Responding to National and Global Crises, 2015–2021
As fate would have it, the early years of the National Academy of Medicine (NAM) coincided with a period of great upheaval in U.S. politics and society, as well as the most damaging global public health crisis in a century—the COVID-19 pandemic. The NAM’s new strategic focus on proactivity and flexibility, as well as its readiness to speak out on issues of concern to its leaders and members, proved ideally suited to respond to the dramatic societal challenges that emerged between 2015 and 2021. The NAM quickly established itself as an organization capable of effecting change at the highest levels through innovative and nimble program models designed to drive collective action and collaborative solutions—while staying rooted in the scientific rigor that formed the core of its credibility and influence.
In 2017, following 2 years of intensive consultation with NAM members, volunteers, sponsors, and other stakeholders, the NAM published its “Strategic Plan 2018–2023: Goalposts for a Healthier Future” (described in Chapter 3) (NAM, 2017d). The plan laid out three overarching strategic goals: (1) identify and address critical issues; and lead and inspire action; (2) diversify and activate the membership of the NAM; and engage emerging leaders and scholars; and (3) build leadership capacity across diverse disciplines. This chapter describes the NAM’s programs and impact between 2015 and 2021 within the context of this strategic framework.
IDENTIFYING, ADDRESSING, AND INSPIRING ACTION IN RESPONSE TO CRITICAL ISSUES (STRATEGIC GOAL 1)
The first overarching goal in the NAM’s strategic plan dictated that it proactively identify and respond rapidly to address the most urgent challenges that present a threat to the health of people worldwide. This approach was in contrast to the early decades of the Institute of Medicine, when the organization developed programs only in response to a request from an external sponsor. This strategic goal also looked beyond the confines of the NAM’s own programmatic response and called for it to catalyze collective action among diverse stakeholders. As described below, the NAM applied this proactive and collaborative orientation in response to global infectious disease
outbreaks, the national crisis of health worker burnout, the U.S. opioid epidemic, health system transformation, and structural racism.
The Ebola Crisis in West Africa
In 2014–2016, the emergence of Ebola in West Africa became the first major issue the NAM took on as a new Academy. The outbreak was the largest of its kind in history, ultimately infecting nearly 30,000 people and killing more than 11,000 (CDC, n.d.f; see Figure 7-1). In Spring 2015, Victor Dzau1 met with Jim Yong Kim, an NAM member who was then president of the World Bank Group, to discuss the unfolding crisis. The two leaders agreed that the global response to the outbreak appeared slow, uncoordinated, and largely uninformed by scientific evidence. Kim encouraged Dzau to mount a response through the IOM that would be seen as independent and authoritative by the international community.
The Commission on a Global Health Risk Framework for the Future (GHRF), which launched in July 2015, the same month the IOM became the NAM, leveraged the NAM’s position as a neutral advisor and convener to lead a formal assessment of the global response to Ebola and develop a framework to guide the response to future pandemics (NAM, n.d.d). The GHRF project developed a novel program model that would become a staple of the NAM’s work in ensuing years: the International Commission. The NAM appointed an oversight board with responsibility for guiding the initiative and a commission to carry out the assessment and author an independent report. The commission consisted of 17 members from diverse geographic regions with expertise in finance, governance, research and development, health systems, and social science. To inform its report, the commission hosted information-gathering workshops across 4 continents and received input from more than 250 experts and stakeholders (NAM, 2015).
1 As this event preceded the July 2015 transition of the Institute of Medicine (IOM) to the National Academy of Medicine, Dzau was then president of the IOM.
The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises, published in January 2016, noted that Ebola and other outbreaks “revealed gaping holes in preparedness, serious weaknesses in response, and a range of failures of global and local leaders” (NAM, 2016a, p. v). Despite the potential of infectious diseases to produce a catastrophic loss of life and an estimated $60 billion in annualized expected losses, nations devoted only a small fraction of the money they spent on national security to pandemic preparedness (NAM, 2016a). The commission urged world leaders to look at health security as a “global public good” and to commit to the creation and maintenance of a “comprehensive global framework to counter infectious disease crises” (NAM, 2016a, p. 1).
The GHRF report was among the first major publications to make a strong case for investment in global health security. It recommended a three-pronged approach that included strengthening public health systems, improving global and regional coordination and capabilities, and accelerating research and development of tools such as diagnostics and vaccines (NAM, 2016a). In the months and years immediately following its publication, a number of new international organizations were formed to take action in these areas. In May 2016, the World Health Organization (WHO) announced the creation of a new Health Emergencies Programme “designed to deliver rapid, predictable, and comprehensive support to countries and communities as they prepare for, face or recover from emergencies caused by any type of hazard to human health” (Bahuguna, 2016). The following year, the Coalition for Epidemic Preparedness Innovations (CEPI), was founded “as the result of a consensus that a coordinated, international, and intergovernmental plan was needed to develop and deploy new vaccines to prevent future epidemics” (CEPI, n.d.a). In 2018, the WHO and the World Bank Group launched the Global Preparedness Monitoring Board (GPMB) to “[bring] together political leaders, heads of United Nations agencies and health experts to strengthen global health security through stringent independent monitoring and regular reporting” (UN, 2018). Dzau served on CEPI’s interim board of directors as well as the GPMB board, alongside GHRF Commission members Jeremy Farrar (Wellcome Trust) and Chris Elias (Bill & Melinda Gates Foundation) (CEPI, n.d.b; GPMB, n.d.a, n.d.b).2
The COVID-19 Pandemic
The lessons of the GHRF report proved prescient as SARS-CoV-2 (the virus that caused COVID-19) emerged in early 2020 (see Figure 7-2). Following declarations of U.S. and global public health emergencies, the staff of the NAM and the National Academies of Sciences, Engineering, and Medicine (the National Academies) were asked to work remotely for an initial period of 3 weeks beginning on March 16, 2020. The remote work period was eventually extended for more than 2 years. Despite challenges in adjusting to working from home, especially for parents of young children, the NAM quickly pivoted its operations and programmatic priorities to focus on the response to COVID-19. “The COVID-19 pandemic brings the National Academies’ mission into stark relief,” Dzau wrote in a letter to NAM members on April 7, 2020.
We were chartered to provide scientific leadership to the nation and the world and advance evidence-based solutions for the most urgent and complex challenges facing humanity. As we witness the most significant pandemic for a century unfold across international borders—and as misinformation threatens the lives of thousands—there is no question of our fundamental obligation to act.3
2 Dzau served on the interim board of CEPI. As of January 2022, Farrar served on the boards of CEPI and GPMB, and Elias served on the board of CEPI.
