| | | | | |  | | By Mohana Ravindranath | Presented by Children's Hospital Association | Welcome to a special edition of the Future Pulse newsletter coming to you this week from the virtual Milken Institute's Future of Health Summit. HOW TO WATCH: Sessions will be livestreamed and viewable online shortly after. The conference runs through Wednesday. | | A message from Children's Hospital Association: Children's hospitals are on the frontlines for America's most vulnerable kids and stepped up in the fight against Covid-19. Sustaining our country's pediatric health care system by supporting children's hospitals adversely impacted by the pandemic is critical to children's health and wellbeing. Learn more. | | | SETTING THE STAGE: Against the backdrop of promising vaccine research, health leaders are already thinking about ways to sustain the path-breaking pace of R&D, public and private collaboration, and tech adoption that have driven the pandemic response. Top HHS officials are slated to speak, including NIH's Anthony Fauci on Monday, FDA's Amy Abernethy on Tuesday, and HHS Secretary Alex Azar and NIH Director Francis Collins on Wednesday. TODAY'S HIGHLIGHTS 9 a.m. ET: Your author will moderate a discussion on the future of telehealth with Krista Drobac of the Alliance for Connected Care, Rod Hochman of Providence St. Joseph Health and the American Hospital Association, Lewis Levy of Teladoc Health and John Squire of Philips Healthcare. 10:30 a.m. ET: USA TODAY Health reporter Jayne O'Donnell leads California Surgeon General Nadine Burke Harris, CDC National Center for Injury Prevention and Control's Debra Houry, and Children's Health Fund's Dennis Walto in a discussion about the pandemic's impact on children. Noon ET: Michael Milken leads a discussion with Pfizer's Albert Bourla and Johnson & Johnson's Alex Gorsky. 1:30 p.m. ET: Catch Fauci on the latest pandemic news. 3 p.m. ET: Milken's Sabrina Spitaletta leads Leidos' Roger Krone, Workit Health's Robin McIntosh, DEA's Matthew Strait, and NIDA's Nora Volkow in a discussion on the pandemic's impact on mental health and substance use disorders. | | | | KEEP UP WITH THE GLOBAL HEALTH AGENDA IN 2021 : As hopeful Covid-19 vaccine news continues to emerge, the focus is on how different countries plan to prioritize distribution. If nothing else, the past year has revealed how critical it is to keep up with the politics, policy, and people driving global health. Our Global Pulse newsletter connects leaders, policymakers, and advocates to the people and politics impacting our global health. Join the conversation and subscribe today. | | | | | REST OF THE WEEK On Tuesday, three former FDA commissioners take the stage to talk about the future of the agency — Margaret Hamburg, Google's Robert Califf, and Duke's Mark McClellan. Later, a bipartisan pair of House members look at their follow up to the 21st Century Cures Act with POLITICO's Dan Diamond. And CRISPR pioneer Jennifer Doudna talks gene-editing with Michael Milken. On Wednesday, FDA's Abernethy, Oxford's Martin Landray, Royalty Pharma's Pablo Legorreta, and Takeda Pharmaceutical's Andrew Plump discuss ways to accelerate biomedical research. And Azar speaks at noon. Follow me, your host, Mohana Ravindranath, for updates from the conference at @ravindranize. Thanks to @joannekenen for help on today's edition. Other POLITICO colleagues will be chiming in tomorrow. MAINTAINING TELEHEALTH'S MOMENTUM: The pandemic gave rise to widespread telehealth adoption: Patients and doctors are embracing the technology for its convenience and safety at a time when people often prefer to stay home. The virtual care business is booming. Advocates — many of whom will be speaking today — are already dreaming up ways to keep the technology around even after the pandemic. "You can start to see how we build upon the amazing tool we have, which is telecommunications," National Institute on Drug Abuse Director Nora Volkow told us. Being able to use video chat and phone for behavioral therapy and to treat substance use disorder has been a "major transformation," Volkow said, adding that video chat technology has also helped people stay connected to support groups. One trade group is already looking at how to make some recent policy allowances for the technology permanent. The Alliance for Connected Care's Krista Drobac , who'll join your author in today's telehealth panel, said the pandemic presents an "unprecedented opportunity to change telehealth for the long term." She expects to focus on expanding Medicare and commercial payers' reimbursement, loosening licensing restrictions that make it harder to practice across state lines, removing federal barriers to prescribing behavioral health drugs to patients virtually, and building out better broadband. "We're going to continue rabble-rousing on the DEA regulations, and we are going to be making a big push this coming year in 2021 on cross-state licensing," she told me. MILKEN'S TIPS FOR TELEHEALTH POLICYMAKERS: The Milken Institute Center for the Future of Aging, Center for Public Health and FasterCures in a policy report out this week also recommended that Medicare lift geographic and site restrictions so that older adults can receive virtual care at home. Among other recommendations: expand