Executive Summary

The importance of a robust public health infrastructure is the cornerstone for preparing for and responding to infectious disease threats regardless of their origin (natural or man-made).  During the past 10 years, several infectious disease outbreaks have shaped current policy developments surrounding public health preparedness. While all but one disease outbreak – the 2001 anthrax attacks in the United States – emerged naturally or accidentally in the human population, their impact on domestic and international public health has been profound. 

Within the U.S., there has been increased funding to boost scientific, public health, and first response capabilities against a disease outbreak from chemical, biological, radiological, and nuclear agents.  High-risk municipalities have been given financial support to improve their public health and traditional first response systems as well as disease surveillance capabilities.  States have been given vehicles to stockpile vaccines and drugs against threat agents, and state agencies play important roles in confirming and mitigating infectious disease outbreaks.  Policy discussions have gone beyond traditional first responders and public health professionals to scientists, veterinarians, and community leaders. 

The U.S. and many other nations have developed national pandemic influenza preparedness plans.  In 2005, the World Health Assembly approved a revised version of the International Health Regulations, which requires improvement of national disease surveillance and public health infrastructures, redefines the criteria for a public health emergency of international concern, allows the World Health Organization (WHO) to use unofficial sources to identify unusual disease outbreaks, and gives WHO the authority to impose travel and trade restrictions on nations with uncontrollable disease outbreaks.  In the midst of these advances in public health, the U.S. and global community have developed and implemented education programs to train relevant audiences, from first responders to public health officials, on how to prepare for and respond to infectious disease threats.  Despite these efforts, there are still major challenges in developing a multi-generational and multi-disciplinary workforce that can respond to unusual infectious disease threats.

Two units of AAAS—the Center for Science, Technology and Security Policy and the Program on Scientific Freedom, Responsibility and Law – have conducted a study on building a knowledgeable workforce to prepare for and respond to infectious disease outbreaks, natural or man-made.  The goals of this study were:

• to document and describe existing educational programs and materials on infectious disease preparedness programs;
• to highlight major challenges and knowledge gaps associated with existing educational initiatives on preparedness and response; and
• to provide recommendations for improving the overall system of workforce development for human health preparedness and response.

We convened a group of experts in public health, nursing, medical, veterinary, and first responder education on infectious disease response, as well as experts in areas including biosecurity and public health law on May 26, 2009 at AAAS to review existing educational programs on infectious disease preparedness and response, and provide recommendations for improving workforce development activities in this area.

Workshop Summary

Several education initiatives were presented and discussed at the AAAS workshop.  There was consensus among the participants that cross-sector training and exercises are among the most useful tools for educating stakeholders on how to work as a team to respond to an infectious disease outbreak.  Educational programs are most successful when lessons are communicated using interactive teaching methods, such as online discussion boards, field experience, and interaction between academic experts and stakeholders in the community. Since all responses start locally, there is a great need to produce a workforce that can work with relevant stakeholders from all appropriate levels of government. 

Significant progress has been made in the development of programs, tools, and core competencies for educating health professionals and first responders about preparing for and responding to infectious disease threats.  However, several challenges still remain.  In the upcoming decade, approximately half of the workforce at public health departments will be eligible to retire and the next generation of public health professionals is not being educated at a commensurate rate to fill this loss.  This pending loss in public health workforce is exacerbated by the age of physicians and nurses, whose average age is currently in the late forties.  Initial and continuing education about infectious disease preparedness and response must be a priority through sustained funding and development of additional educational resources. There was discussion about the need to cross-train stakeholders in a team-based manner to facilitate cooperation in an actual public health emergency.  Participants also noted the utility of defining the national capacity needed, developing decision-type resources, and identifying core competencies and standards for different preparedness stakeholders and functions. While some efforts have been devoted to developing core competencies, these are mainly in the public health and health care communities. Other communities with health-related responsibilities[1] also require appropriate training and could benefit from the development of core competencies and standards around which to design education programs.  Questions remain regarding the availability, experience-level, and retention of instructors.  Few financial incentives exist for subsidizing education for the relevant workforce and few mechanisms exist for including field training in education programs.

Workshop participants highlighted several major gaps and challenges:

Current Workforce and Education

·   The health care workforce (including public health professionals, clinicians, and related health care fields) in the U.S. is approaching retirement age and there is a need for a strategic plan for educating enough health care personnel to fill this gap.

