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Under-Funded and Under-Pressure: State Epidemiologists During the COVID-19 Response
Jeff Jones1,2, Safura Abdool Karim1,3, Ruth Faden1,4
1Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA.
Disaster Medicine and Public Health Preparedness
|May 7, 2025
Summary
State health departments faced significant challenges during the COVID-19 pandemic due to underfunding and increased demands. Future pandemic preparedness requires sustained investment and support for state epidemiologists and health departments.
Area of Science:
- Public Health
- Epidemiology
- Health Policy
Background:
- The COVID-19 pandemic placed unprecedented demands on state health departments.
- Decades of underfunding and resource constraints significantly impacted state-level responses.
Purpose of the Study:
- To understand the challenges and opportunities faced by state epidemiologists during the COVID-19 response.
- To inform future pandemic preparedness strategies.
Main Methods:
- Qualitative analysis of 12 interviews with state epidemiologists from 11 US states.
- Focus on challenges and opportunities during the COVID-19 public health emergency.
Main Results:
- State epidemiologists experienced increased workloads, political, and public scrutiny.
- Underfunding hampered the ability to meet pandemic demands, despite emergency funding.
- Emergency funding created implementation pressures and did not resolve long-standing resource deficits.
Conclusions:
- State health departments were ill-equipped for the COVID-19 response, with funding shortfalls persisting.
- Sustained investment and support are crucial for future pandemic surge capacity.
- Public engagement and skepticism require targeted strategies for effective pandemic response.
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