Cyclospora Awakening: “Eat Real Food” Underpins Robust Food Safety

I spent nearly a decade directing the FDA’s Center for Food Safety and Applied Nutrition. This role convinced me that food security and nutrition are interdependent in many ways, and that if we want to improve the health of our population, we must support both.

In recent weeks, a record number of cases of cyclosporiasis has sent this message far and wide, including to consumers. The FDA is currently investigating six cyclospora outbreaks, only one of which is currently linked to shredded iceberg lettuce.

Fresh fruits and vegetables, which nutritionists have promoted for decades, are particularly vulnerable to cyclospora contamination. In response to an outbreak of diarrheal disease caused by cyclospora, the public has been advised to be cautious about consuming fresh fruits and vegetables. Social media erupted with comments like “no more pizza!” and “Oreos have never given me explosive diarrhea!” Even before this outbreak, like the outbreaks involving E. coli and romaine lettuce, many people told me they would rather eat “a bag of Doritos than a salad.”

The FDA has long evaluated which foods pose the highest risk of microbial contamination and released this list as part of the work to implement the Congressionally mandated FDA Food Safety Modernization Act. The FDA refers to this list as the “Food Traceability List” because these foods have additional traceability obligations to aid in the investigation of foodborne outbreaks. The list includes items such as cucumbers, herbs, leafy greens, melons, peppers, sprouts, tomatoes, other vegetables and fresh-cut fruit. This also includes other products such as certain cheeses. (Note that meat and poultry also have a high risk of contamination with pathogens like E. coli and salmonella, but are not on the FDA list because they are regulated by the USDA.)

What do these high-risk foods have in common? As a group, they are recommended as part of a healthy diet and are certainly among the “real foods” promoted by the administration for better nutrition and reduced risk of chronic disease.

That said, the current administration is now waking up to the importance of microbial food safety as it strives to manage a response to an outbreak that will undoubtedly have ramifications on consumer perceptions and consumption of foods that are highly nutritious and vulnerable to microbial contamination. Over the past 18 months, the administration has focused on chemicals rather than microbes in food and has taken numerous actions that actively undermine microbial food safety:

• Losses of experienced career employees at FDA and CDC. This has direct negative impacts on each agency and can also have cumulative effects. Interagency emergency response is complex and works best when teams of employees have relevant experience working together on previous outbreaks, including Cyclospora outbreaks, which differ in many ways from bacterial outbreaks.
• Budget cuts to the CDC and FDA. These federal agencies help support and fund state food security efforts, and with federal budget cuts, state budget cuts follow. We’ve seen that states like Michigan have taken on a very heavy burden of responding to this outbreak. With less money, the FDA will also do less proactive sampling for microbial contaminants such as cyclospora.
• Changes to the national foodborne illness surveillance program, FoodNet, which previously tracked eight pathogens and eliminated six from federal surveillance, including cyclospora.
• Delay the date by which industry must comply with requirements to be able to trace high-risk foods from the farm/manufacturer through the supply chain. This effort should be in effect now, but has been delayed by the administration until July 2028.
• Closure of a USDA agricultural research center in Beltsville, Maryland, which included laboratories working on cyclospora.
• Dissolution of the National Advisory Committee on Microbiological Criteria in Foods, which provided food safety advice to the FDA and USDA on difficult issues, including cyclospora.

I am often asked about the impact of a particular action on food security, but the reality is that it is the cumulative impact of these and other changes that creates a diminished food security system.

To make matters even more difficult, the administration has called climate change a “hoax” and supports policies that will accelerate it. Warming environments and climate events such as extreme rainfall and flooding will increase food safety risks, and the destruction of affected foods will lead to more food waste. Food waste itself is a recognized contributor to global warming. The destruction of large quantities of lettuce from Mexico can be expected, with wasted energy during the initial production/processing/international distribution of the product, as well as the energy required to dispose of the contaminated product.

The cyclospora outbreak should be a wake-up call to all of us, and especially to our federal leaders charged with protecting and promoting health. Consumers should not face a trade-off between nutrition and food safety: health is only possible when food safety builds consumer confidence in fruits and vegetables. “Real foods” are vulnerable to real pathogens.

Susan Mayne, Ph.D., served as director of the FDA’s Center for Food Safety and Applied Nutrition from 2015 to 2023. She is an assistant professor at the Yale School of Public Health. This essay first appeared on his Substack.