Abstract
CONTEXT: CDC's Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core epidemiology capacity needed to respond to a variety of emerging infectious diseases. In fiscal year 2014, $6 million was awarded to 41 health departments for flexible epidemiologists (FEs). FEs were intended to help meet health departments' unique needs and support unanticipated events that could require the diversion of resources to specific emerging or reemerging diseases. OBJECTIVE: Explore multiple perspectives to characterize how FEs are utilized and to understand the perceived value of this strategy from the health department perspective. DESIGN, SETTING, AND PARTICIPANTS: We conducted 14 in-depth interviews using a semistructured questionnaire with a heterogeneous sample of 8 state health departments; 2 different instruments were administered to ELC principal investigators (PIs) or supervisors, and FEs. The team produced a codebook consisting of both structural and data-driven codes to prepare for a thematic analysis of the data. RESULTS: Three major patterns emerged to describe how FEs are being used in health departments; most commonly, FEs were used to support priorities and gaps across a range of infectious diseases, with an emphasis on enteric diseases. Almost all of the health departments utilized FEs to assist in investigating and responding to outbreaks, maintaining and upgrading surveillance systems, and coordinating and collaborating with partners. Both PIs and supervisors highly valued the flexibility it offered to their programs because FEs were cross-trained and could be used to help with situations where additional staff members were needed. CONCLUSION: ELC enhances epidemiology capacity in health departments by providing flexible personnel that help sustain areas with losses in capacity, addressing programmatic gaps, and supporting unanticipated events. Our findings support the notion that flexible personnel could be an effective model for strengthening epidemiology capacity among health departments. IMPLICATIONS FOR POLICY & PRACTICE: Our findings have practical implications for addressing the overall decline in the public health workforce, as well as the current context and environment of public health funding at both state and federal levels.