3 Victor Dzau to NAM Members, “Fourth Update on NAM/NASEM Response to COVID-19,” April 7, 2020, IOM/NAM Records.
Dzau himself quickly assumed a prominent role in the international COVID-19 response, helping to initiate a Coronavirus Global Response Pledging Conference hosted by the European Commission on May 4, 2020. “This is about solidarity—we cannot let the poorest and most affected countries struggle alone,” said Dzau in remarks at the event. “Infectious disease outbreaks like COVID-19 are among the most complex challenges we face as a global society. We need to work together to accelerate the development of vaccines and treatments and ensure that they will be available to everyone” (NAM, 2020j). Dzau also served on the boards of the Global Preparedness Monitoring Board and Access to COVID-19 Tools (ACT) Accelerator (ACT-A), which supported equitable global access to COVID-19 vaccines through its COVAX facility (Gavi, n.d.).
Providing Scientific Advice in the Early Days of the Pandemic
Dzau also spearheaded a comprehensive response to COVID-19 at the NAM and supported a coordinated effort across the National Academies. One of the NAM’s first actions in response to the pandemic was to launch the “COVID-19 Conversations” webinar series in partnership with the American Public Health Association (APHA) (APHA and NAM, n.d.). Designed to disseminate reliable scientific information during a time of uncertainty and amid conflicting information from government sources, the series was hosted by Dzau and APHA executive officer Georges Benjamin. The series’ advisory committee was co-chaired by NAM members Carlos del Rio of Emory University and Nicole Lurie, who served as the Assistant Secretary for Preparedness and Response under the Obama administration.4 The first webinar of the series, titled “The Science of Social Distancing,” was hosted on March 25, 2020, and attracted more than 10,000 participants—record attendance for the NAM. Webinars were hosted every 2 weeks in the early months of the crisis, amounting to a total of 21 events by August 2021. The series provided rapid scientific analysis of
4 Carlos del Rio was NAM International Secretary at the time. Nicole Lurie was affiliated with the Coalition for Epidemic Preparedness Innovations.
topics that were top of mind for health leaders, policy makers, and the public, ranging from testing and treatment to the reopening of K–12 schools and universities to vaccines, virus variants, and impacts on health equity.
The NAM-APHA series ran in parallel to the work of the National Academies’ Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats (SCEID), launched on February 28, 2020, at the request of the White House Office of Science and Technology Policy. Chaired by former IOM President Harvey Fineberg,5 and with the participation of multiple NAM members, the SCIED produced evidence-based rapid expert consultations (RECs) and consensus reports on topics such as the seasonality of SARS-CoV-2, the effectiveness of face coverings, and crisis standards of care, among many others. By the end of 2021, SCEID had produced 15 RECs and 2 consensus studies, and Fineberg had appeared frequently on national news channels to report on the committee’s findings.
Guidance on COVID-19 Vaccine Allocation and Acceptance
In August 2020, in anticipation of the imminent availability of one or more COVID-19 vaccines, the NAM and the National Academies launched a study at the request of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention to recommend a framework for equitable allocation of vaccine in the United States and globally. One month prior, NIH director Francis Collins had, in testimony before Congress, called for a “group of big thinkers who [can] take a high-level view of this and lay out a foundation of principles that could then be utilized … when the moment comes to actually turn that into an implementation plan” (U.S. Congress, Senate, 2020). The study committee was co-chaired by NAM members William H. Foege,6 former director of the Centers for Disease Control and Prevention (CDC), and Helene Gayle,7 former Chief Executive Officer of the international humanitarian organization CARE. In anticipation of a limited initial supply of vaccine, the committee was charged with determining which groups (e.g., health care workers, older adults, people with serious illnesses, etc.) should be eligible for vaccination first. The study also prioritized the promotion of health equity, given the much higher rates of infection and death among people of color, and of strategies to mitigate vaccine hesitancy. Given the high stakes of this issue, the committee prioritized transparency and the collection of diverse public input. Nearly 1,500 public comments were analyzed and incorporated into the final study, Framework for Equitable Allocation of COVID-19 Vaccine, which was released on October 2, 2020 (NASEM, 2020b).
The report recommended a four-phased allocation framework founded on broadly accepted ethical principles and guided by evidence to maximize the reduction of morbidity and mortality from transmission of the virus. Additional recommendations included the adaptation of existing public health systems and structures for vaccine distribution; measures to ensure that the vaccine would be free of charge; and a CDC-led vaccine risk communication and community engagement program. Finally, the report recommended that the United States take a leadership role in the equitable distribution of vaccine globally. Following publication, several states incorporated principles from the report into their individual vaccine allocation frameworks along with recommendations from the CDC’s Advisory Committee on Immunization Practices.
Shortly thereafter, as pharmaceutical companies Pfizer and Moderna prepared applications for Emergency Use Authorization (EUA) of their COVID-19 vaccines, alarm among public health leaders ran high that misinformation and mistrust could imperil the success of a COVID-19 vac-
5 Harvey Fineberg was President of the Gordon and Betty Moore Foundation at the time.
6 William H. Foege was affiliated with the Rollins School of Public Health at Emory University at the time.
7 Helene Gayle was affiliated with the Chicago Community Trust at the time.
cination campaign (Darrough and Adib, 2020). Widespread mistrust among health care workers, who were first in line to receive the vaccine, was particularly concerning, given that this group was both at the highest risk for contracting the virus and highly influential in advising the general public about the safety of the vaccine. As it had in the 1990s, the federal government reached out to the NAM for help in mitigating concerns about vaccine safety. At the request of CDC and the Food and Drug Administration (FDA), Dzau hosted a private “NAM Town Hall on the COVID-19 Vaccine for Health Care Leaders” on December 5, 2020. CDC, FDA, and NIH leaders delivered remarks before about 100 executive-level health care leaders about the trustworthiness of the COVID-19 vaccine development process, despite its unprecedented speed.
By March 2021, vaccines had become readily available to most people in the United States, but remained very scarce in other areas of the globe. Dzau, Gayle, and Foege wrote an open letter urging the U.S. government to immediately allocate a portion of the U.S. supply to nations in need. Such an action “would send an important signal to other nations that investment in global health equity must be part of first-line pandemic response, not an afterthought,” they wrote (NAM, 2021d). In June 2021, the Biden administration announced its plan to share at least 80 million doses internationally by the end of that month, 25 percent of which would support direct surge capacity in other countries (The White House, 2021a). The remainder would be allocated through the COVAX program co-administered by Gavi: The Vaccine Alliance, CEPI, and the WHO as part of ACT-A (Gavi, n.d.). By late 2021, the United States had donated approximately 140 million doses to at least 93 countries, with the largest quantities going to Pakistan, Bangladesh, the Philippines, Columbia, South Africa, Vietnam, Indonesia, Guatemala, Uzbekistan, and Nigeria (KFF, 2021).
