Does Medical Training of Local Health Department Executives Improve COVID-19 Vaccination Uptake and Case Growth?

Objective: To examine whether medical training among local health department (LHD) executives influenced COVID-19 vaccination uptake and case growth rates in US counties. Design: Cross-sectional study using county-level data from January 2020 to June 2022. Setting: US counties with available data on LHD leadership, vaccination uptake, and COVID-19 case growth. Participants: Counties led by medically trained (MD or nursing degree), public health-trained only, or non-medically trained LHD executives. The final sample includes 1466 counties, excluding Alaska, Hawaii, Texas, and Virginia due to data limitations. Main Outcome Measures: COVID-19 vaccination uptake and case growth rates, adjusted for demographic, political, and health system factors. Results: Counties led by medically trained LHD executives had a 2.5 percentage points higher vaccination uptake on average following the April 19, 2021, vaccine eligibility expansion (all P values < .01) and experienced significantly lower COVID-19 case growth rates following statewide mask mandates in 2020. Additionally, counties led by minority executives reported significantly higher vaccination uptake compared with those led by non-Hispanic White executives. Conclusions: Medical training among LHD executives was positively associated with higher vaccination uptake and slower case growth, highlighting the critical role of leadership expertise in shaping public health responses. These findings suggest that incorporating medical expertise into public health leadership could enhance pandemic preparedness and response.