The following speech was delivered by Victor J. Dzau, MD, President of the National Academy of Medicine (NAM), at the NAM Annual Meeting on October 19, 2020.
Good morning, and welcome to our first-ever virtual Annual Meeting of the National Academy of Medicine. I thank you so much for attending. We are making history – this is the first time our annual meeting is taking place entirely online in the midst of a global pandemic.
Let me begin with a huge congratulations to two NAM members who received Nobel Prizes this year — Harvey Alter, who received the Nobel Prize in Medicine or Physiology, and Jennifer Doudna, this year’s recipient of the Nobel Prize in Chemistry. Harvey’s discovery of the virus that causes Hepatitis C has saved millions of lives, and Jennifer’s discovery of CRISP-R Cas-9 gene-editing techniques will change the future of medicine. Congratulations!
These Nobel Prize announcements are one bright spot in what has been a very difficult year. This past year we witnessed the triple existential threat of the COVID-19 pandemic, systemic racism, and climate change.
You heard me say last year that we must not be complacent and NAM must be prepared for the future. And now, recent events have demonstrated all too well that complacency simply is no longer an option.
COVID-19 has taken more than a million lives all over the world and infected millions more. COVID-19 is a health crisis, an economic crisis, an education crisis, and a social crisis.
On top of this, the senseless killing of George Floyd at the hands of the police earlier this year ignited worldwide protests and social unrest — and served as a wake-up call to centuries of racism and injustice against Black Americans and other minorities.
And the massive wildfires in California, Oregon, and Washington are just the latest and loudest signals that we ignore climate change at our own peril. Like the COVID pandemic, the consequences of climate change will be the most severe on many of our most vulnerable citizens.
Abraham Lincoln said, “You cannot escape the responsibility of tomorrow by evading it today.” Well, 2020 is showing us that tomorrow has arrived. We are living the consequences of years of evasion and neglect on so many fronts. But as painful as this year has been, I believe that we can make this a turning point. 2020 can be known as the year that sparked a new resolve in all of us, to face our responsibilities today.
As individuals, and as the NAM, now is the time for us to lead — and to act. Together we can reverse course on decades of woefully insufficient action and investments in our public health systems and national and global emergency preparedness. This year can mark a new beginning in reckoning with our shameful legacy of systemic racism and structural inequality. And this can be the year that we begin to reverse years of neglect and inaction on climate change.
Health and medicine are at the intersection of every one of these crises. I know that you, like me, firmly believe that science and medicine offer solutions that can save lives, reduce inequity, and create a better nation and world for generations to come.
COVID-19 Response
I’d like to discuss our responses to these existential threats.
First, the pandemic. If there is one piece of good news to come from this crisis, it would be the way our science community has galvanized like never before around finding solutions. Researchers all over the world have united to better understand this novel virus and work toward developing vaccines, diagnostics, and therapeutics — often setting aside competition and individual interests.
Science and public health officials are working hard –but often under great stress. Indeed, amid growing reports and incidents of political interference in science and public health guidance, I with Marcia McNutt, President of NAS recently issued a public statement that expressed our alarm, especially at this critical time in the nation’s response to the pandemic which depends on trusted science and public health.
“Any efforts to discredit the best science and scientists threaten the health and welfare of us all.”
It is painfully clear that science and medicine alone cannot provide all of the answers. It takes trust, leadership, strategy, and solidarity.
COVID has challenged our understanding of pandemic preparedness and response. Before the COVID hit, the US ranked number one on the Global Health Security Index – the most prepared nation for a global health emergency. With COVID, we are one of the poorest performers in our response. Without strong leadership and a national, coordinated strategy, it is impossible to mount clear and effective responses, earn public trust, and take strong, proactive measures to control the pandemic.
In this highly fragmented and politicized time in our nation, the NAM is demonstrating leadership. We are the nation’s premier academy for health and medicine, and one of its most trusted advisors. We can and must step in and provide desperately needed direction, even when others won’t.
Indeed, our Academy is rising to this challenge, working nationally and on the global stage to address these complex issues. Our work is organized into the following areas: leadership, communication, connection/engagement, response, and recovery
The NAM and the National Academies have taken a strong leadership role in responding to Covid since the very early stages of this pandemic. We established a standing committee on “emerging infectious diseases” led by my predecessor, Harvey Fineberg to engage regularly with the federal government on key questions related to the pandemic.
