Background Local health protection systems play a crucial role in the prevention, management, and control of infectious diseases in England and were critical to the recent pandemic response. Despite this vital function, few studies have explored the lived experience of health protection practitioners managing COVID-19. This paper fills this gap by using a qualitative methodology to examine how COVID-19 shaped the work of health protection staff managing infectious diseases in England during the pandemic.

Methods Twenty semi-structured interviews were conducted between June 2021 and October 2022 with staff working in a variety of health protection roles across three socio-economically contrasting local authorities in England. Participants included: staff working in local authority public protection teams (n=7); Public Health England staff (n=6); local authority consultants in public health (n=5); and community infection prevention and control nurses (n=2). Data was analysed using a reflexive thematic analysis and we draw out three themes below.

Results Our first theme demonstrates the huge amount of work created by COVID-19 and the massive disruption and stress for health protection staff working to control the pandemic. We show how one of the consequences of these workloads was that, over time, health protection responsibilities were shifted to staff with limited health protection expertise. Our second theme shows how COVID exposed the cracks in a health protection system stressed by reductions in funding in the years leading up to the pandemic. Injecting money into the COVID response did not make up for lost health protection expertise and virtually all non-COVID health protection infectious disease work stopped. Our final theme shows how COVID has enhanced the capability and capacity for work around infectious diseases. COVID has increased funding for, and raised the profile of, health protection work, created a common cause across local authorities and has driven collaborative working.

Conclusion While our findings may not be representative of all local authorities in England, they call into question the state’s preparedness for a public health emergency on this scale and suggest a lack of resilience within local health protection systems. The pandemic has also, however, created a ‘window of opportunity’ for health protection. The increases in capacity and capability built within heath protection systems during the pandemic, if coupled with sustained increases in central government funding, could be capitalised on to build resilience for managing infectious diseases, and prepare for future pandemics.