Transcripts For CSPAN Asst. Secretary For Health Brett Giroi

Good morning. Thank you for joining us on cspan. I am really pleased to be here today. To introduce the admiral who is the assistant secretary for health. He is our 16th assistant secretary of health and the department of health and human services. It is his twoyear anniversary in the role. He serves as the secretary Principal Public Health and science advisor and is responsible for coordinating hhss efforts across the administration to fight americas opioid crisis. He also oversees the office of the Surgeon General in the u. S. Public Health Service commissioned corps. His office leads many Critical National initiatives, including a historic new plan to fight the epidemic in america, the National Vaccine plan, and eight cross agency plan for Sickle Cell Disease. Dr. Giroir brings the hands on perspective to his work. Lead america to healthier lives. I want to thank Africa Worldwide for partnering on this. With that, i am pleased to introduce now, admiral giroir. Mr. Giroir thank you very much. I am going to stand up if that is ok with everyone. Good morning. It is great to be here joining you. Again, it has been two years now. As they say in d. C. , the days are long but the years are short, and i can certainly agree with that. It has been quite an amazing two years with a lot of accomplishments and a lot of understanding of what we need to do. If i can get my slides up, please. When we get our slides up, that is ok. I am the 16th assistant secretary for health. That role has changed quite a bit over the years. If you were here in 1995, the assistant secretary for health really ran the Public Health service, meaning everyones budget, leadership, cdc, all came through it. Around that time, it was determined the assistant secretary for health and that office became a policy office. Andprincipal policy advisor science person within the office of the secretary. And how that is defined really depends on the individual in the office and how the sec. Used the role. I will tell you how we view the role with a new strategic plan. We believe our goal is to lead america to healthier lives and provide a roadmap for a healthier nation. There are four components of that. One that is very important is health transformation. Improving the key to health is transforming the current sick care system into a Health Promoting system. You will see how we define that too many of our programs, policies, and frameworks. Secondly, to respond to emerging health challenges. Whether talking about hiv or opioids or the emerging methamphetamine issues, we need to lead the emerging Health Responses so the nation is positioned and not looking in retrospect. Health innovation, very important. If we keep doing things the way we have always done them from a we will not get a different result, so innovating, testing, having hypothesis that can be proven true or false are all part of what we do in order to leverage those new programs into major operational divisions. Finally, we have traditionally been, and it is a very Important Role for us, to ensure that health is not for some but for all. A major part of our portfolio is to advance Health Opportunities for everyone. How do we do that . If you are in cms, you have a 1 trillion budget of one point 2 trillion budget. Youre in c. D. C. , you know what they do. If youre at nih, you have 40 billion in research money, how we operate is by the power of the idea and bring people together to convene them and make changes and provide leadership. First of all, we provide trusted data and information, so many of the items that you may go to, hiv. Gov, vaccines. Gov, health. Gov, are all from our office so we try to provide the American Public and truly the world with the best, no most evidencebased, and sciencebased information possible. Secondly we convene partners. This is an exciting part of my position and very different than other parts of hhs or the government. My job is to look externally. It is to bring people not only from within the government, but state and local partners, private partners, commercial partners, nonprofit organizations, faithbased organizations all together because nothing that were trying to accomplish is simple. Its not just an all federal government approach, but its an all of society approach. We develop novel initiatives and we do that with some of the small amounts of grant money that we have. We test ideas. And if those ideas work and its now required in my office that we have a transition partner. Because if something works for a group of individuals, i dont want it to be funded for 5 million or 10 million for the next 10 years. I want it to be 100 million or a billion Dollar Program within cmf that makes sure that works and we innovate and finally we organize and lead national initiatives. So to give you an idea of some things that were doing, i put this together. Our office is leading a couple of president ial initiatives ending hiv epidemic in america and i will talk more about that. Our National Youth sports strategy. Were leading many initiatives that are president ial or a national level, but were leading them not for the whole government, but for hhs. For example, combatting opioids. Our office and myself as a Senior Advisor for the policy. Healthy people 2030. Its the road map, the report card for health in the country. The physical activity guidelines the physical activity guidelines and the volunteer guidelines and vaccine plans and national hiv, aids plan. The Viral Hepatitis plan and a National Action for