To date, the standing committee has provided 15 rapid expert consultations –- a new quick turnaround product to advise on urgent questions such as crisis standards of care, virus shedding, and antibody response, and laboratory testing. The Rapid Expert Consultations have had a demonstrable effect on decision making at the national and state level.
Most recently, the NAM convened an expert committee to address the issue of equitable COVID vaccine allocation. Even with the optimistic scenario of having an effective vaccine by late this year or early 2021, it is unlikely there will be enough doses for the entire population in the first few months. Therefore, it is important to have a well thought out framework that will help determine who should receive the vaccine in what order, based on science, public health, social factors, and equity. Importantly, the allocation framework must be developed independent of political and other undue influences in order to earn the public’s trust.
This is why the NIH, and CDC came to the NAM to independently advise on an overarching allocation framework. Importantly, our vaccine allocation framework explicitly addresses the high risk, vulnerable populations, and health inequities.
I want to thank the Committee co-chairs, Bill Foege and Helene Gayle, and all the members of the committee who dedicated tremendous time and expertise over the last 3 months. Their report is extremely well received by all.
To build public trust in COVID vaccination, we developed a robust public engagement strategy right from the start, including opportunities for public feedback on a discussion draft of the report before it was finalized. And now with the release of the report, we are actively engaging the public, the medical community, and others, and we will be continuing our outreach efforts in the months ahead.
At the same time, we can’t forget that seasonal or pandemic influenza will soon kick into full swing in the northern hemisphere and pose dual health threats. At the request of HHS, the NAM has established an international committee on U.S. and global influenza preparedness to assess lessons learned from COVID to improve influenza preparedness and response, especially regarding vaccine development.
It is critical that the nation receives accurate, timely, and trusted information on COVID.
Early in the pandemic, NAM partnered with the American Public Health Association to host a webinar series named “COVID-19 Conversations.”
The webinars to date have been widely applauded as a source of trustworthy information to the health care community, policymakers, media, and the public. I am grateful to my co-sponsor, Georges Benjamin, and co-chairs, Carlos del Rio and Nicki Lurie, for their facilitation of this series.
In addition, across the NAM and the National Academies, we have hosted close to 100 webinars, town halls, and workshops on a wide range of topics related to COVID. We have also published multiple NAM Perspectives on important issues of COVID 19.
To leverage the experience and innovation of our members, we launched a member engagement initiative to collect and advance your meritorious ideas. We received over 150 proposals –many of which have informed our work. I want to thank you for your thoughtful contributions.
We have also developed a searchable database of member expertise relevant to COVID to help match your expertise with new and ongoing projects across the National Academies.
At the NAM, we are incorporating COVID response across all of our programs and activities. NAM’s Culture of Health Program is addressing the pandemic’s disproportionate effects on the most vulnerable populations, particularly people of color. Other NAM programs are addressing COVID’s effects on mental health and addiction, the elderly, clinician burnout, and other issues.
In planning for the future, the National Academies have launched a Response and Recovery Strategic Initiative, which will bring together multidisciplinary teams to conduct scenario-based analyses in order to build a more equitable and resilient society with better systems and infrastructure base. Indeed, the NAM Leadership Consortium is planning a Roadmap to study transformational opportunities for the US health system.
Global Response
NAM has also been active in the global response. This pandemic has starkly illustrated just how interconnected we are globally. We can’t truly end this pandemic anywhere until we end it everywhere. We need a strong, cohesive global response if we hope to beat this.
Unfortunately, most countries have been focused on tackling the consequences of the pandemic within their own borders. Indeed, COVID has revealed the costs of a failing multilateral system.
Moreover, efforts to weaken and defund the World Health Organization have hamstrung this key UN health organization in charge of international COVID response, just as many countries are counting on it for help. The NAM spoke out on the importance of sustained U.S. support for WHO, especially in the midst of a pandemic. Simply put, the U.S. cannot fight this pandemic on its own.
NAM members Jeremy Farrar, Chris Elias, Tony Fauci, and George Gao, and I serve on the Global Preparedness Monitoring Board along with which was co-convened by WHO and World Bank in 2018 after the Ebola crisis to monitor global pandemic preparedness.
In March 2020, the GPMB called for the immediate injection of at least $8 billion in new funding to support the development of vaccines, drugs, and diagnostics for COVID.
