Ensuring an Infectious Disease Workforce Education and Training Needs for the 21st Century: Workshop Summary (2006) / Chapter Skim
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Appendix A: Authored Papers
Appendix A: Authored Papers
Pages 51-194
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From page 51... ...
Graduate Dean and Professor of Biology and Public Health Codirector, Center for Deterrence of Biowarfare and Bioterrorism University of Louisville Louisville, KY It is clear that after September 11, 2001, we live in a new era, an era of fear -- fear of foreigners who could be terrorists and fear of scientific information that could be misused by terrorists. The consequence is that we in the scientific and academic communities are now subject to new levels of public scrutiny that are manifest in the regulations governing visas for foreign students and visiting scientists and in the security clearance requirements for those with access to microorganisms and toxins (select agents)
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From page 52... ...
Additionally, we need to educate the broader public as to the importance of international exchange in the scientific arena so as to ensure that regulations are constructed in ways that permit the advancement of biomedical research. We have a need to explain to the public and policy makers that the best defense against the threat of bioterrorism is to advance the research agenda against infectious diseases so that we have the vaccines, therapeutics, and diagnostics needed to combat emerging and reemerging infectious diseases as well as "plagues" that may be introduced by terrorists.
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From page 53... ...
When the ASM looked at the impact of restricting individuals from the few nations that are designated by the United States as supporting terrorism, and only restricting them in the laboratories where a limited number of select agents were present, we found that there were very few scientists and very few exchanges that were being affected in the United States. We agreed to accept that provision, which became a restriction in the Patriot Act and which was subsequently incorporated into the Biopreparedness Act, and thus, into the regulatory scheme of the Centers for Disease Control and Prevention and the U.S.
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From page 54... ...
If we limit our ability to exchange scientific information and train scientists, then we will severely limit our ability to fight infectious diseases -- and infectious diseases do not respect any political borders. The ASM therefore urged the State Department to eliminate the adverse impact of visa policies on the continued education and training of foreign students in the United States.
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From page 55... ...
We face a new regulatory environment -- one crafted out of fear of terrorism. We face a critical need to advance biomedical science to combat the threat of bioterrorism as well as the emergence and reemergence of deadly infectious diseases.
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From page 56... ...
To remedy this situation and avert the consequences of more dire workforce deficiencies, public and private employers, trade groups, and relevant government agencies must find new ways to attract and retain the nation's next generation of laboratory technicians and scientists. Public Health Laboratories and Microbial Threats to Health As vividly demonstrated by efforts to contain West Nile virus in 1999, anthrax in 2001, and severe acute respiratory syndrome (SARS)
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From page 57... ...
. These services include: · Conducting research to develop and validate diagnostic tests for emerging infectious diseases and to improve existing infectious disease tests (for example, by developing rapid test methods)
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From page 58... ...
Tennessee is one. The state public health laboratory has been struggling since late 2001 to fill fully a third of its clinical microbiology positions (personal communication, J
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From page 59... ...
. From a second vantage point, the public health laboratory workforce shortage can be seen as part of a serious labor problem plaguing public health and private clinical laboratories throughout the nation.
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From page 60... ...
The 2001 terror attacks and recent SARS outbreak afforded laboratorians some measure of public appreciation for their work, but also raised fears of extraordinary biosafety risks for all infectious disease laboratorians. In addition, the terror attacks spawned new federal legislation that complicates the hiring process for some laboratories, including all state public health laboratories and many university-based research facilities.
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From page 61... ...
, real-time PCR (used for emerging infectious diseases and agents of bioterrorism) , pulse field gel electrophoresis (a molecular "fingerprinting" technique used for outbreak investigations)
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From page 62... ...
The USA Patriot Act, which became law after the 2001 terror attacks, raises a number of legal hurdles for employees in all laboratories that work with so-called select agents -- high-consequence organisms such as anthrax, ebola, and Yersinia pestis. In practice, most of the diagnostic laboratories affected by the legislation are public health laboratories.
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From page 63... ...
. Certainly, one area in need of further investment is the nation's infectious disease workforce, and, in particular, the clinical laboratory scientists who come face-to-face with the microbes themselves.
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From page 64... ...
Other than through the center's activities and on-the-job experience, current laboratorians have almost no mechanism to acquire the managerial, public policy, communications, and other leadership skills essential to oversee the complex workings of a public health laboratory. The center is identifying and disseminating the knowledge needed for effective decision-making in public health laboratories and also providing technical assistance -- such as workshops in grant writing, media relations, and the regulatory inspection process -- to support current laboratory leaders.
