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BACKGROUND: CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement assists state, local and territorial health departments maintain and strengthen core epidemiology capacity needed to track and respond to a variety of infectious diseases. In FY2013, $4.7 million was awarded to 41 health departments for “flexible” epidemiology personnel to work on a variety of infectious diseases and respond to emergencies.
METHODS: In this study, we explored multiple perspectives to characterize how “flexible” epidemiologists were utilized and examined how their roles are supporting epidemiology capacity. We conducted 14 in-depth interviews using a semi-structured questionnaire with a heterogeneous sample of eight state health departments; two different instruments were administered to program managers and epidemiologists. Data were coded and analyzed using MAXQDA qualitative analysis software.
RESULTS: All respondents indicated that “flexible” epidemiologists support priorities and gaps across a range of infectious diseases, with half focusing on mostly enteric diseases. Almost all of the health departments utilized epidemiologists to assist in the detection and investigation of outbreaks, maintenance and upgrade of surveillance systems, and strengthening of coordination and collaboration with partners. Half of the epidemiologists also participated in conducting trainings and sharing data. Supervisors valued the ability to direct epidemiologists to areas of greatest need such as emergency responses (e.g., fungal meningitis), and viewed flexible positions as an effective model for building capacity among health departments.
CONCLUSIONS: ELC enhances epidemiology capacity in state health departments by providing flexible personnel that help sustain areas with losses in capacity, programmatic gaps and unanticipated events. Our findings support the notion that programmatic strategies emphasizing flexibility for carrying out infectious disease activities can be an effective strategy to help strengthen epidemiology capacity in health departments.