Natalie Holt sees reminders almost everywhere of the serious consequences of a years-long syphilis outbreak in South Dakota. Working to stem the spread of this devastating disease, public health officials are broadcasting messages to South Dakotans on billboards and television, urging people to get tested.
Holt works in Aberdeen, a city of about 28,000 surrounded by a sea of prairie, as a physician and chief medical officer of the Great Plains Area Indian Health Service, one of 12 regional divisions of the federal agency responsible for to provide health care to indigenous people. Americans and Alaska Natives in the United States
The response to this public health problem, she said, is not that different from the approach taken for the coronavirus pandemic: federal, state, local and tribal groups must “divide and conquer” so as they work to test and treat residents. But they are responding to this crisis with fewer resources because federal officials have not declared it a public health emergency.
Public calls for testing are part of health officials’ efforts to end the outbreak that has disproportionately affected Native Americans in the Great Plains and Southwest. According to the Great Plains Tribal Epidemiology Center, syphilis rates among Native Americans in its region jumped 1,865% between 2020 and 2022, more than 10 times the 154% increase seen nationally during the same period. The Epidemiology Center region spans Iowa, Nebraska, North Dakota and South Dakota. The center also found that one in 40 American Indian or Alaska Native babies born in the region in 2022 had a syphilis infection.
The rise in infections has accelerated in 2021, straining public health officials still reeling from the coronavirus pandemic.
Three years later, the epidemic continues: the number of new infections so far this year is 10 times the 12-month total recorded in some years before the surge. And tribal health officials say their calls for federal officials to declare a public health emergency have gone unheeded.
Calls for help from local and regional tribal health leaders like Meghan Curry O’Connell, public health officer for the Great Plains Tribal Leadership Health Council and a citizen of the Cherokee Nation, preceded a September letter of the National Indian Health Council, a Washington, D.C.-based nonprofit organization that advocates for health care for American tribes, to publicly urge the Department of Health and Human Services to declare a health emergency public health. Tribal leaders said they need federal resources, including public health workers, access to national data and stocks, and funding.
According to data from the South Dakota Department of Health, there have been 577 cases of syphilis in the state this year. Of those, 430 were Native Americans, accounting for 75 percent of the state’s syphilis cases, even though that group makes up only 9 percent of the population.
The numbers can be difficult to process, O’Connell said.
“It’s completely preventable and curable, so something went horribly wrong when this happened,” she said.
The Great Plains Tribal Leaders Health Council first asked HHS to declare a public health emergency in February. O’Connell said the federal agency sent a letter in response outlining some resources and training it had directed toward the outbreak, but it did not go so far as to declare an emergency or provide the substantial resources requested by the council. The request for resources launched by the council for several months now resembled the recent request from the National Health Council of India.
“We know how to solve this problem, but we need additional support and resources to do it,” she said.
Syphilis is a sexually transmitted infection that can cause life-threatening damage to the heart, brain, and other organs if left untreated. Women infected during pregnancy can pass the disease to their babies. These infections in newborns, called congenital syphilis, kill dozens of babies each year and can have devastating effects on the health of others.
Holt said the Indian Health Service facilities she oversees average more than 1,300 syphilis tests per month. She said a recent decline in the number of new cases detected each month – from 92 in January to 29 in September – could be a sign of improvement. But a lot of damage has been done in recent years.
Cases of congenital syphilis across the country have more than tripled in recent years, according to the Centers for Disease Control and Prevention. In 2022, 3,700 cases were reported, the highest figure in a single year since 1994.
The highest rate of primary and secondary syphilis cases reported in 2022 was among non-Hispanic American Indians or Alaska Natives, with 67 cases per 100,000 people, according to CDC data.
O’Connell and other tribal leaders have said they don’t have the resources to keep pace with the outbreak.
Chief William Smith, vice chairman of the Valdez Native Tribe of Alaska and chairman of the National Indian Health Council, told HHS in the organization’s letter that tribal health systems need federal investment more important in order to better respond to threats to public health.
Rafael Benavides, HHS deputy assistant secretary for public affairs, said the agency received the letter sent in early September and will respond directly to the authors.
“HHS is committed to responding to the urgent syphilis crisis in American Indian and Alaska Native communities and supporting the efforts of tribal leaders to mobilize and raise awareness to address this important public health crisis ” he said.
Federal officials from the Department of Health and the CDC have formed task forces and held workshops for tribes on how to address the outbreak. But tribal leaders insist a public health emergency declaration is needed more than anything else.
Holt said that even though new cases appear to be decreasing, authorities continue to fight the spread of the virus with the resources they have. But obstacles remain, such as convincing asymptomatic people to get tested for syphilis. To make this easier, no appointment is required. When people pick up their medications at a pharmacy, they receive leaflets about syphilis and information on where and when to get tested.
Despite this “all-out legal pressure” approach, Holt said, officials know there are people who don’t often seek health care and may fall through the cracks.
O’Connell said the ongoing outbreak is a perfect example of why staffing, funding, access to data and other resources must be in place before an emergency develops, allowing public health agencies to respond immediately.
“Our requests have been specific to this outbreak, but in reality they are necessary as a basis for everything that comes next,” she said. “Because something is going to come next.”
Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News.
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