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From page 65... ...
. The IOM has recommended that the CDC, the Department of Defense, and the National Institutes of Health develop new programs and expand current programs to train the infectious disease workforce, incorporating hands-on experience at public health agencies whenever possible (IOM, 2003)
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From page 66... ...
Educating Future Laboratory Directors. Washington, DC: Association of Public Health Laboratories.
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From page 67... ...
This is particularly relevant for the "infectious diseases workforce of the twenty-first century," the subject of this symposium, for we must understand the context in which that workforce will be functioning and the technologies that will be utilized to address the diseases. Only then can we plan for the education and training needs of that workforce.
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From page 68... ...
For instance, promoting global health equity is in the interest of the developed world: healthy developing world populations not only represent expanded market opportunities for products from industrialized countries, but the control of infectious diseases is becoming a major security issue for countries like the United States. As Martin Luther King said, "It really boils down to this: that all life is interrelated.
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From page 69... ...
The top 10 list includes technologies and technology platforms to address a range of developing world problems including infectious diseases, non-communicable diseases, malnutrition, and environmental contamination. These include: · Simple hand-held devices using molecular-based diagnostics to conduct rapid, low-cost testing for a variety of infectious diseases, such as HIV and malaria.
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From page 70... ...
For example: using DNA technology to design an AIDS vaccine candidate specifically for Africa; or plant-made vaccines incorporated into potatoes and other vegetables and fruits to protect against hepatitis B, cholera, measles, and other ailments · Alternatives to needle injections (e.g., inhalable drugs, powdered vaccines) that could make vaccine and drug delivery safer, easier to administer, and potentially less expensive · Genetically modified bacteria and plants that can clean up contaminated air, water and soil · Vaccines and vaginal microbicides that empower women to protect themselves from sexually transmitted infections and achieve contraception without needing consent from male partners · Computer-based tools to mine data on human and nonhuman gene sequences for clues on preventing and treating infectious and non-communicable diseases · Genetically modified staple foods such as rice, potatoes, corn, and cassava with enhanced nutritional value Even though we highlight the potential of biotechnologies for improving health in developing countries we are not dismissing the value of conventional ways to improve health in developing countries -- such as water sanitation, or access to mosquito bed-nets.
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From page 71... ...
However, due to the enormous inequities in global health and global health research discussed above, knowledge -- including genomics knowledge -- is not optimally developed or utilized for improving the health of people in developing countries. In a closely interconnected world, localized sub-optimal utilization of scientific knowledge to alleviate misery and protect against diseases such as HIV/AIDS can have global repercussions.
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From page 72... ...
In other words, genomics has certain innate characteristics reviewed above that make it a global public good, but the social and political organization of initial genomics research has enhanced its global public goods characteristics. The way the Human Genome Project was funded and undertaken, and the emphasis on placing the resulting knowledge in the public domain where it can be freely shared are factors that strengthen the global public goods characteristics of genomics.
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From page 73... ...
International Collective Action Is Needed to Strengthen Genomics in Developing Countries International collective action is also needed to mobilize genomics for global health and help bring genomics to society. Such action can drive efforts to improve research infrastructure, education, and training to provide developing countries with the "access goods" they need.
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From page 74... ...
A focused, collaborative initiative-such as the Global Genomics Initiative -- that aims to promote genomics as a global public good could reinforce these efforts and channel them towards one of the most pressing issues of our time -- improving global health. Genomics and related biotechnologies are relevant to and should be harnessed for purposes of global development and health so the benefits of the Human Genome Project will reach the 5 billion people who need them the most -- not just the privileged 600 million in the developed world.
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From page 75... ...
2003. Global Health Ethics: The Rationale for Mutual Caring.
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From page 76... ...
. As illustrated in Figure A-1, the workforce necessary to accomplish the needed improvement in the population's health must be supported with strong training programs that bring to attention a variety of health education and health promotion roles, while providing an increased understanding and awareness of the wider PH context in which health professionals practice (Latter and Westwood, 2001)
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From page 77... ...
77 of care Journal Institutions Services teams health Staff imary Academic Health CHW Core Community NGO/Vas practice pr PHC PHC, Outcomes? " practice multiprofessional enter of PHC services use who practice Similar HPE education; enter PHC MS PHC who Increase influence Perceive NS enter Provide Increase professions will who Increase health permission.
