BUDGET CUTS DISCOURAGE HIGHLY QUALIFIED PEOPLE FROM CAREERS IN PUBLIC HEALTH
ONLY PROGRAM DIRECTED TO PREPARING LAB SCIENTISTS TO END
FEATURING: Syreeta Miles, PhD, Los Angeles County Public Health Laboratory, Los Angeles, California
PUBLIC HEALTH LABS: PROTECTING THE HEALTH OF AMERICANS
Public health laboratories—governmental laboratories working at the federal, state and local level to protect the health of Americans—monitor and detect health threats ranging from infectious diseases, such as avian influenza and dengue fever, to radiological and environmental contaminants, terrorist agents and genetic disorders in newborns. Equipped with sophisticated instrumentation and staffed by highly trained scientists, these unique institutions deliver services that may be unavailable or cost-prohibitive elsewhere.
In a single morning at an average state public health laboratory, bats, beach water, human specimens and an unidentified white powder arrive for analysis. Testing must be completed promptly because test results will assist health officials and health care providers to make life-saving decisions. Will the four-year-old girl who picked up a bat require vaccination for rabies? Is it safe to swim at the local beach? Did the critically ill hospital patient contract a new and deadly virus? Does the white powder found at the local bank represent a terrorist threat or an accidental spill of an innocuous substance? The public health laboratory will deliver the answers.
And when the state is hit by a hurricane, flood, or disease outbreak, this same laboratory will shift into emergency response mode, working long hours, often under difficult conditions, to handle a surge in testing while also maintaining regular laboratory services. Babies won’t wait to be born even during a hurricane.
DOORS OPEN TO LAB LIFE
Dr. Syreeta Miles had never considered the possibility of working in a public health laboratory, until she applied for and was awarded a fellowship opportunity as a public health microbiologist at the Los Angeles County Public Health Laboratory, where Legionnaires’ disease, a highly infectious illness spread through airborne water droplets, was sickening patients at a local nursing facility. Within a month of her arrival as a Research Fellow, Syreeta found herself collecting samples from the air conditioning unit, water fountains, showers, and sinks at the nursing facility, and testing them to identify infected areas of the building. Her hard work contributed directly to halting the outbreak. With the test results in hand, nursing facility staff performed a hyper-chlorination process in areas that required disinfection, and the crisis abated.
For Syreeta, working on the outbreak was a highlight of her fellowship experience; experience that she continues in her current position where she is implementing new and faster tests to speed detection of foodborne outbreaks. Eventually she aims to become the director of a public health laboratory.i
For 19 years, the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) have partnered to provide career opportunities in public health laboratory science to young scientists such as Syreeta through the Emerging Infectious Diseases (EID) Laboratory Fellowship Program. Alumni from the fellowship program have gone on to top leadership positions in governmental health laboratories, including the Director of the North Carolina State Laboratory of Health and the Director of the Colorado Department of Public Health and Environment. They also have become the Chief of Biodefense, the Chief of Bacterial Disease, the Primary Investigator for Rabies, the Research Scientist in Virology, the Research Scientist in Mycobacteriology, and the Research Scientist in Bacteriology, to name a few examples.ii
Demand for the program and the fellows remains high—in 2013, over 375 applicants applied for entry into the prestigious program, and many CDC, state, and local public health laboratories seek to host a fellow. Yet only 14 were placed in labs due to limited federal funding.iii
Now—as a direct result of federal austerity measures—federal funding for the program will be eliminated as of July 1, 2015. APHL and CDC have identified limited internal funding to support one-year fellowships for five scientists out of 325 applicants to keep the program going. Beyond July, the future of the fellowship program is in jeopardy.iv
LOSS OF FELLOWS IS LOSS FOR PUBLIC’S HEALTH
The mission of the fellowship program is straightforward: to train and prepare scientists for careers in public health laboratories and support public health initiatives related to infectious disease research. The loss is equally straightforward: Of the 493 participants in the program over nearly two decades, more than one-third were hired to work at CDC, or in a state or local public health department. For the 105 research fellows at the post-doctoral level, the percentage entering the field of public health was even higher at 50 percent.
EID Laboratory Fellows performed vital work for their host laboratories. Through their experience, these fellows have developed a real time polymerase chain reaction (PCR) test used a recent mumps epidemic; established the method to prepare samples at the beginning of the 2009 H1N1 influenza epidemic; sequenced tuberculosis samples for faster and more accurate results; assured the accuracy of influenza molecular testing; and completed an analysis of hospital and commercial laboratory training needs to guide state emergency preparedness outreach and training activities.v
These highly technical and specialized activities share a single goal: to keep US Americans healthy and safe by preventing and controlling health threats.
When told of the elimination of funding for the EID Fellowship Program, Syreeta responded:
How will we recruit highly qualified people into public health? There is a serious shortage of laboratory professionals, and this is the only program out there that directs lab scientists into public health. If we don’t have the EID Fellowship Program, what do we have?vi
Our environment is continually in flux. New and deadly diseases take a ride on a plane and arrive in the U.S. in hours; contaminants leak or spill into our water, air and soil; flooding, drought and severe heat cause endemic diseases to reemerge; and terrorist attacks loom as a threat. Meanwhile 4 million babies are born each year, all requiring prompt screening for genetic and metabolic disorders to prevent lifelong disability or death.
Public health laboratories must confront these evolving threats while also maintaining time-critical services like newborn screening. This is their job: lives are at stake. But they cannot meet this obligation without highly qualified staff who can quickly respond as new hazards arrive on our doorstep. Ultimately, training public health laboratory professionals is not about them, it’s about us.
Before its termination, the Emerging Infectious Diseases (EID) Laboratory Fellowship Program offered a one-year program designed for bachelor’s and master’s level scientists, with emphasis on the practical application of technologies, methodologies, and practices related to emerging infectious diseases, and a two-year program designed for doctoral level scientists with an emphasis on research of infectious diseases.
For the one-year program, fellows were placed in local, state, and federal (CDC) public health laboratories for advanced infectious disease laboratoryrelated training. A specific objective-based curriculum was developed for each fellow focusing on: vaccine-preventable diseases, drug-resistant pathogens, molecular methods, vector-borne or zoonotic diseases, foodborne and waterborne illnesses, sexually transmitted diseases, imported infections, computer and systems support, applications of vector or animal control, and diagnostic testing methods and instrumentation.
Postdoctoral Fellows for the two-year program were placed in local, state, and federal (CDC) public health laboratories to conduct applied research in areas relevant to public health, including development and evaluation of diagnostic and subtyping techniques, antimicrobial sensitivity and assessment of mechanisms of resistance, principles of vector or animal control, and improved methodologies for environmental sampling, testing, and evaluation.vii
Association of Public Health Laboratories
i. Miles, Syreeta. Interview by Laura Siegel. Phone interview. Silver Spring, MD, March 10, 2014.
ii. Roney, Heather. Interview by Peter Kyriacopoulos. Phone interview. Silver Spring, MD, April 8, 2014.
iii. Focus on Fellows 2013. Silver Spring, MD: Association of Public Health Laboratories, 2013.
iv. Perlman, Eva. Interview by Jody DeVoll. Silver Spring, MD, April 15, 2014.
v. Roney, interview by Kyriacopoulos, April 8, 2014.
vi. Miles, Syreeta. Interview by Jody DeVoll. Phone interview. Silver Spring, MD, April 11, 2014.
vii. Roney, interview by Kyriacopoulos, April 8, 2014.