As Covid-19 rages, about 4,000 highly skilled epidemiologists, communications specialists and public health nurses have been recruited by a nonprofit organization affiliated with the Centers for Disease Control and Prevention to plug the holes in public health departments battered on the front lines.
But over the past few months, most of the CDC Foundation’s contracts for public health workers at local and state departments have ended as the group spent nearly all of its $289 million in covid relief funding. The CDC Foundation, an independent nonprofit organization that supports CDC’s work, expects more than about 800 of its 4,000 paid employees to eventually work in those jurisdictions, said spokesman Pierce Nelson.
That has left many local and state health departments understaffed as the nation anticipates a possible winter surge in covid cases and grapples with the threat of monkeypox. explosive charges sexually transmitted infections and other public health problems.
The public health workforce in the US has been underfunded for decades—before the pandemic, only 28% of local health departments had an epidemiologist or statistician. 2020 Associated Press–KHN investigation found. Then public health workers after the pandemic started left in droves they have been criticized for implementing covid rules, blamed for the economic downturn and have struggled with burnout.
Even if funding were available to retain all 4,000 foundation staff, it would not meet the needs of health workers. new research into Journal of Public Health Administration and Practice. At least 80,000 new employees are needed for state and local public health departments to implement the minimum package of public health services, the study found.
However, funding for the foundation’s work was always time-limited because it was intended to help respond to the covid emergency. While the American public’s concerns about covid have subsided, public health experts warn that this is yet another example of the public health sector being underfunded with annual, guaranteed money — leaving the country unable to prevent and properly respond to outbreaks.
“So that boom and bust period It continues despite a million Americans losing their lives to covid,” he said Brian Castrucci, who co-authored the report and heads the de Beaumont Foundation, which advocates for increased support for the nation’s public health. “How many Americans are going to die before we solve this problem?”
Unlike the thousands of inexperienced contact tracers hired to track covid patients to prevent transmission during reproduction, this CDC Foundation workforce usually had public health experience that could fill in the gaps. Dr. Judy Monroe, the foundation’s chief executive, said local and state officials loved the foundation’s ability to cut through the red tape of recruiting, and to her, “it was like a cavalry charge.”
In Chicago, CDC Foundation employees make up about one-tenth of the city’s public health workforce, Dr. Allison Arwady, commissioner of the city’s public health department. Although 26 of those 66 employees were extended through December, losing the rest would hurt, he said. They contributed to everything from public health nursing to bringing the latest pandemic guidance to Chicagoans.
CDC Foundation leader Cayenne Levorse, who is helping organize the foundation’s response in Ohio until her contract expires in October, said her 20 employees must not only work on covid projects, but also help local health departments monitor cancer clusters, rural health disparities and the environment. Health problems.
“These jobs are just sitting there, all unfinished business,” he said.
Five people hired for CDC Foundation covid contracts said KHN they were under the impression that their contracts would likely be extended or they would be hired by local or state governments receiving a flood of covid dollars. Only one of them had a contract until November 8.
Katie Schenk, a senior epidemiologist with a doctorate in public health, conducted covid surveillance for the CDC Foundation at the Illinois and Washington, DC, health departments. Both contracts expired and he was out of a job this summer.
“How do you explain the lack of funding for employment in our field when there is so much work to be done?” he asked. “This is to the detriment of a public health system that is laying off staff like there’s no tomorrow.”
State and local health officials expect $3 billion in November covid relief money aims to strengthen the public health workforce. But that funding comes after most CDC Foundation contracts have ended and those employees have moved on with their lives.
While the amount is significant and will help close an 80,000-job gap, many public health officials and experts have stressed that the cash is short-term and intended to last five years — which could make it difficult to fill positions as candidates seek job stability. It is also shared among the 50 states, US territories, and numerous major health departments. And some state and local officials, such as those who are there Missouri and Michigan has refused to spend covid dollars on public health departments amid a backlash against the pandemic response.
Even with federal money, state and local governments sometimes have restrictions on hiring full-time workers, Monroe said. In some places, he said, wage freezes or reluctance to spend more on health workers than on other government workers have made it difficult to hire highly skilled workers such as epidemiologists. CDC Foundation salaries and benefits are sometimes better than those available at local and state level jobs, Monroe said. Many of the foundation’s staff could face pay cuts if they chose to remain in local departments.
“You certainly don’t go into public health to get rich,” said epidemiologist Susan Knoll, who worked in the private sector as a health consultant after working for the CDC Foundation in Ohio. “You get a grant-funded job. And then you always look for another job.”
That’s “the reality of how we fund public health in this country,” he said Chrissie Juliano, executive director of the Greater Cities Health Coalition.
“We go up and down and don’t think about the day-to-day,” he said. “We must not lose qualified people who are committed to working in public health as a field. These are the people who need to be saved.”
At least 38,000 From the 2008 recession to 2019, public health jobs were lost at the state and local level. Then covid hit, and 1 in 5 Americans lost a local public health leader amid the political backlash of the early years of the pandemic. 2021 AP-KHN research found.
Some of the remaining workforce is looking out the door. Director of North Carolina Granville Vance Public Health department, Lisa Macon Harrison, said she sees 15% to 20% turnover even after implementing flexible benefits, which she blames on burnout.
Levorse noted that epidemiologists and other workers with advanced degrees have student loans to pay and worry about losing health insurance every time the grant runs out.
Arvadi of Chicago said the lack of a steady source of money year after year puts the health department’s programs in jeopardy. He estimates the city will lose 86% of its existing grant funding within two years, putting wastewater tracking, some of his department’s IT staff and community-based assistance on the chopping block.
“We won’t be able to do half the things that the city of Chicago expects of us. ‘Can I bring a vaccine to your home?’ This ‘Can I even stand up as your neighborhood vaccination clinic?’ he said. “I’m afraid that’s how far back we’re going to slide.”
Harrison said he’s seen it all before: After 9/11, funding for pandemic preparedness came in, and then money for staff went, leaving departments flat-footed for covid.
Castrucci of the De Beaumont Foundation spoke of how the current funding structure ensures that the public health sector, which exists to prevent outbreaks and diseases, is not staffed to do so until an emergency occurs.
“You’re basically saying we’re going to wait for the fire to burn until we hire firefighters,” he said.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Inquiry, KHN is one of the three main operational programs KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information about health problems to the country.