For more than four decades, Field Epidemiology Training Programs (FETPs) have been among the most successful workforce development models in public health. Built on the principle of learning by doing, these programs have trained thousands of epidemiologists who have strengthened surveillance systems, investigated outbreaks, responded to health emergencies, and supported evidence-based decision-making around the world.

Central to this approach is hands-on field experience, with approximately 75% of training taking place through supervised field placements under the guidance of mentors. 

Today, more than 80 FETPs operate across more than 160 countries and territories and continue to serve as a cornerstone of global health security. Yet the public health landscape that shaped the first generation of FETPs is no longer the same. Climate change, antimicrobial resistance, mental health challenges, humanitarian crises, and increasingly interconnected health threats are reshaping workforce needs and expanding expectations of field epidemiologists.

The challenge facing FETPs is no longer whether they should evolve, but how they can adapt while preserving the practical, competency-based approach that had defined their success. 

As a result, countries are increasingly seeking epidemiologists who can operate across disciplines, generate actionable evidence, support decision-making, and respond to a broader range of public health priorities than ever before. 

Rethinking the Epidemiology Workforce

Global guidance recommends at least one field epidemiologist per 200,000 people, yet many countries remain far from achieving this benchmark. Expanding workforce capacity remains important, but numbers alone are no longer enough. 

Today's health systems require epidemiologists who can generate evidence, communicate risk, engage communities, support policy development, and collaborate across disciplines. Increasingly, they must also operate within complex humanitarian and emergency settings, where preparedness, coordination, and adaptive decision-making are as important as technical epidemiological skills. Rather than producing a single type of epidemiologist, FETPs are increasingly preparing professionals capable of applying epidemiological competencies in diverse and evolving contexts. 

"The landscape of field epidemiology is evolving, with increasing demands in emerging areas such as zoonotic diseases, antimicrobial resistance, genomics, and non-communicable diseases, while high demands to investigate and respond to outbreaks of infectious diseases continue."
— WHO South-East Asia 

Expanding Field Epidemiology for a Changing Public Health Landscape

One of the most significant developments in recent years has been the emergence of thematic and specialized FETP tracks. As public health priorities evolve, FETPs are increasingly expanding into areas such as immunization, mental health, climate and environmental health, genomic surveillance, antimicrobial resistance, and One Health. 

Rather than representing a departure from the traditional FETP model, these tracks build upon its foundations. The same competencies that support outbreak investigations and surveillance activities can be applied to vaccine-preventable diseases, climate-sensitive health threats, mental health systems, or antimicrobial resistance. 

Alongside specialization, FETPs are increasingly embracing contextualization, adapting training models to address country-specific workforce gaps, health priorities, and operational realities. This flexibility allows programs to remain relevant across diverse settings while preserving the principles that underpin field epidemiology training.

Across the Eastern Mediterranean Region (EMR) and beyond, EMPHNET has contributed to this evolution through the development and support of specialized tracks including:

• Regional Intermediate and Advanced FETP in mental health in collaboration with Africa CDC
• Climate and environmental epidemiology curriculum development in collaboration with UKHSA (Read more about it here)
• Public Health Empowerment Programs (PHEPs) focused on priority public health threats and preparedness areas such as:
  • Respiratory viruses (PHEP-RV)
  • Middle East Respiratory Syndrome (PHEP-MERS)
  • Immunization-focused programs (PHEP-EPI/PEO)

One of the clearest examples of this shift can be seen in the growing integration of mental health into field epidemiology training. As noted by Mr. Dumsani Njobo Mamba, Mental Health Technical Officer at Africa CDC:

"The goal is no longer to train epidemiologists solely to investigate disease outbreaks, but also professionals who understand broader public health challenges, including mental health."

Mental health is only one example of how epidemiological competencies are being applied in new contexts. Immunization-focused FETP and PHEP tracks provide another example of this evolution, applying epidemiological competencies to vaccine-preventable disease surveillance, routine immunization, preparedness, and outbreak response. As some of the earliest specialized training models in the region, programs in countries such as Afghanistan, Lebanon, Sudan, and Yemen, have strengthened disease prevention efforts while informing newer tracks focused on respiratory viruses, One Health, and climate-related health threats.

Together, these examples illustrate a broader shift in workforce development, where field epidemiology competencies are increasingly being applied to emerging priority areas while preserving the foundations of FETPs. As a result, field epidemiologists are increasingly expected to generate evidence, work across sectors, and contribute to multidisciplinary solutions that strengthen public health systems.

Specialized tracks therefore represent more than curriculum expansion. They reflect a broader effort to make field epidemiology training more adaptive, relevant, and responsive to the realities facing modern public health systems.

From Responding to Threats to Generating Evidence

Historically, FETPs have been recognized for producing professionals capable of detecting and responding to outbreaks. Today's health systems require something more.

The ability to generate evidence is becoming just as important as the ability to respond to emergencies. Operational research, surveillance evaluations, implementation science, policy analysis, and program assessments are increasingly informing public health decisions and shaping health system performance. 