sexually transmitted infections, et cetera, et cetera, et cetera. A lot of really the strategy that will govern how the federal government and the entire country goes are really written through our office with all the input from all the people youve seen. New initiatives improving Maternal Health, in a National Strategy for tick born diseases. Youll see much more of that coming up in the next few months and of course, the Surgeon General functioning again as the nations doctor being very vocal on a number of issues, advisories like naloxone, like the marijuana advisory discussing the dangers of marijuana, particularly for youth and for pregnant women, and a number of reports coming out this year. So what i wanted to do in the remaining 14 or 15 minutes, is just highlight, give you very high level everviews of four different topics that come from here. Number one, the ending hiv initiative and number two, with are we are with combatting ipos in the overdose crisis. Number three, Sickle Cell Disease, as a pediatric critical care. And my true Love Commission corps of United States Health Service which im honored to lead with the Surgeon General and assistant Surgeon General and all the assistant Surgeon Generals and we will have a good interactive questions. So, one of the benefits and in fact, the only benefit i think of a very long time for confirmation is i had about nine months to really think about issues and to really understand issues that were not part of my normal practice. And one that astounded me was the data, the fact that we have cases of h. I. V. Every year in the United States. I could not believe that, because we have the tools and technology, this disease has been with us for such a long period of time and i asked the question. Why do we still have 40,000 new cases of hiv in our country every year . When i got to h. H. S. And talked like tony fauci and bob redfield around the table and the admiral, we have 40,000 new cases because no one made the decision we were not going to have 40,000 new cases. And in fact, the time was exactly right to end hiv in america. Why do i say that . First of all, when you look at the map, over 50 of new cases occur in only 48 jurisdictions within our country, not 3,000, but 48, plus washington d. C. But 48, plus washington, d. C. , and san juan, puerto rico. So we can have a targeted effort that could really work on where the major focus is and its also demographically very selective, highly affecting africanamerican populations, american natives and alaskan know s and, of course, we how to target and to work with those communities. Antiretroviral therapy. When i started as a pediatric physician, there was no therapy for h. I. V. It was a death sentence. Therapies, you took 20, 30 pills a day, every food, not withth food. There were a lot of toxicities. They were not effective. And now we have single pill regimens that are effective. And we have a pill a day that can prevent over 99 of sexually transmitted hiv infections. And finally, we have proven models of care. Like the Ryan White Program that achieves in the most difficult challenging population that have social determinants now 87 , remarkable given the population. So really the time. This is a shocking chart and i try to put this up mostly for my physician and Health Care Provider audiences is that we both anthis is opportunity and i think a shame for us, is that one in two people with hiv have their virus at least three years before diagnosis. 50 of the people are infected for three years and potentially spreading the virus before its diagnosed. One in four people at least seven years before theyre diagnosed. One in five people are diagnosed with aids, with advanced disease just like i would have diagnosed them, you know, 20 years ago, 25 years ago and seven in 10 people saw a Health Care Provider in the 12 months prior to diagnosis, but failed to be diagnosed. So clearly you understand our opportunity, but also our challenge is to get people diagnosed early and put into care. So the plan is, and its not a fantasy, its a true plan. Based on epidemiology, based on what we stand. Based on sophisticated models at c. D. C. , that we believe we can achieve a 75 reduction in new hiv infections within five years and a 90 reduction in 10 years. We do this by employing the tools that we know now. Dont need a medical miracle to diagnose people as early as possible. To prevent by using preventative measures, including prep, to treat all those because we know that treatment is highly effective and maintaining a normal life and we also know that treatment is prevention, and totable by means respond to every new hiv infection as though its a sentinel event so we dont have clusters around i. V. Drug use. Im proud of this, that we were able to negotiate the donation of prep from gilead for up to 200,000 uninsured people per year for 11 years. This could be upwards of a 20 billion donation, very important because if youre insured or have government programs, prep can be available to you, but at a cost of 1,600 to 2,000 a month if youre uninsured, that would be very, very difficult so this is absolutely free and weve also secured Partnership Agreements with major, major outlists, c. V. S. , walmart, and health mart to distribute at no cost and this was started in december and its going right now. And finally, you know, president s budget in 2020, there was 291 million for new funds for hiv for the initiative that we asked for and in the president s 2021 budget that just came out. Again, that budget had the that we needed with 716 million in new funds distributed that way. Happy to answer any questions. But were getting the resources that we need and we certainly hope that Congress Supports the president s budgets to give us the tools that we need to end the epidemic. I want to make it clear although h. I. V. Here, about symdemics, there are integrated epidemics that come together with Substance Use disorders, hepatitis c and sexually transmitted infections and the office is conveniently writing the plans. At separate them plans but the same people are working on them and theyre integrative and synergistic. We cant fix one without fixing the other. Lets talk about overdoses. Lets start with the good news. In 2018 overdose morality was reduced 4. 