about Salmonella in peanut butter in TAINTED. From Farm Gate to Dinner Plate, Fifty Years of Food Safety Failures, now available in digital, print and audiobook editions.

TAINTED formats 3
“Reads like a true crime novel” – Food Safety News