Are outbreaks of foodborne illness getting worse?

The answer is complicated, due to a combination of improved detection technology, a looser approach to regulation, and rising consolidation in the food industry

It’s been a rough stretch for salad fans. In November 2019, the Centers for Disease Control and Prevention (CDC) recalled more than 75,000 pounds of romaine lettuce from Salinas, California, after more than 100 cases of E. coli infection were linked to the leafy green from the area. That was on top of three romaine recalls during 2018 — all prompted by E. coli — including the March debacle that sickened 200 and killed five. In June of that year, there was a 31-state Class 1 recall (meaning consuming the products could cause serious illness or death) of a popular Italian-style salad dressing. And all of that followed a massive 2017 recall of bagged lettuce prompted by the discovery of a decomposing bat in a bag of organic spring mix in Florida.

Salad is just the tip of the iceberg. Last year, there were notable recalls of potentially contaminated avocados, Chewy Chips Ahoy! cookies, Boston Market frozen dinners, Tyson chicken nuggets and Hy-Vee cheesecake. Though there were no confirmed reports of adverse reactions associated with the recalls, a consumer might reasonably ask, Are outbreaks of foodborne illness getting worse? Are there more of them? Are they just getting more media attention? There is more than one answer.

While the overall number of total recalls fell slightly in 2018, to 703, from 817 in 2017, if you dig into those numbers, you get a more complicated picture. Incidences of Class 3 recalls, for products that violate federal labeling or manufacturing laws, rose 21% between 2017 and 2018, the most recent year for which data is available. Class 1 recalls were up slightly from 2013 to 2018. Meanwhile, close to 48 million Americans continue to get sick from recalls each year, according to CDC estimates.

One explanation is simple: regulators are using improved technology, which translates to more detections of contaminated products. Another factor could be the antiregulatory policies of the Trump administration. While they are not increasing the number of recalls, they have slowed efforts to correct conditions that may cause them.

For example, in 2011, President Barack Obama signed the Food Safety and Modernization Act (FSMA), a sweeping overhaul of food-safety legislation that, among other things, included new produce-water monitoring rules to go into effect in January 2018. But in September 2017, Scott Gottlieb, then the new commissioner of the Food and Drug Administration, extended deadlines for farmers to comply with the rules due to industry pushback. The extensions are staggered and run through 2024.

“One consistent and clear message we received throughout our outreach to farmers and state agriculture officials is that the microbial quality standards for agricultural water are too complicated, and in some cases too costly, to be effectively implemented,” said Gottlieb at the time in explaining the delay. “That’s why we announced our intention to explore ways to simplify our approach to make compliance less burdensome and less costly, while still being protective of public health.”

And 2019’s extended government shutdown also raised concerns about food safety. Gottlieb attempted to assuage consumer concerns on Twitter, sharing that the agency was continuing inspections of “high-risk foods.” But as furloughed workers struggled to afford childcare and commuting costs, the system was strained. At one point in January 2019, enough USDA meat inspectors were calling in sick that the agency temporarily changed its policy to require a doctor’s note for even one day’s absence.

Of course, the U.S. food supply is one of the safest in the world, according to the USDA and independent global surveys of food quality and safety. And systems for detecting outbreaks have become more sophisticated, such as the 1996 introduction of PulseNet, a national laboratory network used to detect outbreaks. Last year, the network aided in monitoring a salmonella outbreak in raw turkey.

But the system by which food is regulated remains confusing to consumers. Two government agencies — the Department of Agriculture and the Food and Drug Administration — share oversight of the food industry, including food recalls. The FDA handles safety issues for about 80% of the food supply, while the USDA’s Food Safety and Inspection Service chips in on livestock, poultry and some egg products. The dual authority has at times bewildered consumers and frustrated legislators, such as in the wake of a 2010 egg recall that spotlighted the two agencies’ split authority over eggs and left many wondering whether there should be just one food-safety agency. In the summer of 2018, the Trump administration proposed just that—the creation of a single food-safety agency within USDA — but that plan hasn’t gone anywhere. Probably the worst food recall in U.S. history was the 2008 withdrawal of 143 pounds of beef produced by Westland/Hallmark meat-packaging company. The meat was suspected of possible madcow-disease contamination after videos emerged of company employees slaughtering animals that were too sick to walk. In response to the consequent furor, the Obama administration in 2009 banned the slaughter of such animals for consumption.