1 . The first reduction in Overdose Deaths if about 28 years, deaths in about 28 years. This is through the combined of everyone. Again, in the federal government, state, local, private, Community Working together. The actual age adjusted morality was down 4. 6 . There is no silver bullet, all programs have to keep working together. What id like to point out here, although the top line numbers look good, depending where you are in states it may not be so good for you. This is the latest morality map six months behind because it takes six months to get the death certificates and everything collected. This is the most recent one reported in february of 2020. If youre in a state thats blue, your morality is going down and we have some great successes like new hampshire, michigan, illinois, pennsylvania, down 10. 4 . But across the country its not always the same. Californias morality is up over 13 . New mexico, 20 . Delaware 18 and when we get in the q a, we can talk about what were doing about that. Were also clearly in the fourth wave. I think i branded this as a fourth wave last march and the fourth wave is clearly methamphetamines. Six monthsmine about ago overtook prescription opioids as a cause of death and heroin as a ertook cause of death within our country. Within a month or two it will overtake cocaine. Methamphetamine is the fourth wave. There are many things we are doing about it. The q a. Well get into this isnt over. And the numbers we have are in we are not dealing with methamphetamine as sangle drug and also the underlying causes of use disorders within our country overall. We will continue to put money out, very, very important. Our strategy is it to make sure that people use evidencebased approaches, but allow the states and localities to pick among the evidencebased approaches in order to fit their population. What works in jackson, mississippi is not necessarily going to work in los angeles or in the Cherokee Nation, so we demand evidencebased approaches like medication assisted treatment, but give a great deal of flexibility. My priorities moving forward directly address the resurgence of methamphetamine. H. H. S. Ed a task force at last march and we have been working diligently on that. Support regions, and trying to get more realtime actionable data, and we have a partnership with millennium health. And so we understand where carfentanil is and the new analogue, where up sophetamine is popping we can work with the realtime and Public Health services. And with the community study, 350 million by the nih focusing on four communities how to integrate all specific solutions and finally, some specific policy initiatives, like Syringe Service programs, and working in emergency rooms, mat, in and out of the criminal Justice System and expanding recovery holistic services, especially for women, children and families. And of course, were looking for longterm solutions and our longterm solutions is to get out of the grantbased solutions and to get the right incentives and the right delivery system. Third topic, Sickle Cell Disease. 100,000 americans live with sickle sell disease. I took care of patients every single day in my Childrens Hospital and many times in my i. C. U. I think if you dont know anyone with Sickle Cell Disease, its a disease of great pain, shortened life span. Nly into the early fourth decade. And whats important about it, patients with sickle cell live at the center of a lot of issues. Their quality of care is poor. Less than 20 of children get the prescribed penicillin, their standard of care to prevent infections and probably less than 15 of all individuals get hydroxyrhea. And people are coming to the emergency room, for example, do not get pain medications they need. Discriminated against. Proven in the literature. Ut on a good side, there are some new medications but they are at very high cost. Theres a potential for a genetic cure, but there really isnt Adequate Funding and attention. So the secretary and i started almost immediately a goal to increase the Life Expectancy of patients with Sickle Cell Disease, quality of life by at least 10 years, within 10 years. And this has been an entire hhs effort bringing in cms, all the major agencies, unprecedented awareness, education, programs to improve adherence to medications and lots of novel strategies for delivery that i would love to talk about more. We also had the president involved. We had the first two president ial messages on Sickle Cell Disease since 1983, first in 2018 and 2019. We sponsored a National Academy study which will be coming out in march to create the First National Strategic Blueprint for action for People Living with Sickle Cell Disease and again, we care about sickle cell because its an important disease, but also, because its emblematic of all the uncommon iseases that together make up about 10 of