Advancing the Public Health Laboratory System Through Partnerships

In many areas of health care, we have witnessed a trend toward increased collaborations and partnerships between investigators, teams, programs, institutions, and agencies. As challenges in health care are frequently complex, multifaceted approaches may result in more effective problem-solving than those undertaken by individual groups or facilities. We have seen these approaches in diverse areas, from cross-functional clinical care teams, to large research initiatives that harness the expertise of multiple investigators, to joint ventures and other collaborations among health care organizations. In public health, partnerships are essential for solving the increasingly complex, multifaceted challenges that are encountered. For public health laboratories (PHLs) in particular, collaborations may include a variety of alliances, including PHL networks; partnerships between PHLs and other laboratories (eg, clinical, commercial, environmental, agricultural, veterinary); and partnerships between PHLs and industry, academia, and other public agencies. The numerous benefits of these collaborations include improved service capabilities and efficiencies, as well as enhanced emergency response and disease prevention strategies.

Public health laboratories provide high-quality data for disease surveillance, detection, control, and response to a wide variety of public health concerns and threats, including emerging infectious diseases, foodborne disease outbreaks, congenital diseases, natural disasters, and exposure to chemical or radiological contaminants. Furthermore, the work of PHLs is crucial for policy-making and public health decision-making, in that it provides critical data and information on antimicrobial susceptibility, toxic chemical testing on water samples, and during outbreak investigations.

In 2002, a report from the Association of Public Health Laboratories articulated, for the first time, the core functions and responsibilities of PHLs.¹ Several of these core functions require engagement with multiple partners because PHLs have a leadership role in developing the PHL systems in their jurisdictions. These systems include participants at the state and local levels, from those who initiate testing to those who use the test results. By ensuring that these functions and responsibilities are implemented and met, PHLs can support all 10 essential public health services.² Ultimately, PHLs provide or assure the full range of laboratory services in support of public health by working with system partners.³ For example, PHLs may collaborate with academic institutions to perform public health–related research, provide training to sentinel clinical laboratories, and work with state and federal agencies in disease surveillance networks. Indeed, several well-known PHL partnerships are national in scope and supported through federally appropriated funds, such as the Vaccine Preventable Disease Reference Centers,⁴ the Laboratory Response Network,⁵ and PulseNet.⁶

In response to financial constraints that have strained PHLs’ ability to provide comprehensive testing services in most jurisdictions, many PHLs have formed additional partnerships and networks to supplement local, regional, and national efforts. Such collaborations strengthen public health infrastructure and facilitate broader and deeper detection, surveillance, preparedness, and response efforts. These additional partnerships are often spearheaded at the local or regional level, such as the Four Corners States Biomonitoring Consortium (http://www.4csbc.org), and self-directed regional networks, such as the Northeast Environmental and Public Health Laboratory Directors consortium.⁷

A 2010 Public Health Reports supplement included several articles that reviewed historical aspects of the development of the PHL system^8-12 and one article that provided a guide for developing laboratory networks.¹³ A 2013 Public Health Reports supplement examined the challenges and benefits of partnerships for laboratory efficiency and the sustainability of the PHL system.^14-18 More recently, studies have reported on a successful collaboration for controlling the transmission of multidrug-resistant organisms,¹⁹ the role of partnerships in achieving HIV treatment targets,²⁰ and the importance of partnerships for the success of newborn screening programs.²¹ These publications highlight the existing and proposed partnerships needed between PHLs and academic, industrial, and commercial partners, as well as with government agencies. Improvements to laboratory capabilities have also been made for many years through laboratory twinning, a process in which 2 laboratories partner to facilitate capacity building and networking. Notably, several issues arise in many of these reported partnerships, including the need for thorough communication planning and support from institutional leaders, management of the opportunities and challenges presented by evolving technologies, the difficulties of staff turnover and other workforce development issues, concerns about funding flexibility and sustainability, and consideration of legal and other agreements that may need to be implemented.^5,13,16-21

Public health laboratory partnerships continue to expand and evolve in complexity to meet new and emerging needs. The articles in this supplemental issue of Public Health Reports describe PHL partnerships at the local, state, national, and international levels. These examples are of particular interest to readers who may want to adopt the concepts in their own jurisdictions.

Partnerships between state PHLs and clinical laboratories are discussed in articles by Bateman et al²² and Strain and Sullivan.²³ Bateman et al review the partnerships and activities of clinical and public health laboratories in Wisconsin, which is a successful collaboration of more than 20 years. Recognizing the difficulties that both clinical and public health laboratories have faced with the declining supply of qualified staff members, Strain and Sullivan describe the success that the Minnesota State Public Health Laboratory has had in addressing this issue through its partnership with both the clinical laboratory community and educational institutions. The Laboratory Response Network, an excellent example of a national laboratory system, is discussed by Villanueva et al.²⁴ The authors report that this network—a collaboration of national, state, and local PHLs devoted to responding to biological and chemical threats—has expanded its mission to provide laboratory infrastructure in supporting the detection of emerging infectious diseases. Kubota et al²⁵ describe a collaboration between PHLs at the national, state, and local level to transform the surveillance system for foodborne disease outbreaks from pulsed-field gel electrophoresis to updated and improved methods by using whole-genome sequencing. Randolph and colleagues²⁶ report on a network of accredited government laboratories that collaborated to achieve International Organization for Standardization/International Electrotechnical Commission 17025 accreditation. Mills et al²⁷ describe the twinning activities of an international PHL partnership as an effective approach for strengthening a PHL system. Two articles examine the role of partnerships in the Zika virus outbreak response. Heberlein-Larson et al²⁸ explain the collaboration between a PHL and a commercial laboratory that was needed to successfully respond to testing demands during the Zika virus outbreak in Florida. Petway et al²⁹ describe the creation through a public-private partnership of a national specimen repository that benefits laboratories seeking materials with which to verify new assays for Zika virus testing. Lastly, Held et al³⁰ describe a collaboration between the state PHL, health care providers, and families to increase the number of newborns in the Amish and Mennonite community screened by the newborn screening program. Additionally, the collaboration sought to provide enhanced access to health care and clinical management of affected children.

Collectively, these articles demonstrate the multiple, ongoing roles of collaborative networks in the evolving PHL system and in public health practice. The experiences gained from these partnerships provide valuable lessons for future collaborations.