This year is the 100th anniversary of the 1918 Spanish influenza pandemic. It comes with the disturbing realization that the impacts of an outbreak — similar to what remains the deadliest pandemic in human history — would be even more catastrophic today, in a world made smaller and more crowded by trade, travel and explosive population growth.
While public health and science have made great strides in the last century, our preparedness for the next pandemic is now compromised by a decline in the numbers of public health experts. Fortunately, this is a problem we can do something about.
{mosads}In 2009, during the swine flu outbreak, the U.S. Centers for Disease Control and Prevention launched a comprehensive response that included a large-scale mobilization of the agency’s cadre of disease detectives, the Epidemic Intelligence Service (EIS).
As the swine flu spread across 49 states, current and former EIS officers were mobilized throughout the country. In the end, the work of numerous EIS officers yielded valuable information and important lessons to improve planning for a future severe pandemic.
Established in 1951 as a response to the threat of biological warfare, EIS has continued to protect national and global health security. It supports the worldwide smallpox eradication campaign, tracked the first cases of Ebola, published the first report on the syndrome that would come to be known as AIDS. In this century it investigated the 2001 Anthrax attack, outbreaks of SARS — Severe Acute Respiratory Syndrome — and MERS – Middle East Respiratory Syndrome, as well as the recent overlapping outbreaks of Ebola and Zika.
In addition, EIS officers are also deployed against, and can specialize in, non-infectious health emergencies and natural disasters, such as the attacks of Sept. 11, 2001, the 2010 earthquake in Haiti, multiple hurricanes and floods in the U.S. (including three in the last year), poisonings due to toxins like lead, and the opioid epidemic.
Over the last decade, however, cuts in funding for hospital and public health programs have diminished resources and capacities to identify and contain infectious disease outbreaks. Rising costs of graduate medical education, combined with disparities between public sector and private salaries for physicians have resulted in fewer physicians applying to the EIS fellowship program.
While CDC once had the authority to offer student loan repayment to EIS fellows (as the National Health Service Corps and the National Institutes of Health and do for clinicians in underserved areas and scientists), CDC’s authority expired in 2002.
Further, repayment required a three-year commitment to work for CDC, making it inaccessible to fellows because EIS is a two-year program. As a result, the average number of physicians trained in the EIS program in recent years has dropped, setting the program back to its training and response capacity of the 1980s.
Fortunately, challenges to the future EIS workforce can be addressed in the upcoming congressional reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA) in which Congress can reinstate CDC’s loan repayment authority and conform the commitment to CDC employment to the term of current fellowship programs.
It is essential that Congress take this opportunity. EIS officers provide frontline defense during their fellowships, while successive classes of the EIS officers continue to serve on the front lines at every level of our public health system.
After training at CDC, EIS officers are a source of experienced public health experts to work in critical roles at our nation’s federal, state and local public health agencies.
I can attest to the benefits of that experience. My EIS training (class of 1992) prepared me well for the demanding work I do today fighting infectious disease outbreaks and other population health threats for Public Health — Seattle & King County, in Washington state, one of the largest metropolitan health departments in the country.
From that vantage point I have an appreciation for what is needed to meet the challenges posed by a broad range of public health threats and unanticipated emergencies, and of the critical need for EIS-trained public health experts at every level of the public health system to ensure optimal outbreak responses and to develop a broad range of disease prevention strategies to protect our communities.
In its funding bill for fiscal year 2018, Congress has already shown recognition of the need to strengthen our public health infrastructure. The next step is to support the work force needed by providing loan repayment.
Dr. Jeffrey Duchin is a representative of the Infectious Diseases Society of America, health officer and chief of the Communicable Disease Epidemiology & Immunization Section for Public Health — Seattle and King County, and a professor in medicine in the division of Infectious Diseases at the University of Washington.