the Disease Burden within the Principal Public Health<\/a> and science advisor and is responsible for coordinating hhss efforts across the administration to fight americas opioid crisis. He also oversees the office of the Surgeon General<\/a> in the u. S. Public Health Service<\/a> commissioned corps. His office leads many Critical National<\/a> initiatives, including a historic new plan to fight the epidemic in america, the National Vaccine<\/a> plan, and eight cross agency plan for Sickle Cell Disease<\/a>. Dr. Giroir brings the hands on perspective to his work. Lead america to healthier lives. I want to thank Africa Worldwide<\/a> for partnering on this. With that, i am pleased to introduce now, admiral giroir. Mr. Giroir thank you very much. I am going to stand up if that is ok with everyone. Good morning. It is great to be here joining you. Again, it has been two years now. As they say in d. C. , the days are long but the years are short, and i can certainly agree with that. It has been quite an amazing two years with a lot of accomplishments and a lot of understanding of what we need to do. If i can get my slides up, please. When we get our slides up, that is ok. I am the 16th assistant secretary for health. That role has changed quite a bit over the years. If you were here in 1995, the assistant secretary for health really ran the Public Health<\/a> service, meaning everyones budget, leadership, cdc, all came through it. Around that time, it was determined the assistant secretary for health and that office became a policy office. Andprincipal policy advisor science person within the office of the secretary. And how that is defined really depends on the individual in the office and how the sec. Used the role. I will tell you how we view the role with a new strategic plan. We believe our goal is to lead america to healthier lives and provide a roadmap for a healthier nation. There are four components of that. One that is very important is health transformation. Improving the key to health is transforming the current sick care system into a Health Promoting<\/a> system. You will see how we define that too many of our programs, policies, and frameworks. Secondly, to respond to emerging health challenges. Whether talking about hiv or opioids or the emerging methamphetamine issues, we need to lead the emerging Health Responses<\/a> so the nation is positioned and not looking in retrospect. Health innovation, very important. If we keep doing things the way we have always done them from a we will not get a different result, so innovating, testing, having hypothesis that can be proven true or false are all part of what we do in order to leverage those new programs into major operational divisions. Finally, we have traditionally been, and it is a very Important Role<\/a> for us, to ensure that health is not for some but for all. A major part of our portfolio is to advance Health Opportunities<\/a> for everyone. How do we do that . If you are in cms, you have a 1 trillion budget of one point 2 trillion budget. Youre in c. D. C. , you know what they do. If youre at nih, you have 40 billion in research money, how we operate is by the power of the idea and bring people together to convene them and make changes and provide leadership. First of all, we provide trusted data and information, so many of the items that you may go to, hiv. Gov, vaccines. Gov, health. Gov, are all from our office so we try to provide the American Public<\/a> and truly the world with the best, no most evidencebased, and sciencebased information possible. Secondly we convene partners. This is an exciting part of my position and very different than other parts of hhs or the government. My job is to look externally. It is to bring people not only from within the government, but state and local partners, private partners, commercial partners, nonprofit organizations, faithbased organizations all together because nothing that were trying to accomplish is simple. Its not just an all federal government approach, but its an all of society approach. We develop novel initiatives and we do that with some of the small amounts of grant money that we have. We test ideas. And if those ideas work and its now required in my office that we have a transition partner. Because if something works for a group of individuals, i dont want it to be funded for 5 million or 10 million for the next 10 years. I want it to be 100 million or a billion Dollar Program<\/a> within cmf that makes sure that works and we innovate and finally we organize and lead national initiatives. So to give you an idea of some things that were doing, i put this together. Our office is leading a couple of president ial initiatives ending hiv epidemic in america and i will talk more about that. Our National Youth<\/a> sports strategy. Were leading many initiatives that are president ial or a national level, but were leading them not for the whole government, but for hhs. For example, combatting opioids. Our office and myself as a Senior Advisor<\/a> for the policy. Healthy people 2030. Its the road map, the report card for health in the country. The physical activity guidelines the physical activity guidelines and the volunteer guidelines and vaccine plans and national hiv, aids plan. The Viral Hepatitis<\/a> plan and a National Action<\/a> for sexually transmitted infections, et cetera, et cetera, et cetera. A lot of really the strategy that will govern how the federal government and the entire country goes are really written through our office with all the input from all the people youve seen. New