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From page 78... ...
Aim and Methods The aim of this report is to emphasize some of the issues that require attention in developing a strategy for the establishment and development of appropriate team concepts in heath care curricula. The insights reported represent the initial "brainstorming" sessions that were held separately by the author with each of five staff members of the Department of Public and Community Health at the School of Health and Social Care, Oxford Brookes University, Oxford, United Kingdom.
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From page 79... ...
At the institution or the school levels, a parallel political commitment of the institution's senior management is necessary. The presence of market forces pointing to a need for health professionals with PH knowledge and background, and the availability of a local and national market niche for multidisciplinary PH, are favorable points.
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From page 80... ...
Weaknesses Resistance and Anxiety The reasons for any resistance to the move toward introducing PH principles within the broader health care curricula will need to be understood. For instance, is there poor staff understanding about where PH could fit in their curricula?
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From page 81... ...
At the financial and human resource allocation levels, any incoming research funds of the lead department instigating the change
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From page 82... ...
When feasible, it could be useful to compare the lead department's PH educational outcomes vis-à-vis other programs and modify where necessary. Capitalizing on school-wide change is also good practice: are there other areas of change that need to take place across the school curricula (such as inclusion and diversity)
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From page 83... ...
Some of the factors to address include whether the lead department is convincing and influential within the institution, and whether there are some members of the lead department with a high level of PH expertise and credibility. Is the size of the lead department and its academic team conducive to supporting the proposed changes?
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From page 84... ...
For 30 years medical educators, health professions students, and physicians in training have been hearing from the general public that health professionals should think more about primary care and less about specialization (Rosenberg, 1999)
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From page 85... ...
Such aspirations are attainable only if PH notions are integrated into the education of the different health professions, preferably at the undergraduate level. But the delivery of quality PH concepts and training to nonspecialist health professionals working in the field is also a challenging endeavor.
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From page 86... ...
. Conclusion If health professions graduates are to contribute to the improved health status of the population, then there is a pressing need for a change in their education.
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From page 87... ...
Hence, a coherent policy framework as well as a national agenda on workforce development will need to be in place. However, research will be required to verify that "learning PH concepts" actually leads to the use of such population elements by health professionals in their later everyday practice.
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From page 88... ...
2005. Health Protection: Communicable Disease, Public Health and Infection Control Educational Programmes -- A Case Study from the UK.
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From page 89... ...
, and global publicprivate partnerships (Buse and Walt, 2000) and community-health services partnering for HIV/ AIDS prevention (Goede and El Ansari, 2003)
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From page 90... ...
. When all of these points have been deliberated, a question then arises: do stakeholders with different value systems and diverse cultural backgrounds actually perceive similar outcomes of their partnership efforts?
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From page 91... ...
Within 5 years, the foundation was to support the development of a major initiative: Community Partnerships for Health Professions Education (Henry, 1996a)
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From page 92... ...
The vision was to promote more effective community-oriented health professions training as well as the development of relevant training for community health workers. With wide community support, and a decision to approach governmental and nongovernmental sources for funding, a multipurpose community center was strategically set
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From page 93... ...
The partnership enabled the university to expand its vision to include a wide cross-section of health professionals. Thus, in addition to medical students, nursing and health education students and community health workers were trained.
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From page 94... ...
The stakeholders felt that the health service component was strong in this partnership, and that there was a great need for the university to strengthen its professional teaching staff by way of development of their capacities. Other activities included the establishment of the Department of Health Professions Education at the university, whose role included the whole medical school program in addition to the activities of the partnership, as these were inseparable.
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From page 95... ...
They were isolated, underdeveloped, lacked infrastructure, and had high levels of poverty and unemployment. The academic partner consisted of a wide array of training institutions: the health sector at the local university encompassed community health sciences, nursing, social work, psychology, physiotherapy, occupational therapy, child guidance, dietetics, human ecology, student counseling, and dentistry.
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From page 96... ...
One anticipated outcome of the community partnerships was to improve health professions education by way of creating alternative settings for the education of health professions. Curricular outcomes.
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From page 97... ...
included the lay community, community health workers, and nongovernmental and community-based organizations and voluntary agencies. The levels of certainty of the two groups in relation to the accomplishment of 16 different anticipated partnership outcomes (clustered under the eight categories described above)
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From page 98... ...
