Update: CDC Requests HICPAC Committee Reforms & More Revision of Guidelines Proposed for Healthcare Infection Control

Join us in urging the CDC to “Listen to frontline health care workers and patients” and ensure that the expertise on HICPAC is inclusive.

Last week, the CDC kicked the horrible and unsafe new hospital infection control guidelines it was considering back to the advisory committee (HICPAC) that had proposed the draft guidelines. It told the committee that they needed to include a wider range of technical backgrounds and provide better opportunities for the public to get involved, in order to comply with federal law.

Bad guidelines have been delayed, and the next fight over them will hopefully be on a more level field, and hopefully in a process at least in some ways more transparent. That argument will happen at the committee’s next meeting – previously scheduled for  February but now “TBD”. The People’s CDC is studying this new development, and our thoughts on what needs to happen next will be forthcoming. Public health advocates have gained another round in this fight, and we’ll need your help. (You can start with this petition!)

The CDC, in its own words in a Jan. 23rd web post, acknowledged that the “significant interest in the draft recommendations” – the thousands of people who submitted public comments in November¹ and earlier, attended HICPAC meetings, or wrote letters to CDC administrators criticizing the process and spoke to politicians about its mismanagement – made this happen. Thank you all.

Here’s why this is cause for public health advocates to be hopeful:

1. HICPAC’s proposed guidelines were FAR too weak to keep healthcare workers and patients safe. In fact, those proposals would undo some long-standing safety measures and weaken already insufficient healthcare infection control standards rather than strengthening them. So another round of revision is a chance to improve the guidelines.

   
   The People’s CDC and many other groups – with invaluable leadership from National Nurses United (NNU) – for months have been extremely critical of HICPAC’s work on the guidelines. Yet HICPAC members unanimously approved them in Nov. just a day after making them public. HICPAC’s work refuses to reckon with the aerosol transmission of infectious diseases such as SARS-CoV-2, and does not propose crucial measures such as universal masking with well-fitted respirators, isolation periods, and ventilation. To get a detailed critique, see the public comment that the People’s CDC submitted to HICPAC.
   
   

2. When asking HICPAC to reconsider their draft, CDC specifically directed them to implement some reforms to their committee that public health advocates have been pressing for. If those reforms happen soon enough, they may help advocates participate more effectively in the next round of guideline revisions.
   
   Severe deficiencies in HICPAC’s current draft may partly reflect their failure to include relevant experts and their decision to allow only minimal public involvement. Around 900 experts wrote an open letter to CDC Director Mandy Cohen in July noting many serious problems with the draft guidelines and stressing these points – that the draft was “developed without input from many important stakeholders, including frontline personnel and unions, patient safety advocates, and other experts and scientists” and that “CDC/HICPAC’s process is non-transparent and essentially closed to public access or engagement.” A follow-up letter in September reiterated those concerns.
   
   Ultimately, these arguments seem to have convinced the CDC that it needs to change the way HICPAC works — and ask them to redo their work, by “expand[ing] the scope of technical backgrounds of participants on the HICPAC Isolation Guideline Workgroup and eventually among the committee members”.

3. By sending HICPAC’s draft back to the committee and specifically referencing the Federal Advisory Committee Act (FACA), the CDC is implicitly acknowledging its first attempt at drafting these guidelines may not have complied with federal rules.
   
   While pointing out the damage that HICPAC’s uninclusive, non-transparent processes had done to their proposed guidelines, dozens of advocates in written and oral critiques  before and to the November meeting noted that these missteps on CDC/HICPAC’s part actually violate federal rules that govern how federal agency advisory committees like HICPAC are supposed to run. The CDC’s announcement noted that it is working to expand the scope of committee members “through established processes in accordance with the Federal Advisory Committee Act (FACA) regulations and guidance.” This statement suggests that the CDC is aware that public health advocates who have been criticizing the way HICPAC is conducting its work are correct that HICPAC’s work to-date may not have complied with federal rules – and suggests that the agency may be sensitive to process-based critiques like this going forward, if the next round of revisions also fails to be sufficiently transparent. This means that people may have the power to push CDC to include more voices on its committee – including “directly affected” groups like patients and front-line healthcare workers.

As a first step, please sign and share this new petition, initiated by the nurses union, NNU. The petition urges the CDC to “Listen to frontline health care workers and patients” and ensure that the expertise on HICPAC includes healthcare workers, patients, and relevant professionals: https://act.nnu.org/sign/urge-cdc-listen-to-health-care-workers-and-patients/   Thanks!

1.   Nov. 2023 HICPAC meeting minutes include oral public comments (pgs. 80-92, 99-106) and written comments (pgs. 111-729). https://www.cdc.gov/hicpac/pdf/2023-November-HICPAC-Summary-508.pdf