As Covid-19 spread, roughly 4,000 highly skilled epidemiologists, communication specialists and public health nurses were recruited by a nonprofit organization affiliated with the Centers for Disease Control and Prevention to plug the holes in public health departments on the front lines.
But over the past few months, most of the CDC Foundation’s contracts for those public health workers at local and state departments have ended as the group spent its nearly $289 million in Covid relief funds. The CDC Foundation, an independent nonprofit that supports the CDC’s work, estimates that no more than about 800 of its 4,000 recruits will eventually staff those jurisdictions, said spokesman Pierce Nelson.
That has left many local and state health departments facing staff shortages as the country braces for a potential winter surge in Covid cases and grapples with the ongoing threat of monkeypox, an outbreak of sexually transmitted infections and other public health issues.
The public health workforce in the U.S. has been underfunded for decades — just before the pandemic began, only 28% of local health departments had an epidemiologist or statistician, a 2020 Associated Press-KHN investigation found. Then, after the pandemic began, public health officials left in droves as they were vilified for establishing Covid rules, blamed for the economic downturn and struggled with burnout.
And even if funding were available to retain all 4,000 foundation employees, it would not meet the needs of public health workers, according to new research in the Journal of Public Health Management and Practice. State and local public health departments need at least 80,000 new employees to implement a minimum package of public health services, the study says.
However, funding for the foundation’s work has always been time-limited as it was intended to aid the Covid emergency response. And while the American public’s Covid anxiety has subsided, public health experts warn that this is another example of the failure to properly fund the public health sector with annual, guaranteed money — leaving the country unable to prevent and properly fight the outbreak.
“So the boom-and-bust cycle continues even after a million American lives have been lost to Covid,” 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 American deaths will it take until we solve this problem?”
Unlike the thousands of inexperienced contact tracers tasked with following Covid patients to prevent the spread of the outbreak, this CDC foundation workforce typically had public health expertise that could fill previously existing gaps. The foundation’s head, Dr. Judy Monroe, said local and state officials loved the foundation’s ability to recruit red tape, telling her “it was like showing off the cavalry.”
In Chicago, CDC Foundation employees make up about one-tenth of the city’s public health workforce, said Dr. Alison Arwadi, commissioner of the city’s Department of Public Health. Although he said 26 of those 66 employees have been extended through December, he said losing the rest would be a loss. They have contributed to everything from public health nursing to providing Chicagoans with the latest guidance on the epidemic.
Ken LeVorce, a CDC Foundation leader who helped organize the foundation’s response in Ohio until his contract ended in October, said his 20 employees will not only have to set up the Covid project but also track local health departments on cancer clusters, rural health disparities and environmental issues. have to help Health problems.
“Those works are sitting, all the work remains unfinished,” he said.
Five people hired by the CDC Foundation for Covid contracts told KHN they anticipate their contracts will likely be extended or local or state governments will hire them after receiving a flood of Covid dollars. As of November 8, only one of them had a contract.
Senior epidemiologist Katie Schenk, who holds a doctorate in public health, conducted Covid surveillance for the CDC Foundation in Illinois and the Washington, D.C., Department of Health. Both contracts expired, and he was let go this summer without a job.
“How do you explain that there is no funding for employment in our field when there is clearly so much work to be done?” she asked. “It’s to the detriment of the public health system, which is leaving workers like there’s no tomorrow.”
Sometime in November, state and local health officials expect $3 billion in Covid relief money to strain public health workers. But that funding is coming after most of the CDC Foundation’s contracts have expired and those employees have moved on with their lives.
While that figure is substantial and will help close the 80,000-worker gap, many public health officials and experts insist the cash is short-term and slated to last five years — which could make it harder to fill positions as candidates seek job stability. It is divided among the 50 states, US territories, and several major health departments. And some state and local officials, such as in Missouri and Michigan, have refused to spend Covid dollars on public health departments amid a backlash against the pandemic.
State and local governments sometimes place caps on hiring full-time employees even if federal money is available to do so, Monroe said. He said some areas have frozen salaries or are unwilling to pay more for health officials than other government employees, making it difficult to hire highly skilled workers such as epidemiologists. And the pay and benefits at the CDC Foundation were sometimes better than what was available at local and state-level jobs, Monroe said. Many foundation staff may face pay cuts if they choose to stay with local departments.
“You definitely don’t go into public health to get rich,” says epidemiologist Susan Knoll, who took a private-sector job as a health consultant after working for the CDC Foundation in Ohio. “You get a grant-funded job. And then you’re always looking for another job.”
“That’s the reality of how we finance public health in this country,” said Chrissy Juliano, executive director of the Big Cities Health Coalition.
“We ramp up, and we ramp down, and we don’t think about routine work,” he said. “We must not lose qualified people committed to working in public health as a field. They are the people who need to be saved.”
At least 38,000 public health jobs at the state and local level have been lost since the 2008 recession through 2019. Then Covid hit, and 1 in 5 Americans lost a local public health leader in the 2021 pandemic’s first year of political backlash. AP-KHN investigation found.
Some of the remaining workers are keeping an eye on the door. Lisa Macon Harrison, director of the Granville Vance Public Health Department in North Carolina, says she’s seeing 15% to 20% turnover even after introducing flexible facilities, which she attributes to burnout.
Levores noted that epidemiologists and other workers with advanced degrees worry about paying off student loans and losing health insurance every time the grant runs out.
The lack of a steady source of funding for years is putting health department programs in jeopardy, Chicago’s Arwady said. He estimates the city will lose 86% of its current grant money in two years, putting wastewater tracking, some of his department’s IT staff and community-based outreach on the potentially cut block.
“We’re not going to be able to do half a dozen things that the city of Chicago clearly expects us to be able to do. Forget ‘can I bring the vaccine to your house?’ It’s ‘Can I stand like a vaccine clinic in your neighborhood?'” she said. “That’s the level of how far back I’m afraid we’re going to slide.”
Harrison said he’s seen it before: A flood of funding for pandemic preparedness came after 9/11 and then money for staffing went away, leaving departments flat-footed for Covid.
Castrucci, of the de Beaumont Foundation, how the current funding structure ensures that the public health sector, which exists to prevent outbreaks and disease, will not be 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.
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