Header photo: Wari Numbere, Nigeria

Background

To safeguard and promote the health of its citizens, every country must have effective field epidemiology capacity. To that end, in 1980, the US Centers for Disease Control and Prevention (CDC) began supporting the development of Field Epidemiology Training Programs (FETPs) in countries throughout the world. This initiative has grown in importance since then, as many countries and regions with inadequate public health capacities face public health threats of increasing scope and complexity.

The FETP initiative has been enormously successful, such that after 38 years of steady investment by CDC, other US Government agencies, the World Health Organization, the European Union, individual countries, philanthropic foundations, and others, there are now 86 FETPs serving more than 160 countries throughout the world. While initially conceived simply as a training program producing field epidemiologists, over the years, it has become clear that the impact of the program is far greater, and more important, than the number of its graduates. The defining essence of the program today is the provision of critically-needed public health and global health security services, through a mentored, learn-by-doing approach that improves the effectiveness of the workforce and systems required to provide those services.

However, as the number and variety of programs has grown, a variety of challenges to continued progress have emerged, including the slow pace of in-country institutionalization of the FETPs; program quality assurance; securing adequate, sustainable funding; assuring a career path for FETP graduates; specifying evidence-based targets for field epidemiology capacity; updating and enhancing the FETP curriculum and the larger FETP system; and mobilizing FETP graduates and fellows in support of international response to epidemics and other public health emergencies.

To provide an opportunity to address these challenges, The Task Force for Global Health convened a meeting of key leaders and partners* from across the globe working to develop effective global field epidemiology capacity. The meeting was held on June 11-15, 2018 at the Rockefeller Foundation Bellagio Center. The goals of the meeting were to craft a guiding, long-term vision of the global FETP initiative; clarify the roles and responsibilities of the various partners in this effort; harmonize the goals and expectations of funders and implementers; and assure effective in-country organizational integration and sustainable long-term funding for this global capacity-building effort.

The Vision of Our Global FETP Effort

After first reviewing the history of the FETP initiative and identifying current strengths and challenges, the group developed the following statement to serve as our guiding vision:

Every country in the world has the applied epidemiology capacities needed to protect and promote the health of its own population, and to collaborate with others to promote global health.

Defining the FETP Enterprise and Its Essential Functions

The group also recognized that what had begun as a relatively small CDC grant program has now grown into a complex, multi-partner undertaking to improve public health and global health security by developing applied epidemiology capacity throughout the world. Consequently, the group developed a new, more comprehensive framing for this global partnership: the FETP Enterprise, defined as the totality of the leaders, funders, implementing partners, government agencies, and other stakeholders engaged in this global effort, along with associated workforce competency targets, standards, agreements, technologies, etc. that undergird this work. The group then specified a set of critical functions that the enterprise must perform to reach our vision.

These functions include (1) health system strengthening, through the learn-by-doing epidemiologic work undertaken for each country’s public health system; (2) education, training, and mentorship of FETP fellows, via provision of real -world experience in applied epidemiology; (3) mobilization for mutual assistance in response to international outbreaks and other public health emergencies; (4) management of specific epidemiologic and other projects that provide experience and deliver services; (5) quality assurance and improvement of FETPs; (6) institutionalization of FETPs into country public health systems; (7) program accountability; (8) monitoring and evaluation, including targeted operational research; and (9) strategic management of the overall FETP Enterprise, to sense and respond to needs and significant changes in the environment in which graduates work.

Recommendations for the Path Forward

Keeping in mind the vision statement, the conceptual framing of the FETP enterprise, and the specification of critical enterprise functions, the group developed the following set of recommendations for action:

1. A broadly representative Strategic Leadership Group (SLG) should be established to provide a driving force for progress for the FETP Enterprise. The SLG would monitor the need for change and enhancement of the FETP Enterprise; develop and promulgate action-oriented guidance, recommendations, and standards; and commission specific work to develop needed tools, systems and policies.
2. The SLG should continually monitor and assure needed improvements and changes in the FETP Enterprise, especially as regards the need to expand and modernize FETP core competencies and curricula.
3. The SLG should promote the development of applied epidemiology workforce targets at each level of expertise (basic [Frontline], intermediate and advanced), to support the development of a workforce capable of meeting country-specific public health and global health security needs.
4. The SLG should assure the development of a cadre of specially-trained FETP fellows and alumni available for rapid response to health emergencies, including but not limited to major outbreaks of infectious disease.
5. The SLG should work with country partners to accelerate the rate at which FETPs become fully institutionalized—programmatically, technically, and financially—into country health systems.
6. The SLG should continue, strengthen, and expand efforts to assure and improve the quality of FETPs, as well as the supporting network-level elements of the FETP Enterprise.
7. The SLG should promote and work to assure sustainable funding for all elements of the global FETP Enterprise.
8. The SLG should foster enhanced alignment and integration of the FETP Enterprise with key global health programs and priorities, including (for example) global health security, One Health, and universal health coverage.*

Together with the vision statement, conceptual framing, and enterprise functional elements, we believe these recommendations comprise the roadmap to the future for the global FETP enterprise. This roadmap is intended to guide and coordinate the work of the many partners and stakeholders engaged in this effort. There is much work yet to do to build demonstrably effective applied epidemiology capacity throughout the world; but the goal is now clearly visible, and the path to success lies before us.

Implementation Meeting

A meeting of key leaders and stakeholders in field epidemiology capacity development was held at the World Health Organization (WHO) headquarters in Geneva on February 13-15, 2019, to develop an implementation plan for the Global Field Epidemiology Roadmap. The report of this meeting can be downloaded from this page.

*Recommendation 8 was formed at the February 2019 meeting in Geneva.

*Bellagio Meeting Participants:

Dr. Mohannad Al-Nsour, Director, EMPHNET
Dr. Kip Baggett, Chief, Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC)
Dr. Peter Bloland, Chief, Strategic Information and Workforce Development Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention (CDC)
Dr. Sam Bracebridge, Director, Field Epidemiology Training Program, Public Health England
Prof. Karl Ekdahl, Head of Unit, Public Health Capacity and Communication, European Centre for Disease Prevention and Control (ECDC)
Dr. Dionisio Herrera, Director, TEPHINET, The Task Force for Global Health
Dr. Hamid Jafari, Principal Deputy Director, Center for Global Health, Centers for Disease Control and Prevention (CDC)
Dr. Wantanee Kalpravidh, Regional Manager, Emergency Centre for Transboundary Animal Diseases, Food and Agriculture Organization (FAO) of the United Nations
Dr. Fadzilah Kamaludin, Director, Institute for Medical Research, Malaysia Ministry of Health
Prof. Martyn Kirk, Professor of Applied Epidemiology, Australian National University
Dr. Jeff Koplan, Vice President for Global Health, Emory University
Mr. David Lubinksi, Senior Progam Officer, Financial Services for the Poor, Bill & Melinda Gates Foundation
Dr. Patrick O'Carroll, Sector Head, Health Systems Strengthening, The Task Force for Global Health
Dr. Martha Ospina, Director General, National Institute of Health, Colombia
Dr. Carl Reddy, Director, South Africa Field Epidemiology Training Program, National Institute for Communicable Diseases, South Africa
Dr. Dave Ross, President and Chief Executive Officer, The Task Force for Global Health
Dr. Sally Stansfield, Managing Director, Social Impact Practice, Deloitte Consulting LLP
Prof. Mufuta Tshimanga, Director/Coordinator, Zimbabwe Field Epidemiology Training Program, Department of Community Medicine, University of Zimbabwe
Ms. Ellen Wild, Director of Business Strategy, The Task Force for Global Health