· Although academic institutions are starting to employ retired or adjunct professors with real-world experience to educate students, this is not uniform.  There is a clear need to hire educators with real-world experience and to have students participate in apprenticeships or internships to gain field experience.

· There is a need to develop information tools that are duty appropriate.  Some information may be critical to have incorporated into formal education programs, some may be appropriate to provide on a periodic basis as part of continuing education or refresher programs, and some may be appropriate as reference only.

· Few public health lawyers have experience in responding to public health emergencies.  There is a greater need to provide public health lawyers with field experience[2] so their guidance is appropriate in a real-world setting.

·  There is a shortage of knowledgeable health care workers in many countries due to a lack of educational opportunities and stressful and often-times undesirable working conditions.

Program Development

·  There is a need to incorporate communication training into the curriculum for all stakeholders involved in preparedness and response activities.  This would include strategies for communicating the needs of relevant communities to policy-makers.  There is a need to educate all relevant stakeholders on how to communicate risk before, during, and after an emergency with the general public.

· There are a substantial number of public health preparedness and homeland security programs, but not enough coordination among programs educating the relevant workforce about preparedness and response activities against infectious disease threats.

·  There is no single process for vetting existing programs for their content and usefulness.  This is particularly problematic since some are not accredited.

·  There is a lack of standardized criteria for evaluating whether initial training was successful in raising awareness of or educating about infectious disease preparedness and response.  In addition, there are no mechanisms for evaluating whether information has been retained over a long period of time.

·  There is a need for educational programs that are interdisciplinary and incorporate information or real-world experience addressing the needs of all sectors involved in preparedness and response activities, as well as building relationships between disparate stakeholders, like law enforcement and public health professionals.

· There are few mechanisms for subsidizing the education of the workforce about infectious disease preparedness and response.  There is a need to provide financial incentives for talented individuals to enter the workforce; these may include fellowships, scholarships, or loan repayment.

Recommendations

The programs presented at the workshop and follow-up discussions identified the breadth of existing programs, as well as gaps and challenges in program development.  It is our hope that the findings and recommendations of this report will improve education efforts in support of workforce development for preparedness and response to infectious diseases.

1.      The U.S. government and professional and trade associations should cooperate to integrate and expand existing databases to include all education programs that address preparing for and responding to infectious disease outbreaks and relevant teaching materials.

2.   The U.S. government should develop competency-based criteria for education programs to evaluate the effectiveness of their curricula for training individuals and teams.

3. Federal, State and local  governments should work with educational institutions to provide fellowships, scholarships, tuition remission, loan repayment, or incorporate paid apprenticeships to provide students with real-world experience in their field.

4. Internationally, health care professionals should be educated in greater numbers to reduce the stress on health systems and improve the retention of a knowledgeable and capable workforce.

5.  Education programs should be reconfigured or designed to include competency-training, team-based learning, field experience, risk communication techniques, and communication skills for engaging with policy-makers and the public.

There are a variety of disciplines involved in preparedness and response ranging from emergency response to public health law; practitioners of these disciplines should be required to obtain some training in infectious disease detection, preparedness and response.  The following recommendations are framed with the acknowledgement that the training content and requirements may differ for personnel with different functions.

     6. Three types of education and training should be provided to relevant audiences in preparedness and response.

a.     Vital information: Includes symptoms or clinical signs of dangerous infectious diseases, should be provided to all audiences

b.    Routine, important information: Includes isolation procedures or therapeutic doses, should be taught to all relevant audiences

c.   Emergency-specific information: Includes phone numbers of coordinating agencies (i.e., reference guides), along with a review of vital and important information should be provided in a just-in-time fashion through email communication or embedded within existing decision support software.

7. Professional societies should develop educational tools in consultation with experienced experts in public health, medicine, veterinary medicine, law enforcement, public health law, first response, and epidemiology.  These tools would help existing preparedness and response programs teach their students about all aspects of detecting and responding to infectious disease threats.  They could also support team-based, cross-sector education.

8.     Practitioners from all relevant sectors should, in the course of their training, participate in internships or externships to gain field experience in infectious disease prevention and mitigation.