Strengthening the U.S. Health System After COVID-19
NAM programs that pre-existed the COVID-19 pandemic also rallied to offer guidance within their specific areas of focus. The Action Collaborative on Clinician Well-Being and Resilience (CWB Collaborative), for example, provided a list of resources to support caregivers, which became one of the NAM’s top five most visited webpages in 2020 (NAM, n.d.b). Dzau and CWB Collaborative Co-Chairs Darrell Kirch8 and Thomas Nasca9 published a perspective article in the New England Journal of Medicine in which they called COVID-19’s impact on clinician well-being a “parallel pandemic” that required a federal response akin to that after the September 11 terrorist attacks (Dzau et al., 2020). In a follow-up op-ed in the Los Angeles Times, Dzau called for a “national strategy, not only to help healthcare workers recover from the pandemic, but also to mitigate preexisting drivers of burnout” (Dzau, 2021). The NAM’s Action Collaborative on Countering the U.S. Opioid Epidemic (Opioid Collaborative) and the Culture of Health Program (COHP), in turn, provided resources for other populations hard hit by the pandemic, including individuals with substance use disorder and populations experiencing health inequities that predated the pandemic (NAM, n.d.e, n.d.f).
Attention also turned to rebuilding crucial health systems on the basis of lessons learned from COVID-19. The NAM Leadership Consortium: Collaboration for a Value & Science-Driven Health System undertook a comprehensive review of nine sectors of the U.S. health care system called Emerging Stronger from COVID-19: Priorities for Health System Transformation. The initiative produced assessments of (1) public health; (2) care systems; (3) research; (4) health payers; (5) clinicians; (6) quality, safety, and standards organizations; (7) health product manufacturers and innovators; (8) patients, families, and communities; and (9) digital health (NAM, 2021g). Each
8 Darrell Kirch, an NAM member, was the President Emeritus of the Association of American Medical Colleges.
9 Thomas Nasca was the President and the Chief Executive Officer of the Accreditation Council for Graduate Medical Education.
assessment identified weakness that existed prior to COVID-19, explored how the given sector had responded to the pandemic, and highlighted opportunities for strengthening and transforming the delivery of health care after COVID-19. The sector assessments were delivered to members of Congress, federal agencies including the Office of the Assistant Secretary for Health and the Office of Science and Technology Policy, and organizations such as the Patient-Centered Outcomes Research Institute to inform their strategic planning.
The NAM also established a Working Group on Urgent Priorities for Science, Medicine, and Public Health After COVID-19, which delivered a letter detailing nine recommended actions to the White House Office of Science and Technology Policy in March 2021 (NAM, 2021l).
Pandemic Prevention, Preparedness, and Response
The COVID-19 pandemic lent a new urgency to the issue of global pandemic prevention, preparedness, and response. In January 2020, as a member of GPMB, Dzau had co-signed a statement recommending “urgent global action” in response to the COVID-19 outbreak and expressing grave concern that many countries were unprepared to respond to the virus—a concern that unfortunately proved justified (NAM, 2020i).
In 2021, Dzau arranged for the NAM to serve as Administrative Secretariat (alongside the Wellcome Trust) of a G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response. The panel’s report called for new international funding totaling $74 billion over 5 years to adequately prepare for the next global pandemic (G20, 2021a). “It is our obligation to prepare for future pandemics with a global mindset,” Dzau said in a news release. “This report makes major requests of many countries, but we know that the financial impact of a future pandemic would be much greater than the investments the Panel has identified” (NAM, 2021e).10
In addition to these activities, with funding from the Office of Global Affairs in the Department of Health and Human Services (HHS), the NAM launched a fast-track initiative to enhance pandemic and seasonal influenza vaccine preparedness and response, drawing on lessons from the COVID-19 pandemic (NAM, n.d.g). The initiative acknowledged that a future influenza pandemic could be even more devastating than COVID-19, as demonstrated by the 1918 pandemic, which killed at least 50 million people worldwide (CDC, n.d.h). The NAM leveraged its International Commission model to explore the current state of the art and recommend improvements to influenza vaccine research and development; vaccine distribution and supply chains; public health interventions and countermeasures; and global coordination, partnerships, and financing. Four consensus studies and an overarching summary were published in November 2021. An overview of the series stated that “the world must learn from [the COVID-19 pandemic] to avoid circumstances similar to or worse than COVID-19, and to finally see preparedness as a muscle that we must strengthen, rather than neglect, during interpandemic times” (NAM, 2021f).
Epidemic of Clinician Burnout
Years before the COVID-19 pandemic, the issue of clinician well-being became a core focus area for the NAM and the subject of one of its inaugural programs. By 2016, a series of high-profile deaths by suicide of medical students and residents had highlighted a disturbing and growing trend among physicians and trainees (Bond, 2017). Yet, the problem went far beyond these groups, with
10 On June 30, 2022, the World Bank approved a proposal to establish a Pandemic Prevention, Preparedness, and Response Financial Intermediary Fund (see https://www.worldbank.org/en/news/speech/2022/07/15/remarks-by-world-bank-group-president-david-malpass-to-g20-finance-ministers-and-central-bank-governors-on-the-global-ec).
serious impacts on clinicians of all types. The crisis of burnout touched every sector of health professional training and care systems, but evidence on prevalence, causes, and interventions was thin, and progress was hampered by lack of awareness. With encouragement from Nasca and Kirch, Dzau established the CWB Collaborative in January 2017.
The CWB Collaborative announced its intention to pursue three major goals within its initial term of 2 years (which would later be extended twice to 2022): (1) to raise the visibility of clinician anxiety, burnout, depression, stress, and suicide; (2) to improve the baseline understanding of challenges to clinician well-being; and (3) to advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver (NAM, n.d.b). More than 60 organizations signed on to the CWB Collaborative as inaugural sponsors, each designating a representative to participate in dynamic working groups on subjects including organizational culture, stigma, workload, technology, measurement, and more.
Among the CWB Collaborative’s first outputs was a comprehensive conceptual model illustrating factors affecting clinician well-being and resilience (see Figure 7-3), which served as a blueprint for the program’s strategic planning. In January 2018, the CWB Collaborative issued a call for formal commitments from organizations working to mitigate burnout at the systems level, receiving more than 200 public statements by mid-2021 (NAM, 2018a). The CWB Collaborative next launched a comprehensive online Knowledge Hub to compile and disseminate the evidence base on causes, effects, solutions, and measurement instruments for clinician burnout (NAM, n.d.h).
At the end of the CWB Collaborative’s second year, its co-chairs began promoting the idea that an NAM consensus report could galvanize policy, organizational, and cultural change. Thirty-one sponsors signed on to support the new study, including universities, foundations, and health care organizations. The Board on Health Care Services within the National Academies’ Health and Medicine Division (HMD) partnered with the NAM to administer the study. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being was published in October 2019
and garnered immediate, widespread attention in the media. “Imagine a health-care system in which doctors and nurses are so exhausted and beaten down that many of them work like zombies—error-prone, apathetic toward patients and at times trying to blunt their own pain with alcohol or even suicide attempts,” read a story in The Washington Post. “That is what America’s broken health care system is doing to its health workers” (Wan, 2019).
Speaking on the occasion of the report’s release, Dzau emphasized the link between physician burnout and patient safety. “Twenty years ago … To Err Is Human and Crossing the Quality Chasm revealed a crisis in patient safety and led to a focus on quality that has revolutionized the U.S. health care system,” he noted. “Today, the same type of transformative change is needed to support clinician well-being, which is linked inextricably to the quality of care” (NAM, 2019a).
