Lab Matters Spring 2021 | Page 26


Preparing the Laboratory Workforce for the Next Pandemic

By Sam Abrams , MPH , senior specialist , Public Health Preparedness and Response
Public health laboratories provide critical testing to help the nation mount an effective response to a range of threats , including emerging infectious diseases such as COVID-19 . Since February 2020 , public health laboratories have tested over 14 million specimens for the SARS-CoV-2 pathogen and continue to maintain a high level of surge capacity for the pandemic . This level of crisis response requires a highly skilled and dedicated workforce . Yet , public health laboratories are chronically underfunded , with resources often provided only at the height of a response . Such a crisis-driven funding approach does little to ensure a warm base — a skilled workforce , equipment , innovative methods , communications and partnerships — for the next pandemic .
Although public health laboratories receive some funding support from state and local governments , the federal government provides the majority of preparedness and response funding . Via the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases Cooperative Agreement ( ELC ) and the Public Health Emergency Preparedness Cooperative Agreement ( PHEP ), the US Centers for Disease Control and Prevention ( CDC ) is the primary funder of state , local and territorial public health laboratories . ELC and PHEP are the bedrock mechanisms for supporting preparedness and response to all-hazard threats .
A Foundation for Preparedness
High testing demands due to the COVID-19 pandemic exposed workforce challenges faced by public health laboratories , an issue which has plagued these laboratories for many years . CDC and APHL stepped up to provide temporary support via the COVID-19 Laboratory Associate Program , a fulltime working appointment for bachelor- , master- and doctoral-level scientists . Associates are placed in US local , state and territorial public health laboratories to assist with the COVID-19 pandemic response . Appropriate training is provided as needed . Once in their host laboratories , associates are supervised by laboratory personnel and work on projects proposed by the host laboratory . In addition to laboratory-specific work , associates participate in distance-based training and learning activities to achieve proficiency in select public health laboratory core competencies .
However , given declining PHEP and other funding coupled with non-competitive salaries , hiring freezes and lay-offs , public health laboratories are lagging behind in workforce readiness . In fact , many laboratories have experienced significant impacts in their ability to respond to public health testing needs because of workforce issues . According to data collated in the 2020 APHL Annual All-Hazards Laboratory Preparedness Survey , from July 1 , 2019 to June 30 , 2020 , 55 % of state public health laboratories experienced slower testing turnaround time for routine testing , with 51 % forced to put non-COVID testing entirely on hold for extended periods of time . During that same time , 98 % of public health laboratories required staff to work additional hours and shifts , which can lead to burnout and increased stress in an already challenging environment .
Ensuring Community Safety
These workforce issues impact the broader health system , as public health laboratories provide vital training on biosafety , biosecurity , packaging and shipping of hazardous materials , and conduct outreach to important stakeholders in the public health community . For instance , 87 % of public health laboratories experienced barriers to providing biosafety training to sentinel clinical laboratories ( e . g ., hospitals ), with 53 % of public health laboratories unable to visit any sentinel clinical laboratories in their jurisdiction .
Philip Kurpiel sets up Cepheid Xpert ® Xpress SARS-CoV-2 assay cartridges . Photo : New York City Public Health Laboratory
While public health laboratories have found a way to operate through a challenging response , the current model is not sustainable . CDC PHEP funding has steadily declined since the initial infusion following the anthrax attacks of 2001 . This has created a challenging fiscal environment for public health laboratories to maintain adequate staffing levels needed to support a large-scale response such as during a pandemic . While justin-time funding measures such as the Coronavirus Aid , Relief , and Economic Security ( CARES ) Act help increase staffing in laboratories , these positions are only temporary and do not allow for laboratories to be adequately prepared as issues emerge . Pandemics require a quick response to provide sufficient testing , which can only be achieved with an existing sufficient and skilled workforce in place . Sustained funding will help address the biggest bottleneck for public health laboratories and ensure that the nation is ready for the next pandemic . n
24 LAB MATTERS Spring 2021
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