This certainty gap was wide and distinct for some of the anticipated services, sustainability, and community outcomes, and conversely the gap was narrow and hazy in relation to the health professions education impact outcomes as well as structural change outcomes. Third, there was an "onion skin" appearance in the levels of each group's certainty.
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From page 99... ...
For instance, the community health workers, the partnerships' core staff, and the community members exhibited significantly higher levels of sense of ownership, commitment, and contentment with the flow of information in their partnerships. Similarly, significantly more participants from these groups indicated high involvement levels in their partnerships, had more belief that their partnerships had long-range plans, and knew the organizational structure and staffing of their partnerships and what their roles in the partnerships were.
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From page 100... ...
The first aim of this report was to describe five South African community partnerships for health professions education and a range of their anticipated outcomes. To this end, an overview was provided of each of the partnerships, as well as the collective challenges they faced and their anticipated outcomes.
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From page 101... ...
. The third aim was to explore whether those groups out of the six specific partners who perceived greater certainty about the outcomes would also experience higher ratings on other related partnership functioning contentment parameters.
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From page 102... ...
1999. A Study of the Characteristics, Participant Perceptions and Predictors of Effectiveness in Community Partnerships in Health Personnel Education: The Case of South Africa.
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From page 103... ...
1996a. Community Partnerships: Going Beyond Curriculum to Change Health Professions Education.
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From page 104... ...
In: Richards RM, ed. Building Partner ships: Educating Health Professionals for the Communities They Serve.
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From page 105... ...
landscape is changing. Issues related to infectious diseases in the context of global health are receiving the attention of world leaders and policy makers.
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From page 106... ...
As infectious diseases pose an everchanging risk because the problem is never static, HP is in the premier division of health priorities (Chief Medical Officer, 2002)
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From page 107... ...
Since the 1970s, about 30 previously unidentified infectious diseases have become important (Chief Medical Officer, 2002; Pennington, 2003) , emphasizing the necessity to strengthen the infection control infrastructure.
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From page 108... ...
Heavy rain provides breeding sites for malaria and causes flooding, which contaminates clean water supplies Health care associated In 1999, it was estimated that healthcare-associated infections infections cost the NHS almost £1 billion per year Fear of bioterrorism Anthrax scare in the United States and fear of smallpox release Changes in animal husbandry vCJD speculated to be caused by eating beef from cattle with bovine spongiform encephalopathy, believed to be due to feeding animals with animal byproducts Vaccination Meningitis C and Hib vaccinations led to a decrease in numbers of infected individuals Media hype MMR vaccine safety scare (UK) could have contributed to decrease in vaccination take up, increase in infected individuals and concern about outbreaks Lifestyle changes Legionella pnemophila colonises air conditioning systems, inhalation of contaminated aerosols leads to infection MRSA, methicllin-resistant Staphylococcus aureus; vCJD, new variant Creutzfelt-Jacob disease; Hib, Haemophilus influenza serotype B; MMR, measles, mumps and rubella; HIV, human immunodeficiency virus, AIDS, acquired immunodeficiency syndrome; NHS, National Health Service
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From page 109... ...
. Education for CD and infection control has been underdeveloped with no single pattern of provision (Public Health Laboratory Service, 2002)
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From page 110... ...
Students specialising in infection control are encouraged to undertake the set of four modules outlined in Figure A-2. Planning commenced in 1999 and the new module was established as the Chief Medical Officer's (CMO's)
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From page 111... ...
`Getting Ahead of the Curve' (CMO2002) National calls for review of content of infectious diseases and health protection in the current education programmes with a view to strengthening it through NHS workforce and education confederations and educational providers Step 4 Communicable Disease and Public Health Module Initiated in 2002; either Level 3 or 4 Same lectures, different assessments Communicable diseases content Addresses control in the community Inauguration of Health Protection For infection control nurses/public health workers Agency 2003 SARS (China)
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From page 112... ...
Students work together to plan how they would collaboratively manage incidents such as a food poisoning outbreak or public water supply contamination. Infection control and CD control are ideally suited to this since no single health care professional group has all the responsibility.
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From page 113... ...
The infection control in practice module focuses on principles of infection control incorporating infectious diseases and epidemiology, both in hospital and community settings. The CD and public health module has a broad public health perspective, and examines the disease epidemiology, trends of emerging infections, surveillance, screening, vaccination, and legal and ethical aspects.
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From page 114... ...