The GPMB call triggered the European Commission President Ursula von der Leyen to lead the Coronavirus Global Response Pledging Event, which had the participation of over 30 heads of state, philanthropists, and leaders. In a mere 7 weeks, the pledge effort raised a total of almost $18 billion.
In addition, an unprecedented collaboration between WHO, the World Bank, GAVI, Global Fund, CEPI and G20 countries, which is known as Access to COVID Tools or ACT-Accelerator – is aimed at accelerating global development of testing, vaccines, and treatments. I serve on the ACT-A steering group, along with Chris Elias and Jeremy Farrar. The ACT Accelerator has made impressive progress toward establishing a multilateral mechanism for end to end research & development,
Finally, the NAM is convening dialogues among global leaders to examine how to achieve global solidarity through improved governance and sustainable financing for the global public good in the future.
Structural Racism
As I mentioned earlier, the COVID-19 pandemic has shone a harsh spotlight on national and global racism, and its insidious consequences. In the U.S., predominantly black neighborhoods are experiencing as much as three-fold higher infection rate and a six-fold higher death rate than other communities. Disparities were also striking among Hispanics and Asian Americans.
This is not a fluke. There are multiple factors at the heart of these inequities – ranging from uneven access to care, inadequate or overcrowded housing, a likelihood to be in frontline jobs that carry more risk, and a higher prevalence of chronic health conditions. But the underlying root cause is structural racism.
As health and medicine professionals, we recognize that structural racism has long been a public health crisis in its own right.
Under our Culture of Health Program, a collaboration with the Robert Wood Johnson Foundation, we produced a 2017 report that succinctly summed up the issue: “Addressing and putting an end to health inequities will only be possible if society and decision-makers broaden their view of health to fully grasp how steep and unjust disparities in social and other conditions limit, thwart, and even destroy some people’s ability to live healthy and full lives.”
At the NAM, we are committed to tackling this important issue. Three years ago, we revised our mission statement to explicitly include advancing health equity as a priority.
In the aftermath of George Floyd’s death, we have urgently ramped up our effort to confront this issue. Immediately after the tragedy, I on behalf of the NAM issued a statement addressing structural racism and social injustice. I told my staff that I am committed to ensuring that all people, and especially people of color, feel safe and supported while working here. I committed myself and the academy to listening, learning, and working with all. I committed to using our platform to improve the lives of people who experience disproportionate health disparities as a result of socio-economic inequity, bias, and structural racism.
In this context, we are prioritizing racial equity in all NAM programs.
Early this year, the leadership and staff of the NAM and RWJF participated in several workshops to better understand the root causes of racism and the role it plays in health inequities. For our joint work, we will be targeting strategies to advance health equity by advancing policies that dismantle structural racism. Furthermore, we are also committed to making the NAM’s internal culture more equitable and inclusive.
At the NAM and the National Academies, we have a lot of work to do to increase racial and ethnic diversity among our staff and membership. We are committed to doing this work and have launched a staff committee on equity, diversity, and inclusion. Several years ago we established a membership diversity task force and we are starting to make progress. This year, for instance, 35 percent of newly elected members come from underrepresented minority groups compared to 16% in 2019– a new record for us — and 38 percent are women and 30% under age 50—another record. We are committed to do the same for NAM staff.
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.
Climate Change
Now, I’d like to focus on climate change and the very real societal and public health threats that it poses.
Climate change, we are facing real consequences. The latest report from the Intergovernmental Panel on Climate Change predicts that in the absence of dramatic, near term action, temperatures are on track to increase in the range of 2.5 degrees to as much as 10 degrees Fahrenheit by the end of this century. This will have devastating impacts on the planet and populations globally.
But we don’t have to wait until the end of the century to see what is already happening before our own eyes. The most recent National Climate Assessment highlights the fact that recent years have seen “record-breaking, climate-related weather extremes, and the last three years have been the warmest years on record for the globe.”
A warmer world brings with it an increase in heatwaves, wildfires, hurricanes, droughts, rising sea levels and floods, and other extreme events. Severe heat and wildfires have raged through California, Washington, and Oregon. In California alone, more than 2.5 million acres have burned so far this year. The fires have killed at least 30 people this year and caused multi-millions of dollars of damage. And no doubt, we will see other adverse health effects in the months ahead.
But extreme events aren’t the only threats. 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.