To drive solutions, the study committee stressed the importance of collective, coordinated action across the entire health care system—with recommendations targeted at health care organizations, health professions educational institutions, policy makers, regulators, health information technology companies, clinician and patient organizations, standard-setting entities, and the research community. At a system level, the report called for actions to create positive work and learning environments, reduce administrative burden, enable technology solutions, support learners and clinicians by eliminating barriers to care, and investing in further research.
As noted earlier in this chapter, the COVID-19 pandemic became a galvanizing event for the CWB Collaborative in 2020. Excessive work hours, lack of personal protective equipment, and fear of infection at the height of the pandemic exacerbated the already high levels of burnout among U.S. clinicians (Dzau et al., 2020). In April 2020, Lorna Breen, a physician who supervised the emergency room at New York-Presbyterian Allen Hospital in New York City, died by suicide. She had contracted COVID-19 and become severely depressed as a result of what she perceived to be her inability to cope with the demands of responding to the pandemic (Knoll et al., 2020). Breen’s death was headline news, and her family reached out to the CWB Collaborative for help in sharing her story and preventing other tragic deaths. In July 2020, the Dr. Lorna Breen Health Care Provider Protection Act was introduced in the U.S. Senate.11 The bill sought to establish well-being programs for health workers, a national campaign to encourage workers to seek support and treatment, grants to support mental health services for workers caring for COVID-19 patients, and a federal study into the mental health of health workers (ACEP, 2020).
“We have the opportunity now to build a better health care system after COVID-19,” Nasca noted in a press release announcing the program’s extension until 2022. “If this pandemic refocuses us on our moral mission to provide care to others, it will have invigorated the profession as much as it has challenged it” (NAM, 2021a). In June 2021, as a signal of the national imperative to protect clinician well-being, 21st U.S. Surgeon General Vivek Murthy signed on as a co-chair of the CWB Collaborative. “I am hopeful about the Collaborative not only in developing a strategy to advance clinician well-being through and beyond COVID-19, but also in bringing policymakers, the private sector, and the public together around action on this priority. We can emerge even stronger than before the pandemic—for the sake of our clinicians and patients,” Murthy said (NAM, 2021n).12
Murthy’s role as a co-chair of the CWB Collaborative was an example of a novel approach to partnerships spearheaded by Dzau as part of the NAM’s orientation toward collective action. By engaging leaders in the public and private sectors as substantive contributors to the NAM’s work, Dzau achieved their early buy-in and paved the way for quick and efficient implementation
11 The Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667) was signed into law on March 18, 2022 (see https://www.aha.org/news/news/2022-03-18-dr-lorna-breen-health-care-provider-protection-act-signed-law [accessed September 8, 2022]).
12 In 2022, the NAM released a National Plan for Health Workforce Well-Being, which outlined specific actions to strengthen workers’ well-being and ensure the health of the nation (see https://nam.edu/initiatives/clinician-resilience-and-well-being/national-plan-for-health-workforce-well-being [accessed September 8, 2022]).
of NAM-facilitated solutions. Other examples of this approach, described later in this chapter, included the role of U.S. Assistant Secretary for Health Rachel Levine in Action Collaboratives on the national opioid epidemic and climate change and the engagement of Johnson & Johnson as a partner in the Healthy Longevity Global Competition.
Building a Learning Health System: The National Academy of Medicine Leadership Consortium
The Leadership Consortium, established in 2006 as the IOM Roundtable on Value & Science-Driven Health Care, formed the backbone of the NAM’s efforts to improve the U.S. health system (see Chapter 5 for more on the roundtable’s work). Leadership Consortium founder J. Michael McGinnis, an NAM member who also served as the NAM’s inaugural Leonard D. Schaeffer Executive Officer, established four Action Collaboratives around key foci for health system improvement: evidence mobilization; digital health; value incentives and systems; and culture, inclusion, and equity. With the engagement of field leaders from public and private sectors, these Action Collaboratives fostered dynamic networks for the sharing of best practices and alignment of goals.
In the years immediately following the IOM-NAM reorganization, the Leadership Consortium developed a number of defining Special Publications,13 including the Emerging Stronger from COVID-19 collection, described earlier in this chapter. Others focused on topics ranging from effective care for high-need patients, to artificial intelligence in health care, to innovative approaches to data sharing to improve patient care and advance the continuously learning health system. For example:
- Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health (Long et al., 2017) resulted from three public workshops that explored what is needed to better care for high-need patients (or the 1 percent of patients who accounted for more than 20 percent of existing health care expenditures) within the existing U.S. health care system, and how the health care system can adapt to more effectively and efficiently care for this patient population. The special publication outlined key characteristics of high-need patients, as there was no consistent definition of need prior to this publication; developed a patient taxonomy with associated implications for care delivery to better understand the subsets of high-need patients; explored existing care models that have effectively cared for high-need patients; and outlined policies that must be enacted or changed to allow for the spread and sustainability of these successful care models.
- Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care (Pronovost et al., 2018) contended that a major impediment to achieving true interoperability in the nation’s health care system was the fragmented and disconnected purchasing of health technology, medical devices, and software applications within medical centers and between medical centers. Hardware that physically could not connect to other hardware stopped interoperability in its tracks—and as hardware was purchased infrequently and was often extremely expensive, further blocked progress in interoperability for years or even decades. This special publication reviewed requirements for interoperable data exchange at three levels: facility-to-facility, intra-facility, and at point-of-care, and outlined progress that could move U.S. health care to the envisioned future state of fully interoperable systems.
- Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril (Matheny et al., 2022), the NAM’s most downloaded special publication by 2022, reviewed opportunities to improve patient and team outcomes, reduce health care costs, and impact population health while reinforcing the need to proceed with caution in order to avoid exacerbat
13 NAM Special Publications are individually authored, peer-reviewed, report-length publications that summarize the state of knowledge on a subject and offer expert analysis and guidance.
- ing existing health- and technology-driven disparities. It outlined current and near-term AI solutions; highlighted challenges, limitations, and best practices for AI development, adoption, and maintenance; offered an overview of the legal and regulatory landscape for AI tools designed for health care application; prioritized the need for equity, inclusion, and a human rights lens for this work; and outlined key considerations for moving forward.
- Sharing Health Data: The Why, the Will, and the Way Forward (Greene et al., 2021) spotlighted 11 novel data-sharing collaborations to dispel the myth that sharing health data broadly was impossible. The authors contend that sharing health data and information across stakeholders was the bedrock of a learning health system, and as these data were increasingly combined across various sources, their generative value to transform health, health care, and health equity increased significantly. The special publication showed how barriers were addressed and harvested lessons and insights from those on the front lines. The examples suggested how intentional attention to health data sharing could enable unparalleled advances, securing a healthier and more equitable future for all.
Following the COVID-19 pandemic, the Leadership Consortium turned its focus to building on the challenges and opportunities revealed by the crisis to build a more resilient, efficient, and equitable health care system for the future.
