Health worker losses surface the year after an epidemic

Clinical takeaway: Health workforce protection belongs in epidemic preparedness planning, with the losses concentrated after the emergency passes, not during it. 

Clinicians who worked through COVID-19 don't need a model to tell them that epidemics claim careers as well as lives. They watched colleagues retire early, scale back, or leave medicine altogether, and they picked up the shifts left behind. This study suggests those workforce losses may not be unique to COVID-19 but part of a broader pattern seen after epidemics around the world.

An estimated 115,500 health workers died worldwide in the pandemic's first year. The professional departures that followed had not been assessed. A new modeling analysis takes up that question, linking epidemics to an estimated 17,500 health worker departures worldwide each year. The toll reaches systems rich and poor and arrives on a schedule worth knowing. 

Assuming the observed associations are causal, the analysis attributes an average of 17,549 health worker losses worldwide to epidemics each year from 1990 through 2019, with an uncertainty range of 5,661 to 29,437. That works out to 2.57 of every 10,000 health workers lost annually, and the timing was consistent: the strongest association appeared one year after an epidemic. Whether those departures are attributable to death, career exit, redeployment, or emigration, the data cannot distinguish. 

Low-income countries lost 15.89 of every 10,000 health workers to epidemics annually while high-income countries lost 0.12, a gap of more than 130-fold. South Asia and sub-Saharan Africa carried the heaviest regional rates, at 20.52 and 18.03 per 10,000, and Niger, Somalia, and Ethiopia topped the national list. Nursing and midwifery personnel absorbed the largest absolute losses of any cadre, 6,125 a year, with aides and emergency medical workers next and physicians behind them. 

A single additional epidemic was tied to a loss of roughly 31 health workers per million residents in high-income countries, about 12 times the point estimate in low-income countries, where the association did not separate from chance. Fewer epidemics, not lower vulnerability, is what kept wealthy systems' cumulative losses small. 

The researchers paired 30 years of epidemic records from EM-DAT, the international disaster database, with modeled national health worker density estimates covering 16 worker cadres across 194 countries and territories from 1990 through 2019. The 1,185 recorded epidemics met at least one disaster threshold, such as 10 deaths or a declared emergency, and workforce associations were estimated at lags of up to five years. Records after 2019 were unavailable by cadre, so the COVID-19 pandemic is outside the analysis entirely. 

The authors' first call is workforce protection. Epidemic preparedness, they conclude, should prioritize retaining the cadres losing the most members: nurses, midwives, and physicians. Many of the outbreaks were waterborne, and they argue wastewater surveillance labs and gastroenteritis vaccination could cut disease before it reaches the workforce.  

Source: Chen M, et al. (2026 Sep 22) PLoS Med. Global, regional, and national impact of epidemic disasters on health workforce equality between 1990 and 2019: An ecological and modeling study