A groundbreaking Centers for Disease Control and Prevention initiative to support harm-reduction groups across the country fell apart this month after the program came under the control of a federal contractor that has done no public health work for the government.
The National Harm Reduction Technical Assistance Center, or TA Center, was founded in 2019 as a coalition of harm-reduction groups partnered with the CDC to offer training, funding, and guidance to those working to reduce overdose deaths. Its success rested on the deep experience and the trust community members had for the three main partner organizations, which included the National Alliance of State and Territorial AIDS Directors, or NASTAD; the National Harm Reduction Coalition, or NHRC; the University of Washington’s Supporting Harm Reduction Programs; and a handful of other groups.
This month, the TA Center ceased functioning as it had for more than three years: Instead of a partnership, the project would be administered as a federal contract. And the CDC gave the sole-source contract to the Florida-based firm H2 PCI, a relatively new federal contractor with close links to the defense industry and the murky world of military special operations.
H2 PCI entered negotiations with the primary partners in the center to make them subcontractors but did not send proposed subcontracts to the groups until early November. Rushed by deadlines, those talks broke down in late November, according to Laura Guzman, executive director of NHRC.
As the H2 PCI contract went into effect on December 1, the primary partner organizations that had made the TA Center a success parted ways with the project, Guzman told The Intercept.
“From the beginning, it was clear that they had zero experience in the public health field and absolutely zero experience in harm reduction,” Guzman said. “It would be really challenging to work with a contractor who has zero understanding of our world.”
Advocates fear the takeover could wash away the years of painstaking work of building up the TA Center and sever its vital connection to on-the-ground harm reduction providers, making it harder for them to serve the people who rely on them for clean needles, naloxone, and other services, according to Maya Doe-Simkins, a veteran harm reductionist who has worked closely with the program.
“This will have lethal implications.”
“This will have lethal implications,” Doe-Simkins said. “I mean, people’s jobs are important, but in communities, it’s also an issue of life and death.”
The project broke down because of what harm-reduction experts said was the CDC’s mismanagement of the process to transition the TA Center to H2 PCI, an unwillingness from CDC brass to address the groups’ concerns about the firm, and what the partners considered H2 PCI’s unworkable subcontract requirements, according to numerous sources formerly involved in the TA Center, including Guzman and others who spoke to The Intercept on condition of anonymity because they still collaborate with the CDC on other public health projects.
The sources expressed concerns about the upstart H2 PCI’s lack of experience doing health work with the federal government. “From the beginning, we asked point-blank: ‘Do you have public health expertise?’” said Guzman. “And the answer was ‘no.’ Definitely logistics and communications, but really absolutely foreign to our world of nonprofit capacity building.”
The sources also questioned H2 PCI’s close ties to Advanced C4 Solutions, or AC4S, a larger defense contractor that has done more than half a billion dollars in federal contracts.
In a statement to The Intercept, Norm Abdallah, the CEO of both H2 PCI and AC4S, praised his firm’s track record and directed further questions to the CDC. “We have built a reputation for being able to deliver a superlative work product and we are excited to undertake the work that CDC has entrusted us to do,” he wrote.
The CDC did not respond to multiple requests for comment, including a detailed list of questions sent by The Intercept to the press office and more than half a dozen division heads and staffers working on the TA Center.
The implosion of the TA Center has already resulted in layoffs and resignations at two of the primary partner organizations, while other partners are scrambling to retain their employees with funding from other sources. The Washington-based Faces and Voices of Recovery, whose approach is based on recovery rather than harm reduction, is the only group still listed by the CDC as a partner for H2 PCI’s TA Center; until recently, the site featured six groups. (Faces and Voices did not respond to a request for comment.)
To many of the harm-reduction veterans who previously worked on the TA Center, the saga is a realization beyond even their worst fears of a feeding frenzy by private firms clamoring for a piece of the action amid an increase in federal funding and a flood of opioid settlement money earmarked for harm reduction.