As a result, field epidemiologists are increasingly expected to investigate outbreaks, conduct research, evaluate programs, generate operational insights, and communicate findings to decision-makers. This shift is reflected in the growing number of publications, surveillance evaluations, and operational research projects emerging from FETPs, transforming field experiences into evidence that informs policy, practice, and public health action.

Expanding Reach and Equity

As FETPs evolve, ensuring equitable access to training has become an increasingly important consideration. Future FETPs must reach frontline and subnational public health professionals through flexible learning models, virtual mentorship, regional hubs, and decentralized field placements. The goal is not simply to train more epidemiologists, but to ensure expertise reaches the places where public health action happens.

Flexible learning approaches, such as:

• Hybrid learning models
• Regional training hubs
• Virtual mentorship
• Local mentor development
• Decentralized field placements. 

Mentorship as a Pillar of FETP Quality

If specialized tracks represent the future of FETP content, mentorship remains the foundation of FETP quality.

The learning-by-doing model depends heavily on mentors. Residents spend most of their training in the field (75%), where mentors guide investigations, review analyses, provide feedback, and support professional growth. Strong mentor networks help maintain quality, strengthen institutional memory, and create pathways for graduates to become future leaders, trainers, and advocates. 

"An excellent set of teaching modules with inadequate mentorship does not result in well-trained field epidemiologists." — Dr. Carl Reddy, TEPHINET’s Director

EMPHNET's investments in mentorship development, exchange programs, and alumni engagement reflect the recognition that sustainable workforce development depends as much on people as it does on curricula.

Building Workforce Ecosystems, Not Just Training Programs

Field epidemiology training does not end at graduation. As public health challenges become more complex, field epidemiologists require ongoing opportunities to learn, collaborate, and exchange experiences throughout their careers. This has led to growing interest in exchange programs, communities of practice, peer learning networks, and continuing professional development initiatives. 

This has prompted a broader shift from viewing FETPs as standalone training programs to viewing them as part of a larger workforce ecosystem. Across the region, initiatives are helping field epidemiologists continue learning and collaborating beyond formal training, including:

• EMPHNET FETP Exchange Program: Providing hands-on learning opportunities across countries and public health systems.
• FETP PeerLab (An Upcoming Initiative): Promoting peer learning, knowledge exchange, and professional development among FETP graduates.
• EMPHNET Electronic Library (EEL): Providing continuous access to evidence, publications, learning materials, and public health resources.
• FETP Ambassadors Program: Strengthening visibility, communication, and knowledge sharing across country programs.
• EMPHNET Webinar Series (WEBi): Building capacity, fostering networking, and increasing visibility of field epidemiology experiences and public health initiatives.
• EMPHNET Regional Conference: Facilitating research dissemination, experience sharing, and regional collaboration.

Together, these initiatives reflect a growing recognition that building public health capacity requires more than training individuals; it requires creating connected platforms that support learning, collaboration, and leadership throughout a field epidemiologist's career.

Sustaining the Future of FETPs

As FETPs continue to expand, questions of sustainability become increasingly important. Many programs still rely heavily on donor support, while long-term institutionalization remains uneven across countries. 

The Global Field Epidemiology Roadmap has emphasized the importance of sustainable financing, stronger institutional ownership, and coordinated action across the broader FETP enterprise. Future success will require diversified funding sources, stronger partnerships, and clear professional pathways for graduates. Yet sustainability alone is not enough. As programs expand and diversify, maintaining quality becomes equally important.

Balancing Innovation and Quality

Perhaps the most important question facing FETPs is how to innovate without compromising quality. As programs expand into new domains and introduce new delivery approaches, quality assurance becomes increasingly important. Curriculum review, competency mapping, accreditation, mentorship standards, continuous assessment, and credentialing discussions all play an important role in ensuring that FETPs maintain their rigor while adapting to changing needs. 

The objective is not to preserve FETPs exactly as they were, nor to reinvent them entirely. The objective is to build adaptive programs that remain grounded in the principles that have made field epidemiology successful for more than four decades.

Looking Ahead

Ultimately, the evolution of FETPs is not simply about expanding curricula or introducing new tracks. It is about ensuring that training translates into meaningful public health action through surveillance, preparedness, outbreak response, evidence generation, and health system strengthening.

Through specialized training initiatives, mentorship development, exchange programs, peer learning platforms, and regional knowledge-sharing networks, EMPHNET is helping shape this evolution. These efforts demonstrate that the future of FETPs lies not only in expanding training opportunities, but also in building resilient workforce ecosystems that support epidemiologists throughout their careers and strengthen public health systems for years to come.

WEBi Spotlight

EMPHNET recently hosted the 54th session of its WEBi Series, titled "The Role of Immunization-Focused FETPs in Preventing and Controlling Vaccine-Preventable Diseases in Fragile Settings." The session explored how immunization-focused FETPs and PHEPs strengthen surveillance, outbreak response, routine immunization, and preparedness capacities in fragile and emergency settings.

Watch the webinar and read more here.