telebehavioral health, increase access to broadband, and establish data sharing standards for the transition between acute, post-acute and long-term care, including care given at home or in residential facilities. … Although recent telehealth adoption was "driven by necessity, emerging data indicate high patient satisfaction with telehealth services and a willingness to engage remotely in the future," authors wrote. DON'T FORGET ABOUT THE OPIOID CRISIS: There could certainly be greater demand for virtual behavioral health services even after the pandemic. Volkow, speaking ahead of today's mental health panel, predicted worsening mental health conditions, increasing rates of substance use disorders and even suicide in the coming months. "It's going to get worse after Covid, because of the economic downturn and loss of jobs and opportunities," she said. ... She also warned of a dangerous overlap between the opioid crisis and the coronavirus pandemic, but said a lack of data makes it harder to tell who's affected by both. "We don't know right now what's happening with overdose mortality," she said. "That information is fundamental" in knowing which areas should have more restrictive lockdown orders, and which areas need extra help, she said. Social isolation also means that people might be overdosing alone in their homes. "If you're socially isolated, you're not going to be taking drugs in the street, and no one can deliver naloxone," she said, referring to a drug that can reverse overdoses. The CDC gathers overdose data, but coroners generally have to corroborate the cause of death. "It should not take so long to determine if someone dies from fentanyl," Volkow said, noting technology like apps that first responders can use to record an overdose could be helpful. "One could improve on those applications and generate models, if the models can get you a more accurate estimation based on alternative measures." Telehealth and opioid use treatment: Virtual medication-assisted treatment could also open the door to other technology to help people with substance abuse, including consumer apps, Volkow said. "There's an app on the market that actually if you're going to be overdosing, there's a person with you all along to tell if you stop speaking [or] responding," and eventually help manage the overdose, she explained. NIDA has also funded research to build an automatic alerting system that can wirelessly monitor breath and heart rate to detect overdoses. Of course, Volkow says, "all these things are depending on the assumption that people have access to wireless technologies … which is not always the case." Education and internet: Given worsening mental health outcomes, broad social interventions should focus on expanding internet access as well as quality education to increase job opportunities, Volkow said. To skeptics, she said, "the first thing we need to convince them [and] show them unequivocally is how poverty is associated with worse outcomes, and increases the likelihood you'll have substance use disorder." Tune in to hear more from Volkow and her colleagues today. | | | |   | | | AMERICAN CHILDREN AND THE TERRIBLE, HORRIBLE, NO GOOD, VERY BAD PANDEMIC: We all know the pandemic is no good for kids: the school interruptions, the disruption of activities and routines, the anxiety, the separation from friends — just for starters. But according to California Surgeon General Nadine Burke Harris , a pediatrician and researcher who has done lot of work on Adverse Childhood Experiences or ACEs, that's just the starting point. And the recognized ACEs — ones that have been researched, defined and categorized — aren't the only sources of toxic stress. Once the pandemic is finally over, there will be much to do. Adverse childhood experiences aren't just bad days, weeks or even months. They are formative, lasting and damaging. They can affect the brain and body systems and are associated with poor health outcomes (physical and behavioral) throughout life. There are 10 identified ACEs, including but not limited to physical and emotional abuse or neglect, exposure to intimate partner violence and having a relative incarcerated. On paper, it looks like some problems have diminished during the pandemic — but they have not. Reports of maltreatment are down 40 percent to 50 percent, but that's not because the pandemic made abusers suddenly stop abusing, Burke Harris told POLITICO's Health Care Editor-at-large Joanne Kenen, previewing today's panel. It's more likely that kids just aren't in places like school and after-school programs or with other caregivers, where they'd be in contact with adults likely to detect and report abuse. "We don't believe that child maltreatment suddenly went off a cliff," she said. "The likelihood is incidence of child maltreatment are going unreported." A slight increase in injured kids presenting in emergency rooms, and some other data, backs that up. California is trying to step up training for educators so they can spot kids who are in trouble even in remote settings. Burke Harris said. State health workers are doing outreach — everything from Nickelodeon to social media and streamed teen town halls — so kids know where they can get help for themselves or for friends and family. "We're making tremendous