“We’ve seen a bunch of what I would call ‘harm-reduction colonialism,’” said Timothy Santamour, a harm-reduction activist in Florida. “It’s no longer a fear, it’s an actuality.”
Newfound Distrust
At its core, harm reduction is best understood as a set of practices and ideas centered around a two-pronged mission of reducing the negative consequences of drug use — access to syringes, naloxone, and other lifesaving public health services —while simultaneously advocating for the rights and dignity of people who use drugs.
The influence of harm reduction in public health has expanded rapidly in recent years, bolstered by a growing body of scientific evidence proving its efficacy. At the same time, to meet increased demand, the number of service providers has exploded as drug users, families that suffered overdoses, and community activists joined existing providers in fighting against the ravages of the opioid crisis.
When Santamour, a co-founder of the Florida Harm Reduction Collective, began laying the groundwork for his organization in late 2019 and early 2020, the TA Center played a key role in helping him get the operation off the ground, in large part due to the trust its partner organizations enjoyed in the community.
“How quickly we’ve been able to grow in Florida and to have an impact, that has really been because of NASTAD and NHRC,” he said. “We would not have been able to do that on our own so quickly.”
The partners who made up the TA Center were originally funded by the CDC through a cooperative agreement, a funding mechanism whose main difference from a traditional contract consists of a higher degree of collaborative work between the funding agency and the partners. The original cooperative agreement was set to expire in 2022 but was extended twice and was supposed to run through December 1.
According to sources previously involved in the TA Center who spoke with The Intercept, the CDC informed the partner organizations in the spring of 2023 that the TA Center would be moving from a cooperative agreement to a contract. The federal officials gave the impression that the new contractor would function merely as a “pass-through,” essentially an added layer of bureaucracy with no substantial role in the operation of the TA Center.
It was not until late September that the partners learned that H2 PCI had been selected for the contract. Tensions flared, the sources said, when the CDC informed the partner organizations that H2 PCI would not be operating as a pass-through; instead, it would be required to receive at least 51 percent of the contract award and would therefore be taking an active role in running the TA Center.
With the December 1 deadline fast approaching, H2 PCI finally offered subcontracts to the partners in early November. The subcontract contained several unworkable provisions, said Guzman, the head of the former partner organization NHRC. For one, there was a nondisclosure provision. While the TA Center had created an information pipeline flowing back to the CDC, now all information with the federal agency would be sent through and vetted by H2 PCI. What’s worse, partner groups feared they wouldn’t be able to discuss aspects of their TA Center work with other groups without clearing it with H2 PCI.
“We are a convener of people, and we are constantly sharing information,” Guzman said. “So with providers, we couldn’t do anything without their approval.”
“The CDC has proven itself to not be a friend or a partner in harm reduction.”
The partner organizations also bristled at the H2 PCI subcontract’s lack of a termination clause, meaning they would not be able to exit the arrangement. The CDC contract contained the possibility for four years of renewal, and H2 PCI’s subcontracts bound the partner organizations to stay on board so long as TA Center money kept flowing.
“This was a unilateral contract that we could not undo,” said Guzman, echoing other partner organizations’ complaints. “I’ve been in the nonprofit world for 30-plus years, and I have never entered into any contract, even smaller contracts, with anybody where it’s not mutual.”
“Their answer was, ‘This is standard practice in our business,’” Guzman said. “And of course that’s where I think we pretty much live in two very different worlds.”
All three primary partner organizations expressed their concerns about the subcontracts to the CDC, to no avail. “We heard over and over that this was a done deal,” Guzman said.
Two of the partner organizations officially rejected the subcontracts on December 1, and H2 PCI rescinded their proposed contract from a third organization. Last week, NASTAD, NHRC, and the University of Washington team were officially removed from the TA Center.
As news of the TA Center’s partial implosion began filtering out last week, it was already threatening to undo much of the progress that the CDC has made to build connections with the harm-reduction movement.
“It’s going to be pretty hard for them to recover from this, because nobody’s going to trust them,” said Santamour. “The CDC has proven itself to not be a friend or a partner in harm reduction.”
