2021 Annual President’s Address to the NAM Membership
Victor Dzau, MD
October 18, 2021
Good morning, good afternoon, and good evening. Welcome to the National Academy of Medicine’s 2021 Annual Meeting. I am so honored that you are joining me today.
Let me begin with good news about some of our members. First, a huge congratulations to David Julius who won this year’s Nobel Prize for Physiology or Medicine. I’d also like to congratulate Eric Lander, who has joined President Biden’s cabinet as his chief science adviser and director of the White House Office of Science and Technology Policy. Eric will be joined by NAM members Frances Arnold, Lisa A.Cooper, Susan Desmond-Hellmann, Paula Hammond, Catherine Woteki, who were recently named to the President’s Council of Advisors on Science and Technology. And finally, please join me in acknowledging Francis Collins’ enormous contributions to science through his leadership at NIH and his own research. Though he is stepping down as director, I know that he will continue to make important contributions. Thank you, Francis!
As I was thinking about this year’s meeting and reflecting on the work we do as an Academy, I was struck by how much the world has changed in the seven years since I became President.
When I took office, the Obama administration was in full swing, and Washington was preoccupied with fights over the Affordable Care Act. So much has happened since then that it almost feels like ancient history. The challenges we face today have become far more global, complex, and wide-ranging.
Indeed, as I said in my address last year, our society is being confronted by triple existential threats – the devastating COVID-19 pandemic, the centuries-long scourge of systemic racism, and the climate change crisis that is already beginning to upend our world. These threats are not going away anytime soon, and if anything, they are posing more challenges and uncertainty to society.
Let’s start with the pandemic, which, after more than a year and a half, is still very much front and center in the U.S. and all over the world. These past few months have been particularly frustrating as the Delta variant caused yet another wave of illnesses and deaths. In the U.S., the greatest tragedy is that this wave could have been prevented if more people would have been masked and vaccinated. And globally, many low-income countries still do not have enough access to vaccines, leaving large swaths of the world’s population highly vulnerable.
Next, let’s talk about racism. Rooting out systemic racism also continues to be an urgent priority for our society. Last year, George Floyd’s senseless murder at the hands of the police forced a reckoning on race in this country and globally. Many leaders, including me, pledged to take action, but much more work still needs to be done.
And third, climate change. With unrelenting frequency, we are experiencing the damages wrought by climate change — from more intense and more frequent wildfires in the west to a more active hurricane season and unprecedented flooding in the east. The most recent report of the UN Intergovernmental Panel on Climate Change says that the damage is now already baked in and that some devastating impacts are unavoidable. But if we act now, there is still an opportunity to keep that devastation from getting even worse.
As we confront these complex threats, I am reminded of the quote from the German philosopher Goethe, “Knowing is not enough. We must apply. Willing is not enough. We must do.”
We know that we must do more to curb the pandemic, not just here but everywhere. We know that we must provide equal opportunity for better health and well-being – not just for a lucky few, but for everyone. And we know that we must work together to be better stewards of our planet, not just for ourselves, but for future generations.
Knowing is not enough. We must apply. Willing is not enough. We must do.
-Johann Wolfgang von Goethe
This is why our work at the National Academy of Medicine, and across the National Academies, is so important. We are hard at work to put the best available scientific evidence into action to improve people’s lives now and in the future. But we also must face a new reality.
The challenges we face now – and the new crises that will undoubtedly come our way — are increasingly regional, national, and global. They are complex and multifaceted, crossing disciplines, and sectors. And so, just as the nation and the world are changing – so too we must change. Big societal challenges require new approaches to how we do our work.
Instead of just reacting to what is happening in the world, we need to be proactive, to anticipate challenges, and to help society be prepared and avoid the worst-case scenarios. We need to leverage our convening power to forge radical new partnerships and inspire action in multiple arenas – across the sciences, across the public and private sectors, and around the world.
Now more than ever, we need to communicate with the public about the value of science, and to stand up for science when it is attacked, distorted, or ignored. And we need to demonstrate the power of science and medicine to create a better world – not just for a few, but for everybody.
In this year’s President’s Report, I will describe how NAM is rising to the challenge. Let me start with our work on the pandemic.
