Without people, there is no preparedness

As we assess our COVID-19 response with the goal of ensuring we are better prepared for future public health crises, we must pay attention to an essential element that remains in dangerously short supply — diverse health care professionals specializing in infectious diseases and outbreak preparedness and response, or ‘bio-preparedness.’ Nearly 80% of counties in the U.S. do not have a single infectious diseases physician. Dig a little deeper and shortages persist among clinical laboratory professionals, infection preventionists, infectious diseases pharmacists and other health care professionals whose expertise and work in our health care facilities are critical to public health and preventing, detecting, and responding to infectious diseases outbreaks.

Infectious diseases and bio-preparedness health care professionals are vital to hospitals’ and health systems’ ability to respond rapidly and effectively during natural disasters, disease outbreaks, and pandemics. Their often unseen and unglamourous activities include developing and managing outbreak response plans, and collaborating with state and local health departments to track disease spread and ensure effective public communication. During disasters and public health emergencies, they also manage personal protective equipment (PPE) and other critical equipment; set up patient triage areas, testing sites and vaccination centers; and facilitate the safe delivery of care for patients. More broadly, they play a critical role in preventing health-care-associated infections, developing diagnostic tests to improve early detection, and managing the appropriate use of antibiotics to ensure optimal patient outcomes.

In 2020 we all heard about how shortages of diagnostic tests, therapeutics, PPE, and hospital beds hampered our response to COVID-19, facilitated increased COVID-19 transmission, and even cost patients’ lives. It is critical that we strengthen our supply chains and our public health preparedness systems to ensure sufficient access to these essential tools. But health care capacity is about more than tests, swabs, treatments, masks, and beds. Our capacity hinges on the availability and equitable distribution of diverse health care professionals with the expertise and knowledge to use these tools to do their job of providing the best possible care for patients.    

COVID-19 has inspired a new generation of people to pursue careers in health care, but many of them hit an insurmountable financial barrier that prevents them from entering the field of infectious diseases.  The average medical student has more than $215,000 in debt from medical school alone, which often becomes a significant driver when selecting a specialty. On average, infectious diseases physicians are among the lowest compensated in medicine. This financial reality can be a barrier to entry that prevents providers from underrepresented racial and ethnic groups from choosing infectious diseases and bio-preparedness as a career path. If we truly want to meet the needs of all communities and improve health equity, we need to take away this financial roadblock. 

COVID-19 is not all that we have to worry about. Longstanding infectious diseases threats and epidemics like HIV, viral hepatitis, antibiotic resistance, and infections associated with opioid use continue to harm patients, and far too many of our communities lack the expert health care professionals needed to care for these patients. These challenges underscore why we are championing the Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act (S. 3244/H.R. 5602). This bipartisan bill would provide loan repayment to health care professionals who dedicate their time to working in public health preparedness and response, or providing infectious diseases care in underserved areas or federally funded facilities. 

We need to do more than thank our health care heroes — we need to invest in them to ensure a qualified workforce is there for all of us in our time of need, because we know the next pandemic is a matter of when, not if.

Tammy Baldwin is a Democrat representing Wisconsin in the U.S. Senate and serves on the Senate Committee on Health, Education, Labor and Pensions. Susan Collins is a Republican representing Maine in the U.S. Senate and serves on the Senate Committee on Health, Education, Labor and Pensions. Daniel P. McQuillen, MD, FIDSA, is the president of the Infectious Diseases Society of America and is Senior Physician at Beth Israel Lahey Health, Lahey Hospital & Medical Center and Assistant Professor of Medicine at Tufts University School of Medicine in Massachusetts.