Global Health and the Infectious Diseases Physician-Scientist Workforce

To the Editor–We read with great interest the article by Singh and colleagues [1] providing timely policy recommendations on optimizing the infectious disease (ID) physician-scientist workforce (PSW). While we agree with the outlined challenges and recommendations, there was scarce to no discussion on global health and its role in enhancing the ID PSW. In our experience, many ID fellows are interested in incorporating global health into their career; thus, providing more opportunities for global health mentorship, training, and research may help increase the ID PSW. In addition, global health experiences for medical students and residents can be formative experiences and lead to pursuing a career in infectious diseases. Additionally, given that infectious diseases disproportionately affect persons in low- and middle income countries (LMICs) and that an increasing amount of ID research including clinical trials are conducted in such settings, it is important to consider ways to increase the ID PSW in LMICs. This would not only improve the “front-line” management of many epidemics and emerging infectious diseases but also provide further valuable in-country mentorship, collaboration, and funding opportunities for US ID physicians interested in global health research.

The surge in global health interest among medical students and physicians in the United States has been well documented, as has the value of global health investment and research by the United States [2–4]. Less attention has been given to the impact of enhancing global health training and research opportunities for medical students, residents, and fellows in the US ID PSW. Given that the interest in ID and global health overlaps for many medical students, residents, and ID fellows and the demonstrated influence of early career mentorship in choosing the specialty of ID, an increased focus on global health could recruit more physicians into the field and enhance their research career potential [5]. The authors briefly mention the National Institutes of Health Fogarty International Center (FIC) and the Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene fellowships. These predoctoral and postdoctoral programs are some of the few opportunities for global health funding, and evaluations on the impact of both programs found that scholars have a high rate of continuing their work in LMICs, further developing and continuing their global collaborations and in obtaining future research funding [6, 7]. The ramping up of these programs, along with new innovative ways to provide global health opportunities such as providing “twinning” programs pairing US and LMIC trainees together on collaborative research projects and increased funding for short-term global health research opportunities (3–9 months), should be considered as a means to increase the ID PSW.

The burden of infectious diseases is mainly carried by LMICs; however, based on our experience in directing 2 FIC research training programs in the countries of Georgia and Ethiopia, there is a major shortage of in-country ID physician-scientists, which is likely similar in most LMICs. To effectively deal with emerging and epidemic infectious diseases where they are happening, it should be an imperative for the Infectious Diseases Society of America (IDSA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS) to help develop an ID PSW in LMICs. We need a global ID PSW to ask the most scientifically and culturally appropriate research questions and lead sustainable local research programs into the future. A focus on a global ID PSW would be in line with an IDSA/HIVMA/PIDS emphasis on global health policy and in providing equitable resources, concern, and guidance for their diverse members who reside in >100 countries. Additionally, creating a cadre of well-trained global ID PSWs would provide a pool of global mentors and collaborators for US physicians, leading to more productive partnerships and additional team-based research funding opportunities. This has been the case with our FIC research training programs in which we have paired 10 US medical students or internal medicine residents with Georgian or Ethiopia Fogarty trainees. All collaborations led to a published manuscript, and 5 of the US trainees have pursued a career in ID and continued their collaborations abroad (including one of the authors). A focus on optimizing the ID PSW in LMICs would be a win-win-win proposition in regard to improving the management of infectious diseases in LMICs, enhancing global health research opportunities for US physicians (thereby increasing the ID PSW), and developing a sustainable approach to combating infectious diseases.

The field of ID is intimately intertwined with global health and has been instrumental in improving the health of people around the world. Providing global health training and opportunities for students/trainees interested in ID and efforts to help develop a global ID PSW will enhance our specialty by enticing more physicians into the field, provide further avenues for a physician-scientist career, and improve the front-line management of infectious diseases.

Notes

Financial support. This authors are supported in part by the National Institutes of Health (NIH) Fogarty International Center (D43TW007124); the NIH National Institute of Allergy and Infectious Diseases (K23AI103044, R21AI122001); the NIH National Center for Advancing Translational Sciences (UL1TR002378 to the Georgia Clinical and Translational Science Alliance); and the Emory University Global Health Institute.

Potential conflicts of interest.  All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.