Vital Directions for Health and Health Care
Under the auspices of the Leadership Consortium, the NAM also prepared a package of formal advice on health and health care for incoming U.S. presidential administrations in 2017 and 2021. In another example of a novel program model for the NAM, phase one of the Vital Directions initiative commissioned a series of papers by more than 150 of the nation’s leading experts to recommend actions for progress around 19 key priorities in support of 3 core goals: better health and well-being, high-value health care, and strong science and technology. The experts’ guidance was published across a series of discussion papers in the NAM Perspectives periodical, as well as in a companion commentary series in the Journal of the American Medical Association and a 2017 NAM special publication titled Vital Directions for Health and Health Care: Priorities from an NAM Initiative. This volume defined a vision, core goals, action priorities, and infrastructure needs, and proposed “vital directions” for advancing health, health care, and biomedical sciences in the United States (NAM, 2017c). The complexity and magnitude of the problems called for strategic investment of existing resources and “vigorous leadership from every corner” and across all levels—organizational, local, state, and federal. Although the challenges were great, so were the opportunities. In addition to informing the incoming presidential administrations in 2017 and 2021 (Health Affairs, 2021) and exploring state-level policy opportunities in 2019 (NCMJ, 2020), the Vital Directions initiative set a framework for the NAM and its continuing activities.
Commitment to Racial and Health Equity
On May 25, 2020, George Floyd, an unarmed Black man, was suffocated by a police officer during the course of an arrest for a nonviolent crime in Minneapolis, MN (Hill et al., 2020). The murder set off a national reckoning with the violence, discrimination, and systemic racism experienced by Black people in the United States, as well as other people of color. As protests took place around the nation, Dzau published a statement that read, in part:
I commit to ensuring that all people, and especially people of color, feel safe and supported while working at the NAM, as well as to pursuing racial equity in our organizational policies and procedures. I commit to using our platform to improve the lives of people who experience disproportion-
ate health disparities as a result of socioeconomic inequity, bias and structural racism. I commit to listening, learning, and working with all of you. (NAM, 2020d)
The NAM moved quickly to operationalize this commitment, appointing Ivory Clarke, director of the COHP, as its inaugural Equity and Inclusion Officer. Clarke, alongside NAM Director of Operations and Chief of Staff Morgan Kanarek, established a Staff Committee on Advancing Racial Equity (CARE) to strengthen internal equity, diversity, and inclusion. CARE’s vision and mission were to promote a culture that challenged racism openly and honestly through education, training, and self-reflection; dismantle structures and systems that reinforced racial inequity in the NAM’s operations; and foster a safe and supportive work environment. Dzau himself supplied a personal donation to enable every member of the NAM staff to contribute to the work of CARE.
Pre-existing CARE was the IOM (later HMD) Committee to Enhance Diversity and Conclusion (CEDI), which launched in 2014 with annual support from Dzau. CEDI was a volunteer staff committee (led by HMD but open to staff from the IOM/NAM) that hosted staff engagement activities and generated strategies for enhancing diversity and inclusion in the organization’s culture and processes. In April 2021, the National Academies hired its first Chief Diversity and Inclusion Officer, Laura Castillo-Page, who was tasked with leading the development of an overall diversity, equity, and inclusion strategy for the organization, including advancing diversity among staff, volunteers, and Academy members.
The sharpened focus on racial equity that began in 2020 augmented the NAM’s longtime emphasis on health equity. In 2016, the NAM had added “health equity” as a key value in its new mission statement: To improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally. “‘Health for all’—the notion of combating health disparities—is built into this statement, as well as the notion that we want to improve health not just domestically, but also globally,” Dzau said in his annual address to the NAM membership. “We believe that health equity is a foundational value and an important goal, and decided to call it out specifically in our mission statement” (NAM, 2016c). Acknowledging racism and lack of diverse representation in science and medicine as major drivers of health inequities, the NAM also advanced its work on racial and health equity through the COHP, as well as through membership diversification activities (both described later in this chapter).
Culture of Health Program
The COHP was established in 2015 through a $10 million grant from the Robert Wood Johnson Foundation (RWJF) to develop a program that would advance health equity by strengthening the evidence base around social determinants of health. Half of the grant was allocated for program activities over 5 years, while half was directed to the NAM’s endowment. “To build a Culture of Health in America, we must find partners capable of providing rigorous, effective, and inclusive programming that addresses our nation’s significant gaps in health equity,” said Risa J. Lavizzo-Mourey, an NAM member and RWJF president at the time. “This investment will help us to identify organizations and communities that are ready to achieve positive change at a scale that will enable all to live healthier lives, regardless of who they are or where they live.”14
The COHP established four goals to guide its work: (1) to lead by issuing a series of consensus studies that strengthen the evidence base and bolster efforts to advance health equity; (2) to translate that evidence by facilitating action and implementation; (3) to strengthen capacity in communities; and (4) to sustain progress by fostering a culture that prioritizes health equity. By 2019, the program had produced four consensus studies, in collaboration with HMD, that served as the
14 See https://sites.nationalacademies.org/giving/noteworthynews/index.htm.
foundation for its efforts: Communities in Action: Pathways to Health Equity (NASEM, 2017o); The Promise of Adolescence: Realizing Opportunity for All Youth (NASEM, 2019f); Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity (NASEM, 2019d); and Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health (NASEM, 2019m).
The COHP also developed a network of diverse community organizations to foster uptake of principles from the Communities in Action report. Over the course of the program’s first 5 years, NAM staff built strong relationships with these organizations, conducting site visits and convening representatives twice per year in Washington, DC. The COHP utilized insights from the communities’ observations and efforts to advance health equity in their own environments and worked closely with each organization to develop “community-driven health equity action plans.” The NAM published the communities’ plans in 2020 (NAM, n.d.i).
The COHP’s goals to translate science and sustain culture change meant the program invested significantly in innovative communications. To engage audiences at the community level and approach the value of health equity from a cultural, rather than academic, lens, program staff invited submissions for a national art show called “Visualize Health Equity” (see Figure 7-4). The project asked people around the country to illustrate, through any media, what health equity looked, felt, and sounded like to them. The show debuted with a pop-up gallery and reception at NAM headquarters and later became a 6-month installation. The NAM also launched a permanent digital gallery and a traveling version of the show that was booked by organizations year-round. Building on the success of this activity, and to align with the COHP consensus reports focused on the health of children and adolescents, the NAM later debuted “Young Leaders Visualize Health Equity,” which was limited to submissions from people ages 5 to 26.
In March 2021, the NAM announced that the COHP would be extended until 2024. “This is a critical moment for our nation to confront racist systems and policies in order to ensure that every-
one in America has a fair and just opportunity for health and well-being. This requires intentionally dismantling discriminatory barriers, including structural racism, because of their negative impacts on the health of people and communities,” said Richard Besser, then President and Chief Executive Officer of the RWJF, in a press release announcing the extension (NAM, 2021c).
