Experiences and Lessons Learned From Surging the Governmental Public Health Workforce During the COVID-19 Pandemic

Context: During the COVID-19 pandemic, the United States relied on the public health workforce to control the spread of COVID-19 while continuing to provide foundational public health services. Facing longstanding staffing shortages, state, tribal, local, and territorial (STLT) public health agencies (PHAs) used various strategies and supports to surge the workforce in response to the pandemic. Objectives: The study explored (1) the types of strategies and supports STLT PHAs used to surge the public health workforce during the pandemic, (2) assessments of surge strategies and supports, and (3) approaches to using the range of surge strategies available. Design: We conducted 27 semi-structured interviews in 2023 and performed thematic analysis. Participants: Interviewees included STLT public health officials, leaders of organizations that directly supported the COVID-19 workforce surge, and public health workforce experts indirectly involved in the workforce surge. Results: To surge the workforce, interviewees relied on partnerships, staffing agencies, the National Guard, the Centers for Disease Control and Prevention Foundation’s COVID-19 Corps, the Medical Reserve Corps, and other strategies. Interviewees valued strategies that rapidly engaged staff and volunteers at no cost to their PHA and flexible funding from the federal government to support surge efforts but noted shortcomings in the strategies and supports available. Interviewees described using multiple strategies simultaneously but noted challenges in implementing these strategies due to inadequate planning and insufficient staff and resources. Conclusion: The study underscores the need for STLT PHAs to establish mechanisms to surge the workforce as part of ongoing planning for emergency preparedness. Focus areas include building administrative and hiring capacity within STLT PHAs and sustaining partnerships and contractual agreements that helped fill staffing gaps during the pandemic. To support efforts to build workforce capacity to meet future surge management needs, STLT PHAs should consider creative solutions to attract and retain staff, as well as opportunities to engage students in public health work.