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AAAS Report Calls for Increased Workforce Development to Address Infectious Disease
Physician and nurse shortages along with increased retirements of public health officials could lead to a scarcity of experts trained to respond to infectious disease outbreaks, warns a new AAAS report
While the United States has boosted funding for scientific, public health, and first-response capabilities, the report says, the next generation of public health professionals— scientists, doctors, veterinarians, nurses, emergency technicians, and lawyers—is not being educated at a commensurate rate to fill the impending workforce loss.
This gap will become increasing apparent over the next decade as approximately half of the workforce at the public health departments becomes eligible for retirement. Compounding the loss is the average age of doctors and nurses, which is currently in the late forties.
"The importance of a robust public health infrastructure is the cornerstone for preparing for and responding to infectious disease threats . . . and there is a need for a strategic plan for educating enough health care personnel to fill the gap," the report reads.
The report also recommends that federal agencies and institutions of higher education develop a database of all educational programs that address infectious disease preparedness and response, establish common curriculum standards, encourage field training, and evaluate their effectiveness. These programs would train experts to respond to both natural and human-made outbreaks - examples include H5N1 avian flu, H1N1 virus, anthrax, and SARS.
While there are discipline-specific databases and standards, the report points out that there is no single resource of all relevant programs, which hinders cross-disciplinary training.
The report—"Workforce Development: Preparing the Next Generation for Infectious Disease Threats"—is the outcome of a 26 May workshop which brought a diverse group of 25 public health officials to AAAS headquarters in Washington, D.C. It was released 17 July. The workshop was organized by the AAAS Center for Science, Technology, and Security Policy and the AAAS Program on Scientific Freedom, Responsibility and Law, with financial assistance from the U.S. Department of State.
Kavita Berger, project director for the AAAS Center for Science, Technology and Security Policy, said that the workshop's aim was to document and describe existing educational programs on infectious disease preparedness, highlight major challenges and knowledge gaps within current educational programs, and provide recommendations for improving the overall infectious disease workforce development.
"There is a strong need to make sure that, as we develop new programs for infectious disease prevention and response, we also need to make sure there is a sizable and well-prepared workforce to implement those initiatives," said Berger. She added that this workforce could serve as an example for other countries as they develop responses to the next infectious disease outbreak.
Beyond promoting education as a means to develop a multi-generational public health workforce, the report called for a multi-disciplinary infrastructure, encouraging professionals to work with experts outside their profession to better anticipate infectious disease outbreaks.
Mark S. Frankel
"It's clear that preparing for and dealing with actual outbreaks will require the involvement of a range of experts, from health care providers, to law enforcement, to lawyers," said Mark S. Frankel, co-organizer of the workshop and director of the AAAS Program on Scientific Freedom, Responsibility and Law. "They will need to be familiar with the role that each plays so that they can work as an integrated team when a threat materializes."
As an example of multi-disciplinary infectious disease detection, the report explained how seven deaths in New York City—originally misdiagnosed as St. Louis encephalitis—were later identified as the first U.S. casualties from the West Nile Virus in 1999.
During the early stages of the outbreak, veterinarians at the Bronx Zoo discovered that several animals had died from the West Nile Virus. Once zoo veterinarians shared their information with public health officials, experts reexamined the human deaths, discovering that they also died from the West Nile virus. While the West Nile virus and St. Louis encephalitis have similar pathologies, St. Louis encephalitis is not known to affect animals.
"The West Nile Virus incident demonstrated that animals are generally infected with an [infectious disease] before humans and can serve as a mechanism for sentinel surveillance to a potential human outbreak," the report reads.
The correlation between disease outbreaks in animals and subsequent human infections emphasizes the importance of training public health officials to communicate with experts outside their disciplines.
"The animals were getting sick before humans, but there was no communication between doctors and veterinarians, so medical doctors did not know to check for West Nile," said Berger.
14 August 2009