United States Government Accountability Office
During four recent zoonotic disease outbreaks, the veterinarian workforce challenge cited most often by federal and state officials was having too few veterinarians to control the outbreak while also adequately carrying out other routine activities.
Specifically, officials from 3 of 4 federal agencies—APHIS, CDC, and Interior’s U.S. Geological Survey (USGS)—and 9 of 13 state agencies cited this challenge. See table 2 for the 17 agencies that were identified as playing an important role, those that cited insufficient veterinarian capacity as a challenge, and other details about these outbreaks.Two primary reasons emerged for this insufficient capacity. First, according to federal and state officials, veterinarian capacity was insufficient because most of the agencies involved in the four outbreaks had difficulty recruiting and retaining veterinarians in general. For example, officials at many of the public health agencies and diagnostic laboratories we spoke with said that it has been challenging to hire or retain veterinarians with the specialized qualifications they need—public health and pathology skills, respectively. According to 2008 survey results from the American Association of Veterinary Laboratory Diagnosticians, it takes most diagnostic laboratories more than 6 months to fill vacancies for veterinary pathologists. In addition, numerous state agency officials told us that the salaries they offer are not competitive with those of the federal or private sectors. Moreover, officials told us that it has been particularly challenging recruiting veterinarians to work in remote areas or in areas with a high cost of living.
Second, in 2002 and 2003 many veterinarians went to California to address a particularly demanding outbreak of exotic Newcastle disease, limiting the number of veterinarians available to respond to other outbreaks.
The exotic Newcastle disease outbreak quickly exhausted California’s supply of veterinarians, both at state agencies and APHIS, because so many backyard birds—which are kept as a hobby or for personal consumption—were affected. Responders had to spend valuable time going door-to-door trying to locate potentially infected birds in densely populated urban areas. APHIS called in over 1,000 federal, state, and private-sector veterinarians from outside California to help with the response. But, even with a task force of over 6,000, it took almost a year to control the outbreak. Moreover, because so many veterinarians converged on California, the number available to work on the other three outbreaks—located in Michigan, Wisconsin, and Colorado—was insufficient, according to federal and state agency officials. In part because of the strain on veterinarian resources during the four outbreaks, officials from 16 federal and state agencies expressed concern that they will not have sufficient veterinarian capacity for multiple outbreaks in the future. FDA assisted in one of the four outbreaks and was the only agency not to express concerns about veterinarian capacity. Some federal officials said that the United States has never been tested with two major outbreaks occurring at once, such as simultaneous outbreaks of foot-and-mouth disease and highly pathogenic avian influenza—two highly infectious foreign animal diseases. They said that should this happen, the effects on animal and public health could be devastating.Federal and state agency officials reported several consequences of this insufficient veterinarian capacity. Examples are as follows:
• Michigan state agency officials told us they had trouble testing enough cattle during the bovine tuberculosis outbreak. Over a 6-1/2 year period, veterinarians struggled to test more than a million cows— an average of more than 3,500 a week—but the state has yet to eradicate the disease.
Table 2. Four Recent Zoonotic Outbreaks We Analyzed
| Disease | Location | Date outbreak began | Date outbreak ended | Animals infected | human cases in the identified | Number of veterinarians involved in outbreak’ | t otal size of workforce involved in outbreak’ | Federal and state agencies involved in outbreak (agencies in bold cited insufficient veterinarian capacity as a challenge)11 |
| Bovine tuberculosis | Michigan | Fall 1994 | Outbreak is ongoing | Wildlife, cattle | 2c | 218d | 412 | APHIS Michigan Department of Agriculture Michigan Department of Community Health Michigan Department OfNatural Resources Michigan State University |
| Exotic Newcastle disease | California | October 2002 | September 2003 | Poultry and other susceptible avian species | 2c | l,250d | 6,039 | APHIS California Animal Health and Food Safety Laboratory California Department of Food and Agriculture California Department of Public Health |
Table 2.
