By Lambert Strether of Corrente.
For readers who don’t know what HICPAC (Healthcare Infection Control and Prevention Advisory Committee) is, we’ll get to that in Section 1 below. On Stafford Beers’ principle that “The purpose of a system is what it does,” HICPAC’s purpose is to infect patients in hospitals and nursing homes with Covid and other airborne diseases by creating CDC (Centers for Disease Control) guidance that does not require universal masking, and by denying the reality of airborne tranmission.
Here is our post on WHN’s (World Health Network) original complaint. WHN’s newly filed Supplementary Complaint adds these four additional points:
1. HICPAC’s Illegally Constituted Membership
2. Conflicts of Interest Among HICPAC Members
3. Failure to Address Airborne Transmission
4. Secretive Workgroup Proceedings in Violation of FACA
In this brief post, I’ll look at all four points in the complaint, but I’ll be quoting some material from NC’s HICPAC posts, because — here lambert preens — I’m told on good authority that they gave WHN’s lawyers some fruitful ideas. So to point 1.
1. HICPAC’s Illegally Constituted Membership
For those who came in late, I promised to explain more about HICPAC in point one, and so let me quote from an earlier post:
CDC describes HICPAC and its putative mission as follows:
HICPAC is a federal advisory committee appointed to provide advice and guidance to DHHS and CDC regarding the practice of infection control and strategies for surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance and related events in United States healthcare settings.
Here is HICPAC’s structure, from CDC’s About page:
HICPAC consists of 14 voting members who are not federal employees. These experts are appointed by the Secretary of HHS following an application and nomination process. HICPAC voting members bring expertise including, but not limited to, infectious diseases, infection prevention and control, healthcare epidemiology, nursing, clinical and environmental microbiology, surgery, hospital medicine, internal medicine, epidemiology, health policy, health services research, public health, and related medical fields.
HICPAC also includes six ex officio members who represent federal agencies within HHS, as well as liaison representatives that bring related patient safety expertise from health-related associations, consumer groups, public organizations, and partners. These ex officio members and liaison representatives are included on the HICPAC charter, which is renewed biennially by HHS. Ex officio and liaison representatives are non-voting members of HICPAC.
“Related medical fields” is doing a lot of work there. Since airborne transmission and its prevention are fundamentally engineering problems, some might find it surprising — given that #CovidIsAirborne — that there are no aerosol sciencists or ventilation engineers on the Committee. Then again, if we view HICPAC as the highest expression of the Infection Control hive mind, we might not find it so surprising.
Note especially the requirement for 14 voting members. From the Supplementary Complaint, page 1:
The HICPAC Charter requires that the committee be composed of 14 members. This violation of its Charter had already been brought to the attention of the Inspector General in WHN’s Primary Complaint. However, on August 22, 2024, HICPAC held a meeting with only 11 members. This action by HICPAC demonstrates that it ignores its own Charter and the authority of the Inspector General to enforce it. From the time of WHN’s original Complaint up until the present day, HICPAC has been and remains an illegally constituted committee with no legal validity or enforceability.
Which is nice, since if the Inspector General finds for the WHN, that would prevent HICPAC from achieving its Beersian purpose of infecting patients.
2. Conflicts of Interest Among HICPAC Members
This material begins on page 2 of the Supplementary Complaint. I’m going to rearrange it a little, in order of placing the gauntlet gently on the table (“A”) through throwing it down (“C”). Also, I need to explain FACA (the Federal Advisory Committee Act). I wrote in this post:
HICPAC meetings are held, says CDC, under the aegis of the Federal Advisory Committee Act (FACA), described by the Congressional Research Service (CRO):
Federal advisory committees are created by Congress, Presidents, and executive branch agencies to gain expertise and policy advice from individuals outside the federal government. Many federal advisory committees are subject to the Federal Advisory Committee Act (FACA; 5 U.S.C. Chapter 10), which includes statutory meeting and transparency requirements. The Committee Management Secretariat (hereinafter “”Secretariat””) of the General Services Administration (GSA) is responsible for matters relating to advisory committees subject to FACA. In the Final Rule, GSA stated [w]hile FACA is not a public participation statute, it directly affects how the executive branch is held accountable for the use and management of Federal advisory committees as a major means of obtaining public involvement…..
I went after what I thought was the jugular, open meetings violations, but WHN has now gone for what is really the jugular: Following the money.
A. Financial Relationships. WHN writes:
An important principle of FACA is that employees of the agency that is being advised (in this case, the CDC) are not allowed to be members of the committee due to the inherent nature of financial relationships that may preclude independence. While funding is not strictly forbidden, it is apparent that conflict of interest should be avoided.
A financial relationship between the institution and individual members such as that which currently exists between CDC and virtually all of the members of the HICPAC committee seriously risks comprising the independence of their judgment. This is the case not merely because funding links may influence particular decisions, but also because the relationships created by such funding may well incentivize the committee to advance or reject decisions of certain types, such as refusing to recognize the full impact of an airborne pathogen on hospital-based infection and the practical steps that must be taken to address this pathogen.