initiatives improving Maternal Health<\/a>, in a National Strategy<\/a> for tick born diseases. Youll see much more of that coming up in the next few months and of course, the Surgeon General<\/a> functioning again as the nations doctor being very vocal on a number of issues, advisories like naloxone, like the marijuana advisory discussing the dangers of marijuana, particularly for youth and for pregnant women, and a number of reports coming out this year. So what i wanted to do in the remaining 14 or 15 minutes, is just highlight, give you very high level everviews of four different topics that come from here. Number one, the ending hiv initiative and number two, with are we are with combatting ipos in the overdose crisis. Number three, Sickle Cell Disease<\/a>, as a pediatric critical care. And my true Love Commission<\/a> corps of United States<\/a> Health Service<\/a> which im honored to lead with the Surgeon General<\/a> and assistant Surgeon General<\/a> and all the assistant Surgeon General<\/a>s and we will have a good interactive questions. So, one of the benefits and in fact, the only benefit i think of a very long time for confirmation is i had about nine months to really think about issues and to really understand issues that were not part of my normal practice. And one that astounded me was the data, the fact that we have cases of h. I. V. Every year in the United States<\/a>. I could not believe that, because we have the tools and technology, this disease has been with us for such a long period of time and i asked the question. Why do we still have 40,000 new cases of hiv in our country every year . When i got to h. H. S. And talked like tony fauci and bob redfield around the table and the admiral, we have 40,000 new cases because no one made the decision we were not going to have 40,000 new cases. And in fact, the time was exactly right to end hiv in america. Why do i say that . First of all, when you look at the map, over 50 of new cases occur in only 48 jurisdictions within our country, not 3,000, but 48, plus washington d. C. But 48, plus washington, d. C. , and san juan, puerto rico. So we can have a targeted effort that could really work on where the major focus is and its also demographically very selective, highly affecting africanamerican populations, american natives and alaskan know s and, of course, we how to target and to work with those communities. Antiretroviral therapy. When i started as a pediatric physician, there was no therapy for h. I. V. It was a death sentence. Therapies, you took 20, 30 pills a day, every food, not withth food. There were a lot of toxicities. They were not effective. And now we have single pill regimens that are effective. And we have a pill a day that can prevent over 99 of sexually transmitted hiv infections. And finally, we have proven models of care. Like the Ryan White Program<\/a> that achieves in the most difficult challenging population that have social determinants now 87 , remarkable given the population. So really the time. This is a shocking chart and i try to put this up mostly for my physician and Health Care Provider<\/a> audiences is that we both anthis is opportunity and i think a shame for us, is that one in two people with hiv have their virus at least three years before diagnosis. 50 of the people are infected for three years and potentially spreading the virus before its diagnosed. One in four people at least seven years before theyre diagnosed. One in five people are diagnosed with aids, with advanced disease just like i would have diagnosed them, you know, 20 years ago, 25 years ago and seven in 10 people saw a Health Care Provider<\/a> in the 12 months prior to diagnosis, but failed to be diagnosed. So clearly you understand our opportunity, but also our challenge is to get people diagnosed early and put into care. So the plan is, and its not a fantasy, its a true plan. Based on epidemiology, based on what we stand. Based on sophisticated models at c. D. C. , that we believe we can achieve a 75 reduction in new hiv infections within five years and a 90 reduction in 10 years. We do this by employing the tools that we know now. Dont need a medical miracle to diagnose people as early as possible. To prevent by using preventative measures, including prep, to treat all those because we know that treatment is highly effective and maintaining a normal life and we also know that treatment is prevention, and totable by means respond to every new hiv infection as though its a sentinel event so we dont have clusters around i. V. Drug use. Im proud of this, that we were able to negotiate the donation of prep from gilead for up to 200,000 uninsured people per year for 11 years. This could be upwards of a 20 billion donation, very important because if youre insured or have government programs, prep can be available to you, but at a cost of 1,600 to 2,000 a month if youre uninsured, that would be very, very difficult so this is absolutely free and weve also secured Partnership Agreements<\/a> with major, major outlists, c. V. S. , walmart, and health mart to distribute at no cost and this was started in december and its going right now. And finally, you know, president s budget in 2020, there was 291 million for new funds for hiv for the initiative that we asked for and in the president s 2021 budget that just came out. Again, that budget had the that we needed with 716 million in new funds distributed that way. Happy to answer any questions. But were getting the resources that we need and we certainly hope that Congress Supports<\/a> the president s budgets to give us the tools that we need to end the epidemic. I want to make it clear although h. I. V. Here, about symdemics, there are integrated epidemics that come together with Substance Use<\/a> disorders, hepatitis c and sexually transmitted infections and the office is conveniently writing the plans. At separate them plans but the same people are working on them and theyre integrative and synergistic. We cant fix one without fixing the other. Lets talk about overdoses. Lets start with the good news. In 2018 overdose morality was reduced 4. 