Congressional Efforts to Bolster Contact Tracing Workforce

May 06, 2020 | ASTHO Staff

As our response to COVID-19 transitions from response to recovery, advocacy efforts continue to intensify in Washington, D.C. to help shape negotiations on the fifth emergency supplemental package.

Last week, ASTHO—in partnership with the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, the National Association of County and City Health Officials, and the National Coalition of STD Directors—urged Congress to provide $7.6 billion in emergency supplemental funding to ensure sufficient national capacity for a robust contact tracing workforce that builds on existing state, territorial, local, tribal, and federal health agency disease investigation programs to quickly identify and isolate COVID-19 cases.

A major component of this emergency supplemental request encourages Congress to support a three-tiered approach to building the national contact investigation workforce. In addition, funding for contact tracing must be provided through the existing system of state, territorial, local, and tribal health departments through the CDC. This new federal funding must also be flexible to meet local needs, while also recognizing the existing expertise of key public health workers and building the workforce for the long-term. Finally, to support a formalized, three-tiered professional workforce, it is also important to strengthen existing mechanisms to facilitate volunteers who may wish to join the public health effort, provide technology and training, and solidify health departments’ ability to recruit, hire, and retain staff with the help of a public health workforce loan repayment program. These three tiers are necessary in order to recruit the people public health agencies need to rapidly build capacity and complement extant expertise in every public health agency.

ASTHO is not the only organization issuing proposals for the contact tracing workforce. During the past month, a group of former health officials and experts from past Administrations that include Andy Slavitt (former Director of Centers for Medicare and Medicaid Services, or CMS), Scott Gottlieb (former Commissioner of the Food and Drug Administration), Joshua Sharfstein (ASTHO alum from Maryland), and Vivek Murthy (former Surgeon General), sent a letter to congressional leadership emphasizing the need to establish a contact tracing workforce and support investments to control the spread of the virus. Their memo requests a total of $46.5 billion in the form of block grants to state and territories twice annually. Of that, $12 billion would be allocated to expand the necessary contact tracing workforce by 180,000 individuals, $4.5 billion would convert vacant hotels into voluntary self-isolation facilities, and $30 billion would support the incomes of those in voluntary self-isolation.

In addition to emergency supplemental funding, members of Congress are releasing legislation with the goal of authorizing funding and programs to enhance contact tracing efforts at federal, state, local, territorial, and tribal jurisdictions. It is currently unclear if any of these bills will move forward. While ASTHO has not formally supported or endorsed any of the following legislative proposals, it is important to understand the federal legislative landscape today acknowledging some of this legislation may gain traction in the upcoming weeks. Here is a rundown of federal proposal to date:

• Introduced by: Sens. Kirsten Gillibrand (D-NY) and Michael Bennet (D-CO).
  What it Would Do: Establish a “Health Force” to respond to public health emergencies and meet public health needs. Training for the health force would be conducted by the CDC, while management would be led by state, local, and territorial health departments. Members would be asked to complete tasks like diagnostic testing and contact tracing; administering vaccines; distributing public health messaging; and providing data entry to support epidemic surveillance. To support this effort and costs associated with the deployment of members on the force, the legislation would provide grants to state, local, and territorial governments.
• Introduced by: Sens. Edward Markey (D-MA) and Christopher Van Hollen (D-MD), as well as Rep. John Garamendi (D-CA).
  What it Would Do: Create a Health Force (similar to Sens. Gillibrand and Bennet legislation) and a Resilience Force, that would provide funding to FEMA to expedite the training of 62,000 Cadre of On-Call Response/Recovery Employees to perform public health tasks.
• Introduced by: Led by Sen. Chris Coons (D-DE) with a group of senators. What it Would Do: Called the Pandemic Response and Opportunity Through National Service Act, it seeks to fund 750,000 national service positions over a three-year period by expanding the number of AmeriCorps and national service positions from 75,000 to 150,000 in the first year. It would then double the number of positions to 300,000 in the second and third year.
• Introduced by: Elizabeth Warren (D-MA) and Rep. Andy Levin (D-MI).
  What it Would Do: It’s a proposal for a national contact tracing program, modeled after the Massachusetts COVID-19 Community Tracing Collaborative. The proposal would require the CDC to develop a national strategy to hire, train, and deploy COVID-19 case investigators and contact tracers, as well as provide grants to state, local, and territorial health departments to hire, train and deploy investigators and contact tracers. It would also require the Department of Labor to fund state, local, and territorial agencies to connect unemployed individuals with contact tracing employment opportunities.

It is important to note the response and recovery will vary city-by-city and state-by-state, as more states and communities begin to ease physical distancing. Workforce capacity must be built for the long-term and COVID-19 will not be the last time the U.S. experiences an infectious disease outbreak. ASTHO will continue to monitor federal legislative efforts and advocate on behalf of state and territorial health departments with Congress and the Administration to ensure that workforce capacity efforts are led by the state, local, tribal, and territorial public health departments in partnership, and in consultation with federal agencies and emergency management stakeholders.