The resistance of dairy farmers is emblematic of the trust gap between key agriculture players in both red and blue states and federal health officials — one that public health experts fear could hamper the nation’s ability to head off the virus’ threat to humans.

“The risk here of something going from one or two sporadic [human] cases to becoming something of international concern, it’s not insignificant,” CDC Principal Deputy Director Nirav Shah said at a recent Council on Foreign Relations event.

“We’ve all seen how a virus can spread around the globe before public health has even had a chance to get its shoes on,” Shah added. “That’s a risk and one that we have to be mindful of.”

On recent conference calls with all 50 state agriculture chiefs and veterinarians, Shah and other senior CDC officials have raised the prospect of sending federal teams to farms to monitor the health of farmworkers and collect other data, including with a survey, according to three state agriculture officials and two other people familiar with the conversation who were granted anonymity to discuss the private calls. State agriculture officials quickly voiced opposition, citing concerns about biosecurity on farms and reluctance among farmers to allow federal officials onto their property.

Democratic, as well as Republican, state officials shared those reservations, including that state and local health officials should continue to lead the response on the ground. Some have also pressed for USDA and its animal health experts to have more of a say in the process.

“Decouple it from an FDA and a CDC issue,” said Pennsylvania Agriculture Secretary Russell Redding. “This is a workforce concern that really ought to be expressed from the USDA and Secretary [Tom] Vilsack.”

Shah emphasized at the CFR event that USDA has been working “shoulder to shoulder with us” on the response effort. “There has been no resistance on the part of our USDA colleagues from our efforts at CDC to get on the farms,” Shah told POLITICO. USDA spokespeople say the department is working “hand in glove” with the CDC and states. The department’s animal health experts have “extensive experience and success” in containing animal health diseases, USDA spokesperson Allan Rodriguez said.

“This situation is no different,” Rodriguez added.

CDC officials will continue trying to find a middle ground as they race to determine how the outbreak is spreading among dairy cows and whether it could spread widely in people and spur another pandemic. Though the odds are considered low, it’s a scenario that public health systems say they are woefully unprepared to handle at this point. State officials say CDC has conveyed “flexibility” in the effort and has streamlined the survey.

“Discussions are underway with farms in multiple jurisdictions to participate in CDC-led epidemiological studies. In the meantime, states continue to test symptomatic farm workers and monitor those who have been exposed to infected animals,” CDC spokesperson Jason McDonald said in an email.

Idaho is one of several states working on a shortened version of the CDC’s lengthy questionnaire, with the goal of developing a uniform survey that can be administered nationally, said the state’s epidemiologist, Dr. Christine Hahn.

“Bless their hearts, CDC wanted to know everything,” Hahn said. “The concern is that it is so lengthy and so detailed that you’ll actually just get a lot of inaccurate answers.”

She noted that the Idaho Dairymen’s Association, which represents dairy farms in the state, has expressed willingness to participate in the survey if it can be trimmed down and administered off-site or over the telephone by the local health department.

“The dairies are considering it. Nothing’s been decided, but they would prefer local health do that, not CDC or even us, which we totally are okay with,” said Hahn, whose state has confirmed avian influenza in two dairy herds. “I think the more local things can get done, the better. It strengthens those relationships.”

At least 30 people have been tested since the bird flu virus was first detected in dairy cows in Texas in March, according to the CDC. The agency said Friday that at least 220 people “have been monitored for [the virus] after relevant exposures.” Federal officials have declined to answer questions from reporters about where in the country the monitored workers are, saying only that officials are “following the herd” of infected cows. But the White House and federal health agencies have repeatedly emphasized the risk to the general public remains low.

Anecdotal stories suggest more people possibly contracted the virus than the one confirmed case of a Texas dairy farmworker, including other dairy workers in the state who have displayed symptoms. Antiviral medication for flu must be administered within days of symptom onset to be effective, meaning early detection is critical if more cases emerge. The infected Texas worker developed conjunctivitis or pink eye and fully recovered.

“One of the big open questions in my mind is whether there’s only been one human case because we haven’t surveyed widely enough or whether that is a true reflection of incidence,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security who was a founding associate director of the CDC’s Center for Forecasting and Outbreak Analytics.

CDC officials are acutely aware of the gaps in the agency’s early response to Covid-19 during the Trump administration, a misstep Biden officials are intent on averting just months before the 2024 election. The White House’s new Office of Pandemic Preparedness and Response Policy has taken charge of coordinating work across the various federal agencies, meeting regularly with top officials and consulting outside experts in an effort to manage the risks facing livestock and humans alike.

Senior pandemic preparedness officials recognize that bird flu represents the first true test for the fledgling office, aides said, especially amid skepticism from Trump and others who have questioned whether it needs to exist.

White House chief of staff Jeff Zients has taken a personal interest in the bird flu response. Since taking over that role, the former Covid response czar has periodically stressed to officials that the administration must closely monitor public health threats, for fear of the damage another national crisis would do to the American psyche and Biden’s political standing.

States typically invite the CDC to conduct field epidemiological studies, something few of the states where the virus has been detected have been willing to do.

Even in states with good relationships between their agriculture departments and dairy farmers, state health officials are struggling to get the kind of access the CDC would need for its research.

In one state with infected dairy cows, a senior health official granted anonymity to speak candidly about the state’s work said health staff have been able to get on-site to provide information about what symptoms people should be looking for, but little else.

One type of research the CDC wants to conduct is testing that can detect if any workers previously were infected with avian flu, according to Shah. But that research — known as serological testing — requires a blood test, and thus the participation of both farmers and workers.

A big reason for the resistance: Farms don’t want to be identified publicly as potential hotspots for the virus, nor do they want to draw scrutiny to their workers, a significant proportion of whom are undocumented immigrants and fearful of government officials.

Given that reality, state agriculture officials have specifically pushed for any interviews with farmworkers to be voluntary and conducted off the farms at a different site.

“We have had conversations with CDC,” said Dr. Justin Smith, Kansas’ animal health commissioner. “We’re willing and the dairies are willing to work through our local public health [offices], there’s been a relationship built there.”

“Having CDC show up with a response team is very intimidating to the workers,” Smith added. “And it’s intimidating to the dairies.”

Megan Messerly and Adam Cancryn contributed to this report.

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