Ensuring an Infectious Disease Workforce Education and Training Needs for the 21st Century: Workshop Summary (2006) / Chapter Skim
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Summary and Assessment
Summary and Assessment
Pages 1-50
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Attention should be focused, in particular, on improving response and detection capabilities in the developing world, where infectious diseases are most prevalent and opportunities for spread are considerable. The report also makes clear the need to better understand the dynamic relationship between microbes and humans, rather than to focus simply on fighting individual microbes.
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The Forum on Emerging Infections (now renamed the Forum on Microbial Threats) convened a 2-day workshop discussion -- the subject of this summary -- to examine the education and training needs to ensure an adequate infectious diseases workforce.
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But new needs are emerging as well, driven, in part, by the shift toward a more systemic view of infectious disease, in which microbes and humans are intricately entwined. For example, participants highlighted the need to attract more people in the physical, chemical, mathematical, and computational sciences to apply their expertise to biological questions.
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Workshop participants explored how to take even greater advantage of this segment of the workforce in meeting current and emerging microbial threats (Ganem, 2003)
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Other factors include a lack of senior physicianscientist role models engaged in research in infectious diseases, and changes in hospital practices. For example, the growth of managed care has imposed financial constraints on academic health centers, and many leaders of clinical departments now require that their faculty members see more patients, thus reducing the time they have available for research or to train upcoming physicianscientists (Rosenberg, 1999)
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The Role of Ph.D. Scientists2 In today's scientific environment, including work in infectious diseases, most Ph.D.
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Strengthening the Public Health Workforce3 By the very nature of their jobs, public health (PH) professionals will be instrumental in protecting society from microbial threats and in mounting effective responses to disease outbreaks, whether naturally occurring or intentional.
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In many cases, data are limited. One widely cited analysis found that for the year 2000, there were 448,254 workers in state and local health departments, schools of public health, and a few selected national voluntary organizations (Gebbie, 2003; Gebbie et al., 2000)
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The training through these centers covers crosscutting topics of relevance to public health practice, as well as specialized topics relevant to emerging infectious diseases. Schools of public health also can advance research, as scientists pursue
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Strengthening the relationship between public health and clinical medicine also will be important in developing plans to handle the surge of patients that might arise during a large-scale disease outbreak. One way that workshop participants explored to integrate knowledge of public health concepts into the broader health context is to revise the curricula used in institutions that train health and scientific professionals, including those in the medical, nursing, veterinary, and laboratory sciences.
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Infectious Diseases Physicians5 Physicians specially trained in the area of infectious diseases (ID physicians) comprise an important part of the workforce that is charged with meeting current and future challenges in detecting, treating, and preventing microbial threats.
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This could be accomplished in a number of ways, including participation in formal monthlong rotations or accessing an Internet-based training course. Such a course might best be developed jointly by the Infectious Disease Society of America and others, including the CDC, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology (Joiner et al., 2001)
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Physicians would be joined on this force by other health professionals, and together they would form a multidisciplinary national resource that stands ready to respond to any natural or intentional major disease outbreak. Epidemiologists/Allied Health Professionals As the science that studies how often diseases occur in different groups of people and why, epidemiology will play a key role in combating microbial threats, whether they arise naturally in a population or are introduced by terrorism (Perl, 2003; Srinivasin, 2003)
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Thus, workshop participants saw a need for training more people to work in hospital epidemiology and infection control, and, in particular, to train future leaders in these areas. Some participants called for the National Institutes of Health to assume this role, just as it now supports training programs to prepare leaders in other areas related to infectious diseases, such as research on HIV/AIDS and tuberculosis.
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As workshop participants heard, however, the workforce of environmental health professionals is showing signs of weakness. In 2000, local health departments nationwide employed approximately 19,400 environmental health specialists; this cohort represented roughly 10 percent of the total public health workforce.
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. Approximately 70 percent of infectious diseases that have newly emerged or reemerged in recent decades were transmitted to humans from animals.
