President Joe Biden’s multibillion-dollar effort to expand the public health workforce will likely take months to stand up, putting thousands of disease investigators and contact tracers to work as the U.S. turns the corner on Covid-19 infections and deaths.
The federal government will offer states $7.4 billion to recruit and hire public health workers to respond to Covid-19 and prepare for future crises, Biden announced Thursday. Most of that money, $4.4 billion, will allow state and local health departments to hire specialists to do vaccination outreach, virus testing, and contact tracing.
The new workforce also will need to be able to deal with issues beyond Covid-19, from sexually transmitted diseases to the opioid crisis, health officials say. Otherwise, Biden may create a massive army of public health experts focused on the wrong problems.
“What might happen is we put the resources in the wrong places and we waste the opportunity to improve public health for everyone,” said Leana Wen, an emergency physician and public health professor at George Washington University who previously served as Baltimore’s health commissioner.
“Covid is not the only public health problem there is,” she said.
The hiring is slated to occur as U.S. Covid-19 rates are expected to drop. For the first time this year, the country saw fewer than 40,000 new cases per day over a full week. Roughly 60% of U.S. adults have received at least one dose of a Covid vaccine, government data show.
However, other health issues lingered or worsened through 2020. Almost 89,000 people died of drug overdoses in the U.S. the 12 months leading to October 2020, the highest number of such deaths over a year-long span in recent history, according to Centers for Disease Control and Prevention data.
The U.S. saw 2.5 million cases of chlamydia, gonorrhea, and syphilis in 2019, an almost 30% increase in those STDs between 2015 and 2019, the latest CDC data show.
These trends worsened while the public health workforce shrank.
The public health workforce lost about 50,000 personnel over the last few years primarily due to chronic lack of investment, Georges C. Benjamin, executive director of the American Public Health Association, said.
“Every time something bad happens, people kind of think that it’s over and they stop investing, and the money goes away,” Benjamin said. He noted there’s a shortage specifically of Epidemic Intelligence Service officers as well as laboratory personnel.
The newly announced funds could pay for as many as 6,000 new disease intervention specialists, who work in public health departments to track the spread of diseases, David Harvey, executive director of the National Coalition of STD Directors, said. The hope is that these new “disease detectives” can be used broadly by state or local health departments, he said.
“These are the silent warriors of the public health system that protect people’s health by ensuring they have safe water, food and are free of disease,” Harvey said.
In some cases, state and local health departments will need permission to add new personnel, whereas others can take temporary jobs and make them permanent, Benjamin said.
“There are going to be challenges for states to spend this money in a timely way,” he said. “They’re going have to sit down and think about what their workforce is going to look like in the future.”
Timing may be an issue, but states have already hired temporary contact tracers and community vaccination workers. The new initiative may help keep some of that workforce in place, Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, said.
The new plan “brings the resources and investment public health has been needing for decades,” Plescia said in an email. “Yes there are concerns about flexibility and sustainability but we are now hearing at least some of the funding will be released over a five-year period, which will help address potential hiring reluctance in some jurisdictions.”
How flexible the White House will be with the new funds remains to be seen as well as whether the new hires will have to tackle Covid or if they’ll be focused on areas hardest hit by the virus or states where public health resources are the most drained, Wen said.
Local health departments already lost 20% of their workforce capacity as they went into the pandemic, Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, said in a statement. “The local public health system nationwide has been starved over the past few decades.”
During the pandemic, STDs have increased along with mental health issues while epidemics such as opioids, obesity, and firearm violence never went away.
Covid-19 “is probably going to transform itself into an ongoing disease that’s going to be with us for probably a few years, if not forever,” Benjamin said. “So the ability to do contact tracing, testing, is going to be important.”
The funding plan includes both a short-term piece to “to help us cross the finish line” and end the pandemic along with a $3 billion grant program that looks at building the workforce into the future, he said.
Much of those funds are expected to be doled out over a five-year span and the White House is signaling to lawmakers it plans to renew the funding when it expires, according to two people briefed by administration officials.
The plan to build the workforce comes from a single pot of funds, and public health officials have called for years for more permanent funding.
“There’s a recognition that this is one time money. And then there’s a recognition that we do need to build something more robust in the future,” he said. “And there are efforts to put that into both the appropriations process and the authorization process.”
Stable, long-term funding is even more important than intermittent surges of funding as public health departments have been chronically underfunded, both domestically and globally, Tom Frieden, former director of the Centers for Disease Control and Prevention, who as president and CEO of the global health nonprofit Resolve to Save Lives, a global health initiative of Vital Strategies.
While funding boosts can jump-start progress, “you’ve got to make sure there’s still gasoline to keep running it.”
“We have to make sure the whole public health system and that all these previous supplemental funding surges have an off ramp, so we don’t get into the situation a s we get did with Ebola with a lot of money going in, a lot of the good things done —and the money dries up,” Frieden said. His group receives funding from Bloomberg Philanthropies.
CDC Director Rochelle Walensky, said Thursday there have been measles cases, two Ebola outbreaks, salmonella and other issues the agency had to handle while working on Covid-19.
“We’ve been able to handle that, but we need a public health infrastructure, we really need a more robust workforce, we need a data modernization, which has really been lacking, as well as modernization of our public health labs,” she said.