To put it crudely, if CDC’s handwashing desk writes your HICPAC check, you will be unlikely to give airborne transmission the attention it deserves.
B. Competition for Funding with Rival Siloes. WHN writes:
Furthermore, members of HICPAC, recognized for their expertise in areas such as bloodstream infections, sepsis, sharps injuries, hand hygiene, fomite transmission, sterilization and disinfection, antimicrobial resistance, and Ebola, are funded specifically for their work in these fields and would not be funded for airborne transmission prevention. This creates a potential conflict of interest which may interfere with a decision to shift the focus of infection prevention to airborne diseases, which is required to deal effectively with the hospital-based transmission of COVID-19. Such a shift could threaten the funding that supports their salaries, research, staff, and programs, as well as their positions of authority in infection prevention and control [IPC], and that of their colleagues. This inherent tension is compounded by similar conflicts of interests among CDC officials responsible for nominating HICPAC members and setting the committee’s agenda, including the current and former HICPAC Federal Officers and the director of NCEZID.
I don’t know anybody who has an issue with threatening IPC. Do you? (And if these two sections make HICPAC and CDC seem like a snakepit of self-dealing, well, it looks like that’s what it is. It would also be interesting to know if the CDC Foundation is hooked into this “inherent tension” at all.)
C. Perverse Incentives in Fee-for-Service Systems from Hospital-Acquired Infections. WHN writes:
HICPAC’s Charter mandates providing guidance on “prevention, and control of healthcare-associated infections” Therefore, committee members that are compensated for encouraging spread of infection (or compensated for being knowingly or willfully ignorant of the science of infection control in a healthcare setting), are in conflict of interest with HICPAC’s objective.
More specifically, it is well established that direct payment systems can lead to perverse incentives against the prevention of hospital-acquired infections (HAIs). In fee-for-service payment models, hospitals are reimbursed for services provided, including the treatment of HAIs. In such a system, hospitals can generate more revenue by providing additional care to treat these infections, rather than by preventing them in the first place. Many members of HICPAC are from hospital management, and as such, have direct financial interests that conflict with the prevention of HAIs. This conflict of interest, long recognized in the context of other HAIs, must now also be addressed for COVID-19 and other airborne diseases.
No matter how hard I try, I’m never cynical enough. The best financial incentives I could come up with involved line items; not wanting to spend money on respirators instead of the cheaper baggy blues; not wanting to unbelt for HEPA air filtration systems. It never occured to be that a hospital could be incentivized to make patients sicker, and that therefore masking and non-pharmaceutical interventions of all kinds would encounter institutional resistance, but the logic is clear.
3. Failure to Address Airborne Transmission
From page 4:
As submitted in the Primary Complaint, the COVID-19 pandemic and the continuous presence of COVID-19 in the United States have increased the urgency of understanding airborne transmission of infection in healthcare settings. In fact, in 2024, the CDC has confirmed the airborne nature of COVID-19 transmission. However, despite still having three vacancies, HICPAC continues to fail to include members with an expertise in airborne transmission.
Instead of adding Members to HICPAC proper — i.e., people who could actually vote on the Guidance, this is what HICPAC did instead:
4. Secretive Workgroup Proceedings in Violation of FACA
HICPAC invented a “workgroup,” without voting power, that meets in secret. From page 3:
HICPAC has composed the Isolation Precautions Guideline Workgroup to assess the matter of airborne infection transmission in healthcare settings. However, the dealings of this Workgroup are not open to the public contrary to 5 U.S.C. App. § 10(a)(1) [FACA], where the exceptions to having meetings open to the public under 5 U.S.C. App. § 10(d) do not apply.
The composition of the Workgroup emphasizes that the current HICPAC members do not possess the required expertise to decide upon airborne transmission in healthcare settings. While HICPAC, in direct violation of its Charter, still has three vacancies, and the Workgroup has qualified airborne transmission experts, rather than bringing the committee into legal compliance, it decided instead to establish a Workgroup with these experts. We submit that this act of constituting a Workgroup can be construed by the public as a tactic for HICPAC to avoid having delicate and potentially contentious debates exposed to the scrutiny of the public eye. WHN submits that HICPAC should instead concentrate on filling its remaining vacancies [on the Committee proper] with experts versed in airborne transmission.
Conclusion
It’s hard to see why CDC and HICPAC are acting this way. It’s almost like they have something to hideMR SUBLIMINAL Ka-ching! Bodies stacked up too high?
APPENDIX: The WHN Supplementary Complaint
Here is the Supplementary Complaint:
Supplementary-Complaint-HICPAC-23.10.2024-Final
Here are the Supporting Materials for the Supplementary Complaint:
Supplementary-Complaint-Supporting-Materials-HICPAC-23.10.2024
Congratulations to WHTN for a job well done.