Excellent, brilliant, standard Too information Much are Protection Health professions, miles student miles HPA, 50 international 120 numbers, and to within miles Health; miles miles miles miles miles Locations All International Local Local Local 30 40 50 120 Local 45 Local 35 Local Local Public student of on or officer Control stand- manager manager; Master's nurses working PH practice either a PH of nurses nurse (PH) as training health 1 Recruitment: students MPH, nurse students MPH assistant PH general students 1 PH control homeless of students PH for (Infection taking of visitor director in officer A-3 hospital the student hospital analyst module development health; run -- 22 specialists; nurse; run -- 26 run -- seven students infection acute community with MPH acute health deputy director nursing nursing policy fast-track studying Award)
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From page 115... ...
IC, infection control; CD, communicable diseases; NHS, National Health Service
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From page 116... ...
Staffing and Human Resources A full-time lecturer with CD/public health experience participated in the planning, but had other administrative responsibilities. A part-time lecturer with infection control/CD experience was employed to develop, validate and lead the module, but also had other responsibilities.
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From page 117... ...
For instance, one request was to explore the practical problems of infection control in resource-limited developing countries. A group discussion was greatly enhanced with a presentation by a student with first-hand experience of working in such settings.
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From page 118... ...
. On the other side of the Atlantic, the postwar development of drugs to treat infection led to a view in the 1960s and 1970s that infectious diseases might be conquered (Chief Medical Officer, 2002)
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From page 119... ...
, the HPA aims to improve knowledge about HP through development, education and training. Consequently, there are calls for a focused educational strategy on CDs and to "review the content of infectious diseases and HP in the current education programmes with a view to strengthening it through NHS workforce and education confederations and educational providers"(Chief Medical Officer, 2002:142)
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From page 120... ...
However, an important point is that the number of infection control and CD courses around the UK is increasing. For instance, the HPA implements an introductory course in epidemiology and surveillance of infectious diseases, but it is more suitable for public health medicine trainees (Anonymous, 2003)
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From page 121... ...
The teaching teams include inputs from a range of "external" contributors (former and current consultants in CD control, professor of microbiology, HPA senior member, consultant microbiologist and environmental health officer) and "internal" contributors (the course organiser, a former infection control practitioner and the programme leader, a reader in public health)
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From page 122... ...
Infectious diseases are a leading cause of death and disability in developing countries and are re-emerging as a serious health problem in developed nations. They require global responses (Chief Medical Officer, 2002; IOM, 2003)
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From page 123... ...
2003. Health Protection Agency: Introductory Course in Epidemiology and Surveillance of Infectious Diseases (Advertisement)
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From page 124... ...
2001. Infectious Diseases: Considerations for the 21st Century.
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From page 125... ...
2001. Infectious Diseases: Career Preparation.
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From page 126... ...
2003. MSc community infection control 2003.
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From page 127... ...
It was proposed at the Institute of Medicine (IOM) Forum that emphasis should be placed on a global perspective in addressing health workforce issues, rather than one of international health.
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From page 128... ...
Also to be included must be ministries and senior academic administrators responsible for higher education (because of their responsibility for universities and medical schools) and for civil service and public employment policies and practices (because such a large share of the health workforce is employed in the public sector)
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From page 129... ...
, the trend could be considered a "bug." Emerging infectious disease challenges may appear anywhere on the globe, and a smaller proportion of experts may enter the global community if the trend continues. Adequacy of Infectious Diseases Training Within the past decade, there have been two published surveys that addressed the adequacy of ID fellowship training (Slama et al., 2000; Joiner et al., 2001)
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From page 130... ...
130 (79) Mucha, 2002 105 251 198 51 A.C.
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From page 131... ...
. Demographics of IDSA Members To ensure an adequate infectious diseases workforce, one must first know the nature of existing ID expertise and how their professional effort is distributed.
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From page 132... ...
02.77 Clinical Micro. 02.54 Other 01.51 xx Infectious Diseases Job Market Two studies have examined the infectious diseases job market by evaluating advertisements in widely circulated journals covering internal medicine.
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From page 133... ...
They noted that many positions were being advertised due to turnover and that many recent positions had been reposted because of a lack of qualified applicants. Resources to Develop Infectious Diseases/ Public Health Physician Expertise Funding sources to develop ID/PH expertise are diverse, with ID fellowships traditionally financed through hospitals, medical schools, and some research training grants.
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From page 134... ...
A minority of these directors had preexisting public health backgrounds or training, and they were not physicians. Local health district boards have physician membership, but in general they are not trained in infectious diseases or public health (Personal Communication, A
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From page 135... ...
