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Science  28 Aug 2009:
Vol. 325, Issue 5944, pp. 1087
DOI: 10.1126/science.325_1087

28 August 2009

Edited by Edward W. Lempinen

Public Health

Report: Shrinking Health Workforce Risks U.S. Outbreak Response

Although the country's top health officials say that they have made extensive preparations for this year's H1N1 flu season, a new report from AAAS warns that a looming shortage of infectious disease experts could hamper the U.S. response to future pandemics.

In the next decade, nearly half of the public health department workforce will be eligible to retire, and physician and nurse shortages will strain the resources necessary to prepare and respond to an outbreak. The next generation of public health workers is not being trained at a commensurate rate to fill these vacancies, and the country lacks a strategic plan to educate these responders, the report says.

“As we develop new programs for infectious disease prevention and response, we also need to make sure that there is a sizable and well-prepared workforce to implement those initiatives,” said report coauthor Kavita Berger, project director at the AAAS Center for Science, Technology and Security Policy.

The report—“Workforce Development: Preparing the Next Generation against Infectious Disease Threats”—is the outcome of a 26 May workshop at AAAS that brought together public health educators and experts in biosecurity and public health law. The workshop, organized by the center and the AAAS Scientific Freedom, Responsibility and Law Program, was followed by a 2 July briefing at AAAS at which top public health officials focused on responding to the H1N1 virus.

At the briefing, speakers were cautiously optimistic about the government's vaccine development and flu response programs. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said that the federal government has been aggressively preparing for an infectious disease outbreak for the past several years.

Rear Admiral Anne Schuchat, an assistant U.S. surgeon general, said that one of the largest challenges the government faces is communicating the risks and steps to control the outbreak, while correcting misinformation.

Meeting such challenges could become increasingly difficult as the infectious disease workforce dwindles. But according to the new report, even today's health workers may not be properly trained in fields such as risk communication and disaster planning.

Future threat.

Nearly half of the U.S. public health department workforce could retire in the next decade.

A decade of threats, from the 2001 anthrax attacks to the emergence of SARS and avian flu, led to a proliferation of education programs for outbreak responders. But the plans have been developed without a common guiding curriculum, the report concluded, and few have been rigorously evaluated to determine their effectiveness.

“It is surprising to me, eight years after the anthrax attacks … that there are still so many questions about the most effective way of training people,” said workshop participant Julie Fischer, a senior associate at the Henry L. Stimson Center's Global Health Security program. “We're still struggling to find a way to take the best practices and share them with the right stakeholders.”

Training differences were illuminated during the anthrax attacks, when the first case was detected in Florida by a doctor who had just returned from a bioterrorism responder program at the U.S. Centers for Disease Control and Prevention. The doctor accurately diagnosed the disease and contacted a local hospital, state public health laboratories, and the CDC for confirmation. New York City health officials were much slower in confirming later anthrax attacks, the report noted, in part because the officials did not receive the same training.

The front lines of an outbreak include responders from a variety of backgrounds, and the report encourages cross-training of professionals to better anticipate outbreaks and respond to a disease's far-reaching and sometimes unexpected effects.

“Communities worry about leaks into the local environment. Local responders must be prepared to treat persons exposed to toxic pathogens. Lawyers and local government officials need to balance individual rights such as the freedom to travel with the possible spread of a lethal infection,” said Mark S. Frankel, director of the Scientific Freedom, Responsibility and Law Program.

As the H1N1 pandemic demonstrated again last fall, infectious disease preparedness is a worldwide concern. In 2007, the United States joined 193 countries in adopting the World Health Organization's International Health Regulations 2005. Under the agreement, the U.S. is legally obligated to improve its public health capacity as part of an international effort to fight infectious disease.

The report recommends international standards and increased funding for training infectious disease workers in developing countries. “These are the places that have the greatest risk of emerging diseases … and they are the places that generally have the smallest skilled lab workforce,” said Fischer. Robust global cooperation, she noted, could lessen the impact of future pandemics.

Read the full report at

Science Policy

AAAS Issues Guide to S&T Policy Studies

AAAS has updated and expanded its Guide to Graduate Education in Science, Engineering and Public Policy, a valuable resource for the growing corps of students and professionals who are considering a career in public policy as a way to address climate change, energy, and other global issues.

The 4th edition of the guide—available for free online—includes a list of over 40 schools in the United States and abroad that offer special graduate programs in science, engineering, and public policy (SEPP), along with a discussion of possible career paths, answers to frequently asked questions, and a wide-ranging collection of helpful links.

“The institutions and programs listed in the SEPP Guide are essential to meeting the growing demand for individuals who can bridge the two worlds of science and policy,” said Al Teich, director of Science and Policy Programs at AAAS.

Find the guide at

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