When Milwaukee officials discovered in January that lead paint in school buildings had poisoned kids, they called the Centers for Disease Control and Prevention.
City Health Commissioner Michael Totoraitis has been leaning on federal experts to help prioritize which of the city’s 68,000 public school students to test first for the potent neurotoxin — and to advise what to do if lead tests come back positive.
But he was forced to stop calling Tuesday morning when staffers at the CDC’s Childhood Lead Poisoning Prevention Program were fired.
“CDC was guiding us on how to triage these children we are anticipating to find, because we are just not equipped to handle the scale of the problem we are talking about here,” Totoraitis said in an interview Thursday evening. “Now I don’t have anyone to call now at CDC because the entire office is eliminated.”
CDC’s lead experts were sent reduction-in-force (RIF) notices Tuesday as part of a massive restructuring at the Department of Health and Human Services that resulted in the elimination of multiple offices and 10,000 civil servants losing their jobs. The effort is meant to “streamline” the department and target chronic illness “by focusing on safe, wholesome food, clean water and elimination of environmental toxins,” HHS said.
The lead program’s fate is uncertain.
Health Secretary Robert F. Kennedy, jr., indicated Thursday evening that it could be “reinstated,” but HHS spokesperson Emily Hilliard would say only that the agency “is planning to continue the important work” of lead poisoning prevention in another HHS office.
Hilliard didn’t respond to questions about why the program’s entire staff received RIF notices earlier this week, whether any of those experts would be rehired, or when they might return to work. An HHS official told ABC news that “the personnel for that current division, of how it exists now, are not being reinstated.”
As of Friday morning, none of the 26 experts in the lead program had been pulled back from administrative leave, said Paul Allwood, who leads CDC’s Lead Poisoning Prevention and Surveillance Branch.
“It’s just a tremendous, missed opportunity to really live up to the billing of making America healthy again by ensuring that our children are protected,” he said. “If we don’t have the experts of this program, we are putting all of our children in jeopardy.”
‘The children would keep eating the lead’
Lead is a powerful neurotoxin that can do irreversible damage to the nervous system and brain, particularly in babies and children under 6 years old. They are more prone to accidentally ingest lead, which can have outsize effects on their developing bodies.
Until Tuesday, CDC’s lead program promoted blood testing to screen toddlers across the country for lead poisoning so contamination can be stopped early. Staff in the office — and those at 62 state and local public health departments that receive CDC grants — screened blood lead data to identify potential poisoning cases. When cases were found, CDC experts advised local officials on how to reverse damage from potential exposures and prevent it in the future.
No other team in the federal government does that work.
HHS’s Hilliard indicated that the lead-prevention efforts will continue as part of the newly created Administration for a Healthy America. That new office includes the Agency for Toxic Substances and Disease Registry (ATSDR) that was formerly housed within CDC, along with some mental health and occupational health experts.
But ATSDR staff are primarily tasked with establishing cleanup levels for dangerous chemicals in toxic waste dumps and determining “minimal risk levels” of chemicals that can harm people’s health. Its toxicologists lack experience with monitoring nationwide blood databases or identifying kids who have been poisoned.
“For them to eliminate us, they must not understand what we do,” said a federal lead expert who was granted anonymity to speak freely while her employment is in flux. “People don’t know that your state health department is three people who are charged with doing everything health-related. We provide help to those individuals and surveil national data to protect our kids.”
Take, for example, the 2023 case of lead-contaminated applesauce pouches.
In June of that year, routine blood testing of 1- and 3-year-old siblings in Western North Carolina showed blood lead levels roughly five times higher than the level CDC experts consider unsafe.
Investigators at the North Carolina Department of Public Health, funded by grants from CDC’s lead program, tested water, paint and soil at the children’s homes and areas where they often spent time, without finding any lead sources. After the parents noted their kids commonly ate cinnamon applesauce pouches from the company WanaBana, state investigators conducted tests and found high levels of lead they reported to the Food and Drug Administration.
FDA issued a press release about the lead contamination in October 2023 and helped spread news about a voluntary recall from WanaBana and other manufacturers.
But it was experts at the CDC’s lead program who were tasked with tracking down other children who had consumed the apple sauce pouches, identifying whether they had been poisoned by them, connecting them with resources to prevent further harm and ensuring families who had already bought the applesauce pouches didn’t feed them to their children.
By March 2024, CDC had identified 519 cases of lead poisoning from the applesauce.
“If we did not exist, that would not have happened,” said another federal lead expert granted anonymity to speak freely while her employment is in flux. “The children would keep eating the lead in the applesauce, and more people would have been exposed with dire consequences and no intervention.”
That employee had recently been contacted by a community that suspected there was lead contamination in its water supply but needed support figuring out what areas needed to be tested and processing the results.
“These are kids that need help, and I am not there to give them guidance,” she said.
‘You’re in trouble’
Dozens of state and local health departments depend on the CDC’s lead prevention and surveillance experts, said Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials.
Many state and local health departments don’t have staff dedicated to lead exposures. When new cases arise, they might have an idea of how to prevent exposures from well-understood sources, like drinking water, but they especially rely on CDC experts to help in less common situations.
One Ohio county, for example, used CDC lead experts to figure out that lead paint exposure was more common among kids who lived at rental properties and to devise a strategy “that was different than what you would use if the families own the home.”
“You do not want to be waiting until you have lead in your community to figure out the best practices for preventing exposure by trial and error,” Casalotti said. “You want to be able to call the people with the broad expertise who have seen everything and know what works.”
That’s the case in Milwaukee, where Totoraitis is now trying to move forward without the federal expertise he was planning to rely on.
In a major city with old housing full of lead paint and lead pipes, Milwaukee’s public health department usually sees 1,200 lead poisoning cases a year, 200 of which involve comprehensive investigations.
But with lead paint in at least seven schools — three of which are currently shut down due to contamination concerns — “we are now dealing with several times the magnitude of what we are used to.”
The city had just finished conducting in-depth, daylong investigations at each of its public schools to determine which ones had the worst lead paint problems. CDC lead experts had helped determine which students should have their blood tested first, based on which classrooms had the worst contamination. Federal experts were planning to deploy later this month to help sort through blood test data.
One CDC lead expert who worked on the Milwaukee case said it’s possible epidemiological investigators could still go to Milwaukee, but “none of them will have the lead-specific expertise.”
That could be a problem for Totoraitis, who is worried about what happens when blood tests come back and “we have 2,000 5-year-olds we need to do case management on.”
“CDC is the expert,” he said. “If they can’t answer your question, you are in trouble. And the people who were answering our questions are just gone.”
