H1N1 put further strain on public health work force

Although the nation's public health system kept pace with the rapid spread of influenza A(H1N1) earlier this spring, a looming shortage of physicians, nurses and lab workers could make it more difficult to contain a larger threat, several health care organizations warned during a recent briefing.

H1N1 proved a "mild test of our preparedness," said Linda Rosenstock, MD, MPH, dean of the University of California, Los Angeles, School of Public Health at a May 21 Capitol Hill briefing. "And we have done well," she added, noting that the public health work force was stretched to its limit.

Physicians and others at public health departments worked extra hours during the height of the H1N1 outbreak, which meant routine tasks such as restaurant inspections, health education and tuberculosis testing were often put on hold. Workers had to determine quickly what the virus looked like, devise a rapid lab test to identify cases and find out whether antivirals were effective treatments.

"These are the same people who deal with food outbreaks," said Georges C. Benjamin, MD, executive director of the American Public Health Assn. "Now they have to go back and play catch-up with their other work."

More severe shortages of physicians, nurses, epidemiologists, health care educators and administrators are anticipated, Dr. Rosenstock said.

Part of the problem is an aging work force. About a fourth of public health workers are eligible for retirement, she said. And about 15% of each year's 8,000 public health school graduates are international students who return to their home countries to practice.

The nation's economic downturn also has affected public health, said Robert M. Pestronk, MPH, executive director of the National Assn. of County and City Health Officials. In 2008, 7,000 public health staffers lost their jobs, and it is likely that just as many will become unemployed this year, he said.

Bills would provide training funds

Legislators have noted the work force shortage, and have introduced bills to address the need for more physicians. A Senate measure, introduced May 21, would establish scholarship and loan programs to enable schools of public health to award funds to mid-career public health professionals for additional training.

"The recent outbreak of influenza A(H1N1) virus, which has infected thousands of Americans and caused nearly a hundred deaths worldwide, demonstrates why an adequately prepared public health work force is critical to protecting the health of the nation," Assistant Senate Majority Leader Dick Durbin (D, Ill.) said in a statement. Durbin introduced the bill, which has a companion measure in the House.

Meanwhile, a month into the nation's response to the new virus, Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said the agency is transitioning from learning about the new virus to looking to the fall.

"We really are on a fast track over the next eight to 10 weeks to learn as much as we can as this virus heads to the Southern Hemisphere," she said during a May 26 briefing. The agency will watch to see if the virus becomes more resistant to treatment or more severe or transmissible, she said.

The CDC is preparing for the arrival of seasonal influenza this fall and will try to distribute vaccine as early as possible to get the immunization campaign under way, said Daniel Jernigan, MD, PhD, deputy director of the CDC's influenza division. The CDC is working with other federal agencies to develop a vaccine to combat H1N1 should the virus flare in the fall.