Although the National Academies have worked on advancing the science of climate change, focusing on the human health impact is new for the institution.
Many NAM members have urged the academy to take this on. Last year, a new member interest group was formed with enthusiastic participation. Also, in anticipation of the 50th Anniversary of the NAM, climate change was identified by a high-level committee of distinguished leaders as one of the five big ideas for the future. Indeed, “human health and climate change” has been now identified as a high-priority issue for NAM going forward.
As a first step, last December, we collaborated with the National Academies Climate Communications Initiative, and the Burroughs Welcome Fund to convene a meeting of experts to review the issues. In addition, NAM & BWF provided 9 “opportunity grants” to support interdisciplinary teams across the National Academies to stimulate new projects.
And importantly, I asked Judith Rodin and Phil Pizzo to chair a planning group of diverse experts to develop a signature initiative on Human Health and Climate Change for the NAM.
Based on their work, I am pleased to announce that the NAM will launch the Grand Challenge on Human Health & Climate Change, a five-year, multi-million-dollar strategic initiative.
Through bold thinking and radical partnerships with public and private sectors, this signature initiative will focus on three objectives:
- Develop a comprehensive and long-term roadmap for transforming systems – such as health care, transportation, infrastructure, or energy – which impact or are impacted by climate change, with a focus on human health, well-being, and equity.
- Mobilize the full spectrum of actors and institutions in the health community along with those in other sectors to reduce the health sector’s environmental impacts and commit to sustainable transformation. The first area for action is Decarbonization of the Health Sector – an ambitious but important effort.
- Launch a global competition to foster innovative interdisciplinary research and actionable solutions at the intersection of climate change and human health.
The initiative will be global in scope but will emphasize what the United States can and must do as a global citizen.
Summary
The crises I spoke of today– the pandemic, systemic racism, and climate change — pose extreme threats to society and human health. The stakes for society are about as high as they can be –– nothing less than the future of our nation and our planet. Each of us must do our share, but our strength as the National Academy of Medicine is our ability to break down the siloes that may divide us. We are focusing on these complex challenges at today’s meeting so that, together, we can bring our collective expertise and leadership to bear on identifying and advancing solutions.
The National Academies were created for moments like these. We have helped steer society through many crises, including the Great Depression, two world wars, and the 2008 financial crisis. Today, it is clearer than ever that our mission – to provide scientific leadership to the nation and the world, to advance evidence-based solutions for the most urgent and complex challenges facing humanity –has never been more important.
Just last week, we announced the winners of the Catalyst Awards. 49 countries and territories got involved, and globally we received over 1,500 applications. Using a 3-tier process (involving many of you as reviewers), we selected 154 awardees globally with 21 in the US, each of whom received $50,000, for novel, bold ideas to extend the human healthspan.
Of course, our other work at the NAM has not slowed down. I’d like to thank our staff, members, and volunteers who have worked so hard to support our mission.
Last year at this annual meeting, we launched our Grand Challenge Global Competition for healthy longevity, which was attended by innovators from all over the world. Just last week, we announced the winners of the Catalyst Awards. 49 countries and territories got involved, and globally we received over 1,500 applications. Using a 3-tier process (involving many of you as reviewers), we selected 154 awardees globally with 21 in the US, each of whom received $50,000, for novel, bold ideas to extend the human healthspan.
The funded projects came from biomedical science, engineering, the social sciences, digital technology, and many other disciplines.
I’m sure you’ve heard the saying – “Life happens when you’re busy making other plans.” Before the pandemic hit, we certainly had many other plans for 2020. This year marks the 50th anniversary of the founding of the Institute of Medicine/National Academy of Medicine, and we had anticipated celebrating that momentous occasion in various ways throughout the year — and especially at this meeting. Of course, the coronavirus had other ideas, and we have had to adjust accordingly. We plan to celebrate our 50th in person! Next year in Washington!
2020 has been quite a year, and it is not over yet. But even the pandemic did not stop us from coming together today. You joined me because you know that together, we can make what seems impossible become possible. We can and will blaze a trail to recovery from this pandemic, and at the same time, we can create a stronger, more resilient, and more just and equitable society – for all of our citizens. I can’t think of anything more important than that – or more necessary.
Thank you for your service, commitment, and support. It is a privilege for me to serve this wonderful academy and you, the members, and to serve the nation and the world.
Thank you!