Since the very early stages, the NAM and the National Academies have taken a strong leadership role in responding to COVID-19. Through our standing committee on “emerging infectious diseases, we have engaged regularly with the U.S. administration and decision-makers on key questions.
The NAM has made a concerted effort to address issues related to the pandemic in all of our programs, from addressing pandemic response, to tackling its disproportionate effects on communities of color, to examining how the pandemic has impacted older adults, mental health, substance use disorder, and clinician burnout. And to get accurate, reliable public health information into the right hands – to health care providers, policymakers, journalists, and the public – we’ve hosted hundreds of webinars and virtual workshops on a wide range of topics and issues. Also, we have issued statements to speak out for science.
Most recently, we’ve been focusing on building trust in COVID-19 vaccines. In addition to working on vaccine hesitancy directly with providers and communities, our Black NAM members developed a video urging Black Americans to get the vaccines, which has been viewed over 240,000 times. And thanks to the Hispanic leadership on our Council, our Latino, and Latina members developed a similar video. You’ll have the chance to watch the videos during the break at 2:30 pm today.
Of course, combatting misinformation around COVID-19 is a big part of the battle. Social media companies — so often the fuel for the spread of misinformation — need to do more to step up and do right. An important first step for these platforms is to identify and prioritize credible sources of information for their users. So when NAM Council member Karen DeSalvo, Google’s Chief Health Officer, asked NAM to help, to work with YouTube, we agreed without hesitation.
We appointed a multidisciplinary advisory group, chaired by Raynard Kington, which engaged in extensive deliberation, solicited widespread public input and released a publication. The publication provided a set of criteria to help identify credible information, attributes of credible sources of information, and categories of entities that could serve as reliable sources of information. Indeed, the Surgeon General Vivek Murthy referenced our publication in his recent public advisory on misinformation in health.
Going forward, we are committed to furthering our work in this area, engaging with many more social media platforms, and partnering to extend this initiative globally.
Here in the United States, the pandemic has revealed the best and worst of our health care system: a system capable of extraordinary care and innovation, but one that has perpetuated inequities and is unprepared to completely meet the challenges of the 21st century.
As we emerge from COVID, NAM is looking to the future. We must capture these important lessons to create a system that is equipped for our rapidly changing world.
Indeed, after President Biden issued a public letter to chief science adviser Eric Lander, asking for guidance on four specific questions regarding science, technology, and public health preparedness, we, the NAM, convened a working group to identify key priorities based on lessons learned from COVID-19.
One priority we identified is transforming the United States’s public health infrastructure. It is fragmented and severely under-resourced, with workforce shortages and outdated technology systems. We need to reimagine, reorganize and invest significantly in the nation’s public health.
The working group also urged major improvement of our health data system to prepare for the next emergency. Our current system is not interoperable and abounds with deficiencies, making it difficult or nearly impossible to glean actionable insights. We need an improved data health ecosystem that focuses on foundational elements such as technical infrastructure, data architecture, and modularity.
Also, protecting and improving the public’s health requires robust capabilities for rapidly identifying new infectious health threats. We need to enhance pandemic surveillance, forecasting, and virus tracking. I am pleased that the CDC has taken an important first step by establishing the Center for Forecasting and Outbreak Analytics.
The overarching priority should be to develop a national strategy for pandemic prevention and preparedness. The Biden administration unveiled the American Preparedness Plan, a $65 billion proposal to remake the nation’s pandemic preparedness infrastructure. We’re gratified that many of the elements outlined by our working group are contained in the plan.
The above areas are all important priorities for preparedness. But as you know well, we really need a long-term transformation of our entire U.S. health system.
The NAM Leadership Consortium led by Michael McGinnis convened leaders from nine sectors of the health system to assess the impact and experiences during the pandemic and recommend changes for the long-term future. You can see the nine sectors listed on this slide.
First, a cross-cutting theme is equity. We must commit to pursuing equity across all domains of health systems transformation. This includes addressing the systems, policies, and barriers that perpetuate health disparities and ensuring that we see meaningful progress toward revamping them. Second, COVID has forced major changes in how we deliver care. Providers had to swiftly leverage telehealth and other technologies, streamline operations and embrace nontraditional care settings. We must build on this momentum to transform health care delivery so that it is safer, more efficient, and easier to access. We should innovate and advance effective ways to engage, monitor, and manage patients remotely at their homes and in the community while ensuring equity in access to care. Third, we need to reconsider how care is financed. COVID-19 has renewed the impetus for transitioning away from fee-for-service and towards value-based payment models, which could drive transformation in other sectors as well. Furthermore, this pandemic has exacerbated already high rates of burnout among clinicians; we must invest in their well-being. These are some of the priority actions, and they represent meaningful steps toward systems transformation across sectors.
