America’s public health infrastructure—already under immense strain—faces an existential workforce crisis. Nearly 80% of U.S. counties have no infectious disease (ID) specialist, and state and local health departments need an 80% increase in staffing to deliver even a basic level of public health services.
To address this, a bipartisan group of lawmakers has introduced a bill to reauthorize and extend two key federal loan repayment programs that are set to expire at the end of Fiscal Year 2025. The proposed legislation—H.R. 4445, the Public Health and Bio-Preparedness Workforce Loan Repayment Reauthorization Act of 2025—aims to strengthen recruitment and retention of public health, infectious disease, HIV, and emergency preparedness professionals in underserved areas.
Led by Representatives Jason Crow (D-CO), Mariannette Miller-Meeks (R-IA), Lori Trahan (D-MA), and Brian Fitzpatrick (R-PA), the bill builds on earlier bipartisan efforts and responds to ongoing workforce attrition. It offers a strategic fix: incentivize service in high-need areas through student loan repayment, thereby supporting both individual professionals and the broader public health mission.
“These workforce shortages leave communities underprepared to respond to public health emergencies and weaken the ability of public health departments to provide screenings and treatment… and inspection or licensing to ensure food safety.”
— Congressman Jason Crow
A Crisis of Coverage
The shortage of infectious disease physicians is not just a rural problem. While rural counties are disproportionately affected, nearly two-thirds of all Americans live in counties with either no or below-average access to ID specialists. This geographic mismatch became acutely visible during the COVID-19 pandemic, where counties with the highest burden of cases were often the ones least equipped to manage them.
ID specialists are essential for managing complex conditions like HIV/AIDS, antimicrobial resistance (AMR), infections in cancer patients, and complications from organ transplants. Studies show that patients treated by ID physicians experience better outcomes, shorter hospital stays, and reduced health care costs. Yet, despite the growing need, interest in the specialty is shrinking—due in large part to lower compensation compared to procedural specialties and longer training requirements, which leave many with significant educational debt.
The Reauthorization Plan
To stem this attrition and expand workforce capacity, H.R. 4445 seeks to reauthorize and extend two programs through FY 2030:
- The Public Health Workforce Loan Repayment Program – Offers student loan repayment to professionals who serve in local, state, or tribal public health departments.
- The Bio-Preparedness Workforce Pilot Program – Targets infectious diseases, HIV, and emergency preparedness professionals working in health professional shortage areas, medically underserved communities, or federal facilities such as community health centers, VA clinics, and Ryan White HIV/AIDS Program sites.
Both programs would repay up to $35,000 in student loans annually for up to three years of qualifying service, making careers in public and ID health financially viable for young professionals.
A Matter of Public Health—and National Security
Strengthening the public health and infectious disease workforce isn’t just a healthcare issue—it’s a matter of national preparedness and public safety.
When communities lack skilled personnel to detect, contain, and treat infectious diseases, outbreaks spread faster, health care systems become overwhelmed, and vulnerable populations suffer disproportionately. Robust public health and ID capacity is critical to protecting Americans from known and emerging threats, including antimicrobial resistance, pandemics, and bioterrorism. These programs directly support that mission by ensuring more professionals are positioned where they are most urgently needed.
Just as critically, the reauthorization supports U.S. preparedness for future pandemics, high-consequence pathogens, and other emerging biological threats. Infectious diseases and public health professionals serve as the operational backbone of biosecurity: they identify unusual patterns in disease surveillance data, confirm and characterize novel pathogens, implement containment and infection control protocols, and coordinate cross-sector responses during crises. The COVID-19 pandemic made clear that when local health departments lack staff, laboratories are under-resourced, and ID specialists are unavailable, the entire response system slows down—delaying case identification, increasing transmission, and compounding both human and economic costs.
Loan repayment incentives can help reverse the chronic underinvestment in these critical capabilities by enabling trained professionals to serve in roles traditionally undervalued or underfunded. Moreover, as synthetic biology, global travel, and climate change accelerate the risk landscape—from zoonotic spillovers to accidental or deliberate biological events—a geographically distributed, expert health workforce becomes as vital to national security as the military or intelligence community. By reauthorizing these programs, Congress can help rebuild a talent pipeline that directly supports faster detection, stronger containment, and greater resilience against the next major biological threat.
A Timely Opportunity for Action
Workforce shortages are growing, not shrinking. Unless Congress acts, these loan repayment programs will expire at the end of FY 2025. Without reauthorization, the federal government risks losing momentum in rebuilding the public health infrastructure and closing the infectious disease care gap.
The bill has broad support from leading organizations including the Infectious Diseases Society of America (IDSA), HIVMA, and the National Association of County and City Health Officials (NACCHO), all of which are calling for swift passage and full funding.
Reauthorizing and funding H.R. 4445 is an essential investment in America’s health security. It is a cost-effective way to recruit and retain skilled professionals in the very areas that need them most. At a time when biological threats are growing more complex and frequent, this bill ensures that the people who protect public health will be there when we need them most.
How You Can Support This Legislation
Public health and infectious diseases professionals, academic leaders, healthcare administrators, and concerned constituents all have a role to play in advancing this critical legislation. If you believe in strengthening the nation’s ability to prevent and respond to biological threats, consider contacting your members of Congress to express support for H.R. 4445 and its full funding through FY 2030. Personal outreach—whether via email, phone, or through professional organizations—can help underscore the urgency of workforce investment to legislators on both sides of the aisle.
For more information or tools to assist with advocacy, visit and support organizations such as the Infectious Diseases Society of America (IDSA), National Association of County and City Health Officials (NACCHO), Association of Public Health Laboratories (APHL), or contact your state-level public health association.
Sources and Further Reading
- IDSA and HIVMA Statement on H.R. 4445
- Rep. Crow’s Press Release (July 2025)
- 80% of US counties have no ID specialists – The Hospitalist
- Staffing Up: Investing in the Public Health Workforce – de Beaumont Foundation
- Public Health Workforce Loan Repayment Act (2021) – Full Bill Text (PDF)
- Reauthorization Bill (2025) – Full Bill Text (PDF)