8

Conclusion

At the beginning of 2020, just as the National Academy of Medicine (NAM) was preparing for a year-long commemoration of the half-century since its founding as the Institute of Medicine (IOM), a rapidly developing global crisis posed the greatest challenge to the institution in its history. In January, officials in the United States and other countries became aware that a new respiratory virus, SARS-CoV-2, was spreading in China. By the time of the first reported U.S. case, on January 20, and the first reported U.S. death, on February 6, the disease, later named COVID-19, was already spreading rapidly in the United States and many other countries. Over the course of the year, infection rates and fatalities skyrocketed as policy makers struggled to mount effective public health responses and scientists worked to understand how the disease could be treated and prevented. By the end of 2021, more than 5 million people around the world had died as a result of the virus (JHU, n.d.).

The COVID-19 pandemic revealed the flaws in the health system that the IOM/NAM had highlighted throughout its first five decades. The public health response was inadequate in key respects and poorly coordinated. Groups already experiencing health inequities—including Black, Indigenous, and people of color (BIPOC)—suffered much higher levels of infection and death. The U.S. health care system was severely strained in providing critical care for so many desperately ill patients. The global response lacked coordination and failed to adequately protect poorer nations.

The COVID-19 pandemic also revealed the tremendous potential of science and medicine to meet formidable challenges. Researchers from all over the world set aside their individual interests to understand the virus and rapidly develop diagnostics, therapeutics, and vaccines. Better understanding of how the virus was transmitted led to increasingly effective public health measures. Chinese health authorities and the WHO announced the discovery of SARS-CoV-2 on January 9, 2020; just 2 days later, full genomic sequence of the virus was posted online (Institut Pasteur, 2020). Within 69 days of the virus’s discovery, the first vaccine candidate entered a clinical trial (Kim et al., 2020). By the end of 2020, two new vaccines, based on revolutionary mRNA technology, had been authorized for emergency use in the United States and other countries. In 2021, death rates in the United States and other countries began to fall, although virus variants and uneven adherence

to public health measures led to new spikes in infection. By the end of the year, it was clear that COVID-19 would remain a pressing and uncertain threat indefinitely.

The year 2020 was notable for other reasons. The killing of George Floyd triggered worldwide protests against the centuries of systemic and structural racism experienced by Black Americans and other people of color. At the same time, heatwaves, wildfires, hurricanes, droughts, rising sea levels, floods, and other extreme events highlighted the ongoing crisis of climate change. All three of these global traumas—the COVID-19 pandemic, systemic racism, and climate change—disproportionately affected the most vulnerable people, including low-income communities, BIPOC, children, and the chronically ill. These challenges came at a moment when mistrust in science, fueled by a fraught political environment in the United States, appeared to be at an all-time high.

The NAM and its members mounted a broad and aggressive response across all these fronts, leveraging its influence as an impartial, trusted, and authoritative advisor, as well as its ability to convene leading experts and facilitate their implementation of scientific, medical, public health, and policy solutions. Plans for the IOM/NAM anniversary celebration, including this history volume, were largely deferred to 2022 or later. Yet, in many ways, the 50th anniversary year unfolded as a testament to the NAM’s historical influence as well as a window into the impact it could have in the future—exactly the themes the Academy had hoped to emphasize in its commemorative activities.

The “tagline” the NAM selected for its anniversary celebrations captured this dual focus: “Celebrating a legacy of impact. Forging a healthier future” (NAM, n.d.j). A survey of the IOM/NAM’s major historical impacts (see Box 8-1) showed that it played an influential role in many major U.S. and global health policy developments—from the expansion of Medicare to the quality and patient safety movement to the application of the Patient Protection and Affordable Care Act. As major advances in science and technology led to unimagined progress in understanding and treatment of diseases such as cancer and HIV/AIDS, the IOM/NAM was a steady and trusted advisor to researchers, regulators, and providers—ensuring the safe and appropriate application of breakthroughs. The IOM/NAM advanced the field of population health, building the evidence base for foundational concepts including the social determinants of health, disparities in health and health care, and strategies to advance health equity. And, despite its original mandate as an advisor to the nation, the IOM/NAM built a strong body of work globally, helping to ensure the U.S. government’s ongoing investment in global health, securing the future of important international programs such as PEPFAR and leading global efforts in pandemic preparedness and response.

The upheaval of 2020–2021 brought the IOM/NAM’s historic mission into sharp relief. The world was confronted with what Dzau described as the triple “existential threats” of pandemics, climate change, and systemic racism. In each of these crises, there was a role for the NAM to advance evidence-based solutions and spur action among stakeholders across sectors. The organization’s impact in the future would rely on both its longtime reputation as a trusted, nonpartisan advisor and its innovative and proactive approach as an Academy. In his 2020 annual address to NAM members, Dzau said it best:

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