Lessons from COVID-19 can and should also help inform overall public health measures and especially as we enter the flu season, on influenza preparedness. Sponsored by HHS, we formed an international committee to do just that from a global perspective. The initiative issued four reports informing future influenza vaccine development, supply chain issues, public health interventions, diagnostics, and treatment strategies, and international coordination, innovative partnerships, and financing based on lessons from COVID-19.
I’m also proud that NAM is active globally in major activities related to pandemic preparedness and response. NAM serves as the secretariat for the G-20 High-Level Independent Panel which generated an important report, “A Global Deal for Our Pandemic Age” that calls for critical actions and the doubling of international financing to at least $75 billion over the next five years to close gaps in pandemic prevention and preparedness.
In addition, along with other NAM members, I have been actively engaged in the Global Preparedness Monitoring Board, to provide independent monitoring to ensure preparedness for global health crises, and in the Global Access to COVID-19 Tools Accelerator and COVAX, which works toward equitable access to COVID-19 tests, treatments, and vaccines worldwide.
Diversity, Equity, and Inclusion
The pandemic has shone a harsh light on another crisis – and that is racial and socioeconomic disparities in health care and health outcomes. It’s clear that people of color have disproportionately suffered and died in this pandemic because of longstanding inequities in our society.
Last year, I on behalf of NAM, made a public commitment to address racism and center equity in all that we do. We are committed to creating an internal environment and culture of diversity and equity. We will have an equity lens in all of our programs and activities.
A signature initiative is our Culture of Health Program, a multi-year effort supported by RWJF to identify strategies to achieve health equity. We are now entering into the second phase of this program, which will focus on how to address the root causes of inequity. We are planning two consensus studies addressing structural racism in the health and longitudinal and cross-generational causes of persistent health inequities.
Within our own Academy, our hard work at increasing the diversity of NAM members is paying off. Our members are becoming more diverse not only racially and ethnically, but we’re also consistently electing more women and more people from underrepresented areas of the country.
We have much to be proud of: 50% of this year’s class of new members are underrepresented minorities — a record number – and that this class also includes a record number of women at 52%. Another record is the election of 4 Native Americans / Alaska Natives to membership. I am very proud of this development.
Indeed, at the NAM, we are absolutely committed to practicing what we preach. To lead our internal efforts, we appointed Ivory Clark as NAM’s equity and inclusion officer and recruited Joi Washington to the new position of senior administrative officer to implement the changes.
We launched the staff Committee to Advance Racial Equity to put our commitment into practice. Ivory is also working closely with Laura Castillo-Page, our first chief diversity and inclusion officer for the National Academies to develop an Academies-wide strategy for promoting diversity in our work and culture.
With regards to Climate Change, we can no longer pretend that our climate catastrophe can be dealt with down the road, or that it will only affect future generations. Climate change is the here and now.
Clearly, climate change is not just an environmental catastrophe, but also a public health crisis. Already, some 20 million people are dying every year globally because of key factors linked to climate change. And sadly, just as we have seen with the pandemic, the worst impacts of climate change are experienced by people of color and other vulnerable populations because of the longstanding inequities in our systems of health, housing, food security, and employment.
We in health and medicine have an obligation to act and to start treating climate change as the public health crisis that it is. We can and should help raise the alarm about these threats. We have a duty to advocate for health and equity to be at the center of climate change planning and policy.
The Biden administration has pledged to make climate change a top priority, with a major focus on environmental justice. We are working closely on these issues with Rachel Levine, assistant secretary for health who oversees the new HHS Office of Climate Change and Health Equity as well as the White House National Climate Advisor Gina McCarthy and their teams.