AUTHORED PAPERS 135 FIGURE A-3 Shaded regions indicate local health department coverage pre-9/11/01. FIGURE A-4 Shaded regions indicate local health department coverage 2003.
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From page 136... ...
These physicians are largely in private practice and are not necessarily ID specialists. Some of them may serve on their local health district boards, yet lack adequate training and knowledge about public health, epidemiology, and infectious diseases.
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From page 137... ...
Some of the lessons learned from the recent efforts at bolstering bioterrorism preparedness should be applied to the problem of ensuring an adequate infectious diseases workforce both in quantity and quality. As an anecdotal example, the diagram in Figure A-6 depicts the initiatives of the Center for Biopreparedness Education (CBE, 2003)
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From page 138... ...
This certification is not like board certification of medical specialties, but is more analogous to Basic Cardiac Life Support that crosses disciplines. Among the live conferences, the center cosponsors the military-derived Medical Management of Chemical and Biological Casualties Course (Chemcare)
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From page 139... ...
While this consortium is designed for BT education, a similar model could be adapted to enhance the training of the infectious diseases workforce. Assessment and Recommendations There clearly is a current demand for more infectious diseases expertise both in the private sector and in an official public health capacity, yet the number of ID fellowship training slots is slightly lower than in 1994.
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From page 140... ...
Mechanisms for rapidly educating existing local ID/PH resources need to be developed. Even with best efforts at continuing education, sudden demands for training may arise in unforeseen outbreaks of emerging infectious diseases.
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From page 141... ...
Incentives to encourage individuals to pursue infectious diseases training and careers in public health/infection control activities must be developed. Marketing of PH careers should take place prior to the accumulation of a large educational debt while students are still in an "undifferentiated" career state, because large economic pressures clearly play a role in career choices.
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From page 142... ...
1998. Fellowship Training in Infectious Diseases: A Report from the Regional and National Meetings of Infectious Diseases Division Chiefs and Program Directors.
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From page 143... ...
Gray, Ph.D. Division of Health Sciences and Technology Massachusetts Institute of Technology Harvard University Cambridge, MA "The United States has shown leadership in the past by strengthening its own and others' capacities to deal with infectious diseases, but the present reality nevertheless is that public health and medical communities are inadequately prepared.
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From page 144... ...
As one might surmise from the similarity of Figures A-7 and A-8, it should be straightforward, in principle, to adapt these models to establish the kind of training suggested by the complex multifactorial nature of the infectious disease threat. The notion of multidisciplinary education (or research)
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From page 145... ...
why mess with success, as our institutions are very well honed and have a good track record in handing off new biomedical science and technology to the industries that can translate and deliver them to the benefit of humans and human health. The outcome data from the training models described below largely refute those two objections.
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From page 146... ...
We focus particularly here on two prototypical training models established over the past 1525 years -- models that could be suitably adapted to focus on infectious disease in accordance with the 2003 IOM report (IOM, 2003)
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From page 147... ...
in deciding on mentors, collaborators, and courses. The applicants also are attracted to the concept of learning and working alongside medical students.
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From page 148... ...
This opportunity to participate in clinical training, through coursework with medical students and hands-on experience, is a distinctive hallmark of the MEMP program. The first 6-week period is an intensive introduction to clinical medicine.
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From page 149... ...
roughly 10 years prior to the study had ever held an NIH grant (NIGMS Medical Scientist Training Program, 1998)
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From page 150... ...
However, in many cases the courses are specifically created for BME students and do not include medical students. (A reasonable summary of these curricula can be gleaned from the Whitaker Foundation Web site [www.whitaker.org]
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From page 151... ...
Sixteen students each year were selected after admission to the Division of Medical Sciences. These students took a number of preclinical courses with the Harvard medical students, and they had regular visits to hospitals where they would meet with investigators doing research at the interface of basic science and clinical medicine, talk with patients, and see clinical procedures (Bunn and Casey, 1995)
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From page 152... ...
In applying the principles underlying the HST-type training model (or the targeted exposure model) to a focus on infectious disease, we offer the following guide: 1.
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From page 153... ...
Third, there are benefits to teaching graduate students clinical medicine and medical science in the same way that one teaches medical students. In other words, it is not necessary (and is, in fact, not desirable)
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From page 154... ...
. The multidisciplinary, multiprofessional training models described here offer a principled approach to creating training programs in infectious diseases to build a cadre of individuals who have a deep appreciation of the complex multifactorial (multidisciplinary and multiprofessional)
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From page 155... ...