The U.S. Opioid Epidemic
Another crisis that was exacerbated by the COVID-19 pandemic was the crisis of opioid use disorder in the United States, which became the topic of an NAM Action Collaborative established in 2018. The statistics at the time were alarming. In 2016, 65,000 Americans died from a drug overdose, with nearly two-thirds of recent drug deaths attributed to the misuse of opioids. Half the deaths were related not to drugs bought illegally but rather to drugs obtained by prescription. Nearly two dozen opioid medications were on the market, most used for the treatment of pain. In 2015, about one-third of American adults used prescribed opioids at one time or another, and 2.5 million struggled with opioid-related disorders. Patients with an opioid addiction filled up the emergency departments of hospitals but had trouble gaining access to additional treatment. Opioid addiction surpassed HIV infections and automobile fatalities as a public health problem (NAM, 2017b). The resulting spike in death rates among people ages 25 to 54 contributed, at least in part, to a decrease in life expectancy among middle-aged white men and women in the United States (NAM, 2017b).
Countless community organizations, law enforcement entities, health care organizations, faith communities, researchers, government bodies, and nonprofits dedicated resources to respond to the crisis, but rates of opioid misuse and overdose continued to skyrocket. The NAM recognized the need for a national body to coordinate the response and concentrate efforts around a few key priorities. In July 2018, the NAM announced its intention to form an Action Collaborative on Countering the U.S. Opioid Epidemic (Opioid Collaborative) in partnership with the nonprofit Aspen Institute. “So many organizations are working around the clock to reverse the opioid epidemic, yet progress has been slow,” Dzau said in a statement. “The problem is clearly not absence of will, but insufficient alignment and coordination across sectors. The complex drivers of the opioid epidemic make it impossible for any single organization or professional sector to make a significant impact on its own” (NAM, 2018b). By 2021, the Opioid Collaborative had more than 55 participating sponsors and an additional 100 organizations contributing as “network” organizations committed to advancing the goals of the program. Like the CWB Collaborative, the Opioid Collaborative called for and publicly posted statements of commitment from supporting organizations (NAM, 2019b). The program acted as a “one of a kind public-private partnership … to build collective solutions and accelerate the pace of progress” (NAM, 2018b). Members of the collaborative concentrated on four different aspects of the crisis: health professional education and training; pain management guidelines and evidence standards; prevention, treatment, and recovery services; and research, data, and metrics needs.
In early 2021, more than 1 year into the COVID-19 pandemic, there were worrying indications that the U.S. opioid crisis was worsening, with possible drivers including barriers to treatment and the mental health impacts of the pandemic. An analysis by The Commonwealth Fund found that opioid use–related deaths may have exceeded 90,000 in 2020, making it the deadliest of the past 20 years (Baumgartner and Radley, 2021; NCHS, 2020). In April 2021, the Opioid Collaborative announced an extension of its work for another 2 years.
Standing Up for Science
As another indication of the NAM’s more proactive strategic orientation, Dzau (as well as other NAM/National Academies leaders) become more vocal in commenting on events and policies with significant impacts on health and where the scientific evidence base offered clear direction. In the
years following the IOM-NAM transition, many NAM members believed that respect for the scientific process—by necessity objective and apolitical—was eroding to a dangerous degree. Between 2017 and 2020, at the urging of members, Dzau used the NAM platform to speak out publicly in defense of science more than ever before.
For example, in March 2017, President Donald J. Trump signed an Executive Order preventing citizens of the Muslim-majority countries Iran, Libya, Somalia, Sudan, Syria, and Yemen from entering the United States for a period of 90 days (Siddiqui et al., 2017). In May, the Department of State followed up with a new proposed rule (Department of State, 2017) that would add arduous additional questions to certain foreign visa applications as part of an “extreme vetting” approach promised by President Trump during his campaign (Shear, 2017). Dzau, NAS President Marcia McNutt, and National Academy of Engineering (NAE) President Dan Mote15 wrote a public letter to the Department of State expressing concern that limiting entry to the United States from certain countries “will have significant negative unintended consequences on the nation’s international leadership in research, innovation, and education.” The presidents further noted that international collaboration is critical to the advancement of science and that approximately one-quarter of NAM, NAS, and NAE members were born outside the United States (NASEM, 2017m).
In another example, on April 14, 2020, President Trump announced a freeze on funding to the WHO as a reaction to what he characterized as “severely mismanaging and covering up the spread of coronavirus” (Klein and Hansler, 2020). The following day, Dzau expressed his strong disagreement with the decision in a letter to members: “The WHO’s work is essential, not only to fight the COVID-19 pandemic, but also to support public health, global development, and international cooperation at all times. To put it bluntly, defunding the WHO will cut off a lifeline for low- and middle-income countries and place hundreds of millions of people at risk.”16 At the urging of Dzau, the NAM, the NAS, and the NAE presidents issued a public statement in support of the WHO the same day (NASEM, 2020d). However, about 6 weeks later, President Trump announced the formal termination of U.S. participation in the WHO (BBC, 2020). The stalemate would last until Joseph Biden took office in January 2021.
Tensions continued, and in September 2020 President Trump suggested that he would oppose the FDA’s proposal to enhance approval standards for the emergency use of vaccines against COVID-19. At the urging of NAM and NAS members, Dzau and McNutt went public with a strongly worded statement that read, in part:
We find ongoing reports and incidents of the politicization of science, particularly the overriding of evidence and advice from public health officials and derision of government scientists, to be alarming. It undermines the credibility of public health agencies and the public’s confidence in them when we need it most. Ending the pandemic will require decision-making that is not only based on science but also sufficiently transparent to ensure public trust in, and adherence to, sound publichealth instructions. Any efforts to discredit the best science and scientists threaten the health and welfare of us all. (NASEM, 2020e)
The statement, unusually bold coming from an organization accustomed to standing back from the political fray, garnered significant pickup by national media, as well as gratitude and support from the scientific community.
DIVERSIFYING AND ACTIVATING MEMBERS AND ENGAGING EMERGING LEADERS (STRATEGIC GOAL 2)
“Members are the lifeblood of our Academy; without their expert guidance and leadership, our advisory initiatives would not be possible,” Dzau wrote in the NAM’s 2018 Annual Report (NAM,
15 Mote’s term as NAE president ended in June 2019. He was succeeded by John Anderson.
16 Victor Dzau, “Personal Letter to Members Expressing Support for the WHO,” April 15, 2020, IOM/NAM Records.
2018c). As called for in the second overarching goal of the NAM’s strategic plan, promoting the engagement and diversity of the membership—in terms of specialty, race, ethnicity, gender, age, and geography—was an early organizational priority, as was the imperative to engage members in the organization’s governance.
