2 tables omitted
The anthrax attacks in fall 2001 highlighted the role of infectious
disease (ID) epidemiologists in terrorism preparedness and response. Beginning
in 2002, state health departments (SHDs) received approximately $1 billion
in new federal funding to prepare for and respond to terrorism, infectious
disease outbreaks, and other public health threats and emergencies.1 This funding is being used in part to improve epidemiologic
and surveillance capabilities. To determine how states have used a portion
of their new funding to increase ID epidemiology capacity, the Iowa Department
of Public Health's Center for Acute Disease Epidemiology and the Iowa State
University Department of Microbiology conducted two surveys of U.S. state
epidemiologists during September 2000–August 2001 and October 2002–June
2003. This report summarizes the results of these surveys, which determined
that although the number of SHD epidemiology workers assigned to ID and terrorism
preparedness increased by 132%, concerns remained regarding the ability of
SHDs to hire qualified personnel. These findings underscore the need to develop
additional and more diverse training venues for current and future ID epidemiologists.
All 50 SHDs responded to both surveys. A total of 47 SHDs reported adding
or expecting to add ID epidemiologists, who were assigned various responsibilities
(e.g., terrorism preparedness, ID and terrorist agent surveillance, outbreak
and possible terrorist threat investigation, public health worker and health-care
provider training, and grant writing) (Table 1). Overall, during 2001-2003,
the number of epidemiology workers employed in ID and terrorism preparedness
increased by 132%, from 366 to 848 (Table 2).
Despite these hiring increases, the surveys identified multiple challenges,
including problems (1) allocating time for planning (66% of responding SHDs),
(2) establishing disease surveillance systems (55%), and (3) hiring qualified
ID epidemiologists (57%). Other challenges to preparedness included the complexity
of food-security issues, state hiring freezes and budget deficits, political
and public policy considerations, and difficulty allocating the necessary
time and resources for the pre-event smallpox vaccination program.
G Shipp, MPA, J Dickson, PhD, Iowa State Univ, Ames; P Quinlisk, MD,
C Lohff, MD, Iowa Dept of Public Health, Des Moines, Iowa. N Franklin, 2002
Knight Public Health Journalism Fellowship Program, CDC Foundation, CDC.
Long before the terrorist attacks of September 11, 2001, and the subsequent
anthrax attacks, public health officials recognized that the U.S. public health
infrastructure was not equipped to respond adequately to events of biologic
terrorism and other national public health emergencies.2 In
2003, the number of qualified persons employed in microbial threat preparedness
remains dangerously low.3 Since 2001, Congress
has appropriated increased amounts of funding to improve the overall capacity
of state public health departments for terrorism preparedness.1 This
funding was key to increasing the number of ID epidemiologists and the surveillance
and response capabilities of SHDs. However, barriers to preparedness remain,
and continued public, political, and financial support are essential to removing
The findings in this report are subject to at least two limitations.
First, the surveys were conducted during a period when the responsibilities
of ID epidemiologists were in rapid transition, making consistent categorizing
by utilization difficult. Second, although all SHD workers described in the
surveys performed duties related to epidemiology, because of broad differences
in academic background and experience, the nature of their roles and abilities
were highly variable.
The findings in this report reflect concerns expressed by respondents
to the national Epidemiology Capacity Assessment (ECA) regarding inadequate
epidemiology staff and resources to conduct the 10 essential public health
services.4 In the ECA survey, as of November
2001, approximately 42% of epidemiology workers were reported to have had
no formal training in epidemiology, underscoring the need for increased curricula
and training programs to improve the capabilities of current and future state
and locally based ID epidemiologists.
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