1 . The first reduction in Overdose Deaths<\/a> if about 28 years, deaths in about 28 years. This is through the combined of everyone. Again, in the federal government, state, local, private, Community Working<\/a> together. The actual age adjusted morality was down 4. 6 . There is no silver bullet, all programs have to keep working together. What id like to point out here, although the top line numbers look good, depending where you are in states it may not be so good for you. This is the latest morality map six months behind because it takes six months to get the death certificates and everything collected. This is the most recent one reported in february of 2020. If youre in a state thats blue, your morality is going down and we have some great successes like new hampshire, michigan, illinois, pennsylvania, down 10. 4 . But across the country its not always the same. Californias morality is up over 13 . New mexico, 20 . Delaware 18 and when we get in the q a, we can talk about what were doing about that. Were also clearly in the fourth wave. I think i branded this as a fourth wave last march and the fourth wave is clearly methamphetamines. Six monthsmine about ago overtook prescription opioids as a cause of death and heroin as a ertook cause of death within our country. Within a month or two it will overtake cocaine. Methamphetamine is the fourth wave. There are many things we are doing about it. The q a. Well get into this isnt over. And the numbers we have are in we are not dealing with methamphetamine as sangle drug and also the underlying causes of use disorders within our country overall. We will continue to put money out, very, very important. Our strategy is it to make sure that people use evidencebased approaches, but allow the states and localities to pick among the evidencebased approaches in order to fit their population. What works in jackson, mississippi is not necessarily going to work in los angeles or in the Cherokee Nation<\/a>, so we demand evidencebased approaches like medication assisted treatment, but give a great deal of flexibility. My priorities moving forward directly address the resurgence of methamphetamine. H. H. S. Ed a task force at last march and we have been working diligently on that. Support regions, and trying to get more realtime actionable data, and we have a partnership with millennium health. And so we understand where carfentanil is and the new analogue, where up sophetamine is popping we can work with the realtime and Public Health<\/a> services. And with the community study, 350 million by the nih focusing on four communities how to integrate all specific solutions and finally, some specific policy initiatives, like Syringe Service<\/a> programs, and working in emergency rooms, mat, in and out of the criminal Justice System<\/a> and expanding recovery holistic services, especially for women, children and families. And of course, were looking for longterm solutions and our longterm solutions is to get out of the grantbased solutions and to get the right incentives and the right delivery system. Third topic, Sickle Cell Disease<\/a>. 100,000 americans live with sickle sell disease. I took care of patients every single day in my Childrens Hospital<\/a> and many times in my i. C. U. I think if you dont know anyone with Sickle Cell Disease<\/a>, its a disease of great pain, shortened life span. Nly into the early fourth decade. And whats important about it, patients with sickle cell live at the center of a lot of issues. Their quality of care is poor. Less than 20 of children get the prescribed penicillin, their standard of care to prevent infections and probably less than 15 of all individuals get hydroxyrhea. And people are coming to the emergency room, for example, do not get pain medications they need. Discriminated against. Proven in the literature. Ut on a good side, there are some new medications but they are at very high cost. Theres a potential for a genetic cure, but there really isnt Adequate Funding<\/a> and attention. So the secretary and i started almost immediately a goal to increase the Life Expectancy<\/a> of patients with Sickle Cell Disease<\/a>, quality of life by at least 10 years, within 10 years. And this has been an entire hhs effort bringing in cms, all the major agencies, unprecedented awareness, education, programs to improve adherence to medications and lots of novel strategies for delivery that i would love to talk about more. We also had the president involved. We had the first two president ial messages on Sickle Cell Disease<\/a> since 1983, first in 2018 and 2019. We sponsored a National Academy<\/a> study which will be coming out in march to create the First National<\/a> Strategic Blueprint<\/a> for action for People Living<\/a> with Sickle Cell Disease<\/a> and again, we care about sickle cell because its an important disease, but also, because its emblematic of all the uncommon iseases that together make up about 10 of the Disease Burden<\/a> within the United States<\/a>. We have to fix this as a model, but