Top 5 Takeaways

1. Workforce Increase: From 2017 to 2021, the number of epidemiologists in state health departments increased by 23%, primarily due to the COVID-19 response.
2. Funding Reliance: Federal funding supports 85% of epidemiology activities and 83% of personnel, with a significant portion designated for COVID-19 response.
3. Capacity Decline: Despite the increase in workforce, overall capacity to deliver essential public health services has declined, with notable decreases in staffing for infectious diseases, chronic diseases, and maternal and child health.
4. Additional Needs: State health departments need an additional 2,196 epidemiologists to meet basic public health service requirements, a 53% increase over current staffing levels.
5. Sustainable Resources Required: More epidemiologists and sustainable funding are necessary to consistently and effectively deliver essential public health services.

Original Article Author and Citation

Corresponding Author

Jessica Arrazola, jarrazola@cste.org, 770-458-3811

Suggested Citation

Arrazola J, Auer S. Assessment of Epidemiology Capacity in State Health Departments — United States, 2021. MMWR Morb Mortal Wkly Rep 2022;71:484–488. DOI: http://dx.doi.org/10.15585/mmwr.mm7113a2

Summary

The COVID-19 pandemic has highlighted the strain on the U.S. public health system, revealing significant gaps in the epidemiology workforce and capacity at state health departments. Despite a 23% increase in the number of epidemiologists from 2017 to 2021, primarily due to the COVID-19 response, many core program areas have experienced staffing declines. Federal funding has been crucial, supporting 85% of epidemiology activities and 83% of personnel, but overall capacity to deliver essential public health services has diminished. More epidemiologists and sustainable resources are needed to ensure consistent and effective public health service delivery.

Methods

The Council of State and Territorial Epidemiologists (CSTE) conducted the seventh Epidemiology Capacity Assessment (ECA) in 2021 using a standardized web-based questionnaire sent to state epidemiologists in 50 states and the District of Columbia. The questionnaire assessed the number of current and optimal epidemiologist positions, funding sources, and the perceived capacity of health departments to lead activities, provide expertise, and manage resources for essential public health services. Data were collected from January 11 to April 1, 2021, and analyzed using SAS software.

Discussion

Despite the largest applied epidemiology workforce since 2001, the decrease in staffing levels and increased need for epidemiologists are concerning. The reduction in staff impacts public health agencies’ ability to detect, investigate, and respond to various health threats. The reliance on short-term COVID-19 funding poses a risk to the sustainability of these positions. Strategies are needed to integrate temporary COVID-19 workforce into long-term roles and invest in core capacity to address future public health emergencies.

Conclusion

To transform public health infrastructure and ensure the delivery of essential public health services, long-term sustainable support and investment in the epidemiology workforce are critical. This includes competitive compensation, career advancement pathways, and integration of epidemiologists across programs. The public health system must harness technology and build a permanent workforce to be prepared for future health threats.

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