2003. Microbial Threats to Health: Emergence, Detection, and Response.
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From page 156... ...
For some scientific work, yes, but for many of the tasks at hand, no. Bringing new approaches into the infectious diseases will require: · Bringing people (and ideas)
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From page 157... ...
And the researchers focusing on human diseases need to look, closer and more often, at plant biology, at the infectious diseases of plants, and at that rich literature of those fields, as well as at veterinary science.
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From page 158... ...
xx There are so many ways of doing science that would be remarkable additions to the field: pages could be spent on listing them. The hurdle is not pointing at the science that needs to be brought in to the infectious diseases, but the practical matter of doing it.
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From page 159... ...
The professional societies concerned with infectious diseases -- the American Society of Microbiology, the Infectious Disease Society of America, and several others -- are important parts of the field's infrastructure and have roles to play in bringing in new approaches. Their oldest and most central roles are convening researchers and publishing journals.
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From page 160... ...
160 ENSURING AN INFECTIOUS DISEASE WORKFORCE and actively support it by protecting time for it and making resources available when strong faculty want to move in new directions. Looking at a related issue, the scientific workforce, in general, and how it is trained, we need to understand what kind of workers are needed at the bench and how we can best train them.
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From page 161... ...
AUTHORED PAPERS 161 9.5 32.5 9 32 Age at Ph.D. (right axis)
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From page 162... ...
162 ENSURING AN INFECTIOUS DISEASE WORKFORCE 100 80 60 Part-time total 40 Postdoctorates Other full-time 20 Full-time junior faculty Full-time senior faculty 0 1973 1979 1983 1987 1991 1995 1999 FIGURE A-11 More researchers are in non-faculty academic jobs. SOURCE: Derived from Science and Engineering Indicators 2002.
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From page 163... ...
RAND suggests, then, creating a "professional doctorate," akin to the way medical schools train a cadre of people to readiness for practicing medicine. In this case, graduates would be ready for industry and would be fed into jobs.
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From page 164... ...
This is a real draw. Evaluations of these programs are only now coming in, but one program has looked at how its graduates are doing in the job market.
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From page 165... ...
Clinical Infectious Diseases 32:675685. Goldman E and Marshall Eliot.
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From page 166... ...
An increased commitment to research and to the recruitment and training of more scientists in the field is necessary to ensure the development of vaccines for the numerous infectious diseases that threaten the world's human population. TABLE A-10 Some Major Infectious Diseases Uncontrolled by Vaccination Chlamydia Influenza Cytomegalovirus Parainfluenza Dengue Malaria EBV Meningococcus B E
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From page 167... ...
. Only recently have additional methods come into play, including live recombinants, alpha virus replicons, reverse genetics, and prime-boost strategies, to name a few.
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From page 168... ...
Peptides Extracted native polysaccharides from the capsules of Haemophilus influenzae type b, pneumococci, meningococci, and typhoid bacilli proved useful in immunizing older children and adults, and, more recently, the conjugation of these polysaccharides with proteins has provided us with immunogens that generate T cell memory and are effective even in young infants. Although peptide subunits of proteins have not thus far been successful against infectious diseases, they do offer hope for vaccines against melanoma and other cancers, and both lipidated and multiepitope peptides show greater immunogenicity against microbes (BenMohamed et al., 2002; Meloen et al., 2001)
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From page 169... ...
. Noninfectious diseases also will become targets of immunization strategies (Frenkel and Solomon, 2001)
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From page 170... ...
Extending vaccination of pregnant women beyond tetanus and influenza to other diseases is being seriously considered, and efforts are being blocked only by the large legal establishment in this country. Most importantly, immunology is being extended to noninfectious diseases, to include immunization against so-called cancer antigens, antigens on neoplastic cells, diabetes, and even against amyloid for Alzheimer's disease.
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From page 171... ...
Postlicensure studies on safety, effectiveness, risk groups, and persistence are necessary as well. The study of pathogenesis is critical to vaccine development, and more young investigators are needed in this field.
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From page 172... ...
. Infectious diseases are complex, a fact that has led to a focus on multidisciplinary and multicultural training.
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From page 173... ...
or Ph.D. degrees to be prepared specifically for careers in vaccinology, either to pursue basic vaccine development research or to conduct investigative clinical trials.
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From page 174... ...