Member Diversification Initiatives
In 2019, the NAM established a standing membership diversity committee to make recommendations to the NAM Council, monitor progress, and ensure accountability. Members also agreed to a change in the bylaws that would enable the election of 100 new members annually, a 25 percent increase over previous years. In 2020, the NAM elected its most diverse class of members ever in terms of representation of underrepresented minority groups (35 percent) and age (30 percent under age 50). Although proud of these numbers, Dzau acknowledged that “We know that the change we’re seeking won’t happen overnight and that this will be a continuous journey. But we are committed to advancing diversity, equity, and inclusion in our work, and within our own institution” (NAM, 2020a). The following year, the NAM again broke its record, electing a historical majority of women (52 percent), and the largest ever proportion of underrepresented minority groups (47 percent).17
A New Role in Governance
In 2019, members voted for the first time to elect new Officers among the NAM’s leadership. Prior to the IOM’s reconstitution as the NAM in 2015, IOM Officers were officially appointed by the NAS president (see Chapter 2 for more information about Officers). As an independent Academy, members had the power to elect their own leadership—one of the hallmarks of the new organization.
When Jane Henney completed her first term as Home Secretary (2014–2018), she pursued and won election for a second term, officially becoming the NAM’s first elected Officer. Carlos del Rio followed in 2020 as the NAM’s first elected International Secretary, and Dzau was elected for a second term as NAM President. “I am truly honored to be elected to a second term and have the privilege of continuing to lead this eminent organization in this new decade, especially on the 50th anniversary of our founding,” said Dzau in a press release announcing his election (NAM, 2020g).
NAM members’ active role in governance went beyond the election of Officers. Members voted in 2019 to establish a Code of Conduct with clear policies and procedures to hold members accountable to a high standard of personal and professional behavior. “The credibility of the advice from the NAM rests on its reputation and integrity, which depends on the reputation and integrity of its members,” the code read (NAM, 2018d). The code prohibited unlawful behavior, prejudicial treatment, harassment, scientific misconduct, professional dishonesty, and concealment of conflict of interest, among other principles. For the first time, the code afforded the NAM a mechanism to take action against members who violated a specific set of principles for ethical behavior.
NAM Member Response to COVID-19
As well as contributing as volunteers to support the NAM’s programmatic response to COVID-19, Academy members were on the front lines of the pandemic, driving solutions within their own fields, from laboratory research to clinical care and from national public health leadership to community advocacy. In November 2020, six NAM members were named to President-Elect
17 IOM/NAM Records.
Joseph Biden’s COVID-19 task force, including David Kessler (Co-Chair), Ezekiel Emanuel, Atul Gawande, Eric Goosby, and Michael Osterholm (AP, 2020). Several more took on permanent roles in the new administration.
In another prominent example, 60 Black members of the NAM (led by Georges Benjamin and Thomas LaVeist) authored a New York Times op-ed encouraging Black Americans to receive the COVID-19 vaccine. “We feel compelled to make the case that all Black Americans should get vaccinated to protect themselves from a pandemic that has disproportionately killed them at a rate 1.5 times as high as white Americans,” they wrote in March 2021 (LaVeist and Benjamin, 2021). The op-ed was accompanied by a video for distribution on social media channels (The Skin You’re In, 2021). Later that year, more than 20 Latinx NAM members signed a letter “affirming their confidence in the vaccine and urging their community to recognize the debilitating risks of the virus that is 2.3 times as deadly to the Latinx/Latino(a)/Hispanic community as it is to their White peers” (NAM, 2021h,i). The letter was presented alongside video messages in English and Spanish, as well as resources to help people book and obtain transportation to vaccine appointments (NAM, 2021j,k).
Emerging Leaders in Health and Medicine
In addition to cultivating its existing membership, the NAM also devoted attention to building the next generation of health and medical leaders—the potential members of tomorrow. The Emerging Leaders in Health and Medicine Program (ELHMP), established in 2016, engaged “exceptional early- to mid-career professionals in health and medicine, NAM leaders and members, and other experts to promote interdisciplinary collaboration and spark new ways of thinking about shared challenges that could lead to transformative change” (NAM, 2019c). New classes of ELHMP Scholars were appointed annually to 3-year terms by the NAM Council and assigned NAM member mentors. The Scholars also organized an annual Emerging Leaders Forum to discuss priority issues with their peers. The ELHMP complemented the NAM’s seven fellowship programs as of 2021 (described in Chapter 2).
BUILDING LEADERSHIP CAPACITY ACROSS DIVERSE DISCIPLINES (STRATEGIC GOAL 3)
The third major goal of the NAM’s strategic plan called for it to forge new ground by building leadership capacity in emerging areas—in terms of human capital, policy and infrastructure, and financial investment. Between 2015 and 2021, the NAM established innovative, cross-sectoral programs in developing areas including healthy longevity; climate change, human health, and equity; emerging science and technology; health misinformation; and global mental health.
Healthy Longevity Global Grand Challenge
In the face of rapidly aging populations worldwide, the race to prepare health care and social systems became the subject of the NAM’s inaugural Grand Challenge program. When the Healthy Longevity Global Grand Challenge (HLGGC) launched in 2019 (see Figure 7-5), it was projected that by 2030, the population of adults over age 65 would outnumber children under age 18 (U.S. Census Bureau, 2018). This shift presented significant hurdles across health, social, and economic sectors, but also constituted an opportunity to accelerate research, innovation, and entrepreneurism in the new field of healthy longevity.
To tackle this mammoth challenge, the NAM combined the International Commission program model with a novel approach—a global prize competition. An International Commission was appointed to author a Global Roadmap for Healthy Longevity report assessing challenges and opportunities in three domains: social, behavioral, and environmental enablers; health care
systems and public health; and science and technology. The report, due for publication in early 2022, would also recommend short-term actions for global societies to capitalize on the benefits of a longer health span.
The Healthy Longevity Global Competition was launched to complement the International Commission’s work by fomenting worldwide research and innovation through a series of monetary prizes and awards. The competition model was uncharted territory for the NAM—an attempt to jumpstart an under-resourced field. Dzau said,
The global competition model is uniquely capable of activating innovation and stimulating breakthroughs. It can energize thousands of scientists, innovators, and entrepreneurs globally to focus on a challenge in a concentrated timespan and generate a wide variety of bold ideas across many disciplines. This wellspring of activity will build momentum around healthy longevity, create new markets, and ultimately lead to transformative innovations that will impact the lives of generations. (NAM, 2019d)
The competition netted more than $30 million in commitments from sponsors and global collaborators by 2020.
The competition was designed to unfold in three phases. In the first phase (2020 to 2022), Healthy Longevity Catalyst Awards worth $50,000 USD each would be issued in recognition of an innovative idea capable of extending the human health span globally and equitably. Eight international organizations initially joined the NAM in issuing Catalyst Awards for the 2020 cycle: Academia Sinica of Taiwan, the Ministry of Health and National Research Foundation of Singapore, the Chinese Academy of Medical Sciences, UK Research and Innovation, EIT Health of the European Union, the Japan Agency for Medical Research and Development, and the U.S. National Institute on Aging.18 In 2021, three more organizations joined the competition—Chile Agencia Nacional de Investigación y Desarrollo and the Chinese University of Hong Kong and The University of Hong Kong (acting together)—bringing the total of countries and regions represented to more than 50.