also for itself. On the global side, its interesting that 300,000 babies a year in africa are born with Sickle Cell Disease<\/a> and 80 of them will die by their fifth birthday, completely unacceptable. But its very clear that if we do simple things like screening, penicillin, and simple preventative care, we can save up to 10 million newborns by age 2050, globally. So we have not been happy just working domestically. Weve over the past year developed the National Coalition<\/a> and at our first meeting, to of the Global Coalition<\/a> for disease, to develop subsaharanograms in africa to reduce morality from 80 to less than 5 and this was cosponsored by h. H. S. , the world bank, and health organization. Exciting with are this is going and the opportunity to save 10 million Children Worldwide<\/a> by 2050. In the final minute and a half i want to talk about United States<\/a> Public Health<\/a> service. Im here as the representation of the Commission Core<\/a> of the Health Service<\/a> which i have the absolute honor and privilege of my life to lead. In operational dress uniform because were all on coronavirus. 96 of us are ready to go. We will talk about our deployment. Its the only mobile, dutybound Health Officers<\/a> in the world. We go anywhere at anytime for the Public Health<\/a> needs, whatever they are. We started in 1798 with the Public Health<\/a> service, and we got into uniform 1889 shortly after the first Surgeon General<\/a> was 1871 and in 1912, the Health Service<\/a> got a fairly significant increase in our powers. What we looked like then in 1889, all men, all doctors. Were now 55 women and the most within thevice Uniformed Service<\/a>s, again, were a Uniformed Service<\/a> just not an armed service. We have 11 categories, not just medical, but dental, engineers, therapists, dieticians, Health Service<\/a> and environmental officers. Over 6,100 of us now with a plan expand to about 7,500 with a new reserve corps. What we do and this is in the last couple of minutes, were a deployable force. In fact, in the last six years weve had over 123,000 deployment days and ill give you an example where they are. We meet Critical Agency<\/a> needs. We talk about the c. D. C. , but there are 900 uniformed officers within the c. D. C. About 3,000 of us work in Underserved Health<\/a> care in the indian Health Service<\/a>, bureau of prisons and in homeland security. We also are fundamental mechanism to help change disparities. Alth were working in h. I. V. Were working in vaccine policy. Working in Substance Use<\/a> all across the country. And finally innovation engine. As an example in 2014, 2015, ebola, 800 officers went to west africa and provided direct care. The only Uniformed Service<\/a> to provide direct care in africa. 7 hurricanes 2017 hurricanes, 2,700 officers deployed. Southern border last year where i went four times. 700 officers. Working to provide care for women and children during the flu outbreaks in customs and border patrol. As you might imagine were on the front lines of covid19 as well. Just some iconic shots. As of today, we have 274 officers deployed and we will have over 300 today and were all over. Were providing leadership, operations, screening, quarantine, Case Management<\/a> and a variety of services in addition to the officers already working the problem at c. D. C. Other agencies. I love this shot. This was at Travis Air Force<\/a> base. We get involved in the science, but its all about caring for people. Of this officer, not only providing care but providing love and comfort, compassion, to a child who is under quarantine. I think thats what were all about in the service of health. Thank you for letting me provide the introductory comments, hopefully well tee of tee up some discussion for everyone and ill be happy to answer your questions. Ms. Dash thank you so much, admiral giroir. So why dont we were going to open it up for questions and try to get to everybodys questions so i would ask when you ask a question, please state your name and affiliation and keep your questions as brief as possible. Let me start off by just asking where you left off around coronavirus, can you give us your sense youve given us a sense how the Commission Corps<\/a> is deploying. Can you tell us a sense how your office fits in with the rest of the government efforts right now to contain and deal with the coronavirus epidemic . Thanks. Adm. Giroir i would say our office is in a strongly supportive role. Clearly the Leadership Structure<\/a> was been set up with secretary azar running the task force and the c. D. C. Provides the epidemiology in their role. Our role has been advice, recommendations, assessments, but also to understand where we need to provide support and the kind of support needed. And again, we have, as of today, well have 300 officers in the field and whats needed at Travis Air Force<\/a> base or Lackland Air Force<\/a> base, that evolves over time from a human support mission to more of a medical mission. And we have individuals, you know, leading the operations center. We have individuals overseas who are coordinating care and transport as you just saw with the transport of the individuals off the cruise ship. So my office is clearly in a supportive role, im a pediatric i. C. U. Doctor with a lot of Infectious Disease<\/a> experience and again, behind all the things you see on headlines are usually people in a blue uniform who are doing a lot of the work with direct patient care, in Case Management<\/a>. Its very important. You cant just take care of a person, you have to