Officers in the Epidemic Intelligence Service (EIS), a program of the Centers for Disease Control and Prevention, have for seven decades tackled some of the most pressing public health challenges in the United States and abroad.
However, student loans might deter many potential EIS officers, who are discouraged from applying to the CDCs two-year disease-fighting program. As new physicians they have the promise of better pay in private practice or at other medical organizations.
The Securing Experts to Control, Understand, and Respond to Emergencies (SECURE) Act, H.R. 5998, may be a remedy to this problem. Hoping the SECURE Act will become part of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2018, U.S. Rep. Jan Schakowsky (D-IL) introduced the bill to provide medical school loan repayment — up to $50,000 a year — for doctors who enter the EIS.
“We were concerned with the decline in the number of and availability of doctors,” said Eric Pevzner, chief of the EIS program. “There’s a broad coalition of groups recognizing that we need to attract the brightest minds, and we’re at a major disadvantage.”
In the past, half of the CDC’s EIS class would be comprised of medical doctors. Last year, of the 500 people who applied, only about 100 were physicians, Pevzner said.
The majority of applicants for the current class constitutes public health school graduates, primarily Ph.D.s who have in recent years been more competitive applicants for the EIS. This is partly because of the ubiquitous nature of schools of public health in the United States, making the competition among these applicants stiff, Pevzner said.
However, physicians have training and experience that Ph.D.s cannot do research without —everything from immunology to pathology to the clinical presentation of the microbes. Being able to provide student loan repayment is critical to the EIS program being able to attract physicians with the skills needed to respond to current and emerging threats, says Pevzner.
Take the 2014 West African Ebola outbreak, in which there were more than 11,000 deaths, including of American health professionals.
“Ebola did stretch us,” Pevzner said. “Every single one of our EIS officers were deployed to Africa at least one time, and even many multiple times.”
During that outbreak, only 41 percent of EIS officers were physicians. Currently, medical doctors are closer to a third of the incoming class.
Amanda Jezek, senior vice president, public policy and government relations for the Infectious Diseases Society of America, represents more than 11,000 members and disease experts, many of whom are EIS alumni. She is working closely with Rep. Schakowsky’s office on the SECURE Act with hopes that it will be attached to broad pandemic preparedness legislation due to expire by Sept. 30. The SECURE Act would give the CDC statutory authority to provide loan repayment to EIS officers. IDSA would then urge Congress, through appropriations committees, to allocate funding for the CDC to implement this new option.
The EIS program is still robust, but difficulty recruiting more competitive physician applicants has long-term implications for public health agencies, Jezek said.
“Any state can request EIS officers to investigate an outbreak or respond to a public health emergency,” Jezek said. “The opioid epidemic is one example of current crisis for which EIS officers are instrumental in the response.”
EIS officers, positioned at local and state health departments, have investigated and responded to outbreaks of HIV, tuberculosis, and hepatitis, a result of the recent opioid epidemic. Many of the EIS alumni then go on to work in the health departments where they had previously served as disease detectives.
This is part of the legacy of the EIS, says Pevzner, of the organization that not only cultivates experts in infectious diseases but also agency and government leaders of the future. Since 1951 30 percent of directors of the CDC are EIS alumni.
Beyond physicians, SECURE Act funding would also allow the CDC EIS program to forgive educational debt for data experts, who help design the systems to better detect and respond to emergence and spread of diseases. These engineers are often lured post-graduation by tech giants who conduct medical research as well.
Currently agencies such as the National Institutes of Health, Indian Health Services, and the Department of Defense have the authority to forgive medical student loan debt.
“We want to be able to get on the same footing as our sister agencies,” Pevzner said.