Three years into the pandemic and 80 percent of U.S. counties are still without a single infectious disease expert, according to a report from the Infectious Disease Society of America released in September.
It is not for lack of demand as COVID-19, mpox, respiratory syncytial virus and other infections continue to dominate the healthcare landscape. Rather, it is a lack of interest from up-and-coming physicians — data released in late 2022 revealed that there has been a significant decline in enrollment for infectious disease physician training programs.
"While there are many factors that may be driving this problem, one factor that cannot be ignored is compensation," a December 2022 press statement from the IDSA reads. "Physicians who focus on infectious diseases are among the lowest paid. Coupled with high medical student debt, low compensation is a chief barrier to entering the field of ID. Many compensation-related roadblocks require policymakers and health systems to take action."
With fewer entering a field inundated with rising need, infectious disease physicians told Becker's that outside of entry barriers to the profession, their top concerns in 2023 are on COVID-19 vaccinations, better responding to crises, addressing antibiotic resistance and the effects global warming will have on disease.
COVID-19 vaccination
On Jan. 26, an FDA advisory panel voted in favor of using a bivalent COVID-19 vaccine for the primary series. Some debated whether it should be given annually like the flu shot, or if further research needs to be done around the virus's seasonality before determining a schedule.
Though the details of a vaccination regimen have yet to be specified, infectious disease experts welcomed conversation around a more regular, routine vaccine strategy. It's something that has been top of mind for them for several years now, and dialogue in the public sector is an important step, experts told Becker's.
Karen Ravin, MD, chief of the division of infectious diseases and medical director for infection prevention and control at Nemours Children's Health in Wilmington, Del., told Becker's that one of her primary concerns has been the misinformation and hesitancy surrounding COVID-19 vaccines. She's hopeful that transitioning to a regular schedule will help things become less confusing for patients and providers alike.
"I think this will optimize our approach to COVID-19 vaccination as we go forward, and I think that's a good thing overall for everybody," Dr. Ravin said.
The hesitancy that has swirled around vaccination is something that has also been top of mind for Kami Kim, MD, infectious disease physician at Tampa General Hospital and the director of the Division of Infectious Disease and International Medicine at the University of South Florida in Tampa, Fla.
"I'm a little bit concerned that with the confusion and fear that the rates of vaccination among kids has gone down," Dr. Kim told Becker's. "A lot of these fears will have ripple effects on public health measures and vaccination compliance and ultimately will have long-term, adverse impacts on the health of our communities."
Along with dispelling vaccination hesitancy, which experts hope a routine vaccination schedule will help normalize in time, infectious disease experts are also closely eyeing COVID-19 variants and the virus's continued evolution.
"COVID, of course, remains front and center for 2023," said Suman Radhakrishna, MD, infectious disease specialist at the Hollywood Presbyterian Medical Center in Los Angeles. "Every time it infects a person, it replicates and has a potential to mutate back to causing severe infections and evading the immunity built up with vaccination and prior infection."
Just as the virus evolves, so will conversations around how to best approach it. For now, Gonzalo Bearman, MD, chief of infectious diseases at Virginia Commonwealth University Health System in Richmond, told Becker's the next step for professionals in the field really lies in "determining the frequency with which COVID-19 vaccines will be required," which he said he senses will come to be treated like influenza.
Better crisis response
Evolving alongside COVID-19 and its future variants, the infrastructure in place to respond quickly is also something that continues to be top of mind for these experts.
"I think this crisis, particularly in the U.S., has highlighted some areas that we need some improvement. The CDC has been criticized a fair amount, but some of that wasn't entirely their fault, because there was so much that was uncertain at the time," Dr. Kim said. "I think since then we've all been focused and have built a network of people who talk to each other regularly, but we need to take those lessons and figure out how to do it better when it happens again, because it will happen again."
Looking ahead to what specifically can be done to strengthen systems in place to be better prepared for the next outbreak when it comes is something that Nagesh Borse, PhD, an infectious disease expert and deputy chief health officer with global health and aid organization Project Hope, told Becker's he is also thinking about.
"If public health centers worldwide are strengthened for these essential public health functions, and are involved in community engagement, these efforts can assist in making sure that prevention is a priority and in making sure that early detection, quick response can happen," Dr. Borse said.
Antibiotic resistance
Experts are also closely monitoring the continued increase of bacteria's resistance to antibiotic treatments. Some of the most prominent infections, including gonorrhea, pneumonia, tuberculosis and others, are increasingly growing resistant to treatments.
It's something experts say needs to be addressed both medically and legislatively nationwide.
"During the pandemic, unfortunately, we saw a lot of overuse of antibiotics when they weren't really needed, and that can contribute to the development of antimicrobial resistance," Dr. Ravin told Becker's. "We need better research and more work on getting better drugs in the pipeline to help combat and target resistant organisms. I'm in support of legislation that will help us develop that and increase our stockpile of drugs that are in the pipeline that could potentially help combat these infections."
John Rex, MD, chief medical officer at drug discovery company F2G, told Becker's he also feels the solution is two-part: legislative and research-driven.
Dr. Rex likened the nation's need to have a stockpile of strong, newly developed antibiotics to a fire extinguisher. Every building needs one, you don't want to be without it — and if you are without one when you need it most, devastating outcomes can happen.
"Something can happen to you tomorrow, if you have bad luck. Right now, we don't have the drugs that we need," Dr. Rex said. "It's really hard to admit that we don't have the drugs that we need. We have actually had companies invent interesting, new drugs, but then see them go out of business. It's not because the drug isn't interesting. It's because we want to — and should — save the new drug for a rainy day." Though to keep innovation going and encourage new inventors, he said, "We need a different way to buy antibiotics."
As such, Dr. Rex and Dr. Ravin noted the importance of legislation like the Pasteur Act, which was introduced in 2021, "to establish a program to develop antimicrobial innovations targeting the most challenging pathogens and most threatening infections." The act has not yet been passed, but Dr. Rex said he is hopeful that will change this year.
Global warming's effect on diseases
In addition to diseases becoming more difficult to combat because of antimicrobial resistance, global warming is yet another factor contributing to this — making infectious disease experts cautious about the future.
"With global warming and with increased deforestation, insect vectors will expand across regions, expanding the reach of certain infectious diseases and new pathogens will emerge as humans are in greater proximity to less commonly encountered species," Dr. Bearman told Becker's, adding that, "Global warming, crowding, mass migrations, food scarcity, rising tides and areas of greater drought will increase the transmission of pathogens."
Dr. Borse also underscored the importance of the climate crisis's role in shaping the changing landscape of the infectious disease profession — because it's something that will affect everyone in all corners of the globe, he noted.
"I am concerned about the climate crisis and the potential impact on infectious diseases," Dr. Borse said. "As countries experience extreme heat, the viruses and bacteria that do well in hot conditions are going to thrive, and vector-borne diseases are going to go up."
While many unknowns continue to persist as infectious disease experts navigate what's next in their profession, change is certain.