2021 NAM President’s Address

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 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.

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.

COVID-19

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.