What are the downstream effects of smaller EIS class sizes?

Issue: June 2017

Due to budget concerns, the incoming class of the CDC’s Epidemic Intelligence Service, or EIS, has been reduced to 71 members — 10 fewer than last year. The agency also intends to cut the class size next year, according to an overview of its 2018 fiscal year budget. Infectious Disease News spoke with former EIS officer Ali S. Khan, MD, MPH, now dean of the University of Nebraska Medical Center, College of Public Health, about the consequences of reducing the number of EIS officers available to tackle health threats around the world.

The CDC’s Epidemic Intelligence Service program, the training ground for our nation’s disease detectives, is being neglected. It is being neglected by the same agency that created the program during the Korean War to address the dearth of trained field epidemiologists and provide a cadre of front-line defenders for a potential biowarfare attack. These officers — with the backup of the whole of the intellect of the CDC — are essential for the nation’s health and safety. From their role in the sublime (such as identifying the association of prairie dogs with monkeypox or illegal hooch with botulism), to the deadly (anthrax in the nation’s capital or Ebola in West Africa), these officers have been guardians of our health. It is no wonder that the CDC is called the “House that Langmuir Built,” after the visionary founder of the EIS program. Many EIS graduates go on to key leadership positions at the CDC, state health departments, and nongovernmental organizations and continue to serve as sentinels for health threats. The EIS is also the model for similar programs worldwide that form a global health security nexus.

The reduction in the number of these officers is perhaps not surprising and might even be a relief to the program managers given the chronic failure of the CDC to prioritize and adequately fund the necessary support functions of the program, like their training and travel — not just the number of officers. But this is not the time to retrench and wind back our health security gains and reduce our boots on the ground.

Now is the time to markedly expand this program to all relevant U.S. health agencies and other partners — Department of Defense, U.S. Agency for International Development, Agency for Healthcare Research and Quality, FDA, Department of Agriculture, World Organization for Animal Health, Food and Agriculture Organization, WHO, American Red Cross, and other nongovernmental health actors come to mind immediately. Expanding officers to these health-related agencies and response partners would more broadly address emerging health threats (including chronic diseases and injuries) and bring the EIS ethos of investigation, critical analysis and deliberation, and immediate collective action. Needless to say, the program would have to expand to also ensure quality mentorship and other support services.

For too long, the CDC has cobbled together the funding for this program from various funding streams, which has depleted the core support functions for EIS officers and left the number of officers up to the vagaries of targeted budget reductions. This benign neglect now appears to be coupled with the proposed active reductions in many national preparedness activities. Is it so difficult to fully fund and support a cohort of 80-100 officers in the CDC budget as part of a broader effort to improve our nation’s health defense?

The next pandemic may not be the time to find out ...

References:
CDC. Overview of the CDC FY 2018 budget request. https://www.cdc.gov/budget/documents/fy2018/fy-2018-cdc-budget-overview.pdf. Accessed May 25, 2017.
Khan AS. The Next Pandemic. On the Frontline of Mankind’s Greatest Dangers.” New York: Public Affairs; 2016.

Disclosure: Khan reports no relevant financial disclosures.

Editors’ note: This article has been updated with Dr. Khan’s correct title and affiliation. The editors regret the error.