We in the health care sector must also be accountable for reducing our considerable carbon footprint. In the U.S. alone, our sector is responsible for a whopping 8.5 percent of the nation’s carbon emissions – which occur in every health care delivery setting from hospitals to clinics, from home care to nursing homes, to research facilities, and throughout the health care infrastructure – from medical devices & equipment manufacturing to the supply chain. As major contributors to climate change, we must be part of the solution. That is why we launched a signature global initiative – the Grand Challenge on Climate Change, Human Health & Equity – at last year’s annual meeting.
This multi-year global effort chaired by NAM members Phil Pizzo and Judith Rodin will harness bold thinking and radical, innovative, and collaborative partnerships to focus on the following strategic objectives. First, we must communicate the climate crisis as a public health and equity crisis. Second, we need to develop a comprehensive and long-term roadmap for systems transformation. Third, is prioritizing and catalyzing multi-sectoral actions to drive health sector transformation. And fourth, is stimulating bold and interdisciplinary solutions to accelerate the pace of innovation and transformation. We’ll hear more about the Grand Challenge later today, at the President’s Forum.
As an important part of the grand challenge, we recently launched our Action Collaborative on Decarbonizing the Health Sector, a public-private partnership, bringing together leaders from across the U.S. health system, the federal government, industry, hospital systems, private payers, clinicians, and academia to identify and implement actions aimed at reducing the environmental impacts of the health sector and strengthening sustainability and resiliency.
I am co-chairing the Action Collaborative along with George Barrett, former Chairman, and CEO, Cardinal Health, Andrew Witty, CEO, UnitedHealth Group and we are excited to work closely with the Biden administration and Rachel Levine, assistant HHS secretary, who also serves as a co-chair of this collaborative.
The Action Collaborative will focus on reducing our carbon footprint by focusing on these key areas as working groups: health care infrastructure and supply chain; health care delivery; health professional education and communication; and policy, financing, and metrics.
We have high hopes for the impact of the Action Collaborative. And we are also working closely with divisions across the Academies on climate-related projects and activities to leverage the expertise of the other academies and to develop an integrated approach.
As I am drawing this address towards closing, let us also not forget the many other important projects we are undertaking, as shown on this slide. Our action collaborative on promoting clinician well-being and fighting burnout has been more important than ever during the pandemic. The same is true for our Action Collaborative on Countering the U.S. Opioid Epidemic, as well as our recent study which updated the 2010 Future of Nursing Report for 2020-2030. And importantly, the NAM Committee on Emerging Science, Technology, and Innovation in health and medicine is developing a cross-sectoral governance framework to guide the development and use of transformative innovations while mitigating potential societal risks and unintended consequences.
Lastly, I’m excited to tell you that our publication, NAM Perspectives, was recently accepted to be indexed in PubMed Central this year, which will increase the reach and impact of the publications.
Last night we launched the public phase of the Campaign for the NAM, which is the most ambitious fundraising campaign in the Academy’s history. The campaign goal is ambitious – $100 million, which will provide resources to support NAM to fulfill its important mission. We’re currently at 85% to our goal and I want to thank our members and friends who have already participated in the campaign.
I’m confident that with the help of our members and friends we’re going to reach and surpass the goal in a few years. I encourage everyone to join your fellow NAM colleagues in making a gift of any size to an area that’s meaningful to you.
As I conclude this address, I want to acknowledge that although we still have a lot of work ahead of us, I am grateful for the progress we have made so far. This year has presented many challenges but it also provided some important, though hard-earned lessons.
For one, we now grasp in a very real way that, while our role as independent, objective advisers to the nation is more important than ever, we must also find ways to enable action. We must stand up and advocate for science and research. In today’s information environment, communicating clearly about science and countering misinformation is an absolute must, and each one of us needs to live up to this responsibility.
We have also learned how interconnected we all are. When it comes to the crises we face, we are truly all in this together. We need solidarity, new partnerships, and new approaches in how we collaborate across borders, across disciplines, and across society.
The challenges ahead of us are not for the faint of heart. We need to create a more just, equitable society, and a healthier planet for ourselves and future generations. These are big, complex goals with health and medicine right at the core.
And this brings me back to that Goethe quote, “Knowing is not enough. We must apply. Willing is not enough. We must do.” With the power of science and medicine at our disposal, I firmly believe that together, there is no challenge that we cannot overcome. This is hard work, but it’s important work – and it matters. Let’s keep doing it – together.
It is a privilege for me to serve this incredible academy as your president.