Jointly Owned Subsidiary
It is not entirely clear how or why the CDC selected H2 PCI to operate the TA Center, but records show the company won the $3.8 million annual contract thanks in large part to its status as a Native-owned “disadvantaged small business.” The designation makes companies eligible for no-bid contracts set aside as part of federal efforts to expand opportunities to marginalized communities.
H2 PCI is a jointly owned subsidiary of two Native groups — Hui Huliau, a Native Hawaiian organization, and the Alabama-based Poarch Band of Creek Indians — that do business with the Defense Department and other agencies through a raft of holding companies.
Incorporated in 2021, H2 PCI’s only other federal contracts are for supplying furniture and performing construction at State Department buildings in Cameroon and Zimbabwe. It won both public tenders in a no-bid process like the TA Center contract. Because contracts set aside for Native- and minority-owned businesses are not competitive, the contract officer selecting the entity must justify its appropriateness for the work entailed in the contract — though the justifications in the case of H2 PCI and the TA Center have not been made public.
H2 PCI shares an address and a CEO with the more well-established firm Advanced C4 Solutions, which is also owned by Hui Huliau. Over the years, it has received hundreds of millions of dollars in federal contracts for services. For the State Department, the company had a contract during the winding down of the Afghanistan war and various transport tasks in Syria, Libya, and other hotspots. A 2014 State Department email released by WikiLeaks describes AC4S doing private security work in Yemen. The company’s website says its customers include federal intelligence, defense, and security agencies, including a host of Defense Department agencies doing work like bolstering “the War fighter’s Information Dominance objectives.”
“The industry practices that they prefer have nothing to do with our industry practices. The mechanism of contracting was very, very, very different from the way that we operate.”
Abdallah, the CEO of both H2 PCI and AC4S, is described in a company biography as having “over 20 years of experience in Joint, Special Operations and Air Force Combat Communications as well as Air Traffic Control support,” as well as being a “cyber operations officer” in the U.S. Air Force Reserve.
In promotional materials available on the website of the Poarch Band of Creek Indians, H2 PCI is described as offering “tactical global logistics and construction,” with no mention made of public health or harm reduction.
In early conversations with the partner organizations of the TA Center, according to people with knowledge of the conversations, Abdallah and other members of H2 PCI pointed to their extensive work coordinating logistics in challenging locales as a selling point for its ability to take on the mission of coordinating technical assistance.
Guzman, the former TA Center partner organization head, said the background in a different industry made a big difference in the failed subcontract negotiations.
“The industry practices that they prefer have nothing to do with our industry practices,” she said. “The mechanism of contracting was very, very, very different from the way that we operate; not just the nature of the contract, but also because it is the key to success to be collaborative.”
Fighting the Overdose Crisis
Driven in large part by the contamination of black-market drugs with synthetic opioids like fentanyl and its analogues, overdoses have become the leading cause of accidental death in the United States, killing 106,699 people in 2021, the last year for which statistics are available. In response, there has been an explosion in the number of groups providing syringes, the overdose-reversal drug naloxone, and other lifesaving services to people who use drugs.
The TA Center was formed in 2019 and in some of the darkest days of the ongoing epidemic dispensed tailored help through its partner organizations.
With funding from the CDC and the Substance Abuse and Mental Health Services Administration, the TA Center has, in its four years of operation, responded to more than 1,700 requests for assistance, helping hundreds of local organizations get off the ground, remain afloat, and navigate the often Byzantine rules of local health departments.
The TA Center was the flagship program funneling CDC resources and assistance directly to local harm reductionists. It had become a critical lifeline for front-line public health activists, who are often cash-strapped and frequently labor under intensely hostile and isolating conditions, according to Doe-Simkins, who co-founded Remedy Alliance, which helps supply providers with free and low-cost naloxone.
“Folks were working in really hostile, scary environments, and it is very isolating to be running an underground syringe-service program,” she said. “And the TA Center connected those folks to each other, which was such a really deep comfort for people who are doing some of the most groundbreaking public health work in this country.”
