Skip to main content

New peer-reviewed study documents operational challenges and lessons learned by US public health laboratories during the COVID-19 response

Center News


August 2, 2022 – A new study—conducted by scientists from the Johns Hopkins Center for Health Security and colleagues and published in The Journal of Public Health Management & Practice—documents challenges faced and lessons learned by local and state public health laboratories (PHLs) during the COVID-19 pandemic response.

In the early days of the pandemic, PHLs across the United States were strained in multiple ways, especially related to developing and deploying COVID-19 tests. The study collects and analyzes information about state and local PHLs’ early COVID-19 experiences to support the development of best practices for current and future health emergencies.

“Identifying Operational Challenges and Solutions During the COVID-19 Response Among US Public Health Laboratories” was conducted by researchers at the Center for Health Security, the Association of Public Health Laboratories, and the Brown University School of Public Health.

In 2021, the researchers interviewed 68 leaders and staff representing 28 local and state PHLs across 27 states. Key challenges identified include:

  • A lack of a clear mandate, as PHLs shifted from their traditional surveillance-based testing role to large-scale clinical diagnostic testing;
  • Confusing or insufficient operational guidance from federal agencies, including the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA);
  • Political interference at the state or local levels; and
  • Antiquated information systems limiting testing capacity.

The researchers also found that as the pandemic progressed, so did the nature of the challenges. Early struggles revolved around poor or limited diagnostics, and later, around scale-up of testing services. Throughout the beginning of the pandemic, PHLs also experienced staff burnout, aging infrastructure, difficulty meeting staffing or supply needs, and challenges collaborating and coordinating with partners.

Implications for policy and practice include:

  • Lessons learned by PHLs during the COVID-19 pandemic can inform solutions to current challenges and future preparedness efforts for similar emergencies for both PHLs and other diagnostic laboratories.
  • Federal and jurisdictional leaders must recognize and address long-standing gaps related to funding, lab workforce, and lab needs in preparedness policies for future public health emergencies.
  • Jurisdictional leaders must strengthen relationships with PHLs, including establishing lines of communication that allow for consistent support.
  • While PHLs may be able to solve some problems on their own, addressing many of the remaining challenges will require effort from jurisdictional and federal leadership and other partners. PHLs must build—and sustain—strong relationships with leaders and other partners.

Read the study here.