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In addition, schools can strive to expand the "professional value" of their graduates. Well-trained veterinarians will be needed to participate in such activities as disease and pathogen surveillance, epidemiology and investigation of infectious diseases, population health and medicine, monitoring antimicrobial resistance, wildlife epidemiology and management, and biomedical research in which they will work hand in hand with scientists from numerous other disciplines.
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Vaccinology7 Vaccines against infectious diseases are one of the major success stories of modern medical science. Yet in the United States and worldwide, many diseases remain for which vaccines either have not been developed or are not readily available.
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Safety assessments also have become increasingly important, and people with a broad understanding of diseases are needed to analyze immune reactions in studies performed in both laboratory and clinical settings. Participants suggested that in order to help strengthen the workforce in vaccinology, medical schools can do more to teach their students about vaccinology and disease prevention via vaccines, so that they will consider this a realistic career path.
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Faced with such challenges, a number of organizations have launched innovative programs to help fill workforce needs. Among the examples described at the workshop is the Emerging Infectious Disease (EID)
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Collaborative Research The complex problems involved in controlling infectious diseases-from emergence and detection to treatment and prevention -- will require the involvement of experts from a broad range of disciplines and health sectors. Furthermore, an interdisciplinary, collaborate approach can facilitate the training of the workforce needed to meet these challenges (Cassatt, 2003)
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It should be noted, too, that lessons about collaborative research might be gained by looking to industry. As workshop participants reported, interdisciplinary research is literally the order of the day at pharmaceutical and other health-related companies.
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As an example of some of the challenges involved in promoting behavioral change, workshop participants discussed a project under way to improve the outcomes of infectious disease control in selected developing countries. The 5-year effort is hosted by the Johns Hopkins University School of Public Health, in partnership with a number of other organizations, and is supported by the U.S.
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The advocacy teams strive, for example, to get policy makers to add more money to national health budgets, to increase allocations for controlling infectious diseases, to adopt policies that will most effectively address health needs, to fill vacant positions in the health workforce, and to take action to reduce the stigma often associated with some of these diseases. The second audience includes health service providers.
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Workshop participants noted that not only is there a moral and social argument for industrialized nations to move aggressively in sharing emerging scientific knowledge and tools, but there is also an argument based on enlightened self-interest. Since infectious diseases often emerge first in the developing world, controlling them on that "front line" might prevent or at least slow their spread globally.
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and global needs for such programs and examined a number of examples of current efforts. Public Health Leadership Public health professionals play key roles in protecting society from microbial threats and in mounting effective responses to disease outbreaks.
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Conducted with help from outside consultants, the evaluation included a survey of scholars (which had a 67 percent response rate) and a set of 18 in-depth interviews of individuals in four groups, including PHLI management and faculty, respected public health leaders who did not participate in the program, CDC staff, and PHLI scholars (for elaboration of survey responses)
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Applied Epidemiology The workforce necessary to improve U.S. and international capacity to respond to microbial threats must be supported with strong training programs in the applied epidemiology of infectious disease prevention and control.
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In addition, the knowledge and skills needed to confront microbial threats must be better integrated into the training of all health professionals. One of the largest current efforts in this area is the CDC's Epidemic Intelligence Service (EIS)
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Many observers have concluded that these programs have contributed significantly to improving their nations' efforts in infectious disease control and prevention. The Public Health Schools Without Walls program, which began in the early 1990s with support and leadership from the Rockefeller Foundation, aims at helping developing nations increase their capacity to train graduates with technical, managerial, and leadership competencies who will respond to practical health problems and direct health systems that are becoming increasingly decentralized (CDC, 2004a)
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Universities and other academic and professional organizations may have an important role to play in this regard, and this role might best be served by their committing to "institutional mentoring" efforts that will be significant in scope and long lasting in duration. Partnerships10 Strategies to improve public health, including efforts to expand the workforce and to combat infectious diseases, increasingly highlight the need and value of forming partnerships.
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The network provides up-to-date information about emerging infectious diseases of international importance, and it seeks to encourage timely and effective notification and control of disease outbreaks. In order to enhance the network's value, researchers from the University of Washington School of Public Health recently developed and tested a new set of instructor-led learning materials and placed them on the Web site, supplementing a viewer-guided page of electronic links to library resource materials.