(Continued)| Disease | Location | Date outbreak began | Date outbreak ended | Animals infected | human cases in the identified | Number of veterinarians involved in outbreak’ | Total size of workforce involved in outbreaka | "e ∙g.S.⅛ ∙? ∙s S x ⅛ ∙a -s⅛^∣∙g2?l∙s? ⅛ ÿ ∙? = = "3 - "Ξ u ß ■g S ≥ g ⅛O ² I B. S ΛsgosΛ?⅛ g,⅞ w S -l > u |
| Monkeypox | Wisconsin | May 2003 | August 2003 | Prairie dogs, Gambian giant rats, dormice, rope squirrels | 27c | 39 | 560 | APHIS, CDC, FDA USGS Wisconsin Dept. of Agriculture, Trade and Consumer Protection Wisconsin Div of Public Health |
| West Nile virus | Colorado | June 2003 | November 2003e | Birds, horses | 2,947f | 27 | 150 | APHIS CDC Colorado Department of Agriculture Colorado Department of Public Health and the Environment Colorado Division of Wildlife. Colorado State University |
Source: GAO.
a Estimates provided by agency officials. Includes veterinarians across agencies.
b The agencies listed are those identified as playing an important role in the outbreak, although additional agencies were involved.
c Number of confirmed human cases, as provided by state departments of public health.
d These estimates include private-sector veterinarians who worked on the outbreaks as contractors or temporary employees.
e West Nile virus is endemic to the United States. There have been seasonal outbreaks across the country every year since 1999.
f Number of CDC confirmed human cases. CDC also reports that the number of confirmed nationwide human cases in 2003 for monkeypox and West Nile virus was 51 and 9,862, respectively.
• Some Michigan officials told us that APHIS and the Michigan Department of Agriculture did not have enough veterinarians to both respond to bovine tuberculosis and address other animal diseases, such as E. coli. In fact, during all four outbreaks, veterinarians at some point had to delay important work on other diseases, in part because there were not enough veterinarians.1
• During the 2003 West Nile virus outbreak in Colorado, a lack of sufficient veterinarians to track and control the disease, among other things, may have allowed the virus to infect more people and animals than it otherwise would have.2
• The volume of work required to control and eventually eradicate exotic Newcastle disease in California physically and emotionally exhausted veterinarians to the extent that, once the outbreak was over, they needed significant time off to recover, further delaying work on routine activities.
• The demanding nature of the exotic Newcastle disease and bovine tuberculosis outbreaks may have caused some veterinarians to seek employment elsewhere.
Despite reports of insufficient veterinarian capacity during these four outbreaks, the agencies have not taken full advantage of two important opportunities to learn from past experience. First, 10 of the 17 agencies have not assessed how well their own veterinarian workforces responded to individual outbreaks. Our prior work has shown that agencies can improve response by conducting postoutbreak assessments.3 One outcome of such an assessment might be a better understanding of how to most efficiently use veterinarians.
For example, APHIS—one of the agencies that has performed postoutbreak assessments—found that it had difficulty locating veterinarians with the specialized expertise needed for addressing the exotic Newcastle disease outbreak. As a result, APHIS is developing a national list identifying veterinarians and their credentials to call upon in the future. In addition, federal and state agencies working on bovine tuberculosis in Michigan meet periodically to assess what strategies are working and what they need to change in order to better control the disease. APHIS also conducts periodic reviews of its efforts and the state's efforts to address bovine tuberculosis.Moreover, none of the 17 agencies have come together to share their experiences across the outbreaks in order to identify workforce challenges that they may have had in common, including veterinarian workforce challenges.
Consequently, the agencies are missing the opportunity to identify and address challenges they are likely to face in the future. The majority of the federal and state agency officials we spoke with agreed that it would be useful for agencies not only to conduct assessments of their own workforce response but also to periodically meet to identify common workforce challenges across multiple outbreaks and discuss strategies for overcoming these challenges. However, some agencies told us that their veterinarian workforce is already facing heavy workload demands that make it difficult for them to meet their existing responsibilities, and thus they have not had time to conduct postoutbreak assessments.