A physician’s warning: The Cyclospora outbreak exposes a surveillance gap

Beyond the exam room, the cyclosporiasis outbreak could serve as a warning about what happens when the federal government pulls back from disease surveillance, said a pediatrician who practices in Michigan, the state hit hardest by the recent surge in cases.

The Centers for Disease Control and Prevention (CDC) has scaled back active surveillance for Cyclospora, part of workforce reductions that cut the agency’s staff by roughly a quarter. Federal reporting mandates for Cyclospora also lapsed in July 2025, even though most states still require it.

Molly O’Shea, M.D., who has run an independent primary care pediatric practice in Michigan for more than 30 years, spoke with Medical Economics about what those cuts mean for physicians tracking outbreaks, how Medicaid and insurance access shape who ends up in her office, and why she believes disease surveillance, health coverage and prevention are impossible to separate from one another. This transcript has been edited for length and clarity.

Medical Economics: Federal reporting mandates for Cyclospora were dropped in July 2025, even though most states still require it. What does that gap mean in practice for physicians trying to track or report a suspected case?

Molly O’Shea, M.D.: Because states still require it, we can get alert bulletins from our state public health officials at the state level, which is valuable. But at the federal level, that’s one of several areas where the dismantling of oversight has hobbled the national response to outbreaks like this, and it’s created a disjointed approach to responding to them. Even if one state can move ahead with clear guidance and structured information, other states that haven’t yet been made aware are only learning about it through news stories. That delays surveillance at the grassroots level in ways that wouldn’t have happened before. There would have been a “danger, Will Robinson” kind of messaging going out nationally: Here are the signs and symptoms, here’s what to look for, don’t forget to send the special test rather than the standard one, whether you’re in Alaska or Michigan. On top of that, the number of scientists available to study parasitic infections has been reduced dramatically at the CDC. We’re running a three-legged race with one leg. We’re just not able to keep up with what’s happening, and we’re seeing this across many infectious diseases right now. We’re at the highest rate of measles infection since 1991.

Medical Economics: Is this something that could turn up in other states and regions, or is it isolated to Michigan and the Midwest?

Molly O’Shea, M.D.: We’re not the only place with Taco Bell, so there you go. It’s going to be happening everywhere. I think because we had early recognition of it and a robust state health department, it resulted in statewide messaging and a coordinated approach that got everybody looking for it, which then allowed for diagnoses. Because of the lack of federal coordination, I think we have many more cases than are being identified right now, because people aren’t sending the test off. It isn’t that people aren’t getting sick. It’s that they’re not sending the test off. [Editor’s note: CDC has stated the outbreak was connected to iceberg lettuce from Taylor Farms de Mexico served at Taco Bell restaurants.]

Medical Economics: Is there a policy recommendation that could be enacted quickly enough to make a difference in this outbreak?

Molly O’Shea, M.D.: I think if someone at HHS (the Department of Health and Human Services) stood up and said, we are in the midst of an outbreak, here’s what we all need to be doing, we’re going to coordinate an effort, we’re going to organize the information that’s cascading out and do the detective work the CDC has traditionally done to get to the bottom of it. They just don’t have the manpower to do that the way they used to, because they’ve cut about 20% of the workforce that does this kind of work. So the policy change would be: We need an emergency response team, let’s get them in here now. But the priority isn’t there. The assumption has shifted to infectious disease being just part of life, how nature works, instead of something we have the opportunity to influence and, depending on the disease, prevent. Because that isn’t front and center, there isn’t the same interest in mounting a full response and tracking it.

Medical Economics: What didn’t I ask about, at the practice level, the state level or the federal level, that you’d like our audience to know?

Molly O’Shea, M.D.: Care has gotten increasingly fragmented for a lot of reasons. In pediatrics, about half of our patients have Medicaid, and as Medicaid has been in peril because of shifts at the federal level, and as the Affordable Care Act and other changes have made insurance less affordable and harder to access, it’s gotten harder for families. Many people are only coming to their primary care office when they need a form completed, or after they’ve already been to urgent care twice and still don’t have an answer. For something like Cyclospora, where it isn’t clear right away what’s going on, a patient may have profuse diarrhea for a while, not sick enough for hospitalization, but debilitated. It’s hard to go to work or school, which means a parent can’t go to work either. If your insurance has a high deductible that makes seeking care cost-prohibitive, or you don’t have insurance because you couldn’t afford it, or you used to have Medicaid but don’t anymore, it’s going to be even harder for us to manage patients as we see more of these infectious diseases, at the same time federal interest in surveilling and preventing them has pulled back.

Medical Economics: You mentioned insurance access. How does that connect to prevention and the habits families build around food and health?

Molly O’Shea, M.D.: There’s a lot of talk from HHS about wellness and prevention, but if you look at the actual strategies we have for disease prevention, including vaccines, that effort has been rolled back too: the promotion of it, the funding for it, and people’s access to the care they’d need to get it. Habits and patterns around health and wellness are often established in childhood and adolescence, then carried into adulthood. If you have the privilege of being in a family that can afford organic food and grass-fed beef, great, you’ve got that going for you. But that’s not most children or most families. Most families rely on what they can afford at the corner store or the big box grocery store, and many rely on SNAP or other food assistance to do that purchasing. So when people hear a big message about Cyclospora, they get nervous about buying fruits or vegetables, because the last thing they need is for their kid to get explosive diarrhea when they can’t afford to take them to the doctor. For a while, they’ll move away from healthier foods toward less healthy ones, which, as any kid will tell you, they’re happy about. It’s a discouraging cycle. You can’t cut costs in one area and assume it won’t affect everything else. Disease surveillance for a parasitic illness like this ends up affecting what foods people buy, and if a family is already living on the edge with insurance issues, they’re definitely not going to be buying the safer option. There’s an opportunity to be more thoughtful about the structural support that provides real infrastructure for wellness: access to health care, vaccines, that kind of thing. I think we, and I don’t mean pediatricians or physicians specifically, decided to gut that infrastructure, and we’re now seeing the result.

Medical Economics: After more than 30 years in practice, has it gotten easier to see how these different systems, clinical, financial and political, connect to each other?

Molly O’Shea, M.D.: I’ve been around the block for a long time, and the connections are easier to see now. When you’re first in practice, you’re still learning how one part of the body affects another, then you start to see the family-systems connections. Once you’re far enough into your career, you begin to see the system-wide connections in a different way. It’s a gift to have been doing this long enough to get to that stage.