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. Particular attention needs to be paid to the developing world, where the burden of infectious diseases is greatest.
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During the workshop, participants made clear that an important part of helping developing nations improve their capacity to handle microbial threats will be to help them to improve their scientific and medical workforces charged with controlling infectious diseases. Framing the Issue Data regarding health workforces in developing nations are limited and largely anecdotal, but participants generally agreed that the apparent shortcomings constitute a crisis.
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Although these programs are valuable in their own right, they will perform best if they rest on robust public health systems within each developing country. This will require increasing the size of the workforces, enhancing the skills of health professionals and allied workers, and strengthening motivations for countries to invest in workforce development and for professionals to choose public health as a career (El Ansari and Phillips, 2001)
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The FIC also conducts the International Training and Research Program in Emerging Infectious Diseases, which was started in 1995 and operates in partnership with several institutes within the NIH. Modeled on the AIDS program, it offers foreign scientists advanced training opportunities at the NIH or U.S.
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Geological Survey. It provides grants to multidisciplinary teams of researchers, in both foreign countries and the United States, who will collect data on a range of topics, with the goal of improving current ability to predict the outbreak of infectious diseases.
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The DoD labs also hold workshops devoted to outbreak response. Professionals from ministries of public health and workers from local and regional health departments attend the workshops, which may last 2 to 3 weeks, to gain skills that will help them better detect emerging infectious diseases on their own.
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Workshop participants universally agreed that the nation must be kept safe, but many of them expressed concern that some of the new security measures may unduly interfere with how research and scientific training are conducted, both in the United States and internationally. Most of the discussions focused on two issues: the system that controls how visas are issued to foreign scientists and students wanting to enter the United States; and the system that controls who may work with certain biological agents and toxins that pose a severe threat to public health and safety ("select agents")
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Foreign scientists and students already in the United States on visas sometimes faced problems as well. In some cases, if a person were to leave the country even briefly -- perhaps to attend a scientific conference or to go home for a visit -- then he or she would have to obtain a new visa and possibly be subject to the same delays that new applicants faced.
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who are involved in programs that bring foreign scientists and students to the United States need to provide them with up-to-date information about the visa application process. When organizing meetings, staff appointments, collaborative research ventures, or fellowship programs that involve foreign scientists and students, U.S.
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laboratories to recruit foreign scientists who have such experience. But following the 2001 terrorist attacks, the government passed the USA Patriot Act, which placed added restrictions on who could have access to select agents within U.S.
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Of course, an important part of helping developing nations improve their capacities to meet microbial threats will be to help them strengthen their scientific and medical workforces charged with controlling infectious diseases. Additional U.S.
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For example, the scientific community is adopting a more systemic view of infectious disease, in which microbes and humans are intricately entwined, and this shift is increasing the need to recruit people from previously overlooked disciplines into the biological arena. Physicists and chemists, mathematicians and computer scientists, evolutionary biologists and ecologists -- all are joining with traditional microbiologists and immunologists to answer complex questions that once were difficult if not impossible to address.
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As participants noted, for example, efforts are needed to boost the supply of physicians who specialize in infectious diseases. ID physicians are and will remain instrumental in meeting microbial threats, but evidence suggests that their numbers are seriously lacking.
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and private foundations can play important roles in fostering such multidisciplinary projects. One major challenge that the nation already faces -- and will continue to face -- as it strives to strengthen the infectious diseases workforce arises not from science or the microbial world, but rather from the government's own policies.
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. Panel Discussion at the Institute of Medicine Workshop on Ensur ing an Infectious Disease Workforce: Education and Training Needs for the 21st Cen tury.
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. Panel Discussion at the Institute of Medicine Workshop on Ensuring an Infectious Disease Workforce: Education and Training Needs for the 21st Century.
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. Panel Discussion at the Institute of Medicine Workshop on Ensuring an Infectious Disease Workforce: Education and Training Needs for the 21st Century.
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. Panel Discussion at the Institute of Medicine Workshop on Ensuring an Infectious Disease Workforce: Education and Training Needs for the 21st Century.
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