18 The National Institute on Aging participated during only 2020.
In October 2020, the NAM announced more than 150 global Catalyst Award winners, totaling more than $7.7 million in prizes. Twenty-four U.S.-based winners received prizes directly from the NAM for ideas including an app to detect early signs of Parkinson’s disease, a deep learning tool to predict biological age from chest radiographs, and software to allow older adults to inhabit avatars of their younger selves (NAM, 2020e).
The second phase of the competition, the Accelerator Phase (which began in 2021), was designed to provide resources, including infrastructure and mentorship, to advance promising ideas that have demonstrated progress and achieved proof of concept. The second cycle of the Catalyst Award competition kicked off in January 2021, and an inaugural Innovator Summit for winners took place in Fall 2021. In the third phase, projected for 2023 or later, one or more grand prizes were projected to be awarded to breakthrough innovations that extend the human healthspan.
Climate Change, Human Health, and Equity
At the NAM’s 50th Annual Meeting on October 19, 2020, Dzau announced the NAM’s next grand challenge—Climate Change, Human Health, and Equity. At the time, the Intergovernmental Panel on Climate Change predicted that temperatures were on a trajectory to increase from 2.5 to as much as 10 degrees Fahrenheit by the end of the 21st century (NAM, 2020a). In addition to the COVID-19 pandemic, 2020 had been plagued by unusually severe weather events, including a record number of tropical storms making landfall in the United States and devastating wildfires in California and Colorado (NOAA, 2021). However, “extreme events aren’t the only threats,” Dzau noted in his annual President’s Address:
Climate change will have adverse consequences for livelihoods, public health, food security, and water availability. This in turn will impact human mobility, likely leading to an even greater rise in the scale of migration and displacement. Negative impacts on food production will further contribute to social and political instability. And all of these effects disproportionately fall on the most vulnerable: low-income communities, people of color, young children, and the chronically ill. (NAM, 2020a)
To plan the Grand Challenge on Climate Change, Human Health, and Equity, the NAM assembled a 30-member international, multi-sectoral committee, co-chaired by NAM members Judith Rodin19 and Philip Pizzo.20 Modeled in large part on the HLGGC, the Grand Challenge on Climate Change and Human Health was designed around four objectives:
- Communicate the climate crisis as a public health and equity crisis
- Develop a roadmap for systems transformation
- Catalyze the health sector to reduce its climate footprint and ensure its resilience
- Accelerate research and innovation at the intersection of climate, health, and equity (NAM, n.d.m)
In September 2021, as part of the climate grand challenge, the NAM launched an Action Collaborative on Decarbonizing the U.S. Health Sector. The press release noted that
the health sector is responsible for approximately 8.5% of U.S. carbon emissions, a leading cause of climate change. The harmful effects of climate change are not distributed equally, but are experienced disproportionally by communities that have been historically and persistently marginalized and disenfranchised—in particular Black, Indigenous, and people of color—who also face the greatest barriers to accessing and receiving quality care. Reducing the carbon footprint of the
19 Judith Rodin was affiliated with the University of Pennsylvania at this time.
20 Philip Pizzo was affiliated with Stanford University at this time.
entire health care sector will benefit society and the economy, as well as advance health equity. (NAM, 2021m)
The Action Collaborative was co-chaired by Dzau, Rachel Levine (Assistant Secretary for Health, Department of Health and Human Services); George Barrett (former Chair and Chief Executive Officer, Cardinal Health); and Andrew Witty (Chief Executive Officer, UnitedHealth Group). The program had four initial workstreams: (1) health care supply chain and infrastructure; (2) health care delivery; (3) health professional education and communication; and (4) policy, financing, and metrics. A primary goal of the Action Collaborative was to achieve collective commitment to carbon reduction goals consistent with those recommended by the U.S. government (50–52 percent reduction from 2005 levels by 2030 (The White House, 2021b).
Emerging Science and Technology
Building on the global impact of its Human Gene Editing Initiative (described in Chapter 4), the NAM established the Committee on Emerging Science, Technology, and Innovation in Health and Medicine (CESTI) in 2020 to consider not only the positive but also the potentially negative implications of developments in biomedical science and technology. The committee sought to identify emerging developments in biological and medical research and technology and attendant social, ethical, regulatory, and workforce impacts and develop an approach to anticipating the impact of these developments. CESTI undertook case studies on noninvasive neurotechnology, telehealth, and regenerative medicine. To build on this work, the NAM announced the launch of a consensus study, Creating a Framework for Emerging Science, Technology, and Innovation in Health and Medicine (chaired by NAM members Keith Wailoo of Princeton University and Keith Yamamoto of the University of California, San Francisco). The study committee, whose report was due to be completed in Spring 2023, set out to “develop a cross-sectoral coordinated governance framework founded upon core ethical principles with a focus on equity, for considering the potential benefits and risks that emerging science, technology, and innovation in health and medicine can bring to society” (NASEM, n.d.b1). Following the release of the study, the NAM planned to launch an Action Collaborative that would facilitate implementation of the framework.
As a final example of an area in which greater leadership and focus was needed, the NAM launched an initiative to identify credible sources of health information in social media. False information spread through social media during the COVID-19 pandemic had helped to fuel negative health impacts including hampered uptake of COVID-19 vaccines (Kington et al., 2021). The NAM assembled an advisory committee chaired by NAM member Raynard Kington, former principal deputy director of the NIH. The committee authored a paper that laid out three key principles and associated material attributes that could help to identify credible sources of health information in social and other digital media. In late 2021, the WHO held a meeting of international public health experts to assess the applicability of the principles and attributes to global contexts. As summarized in the meeting report, attendees affirmed the broad applicability of the NAM paper, and the WHO began to promote use of the principles and attributes by members of its “Tech Task Force” (a group of social/digital media companies including Meta, TikTok, YouTube, and Amazon) (WHO, 2022).
The NAM’s first 6 years became a defining new era for the organization. It successfully defined a unique role and innovative programmatic approach within the National Academies that leveraged public–private partnerships and novel program models such as the International Commission, Action Collaborative, and Grand Challenge. These approaches leveraged the NAM’s greater degree of independence and flexibility as an Academy alongside the NAS and the NAE and were quickly adopted by program units across the broader organization. Yet, the NAM remained true to its roots by maintaining a steadfast commitment to scientific rigor and evidence-based advice, drawing often on the resources and time-tested processes of NRC program divisions such as the HMD.
Well before the conclusion of its first decade, the NAM developed a national and international reputation for impact in the areas of pandemic preparedness, clinician well-being, human gene editing, the U.S. opioid epidemic, the learning health system, health equity, healthy longevity, and climate change, among others. Amid its explosive program growth, the NAM also focused on enriching its membership through initiatives to increase its diversity and strengthen its role in governance. By early 2022, as it launched the second phase of its strategic planning, the NAM had come a long way from the uncertainty of the IOM-NAM transition.
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