Food recalls typically begin when a routine inspection identifies a potential contamination or illness outbreak. The concerns are reported to federal investigators, who decide whether the potentially contaminated products should be recalled. In most cases, the withdrawals are voluntary, with companies responsible for getting their contaminated products off of shelves. But thanks to the Food Safety and Modernization Act, the FDA now has limited powers to issue mandatory recalls, an authority the agency has exercised once in the past eight years. In that case, the FDA issued a voluntary-recall notice to a company called Triangle Pharmaceuticals after several of its products containing kratom, a plant derivative that has psychoactive properties, were found to be contaminated with salmonella. The company failed to comply with the voluntary-recall notice, so the FDA used its power to issue a mandatory recall.

There is a range of consequences for companies whose products are recalled. In run-of-the-mill cases, such as when eight people were sickened by a small E. coli outbreak from hazelnuts produced by the distributor DeFranco & Sons in 2010 and 2011, the business voluntarily recalled its products and the CDC closed its investigation. But there are also businesses that have collapsed in the wake of recalls. For instance, in 2015 the former CEO of the Peanut Corporation of America, Stewart Parnell, was convicted in federal court for his role in an outbreak that resulted in the deaths of at least nine consumers and sickened as many as 22,000. Parnell, who pleaded not guilty, was sentenced to 28 years behind bars, and in the wake of the trial, the Peanut Corporation filed for bankruptcy. The following year, an E. coli outbreak from soy nut butter that sickened 32 people ultimately bankrupted the brand, I. M. Healthy, and a court ordered the company to pay its $11.25 million insurance proceeds to several victims.

In the past, livestock and poultry were responsible for most foodborne illnesses, likely brought about by poor home-cooking sanitary practices or undercooking. But today, fruits and vegetables represent the highest percentage of outbreaks. Part of the reason for this change is shifting consumer trends toward more fresh and prewashed produce, which consumers don’t typically cook before eating.

A major factor in the rise in recalls could be the extreme consolidation in production and processing. Just a few examples of how consolidation has affected our food system: the top four companies in each sector control 85% of beef processing, 79% of soybean processing and 95% of cane-sugar refining. “Because more food is being transferred through a smaller number of processing facilities, if there’s a problem at one of those choke points, it magnifies the size,” says Matthew Stasiewicz, an assistant professor of food microbiology at the University of Illinois at Urbana-Champaign.

Large-scale processing was a factor in one of the largest recalls of 2018, which ultimately affected more than 99 million pounds of food. The producer, McCain Foods, is a Canadian frozen-food company mostly known for its frozen french fries. From a family shop founded in 1957 by two brothers, McCain has grown from 30 to 22,000 employees in the past six decades and is today a multi-billion-dollar enterprise with 52 plants on six continents.

In October 2018, when McCain’s U.S. arm detected salmonella and listeria contamination at its Colton, Calif., facility, it initiated a voluntary recall that came to include tens of thousands of prepared dinners, soup, pizza, Kashi bowls and other grab-and-go foods. No one was reported sickened by the products. The company closed the plant in early 2019.

Farm workplace conditions and policies could also be playing a role in spiking food recalls, says food-safety expert Sarah Taber, a principal at Boto Waterworks, a safety consultancy. In auditing produce farms, Taber says, she’s found that the best food-safety practices rely on workers who are empowered to speak up about systems that aren’t working correctly and who have the time to adequately survey the operation for possible contamination points.

Recent raids by the Immigration and Customs Enforcement agency and fear of deportation could be degrading farms’ food-safety protocols, as workers may be hesitant to speak up about contamination issues, Taber says. “You don’t have time or space to do [that] when everyone is overworked, or when you have a workplace where your No. 1 priority is keeping your head down and not getting noticed,” she adds.

Eventually, the Food Safety Act will be fully implemented and have positive outcomes for food safety trends, comments Erik D. Olson, a senior director with the Natural Resources Defense Council: “It’s the government’s responsibility to make sure that food is safe.” Relying on consumers to eat differently or avoid contaminated products won’t be enough. “These are contaminants that you can’t smell, you can’t see, you can’t taste,” he says. “You can’t shop your way out of this problem.”

Lead image: Food safety has been in the headlines of late, as 2019 saw recalls of everything from romaine lettuce to avocados, cookies to cheesecake. Photo by WAYHOME Studio/Shutterstock.

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This article was originally published in TIME: THE SCIENCE OF NUTRITION, available on newsstands and as an ebook. Reprinted with permission from TI INC. BOOKS, a subsidiary of Meredith Corporation. Copyright © 2020 Meredith Corporation. All rights reserved.