efforts in this period of isolation," she said. Some programs have tackled the dual, entwined topics of health and racial justice. And of course, in addition to the recognized types of ACE, the pandemic is creating new forms of pain and grief and anxiety — wave after wave, all of which can create toxic stress with long-term consequences for health. "The impact of the substantial stress from the pandemic on this generation is likely to be felt for years to come," she said. "A lot of us are now recognizing that social connections are more than just nice to have. They do affect our health, our well-being, our emotional health and our mental health and our physical health as well." All of this leads her to become more certain that trauma-informed systems of care "are more necessary now than they have every been — and they need to be in every sector." The alternative could be harm that lingers for a lifetime. Even kids who don't get Covid-19 could end up with a different type of "long-hauler" syndrome, at increased risk of poor mental and physical health throughout their lives. SPOTTING THE NEXT PANDEMIC EARLIER: Milken is leading a task force to identify emerging pandemics before they spread, says Esther Krofah of Milken Institute's FasterCures. Krofah tells us they're hoping to produce a "global coordinated early warning system" for these new threats, with input from board members including former BARDA director Rick Bright, the Global Virome Project's Dennis Carroll, Johns Hopkins University School of Medicine's Anita Gupta, and John Nkengasong, director of Africa Centres for Disease Control and Prevention. That group met once in November and will meet again this month. ...Pandemic pressure has accelerated the pace of research and development, which Milken's Krofah wants to see continue even after vaccines are distributed. "We have a lot of hope that we can do things differently on behalf of patients" going forward, including designing more inclusive clinical trials that can accommodate a wider range of participants, she said. For instance, she said, "the review of data in real time. Can that be institutionalized in the way [FDA] does their work?" That will be a theme of this summit. Krofah hopes attendees will discuss ways to ensure that companies continue to "collaborate in a non-competitive way" even after Covid. NOT QUITE THERE YET: But as we discuss the future, there are some pretty serious issues health care providers need to grapple with right now — including getting the communities hardest hit by the coronavirus to trust the vaccines, says Helene Gayle, president and CEO of The Chicago Community Trust. Gayle said her biggest concern is meeting the public's expectations for vaccine delivery, citing Pfizer's recently revised supply projections. (The company halved its expectations for the number of vaccine doses it could ship by the end of this year due to supply-chain challenges, The Wall Street Journal reports.) "This may be more challenging than we anticipate, and so much is riding on being able to have an adequate supply with the kind of ramp up that people have talked about." | | | | KEEP UP WITH THE WORLD FROM HOME: Our Global Translations newsletter, presented by Bank of America, layers international news, trends, and decisions with contextual analysis from the world's sharpest minds. At a time when traveling is a challenge, we can bring the world to you. For news, insight, and a unique perspective that you cannot find anywhere else, SUBSCRIBE TODAY. | | | | | QUOTABLE "We have never done anything like this." — Johnson & Johnson CEO Alex Gorsky on distributing coronavirus vaccines to billions of people (Watch here.) "It's fair to say that there should be extra public scrutiny in the setting of an EUA and particularly when you're proposing to treat people who are not sick." — Former FDA commissioner and Verily executive Robert Califf on emergency use authorizations (Listen here.) "Once Covid hit, the role of the clinical trial for vaccine and therapy development became something the broader public was aware of ... We've seen a big shift from clinic-based health care delivery and clinical trial delivery to much more of a remote, digital and connected ecosystem." — Medable's Michelle Longmire on using technology to expand clinical trial access (Listen here.) | | A message from Children's Hospital Association: Covid-19 has affected everyone in America, including the children's hospitals and their staff on the frontlines for our most vulnerable kids. New waves of the pandemic are resulting in additional revenue damages. A growing number of children are becoming infected and long-term mental and behavioral impacts on kids is a major concern. We owe it to our children to ensure that they will have access to care when they need it. That means supporting children's hospitals and ensuring that programs critical to kids' access to care, like Medicaid, remain strong. Learn more. | | | ATTENTION GRABBING President-elect Joe Biden selects California Attorney General Xavier Becerra to lead HHS, POLITICO reports. Covid survivors report sustained mental health problems such as depression and brain fog, the San Francisco Chronicle writes. | | | | Follow us | | | | |
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