US states need 1,200 more epidemiologists to reach capacity

Timothy F. Jones

Although the epidemiology workforce has grown substantially in the United States, researchers found gaps in specialized skills, knowledge and research that limit the ability of state public health agencies to “detect, identify, and respond to emerging health threats.”

Writing in MMWR, Jessica Arrazola, DrPH, MPH, senior program analyst at the Council of State and Territorial Epidemiologists in Atlanta, and colleagues said an additional 1,200 epidemiologists are needed to reach full capacity to conduct the four Essential Public Health Services (EPHS).

“The biggest gap is probably just the number of epidemiologists that we have working at the state and local level,” Timothy F. Jones, MD, Infectious Disease News Editorial Board member and state epidemiologist for the Tennessee Department of Health, told Infectious Disease News.

Most epidemiologists work in ID

According to Arrazola and colleagues, the Epidemiology Capacity Assessment — which evaluates workforce size, funding and epidemiology capacity trends among state health departments — was updated in 2017 “to reflect expansion of health department programs into genomics, informatics and vital statistics.” Data collection for the 2017 Epidemiology Capacity Assessment took place between April 28 and Aug. 11, 2017, with all 50 states and Washington, D.C., responding to the electronic questionnaire. The assessment evaluated current and optimal epidemiologist positions, as well as sources of epidemiologic activity and personnel funding.

Each state health department also reported self-perceived capacity to lead activities, provide subject matter expertise and obtain and manage resources for the four EPHS related to epidemiology, which include monitoring health status, investigating community health problems, evaluating effectiveness and applied research.

According to Arrazola and colleagues, there was a 22% increase in the number of epidemiologists at state health departments, from 2,752 in 2013 to 3,369 in 2017. Epidemiologists working in infectious disease positions accounted for 55% (n = 1,838) of the workforce, those in maternal and child health epidemiologists accounted for 10% (n = 321) and those working in chronic diseases for 9% (n = 304). In contrast, substance abuse, occupational health, oral health, mental health and genomics programs had the fewest epidemiologist positions. Researchers found that although infectious disease positions steadily increased since 2013, preparedness positions, previously known as bioterrorism and emergency response, experienced a steep decline.

Reviewing state health departments’ ability to provide the four EPHS, Arrazola and colleagues said substantial (50%) to full (100%) capacity was highest for investigating health problems and monitoring health status, with health departments reporting capacity levels at 92% and 84%, respectively. However, with a 39% capacity to evaluate the effectiveness, accessibility and quality of health services and a 29% capacity for applied research, significant gaps in specialized skills persist, they said.

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Quality of candidates increasing

In 2017, over half of the funding for epidemiological activities and personnel came from the government, although a slight decrease was observed. In 2013, the government contributed 79% of the funding; that contribution fell to 77% in 2017.

Some 89% of the federal funding for epidemiology personal was provided by the CDC. State contributions, at 19%, remained unchanged since 2013, according to the study.

According to Jones, the biggest challenge to closing capacity gaps is money.

“We’re getting three-quarters of the funding for epidemiologists in our state from the federal government, and it’s great that they’re supporting these programs,” Jones said. “The unfortunate part is our state and local governments are not supporting a lot of the needed capacity. We’re reliant on support and increases from the CDC, mostly.”

Funding allocation for epidemiology programs and initiatives tend to rely on a crisis, such as outbreaks of Ebola, Zika or pandemic influenza, according to Jones. He said it can feel like “we’re riding the crest of successive emergencies.” Although attention is welcome and can result in more awareness and understanding, “it’s not a great way to fund our infrastructure,” Jones said.

According to Arrazola and colleagues, adding 1,200 epidemiologists would be a 36% increase over current levels. Additional positions in substance abuse, mental health and genomics are needed, they said. They recommend more focused hiring practices that seek epidemiologists with the background, skills and knowledge in evaluation and research.

“The quality of candidates for the positions we do have is really going up and that is exciting for the prospects in the future,” Jones said.

Retraining existing staff members, along with prioritizing these skills, may also help state health departments improve EPHS capacity, according to the study.

“The findings suggest that hiring alone, without considering the specialized skills needed to improve the current perceived gaps in capacity, might no longer result in capacity improvements,” Arrazola and colleagues wrote. “Gaps in capacity affect the ability of public health agencies to respond and leave them vulnerable to emerging threats such as the current opioid epidemic.” – by Marley Ghizzone

Reference:

Arrazola J, et al. MMWR Morb Mortal Wkly Rep. 2018;67(33):935-939.

Disclosures: Arrazola and Jones report no relevant financial disclosures. Please see the study for all other authors’ disclosures.