Four Decades of the Field Epidemiology Training Program (FETP): TEPHINET’s Role in the Context of FETP History

COVID-19 is a stark reminder of the urgent need to expand and reinforce field epidemiology capacity for all countries in order to increase the timely detection and response to outbreaks and save lives. Fortunately, the world already possesses a means of scaling up the trained field epidemiology workforce that has proven effective over the course of the last four decades. This is the Field Epidemiology Training Program, or FETP.

Initially modeled upon the Epidemic Intelligence Service (EIS) of the Centers for Disease Control and Prevention (CDC), the FETP initiative has seen tremendous growth over the last four decades. With support from CDC, the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and many others, FETP has expanded to every continent except Antarctica. Today, more than 80 FETPs exist and train public health workers across more than 160 countries and territories. FETPs are providing an integral part of the COVID-19 response workforce in nearly all of these places.

As the global network of FETPs, TEPHINET has been proud to serve at the helm of empowering and mobilizing a competent field epidemiology workforce through standardized training, experiential learning, FETP quality improvement, mentoring, and knowledge exchanges. Collectively, our member programs have trained more than 18,000 "disease detectives" to serve as the boots on the ground in the fight for improved public health for all.

This year, CDC is leading a campaign to commemorate the 40th anniversary of the expansion of FETP outside of North America. In 1980, FETP Thailand was born (preceded by the establishment of the Canadian Field Epidemiology Program in 1975). TEPHINET joins our partners in celebrating this milestone. What would global disease surveillance and outbreak response capacity look like today had these programs never existed? We will never know, but we do know that around the world, FETP alumni are serving at the highest levels of leadership within their countries’ ministries of health; they have conducted thousands of outbreak investigations and set up thousands of disease surveillance systems; and, as field epidemiologists, they have contributed much to our understanding of local communities’ experiences with disease.

We would like to take a moment to reflect on TEPHINET’s role within the context of FETP history. TEPHINET was founded 23 years ago, just after the halfway point of the 45-year FETP trajectory. In the 1990s, several FETP directors began an initiative to organize themselves into a global network, recognizing the benefits of working together to share experiences and resources. These programs included the FETPs in Australia, Canada, Colombia, Egypt, Germany, Ghana, Indonesia, Mexico, Peru, the Philippines, Saudi Arabia, Spain, Thailand, Uganda, and Zimbabwe. With support from CDC, WHO, and the Fondation Merieux, this network was formalized in 1997 as the Training Programs in Epidemiology and Public Health Interventions Network, or TEPHINET.

An administrative headquarters, or secretariat, was needed to manage such a large global network. The TEPHINET Secretariat had truly humble beginnings, starting with just one person working out of an office within a CDC building. In 1999, TEPHINET was incorporated as a non-profit organization in the U.S. state of Georgia. In 2008, TEPHINET merged with The Task Force for Global Health, another non-profit organization based in Decatur, Georgia, and operates today, with 25 staff members, as one of the Task Force’s 17 programs working for better health.

Following the establishment of TEPHINET as the global FETP network, regional FETP networks were also established with strong support from CDC and others. These include the African Field Epidemiology Network (AFENET), Eastern Mediterranean Public Health Network (EMPHNET), South Asia Field Epidemiology and Technology Network (SAFETYNET), South American Field Epidemiology Network (REDSUR), Central American Field Epidemiology Network (REDCEC), and the ASEAN+3 Field Epidemiology Training Network. All of these networks are committed to strengthening FETPs in their respective regions and aim for the same goal of establishing and sustaining effective field epidemiology capacity in every country in the world.

What has having a global FETP network brought to the table after all these years? TEPHINET’s value has been in establishing crosscutting global-level initiatives to strengthen FETPs. To systematically improve program quality worldwide, TEPHINET developed an accreditation process for FETPs and has accredited 18 programs since the first cycle of accreditation in 2016. More than 50 additional programs have been trained by TEPHINET on the accreditation process and standards. Beginning with the first TEPHINET Global Scientific Conference in 2000, we have institutionalized high-quality scientific exchange and shared learning among FETP fellows and mentors through biennial global and regional conferences. The 2014-2016 Ebola outbreak in West Africa highlighted the challenges of identifying skilled FETP alumni to participate in outbreak response. To address this, TEPHINET launched a global FETP alumni online platform, TEPHIConnect, in 2017.

Since 2010, TEPHINET has collaborated with the CDC, CDC Foundation, Skoll Global Threats Fund, U.S. Department of State, and National Cancer Institute to offer small grants to FETP trainees for field epidemiology projects in specific topic areas (including non-communicable diseases and special pathogens). TEPHINET has provided logistical, financial, and technical support towards establishing several FETPs; for example, due to the 2015-2016 Zika outbreak in the Americas, TEPHINET supported the development of Frontline FETPs in 12 countries across Latin America and the Caribbean. TEPHINET provides a vital communications service to its member programs by sharing information relevant to the network in a timely manner. In addition, TEPHINET offers opportunities for specialized learning and professional development to FETP trainees, alumni, faculty, and mentors.

TEPHINET and several partners developed the Global Field Epidemiology Roadmap to chart a path forward for the entire global FETP enterprise, recognizing that several actions need to be taken before we can meet our goal of having sufficient and sustained field epidemiology capacity in every country in the world. We are now working on implementing the Roadmap’s recommendations, starting with the first: the establishment of a broadly representative Strategic Leadership Group (SLG) to provide a driving force for progress for the whole FETP enterprise.

In the context of FETP history, we hope that TEPHINET is viewed as having had a leading role in advancing FETP quality, growth, and sustainability. The first four decades of FETP have shown us the tremendous amount of progress that is possible in public health when passionate and committed people around the world unite to work towards a common cause. Let us maintain this momentum in the next four decades and make sure that FETP training is as robust as possible, that FETPs have adequate funding, and that FETP work continues in strong alignment with key global health programs and priorities. As COVID-19 as shown us, the world needs field epidemiologists more than ever before.

We dedicate this article to the late Dionisio Herrera, the director of TEPHINET from 2009-2018, who was a monumental force in making TEPHINET—the network, as he would emphasize often—what it is today.