2002. Live-Attenuated Virus Vaccines for Respiratory Syncytial and Parainfluenza Viruses: Applications of Reverse Genetics.
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From page 175... ...
2003. Center for Vaccine Development.
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From page 176... ...
. This report presents a summary of recent and ongoing efforts within and outside of public health schools to address some of the demand and supply issues concerning public health professionals.
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From page 177... ...
that are included in the enumeration might function as infectious disease specialists, but the enumeration data failed to capture the functional roles of individual workers. Fourth, since the year-2000 enumeration, staffing for the detection and containment of infectious diseases in state and local health departments has probably increased due to federal bioterrorism funding.
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From page 178... ...
Research Practice-oriented research is needed to answer the questions about how many students and workers are needed to meet the challenges of emerging infectious diseases, and schools of public health have a special role here. Scientists in these schools contribute to the pursuit of research into communicable diseases, their vectors, their incidence and prevalence, their prevention, and their treatments, along with scientists in other schools as well as with those in public-sector agencies and private-sector institutions.
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From page 179... ...
are not restricted to infectious disease alone, they are highly relevant to the capacities and effectiveness of public health systems to face the challenge of emerging infections.The Association of Schools of Public Health (ASPH) , the membership organization of fully accredited institutions in the United States, has provided leadership for the development of practice-oriented research.
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From page 180... ...
. The training provided through these centers includes crosscutting topics of relevance to public health practice as well as specialized topics relevant to emerging infectious diseases.
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Schools should consider the review of academic policies that create disincentives for faculty members to contribute to this research. Third, research and education to assure an effective infectious disease workforce cannot be sustained without federal and state funding commitments.
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From page 182... ...
Improve ments to Public Health Capacity Are Needed for Responding to Bioterrorism and Emerg ing Infectious Diseases. Government Accounting Office Report 03-769T.
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From page 183... ...
Insect physiology came to be considered relevant to tropical medicine and parasitology following a Woods Hole Conference in 1978. Within 4 years, so many proposals of this kind were received that a separate ad hoc study section was formed to consider entomological proposals.
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From page 184... ...
Today, job descriptions continue to be composed mainly around this perception. Before 1982, proposals relating to vectorassociated disease were reviewed by the members of the Tropical Medicine and Parasitology Study Section of the National Institute of Allergy and Infectious Disease (NIAID)
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From page 185... ...
These societies included the American Society of Tropical Medicine and Hygiene, the Entomological Society of America, the Society of Vector Ecology, and the American Mosquito Control Association. The societies pointed out that 93 percent of the 56 grants in vector biology that were funded in 1993 dealt with fundamental insect physiology or molecular genetics, and that their principle investigators mainly were associated with experimental research rather than with tropical medicine or medical entomology.
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From page 186... ...
The creation of an insect that might be released in nature and that would transmit particular useful genes to a disproportionate fraction of its offspring became the goal of many research efforts. The self-generating dynamic that followed the acceptance of insect physiology by the TMP Study Section in 1978 operated once again in 1998.
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From page 187... ...
The federal Centers for Disease Control and Prevention (CDC) recently initiated a system of training grant awards in public health entomology, and it now awards research contracts in response to particular emerging infections.
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. Of this, the $26.5 million that had been spent was devoted mainly to academic research on drug and vaccine development.
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Universities A comprehensive review of the status of training and research in public health entomology was conducted in 1982 as part of the Coolfont Symposium, which was organized by the National Research Council and included participants from various universities, diverse laboratories, the military, federal and multilateral granting agencies, and various foundations. Questionnaires were submitted to 28 schools of medicine, schools of public health, departments of biology, and departments of entomology that were identified as potential sources of training in disciplines that pertained to the transmission of vector-associated disease.
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A smaller but comparable survey of U.S. training opportunities in public health entomology was conducted in 2002 by Walter Tabachnick at the request of the American Mosquito Control Association (personal communication)
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From page 191... ...
The Gates Foundation and the Burroughs Wellcome Fund seem likely to play an important role in this dynamic. The funding policies that they pursue in the immediate future may encourage faculty to engage in insect transgenesis, insect physiology, or research relating to transmission of pathogens.
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A cohort of scientists is required who can usefully produce the next generation of public health entomologists and whose research activities will promote that goal. Their programs will strike some balance between the three entomological interests that have vied for support during the past half century -- vector biology, insect physiology, and molecular biology -- and their work should incorporate strong epidemiological features.
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2003. Microbial Threats to Health: Emergence, Detection, and Response.
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