Bolstering ID workforce crucial to public health response, now and in the future
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NATIONAL HARBOR, Maryland — COVID-19 and monkeypox have caused severe stress on the health care system, which has weakened the overall response to other ongoing infectious disease battles like the one against antimicrobial resistance.
“Fundamentally, our overarching challenge is an increasing workload — due to outbreaks, pandemics, increasing antimicrobial resistance (AMR) and more complex health care — coupled with a declining workforce, that is, fewer people to do more work,” Infectious Diseases Society of America President Daniel P. McQuillen, MD, FIDSA, told Healio. “AMR, COVID-19, monkeypox and future infectious threats require both a clinical workforce to care for patients and ensure our hospital and clinics can function optimally, and a public health workforce to lead community efforts.”
During his keynote address at the World Anti-Microbial Resistance Congress, McQuillen explained that the COVID-19 outbreak put many stressors on public health and the infectious disease (ID) workforce across all avenues of the job, such as tending to the “overwhelming numbers of patients” in both the hospital and outpatient settings; guideline development, implementation and updates; infection prevention efforts; testing and research; surveillance and data collection; and the development, rollout and changes surrounding the COVID-19 vaccines.
Many of these stressors were seen again as monkeypox emerged, and guidelines needed to be developed and implemented, along with testing, research, surveillance and data collection.
“Since March of 2020, I've been stressing that ID experts have had to focus enormous amounts of time or resources on COVID-19 and now on monkeypox,” he said during his presentation. “This really means less time and less resources for AMR.”
He added, “We simply do not have enough people to do the work necessary to protect patients from AMR.”
According to McQuillen, during the first year of the COVID-19 pandemic, an increase of at least 15% was observed in hospital AMR infections and deaths. Some of the biggest increases were observed among carbapenem-resistant Acinetobacter (78%), antifungal-resistant Candida auris (60%), and carbapenem-resistant Enterobacterales (35%).
“We cannot allow cumulative increases in AMR and hospital-associated infections,” McQuillen said.
He explained that health care facilities and public health departments need to have the proper infrastructure and expert workforce to proactively combat this issue, as well as other ongoing and emerging infectious disease threats. He said that ID experts “sit at the intersection of clinical care and public health” and “are critically important to our preparedness and response to emergencies.”
Unfortunately, recent data have shown that the ID workforce is waning, with nearly one in every three of surveyed public health ID workers saying they plan to leave the field in the next year.
This would only add to the existing shortage of ID specialists reported in recent data, which show that 25% of health care facilities have vacant infection preventionist positions. These shortages are likely to continue and potentially worsen because 40% of that workforce is entering retirement age in the next 10 years.
“This is going to be a great problem,” McQuillen said. “You can't do any of this work without somebody that knows what they're doing in that position.”
Despite the “Fauci Effect,” which many have attributed to an increase in ID and public health-related fields during the COVID-19 pandemic, not nearly enough ID physicians are being trained. Data show that in 2019, just 62% of ID fellowship programs were filled. Fill rates increased to 75% in 2020 but decreased again to just 70% in 2021. According to McQuillen, this lack of interest is partially due to low pay and heavy workloads but also because of the treatment they have received in recent years.
“Unfortunately, in this country, we've developed a culture that likes to blame people for things that they don't really have blame for,” he said.
McQuillen said that the waning ID workforce, along with other compounding factors, including climate change, population growth, environmental degradation and increased contact between humans and animals, may make future outbreaks and pandemics even more dangerous.
Estimates shared by McQuillen show that the probability of novel disease outbreaks will likely grow threefold in the next few decades, there is a 47% to 57% chance of another global pandemic as deadly as COVID-19 in the next 25 years and that 4 million deaths can be expected in the next decade from pandemic influenza, coronaviruses and viral hemorrhagic fevers.
“We cannot address AMR or prepare for future threats without building our workforce, so what do we do about this problem?” McQuillen said. “We have to remove the financial barriers currently impeding improvement and have mechanisms in place before the next emergency, ensure staffing resources for future outbreaks and pandemics that are sufficient enough to respond to the emergency, while also maintaining the ongoing essential work, working on AMR.”
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McQuillen, DP. COVID, monkeypox and AMR – Examining the stressors on the U.S. healthcare system and solutions to protect patients. Presented at: World Anti-Microbial Resistance Congress; Sept. 7-8, 2022; National Harbor, Maryland.
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