Regionalization and the Role of the PHL

By Susan Downer, APHL/CDC Emerging Infectious Diseases Training Fellow, Virginia Division of Consolidated Laboratory Services

The recent 2011 APHL Annual Meeting brought together over 400 public health laboratory professionals from across the country. As an EID fellow, and someone relatively new to the public health laboratory scene, I was impressed by not only the dedication and enthusiasm of the conference attendees but the diversity of their laboratory experiences. State public health laboratories of all different sizes and organizational structures were represented, each offering a variety of services – from newborn screening to water testing – to meet the needs of their communities. While the APHL conference certainly provided a forum for state public health labs to share their unique experiences and concerns, it also provided an opportunity to address the next steps for public health laboratories as a whole. The current legislative environment almost ensures that the public health field will be forced to address significant changes to policy and budget. As the conference title aptly captured, public health laboratories are at a crossroads.

The uncertainty faced by public health laboratories was evident as discussions regarding the possible effects of healthcare reform, meaningful use legislation, and diminished grant funding were present in many conference sessions. Dwindling funding now requires a reassessment of the role of the public health laboratory in the community and presents somewhat uncomfortable discussions regarding what Susanne Zanto of the Montana Laboratory Services Bureau labels the “R” word – Regionalization. The “traditional” public health laboratory as Dr. Blank described – one organization per state or other municipality – may become a thing of the past. Funding for more collaborative grant projects in the 1990s has followed with increasing regionalization for newborn screening programs and national surveillance projects. The current lack of funding affecting public health laboratories across the country stands to push even the most reticent along. 

Ms. Zanto described her experiences with the Northern Plains Consortium, a collaborative agreement among Montana, North Dakota, South Dakota, and Wyoming to share the expense of maintaining training, certifications, and proficiencies for costly or infrequently needed assays. Currently, testing services for HIV multispot, 16s ribosomal bacterial identification, molecular TB testing, and hantavirus serology are shared among these states. 

This collaboration requires coordination for funding, sample transport, and contract logistics but Ms. Zanto emphasized that it meets the needs of those state’s citizens while adapting to the current economic situation. It may also open the door for public health laboratories to begin reevaluating their role in a much broader sense. Competition from commercial labs for screening tests may move public health laboratories into niche markets for confirmation testing and disease surveillance. And while even discussion of such drastic changes to the role of the public health laboratory may be disconcerting, it is needed. In addition to much talk of the financial future, was the proposal that adaptation to change may also present an opportunity for reevaluation of purpose and even a “rebranding” of the public health laboratory. This fits with Dr. Friedan’s message that unreliable government funding reinforces the need for public health laboratories to play an active role in shaping their future. 

And while the conference did concentrate on some dismal financial figures, I was only encouraged after meeting so many dedicated speakers and attendees. The next class of EID fellows was interviewed just last week. I am interested to see what the future holds for their fellowship year and for us all.

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