Turbulence and recalibration; an examination of the epidemiology workforce during emergency response

Abstract

The COVID-19 pandemic has exploited weaknesses in the preparedness and response to public health emergencies. Importantly, it has highlighted the under-resourced epidemiology workforce who are at the forefront of the response. In the context of increasingly frequent emergencies, strengthening this workforce is key to improving emergency response.

The aim of my thesis was to identify mechanisms to optimise the epidemiology workforce to respond to emergencies. The study was developed based on the literature and my personal experience as an emergency field epidemiologist. I conducted a mixed-methods study using an exploratory sequential design. I integrated grey and published literature and key informant interviews with emergency response experts. These findings supported development of an online global survey of applied epidemiologists with questions focused on epidemiology training, emergency response experience, and team effectiveness during response. During the pandemic I evaluated a COVID-19 workforce mentorship program using an online survey, interviews, and focus group discussions. Analysis included descriptive, analytic, and thematic methods, the variables for analysis were epidemiology training, gender, and comparison of national and international emergency responder experiences. I outline my findings in three parts; effective individuals, teams, and response.

Effective individuals are the foundation of an effective response. My findings highlighted training gaps that lead to skill and knowledge deficits important for epidemiology emergency response. These included communication, collaboration, political awareness, leadership, and specialised emergency response skills. These skills were rarely taught but considered essential components in the field. Epidemiologists reported limited clarification of roles and identified a lack of support during response. Where there was direct support, responders found that this mitigated their inexperience. Epidemiology responders need appropriate training and periodic updating, and then support during response, to effectively respond to emergencies.

A cohort of effective individuals does not make an effective team. My study found that leadership, communication, and role clarification were most in need of strengthening within response teams. Study participants reported that working in silos was common, with responders experiencing ineffective team communication, high staff rotation, and task replication. I found that for response teams required a mix of skills, leadership, knowledge, experience, and local context awareness. Leaders need training and support to guide response teams, an adaptation of performance management tools would assist in addressing these challenges.

Finally, I propose that effective response to health emergencies requires more than just effective individuals and teams. My findings indicate that compared to international responders, national responders have better understanding of local politics, language, and culture, which may in turn support identification of local needs and priorities. A focus on local leadership and local workforce needs during emergency response is vital and event management systems that safeguard this are required. Country preparedness plans must incorporate strategies to integrate and use external workforce support during emergencies.

Emergency response events are typically turbulent and dynamic. My research suggests that recalibration of the epidemiology emergency response is required, bringing with it a focus on improving the effectiveness of individuals, teams, as well as the overall structure of response. In this thesis I have demonstrated that the epidemiology emergency response workforce must evolve to be more effective in current and future public health challenges, and I have identified mechanisms for moving forward. Show more