really manage them. What are their needs, how do they talk to their family . Their Services Together<\/a> . Hat happens with their job and education . As opposed to just being there with a stethoscope behind a face mask were trying to deal with the human side of the equation. So we have soccer workers, Behavioral Health<\/a> workers and teams. As this evolves, youll see more and more Behavioral Health<\/a> people remain quarantined or theyre afraid. I was just in puerto rico working with those who were displaced by the earthquakes. And theyre clearly there are physical needs and needs are incredible. Think of the hurricane going through your island and now you have an earthquake, its not gone because there are 12 or 13 earthquakes a day and that requires a Behavioral Health<\/a> component and thats why we have Behavioral Health<\/a> support teams. You. Ash thank any questions . Shannon. Reporter shannon, a reporter for medication today. Can you talk a little about Sickle Cell Disease<\/a> and what the initiatives are and can you say what the mission of the National Academy<\/a> task force is and when that report is expected . Sure. Iroir so the first issue with Sickle Cell Disease<\/a> is to really build a coalition and we have the first true federal Interagency Working Group<\/a> because like anything, its not a simple solution, its a complex solution that deals with social determinants of health and deals with delivery system, deals with attitudes, with stigma, it deals with emergency medicine. We work with close partners like the American Society<\/a> of hematology. So a lot of our initiatives have een, number one, education, webinars, specific programs to educate emergency physicians, everywhere i go we speak about it. There will be a new program that is providing incentives to state Medicaid Programs<\/a> to create new ideas about how to get people on the medications they need. Docksy y high hydroxyurea. And most children are well taken care of in Childrens Hospital<\/a>s when they transition, like so many children with complex diseases into the adult system, they kind of get lost, right . Because theyre in a coddled pediatric Childrens Hospital<\/a> environment so working on the transitions of care with Community Health<\/a> centers, fqacs to understand how they can be an important provider and working with project echo to teach people in their practices how to work with patients with Sickle Cell Disease<\/a> so just a lot of things across the board and youll see a lot more coming this year. Weve expanded Data Collection<\/a> and weve gone the c. D. C. Had two states of Data Collection<\/a> and weve expanded to nine. Now covering 32 of patients with Sickle Cell Disease<\/a>. We have letters out from cmf letters out from c. M. S. Talking about Pain Management<\/a> and how they need to be exempted from opioids. There has been a huge amount of activity which is going to culminate in delivery systems. The National Academy<\/a>s report is due in march. We started this probably a year and a half ago. Although we knew we would be spearheading things, we wanted the power of the National Academy<\/a> to make their own assessment and it will be an arguably nonpolitical. Theyre above the politics. We certainly gave them everything they needed. We funded them. Everyone participated, but we have no idea what the reports going to say so its a completely objective report that will give us Important Information<\/a> and again, its important about sickle cell, but i look at sickle cell as a model for all of these uncommon diseases that are going to be going to have expensive where people get poor quality of care and how do we fix that . Theres not enough patients for everybody in primary care for everybody to know what to do, but together make up a huge percentage of the population we need to treat so were trying to use sickle cell as a model, but dont get it wrong. I care about patients with Sickle Cell Disease<\/a>. They bear a tremendous burden for multiple decades and its share in hem to also the benefits of innovations and science that many of the rest of have. Reporter one quick followup. Are you recommending any payment model to Medicaid Programs<\/a> in terms of how this can start . So we had multiple everyone in c. M. S. And were exploring them. Because we are exploring how to deliver care best for patients who there are not enough specialists to see them all, but a lot of them go through the cracks and go to the emergency room. Were exploring that and model were exploring payment mechanisms and model systems. I have nothing else to tell you now, but we think theres way forward to working with hersa, Community Health<\/a> centers, particularly as they overlay in communities where there are many Patients Living<\/a> with Sickle Cell Disease<\/a>. Yes, we have active discussions going on to try to understand how do we solve this issue thats not been solved or even addressed by another administration and how do we make that example to build on for People Living<\/a> with uncommon diseases. Reporter thank you. Ok. Dash keep your hand up if you have a question. You have a question . Reporter sure. You mentioned Maternal Mortality<\/a>. And i noticed in the president s budget, theres a section to encourage states to expand medicaid for a year for women who give birth, but specifically for women who have addictions. Theres kind of a movement to expand medicaid for longer for women postbirth. Why did you pick that narrow population . Do you have data to show that a lot of maternal deaths and disabilities are tied to Substance Abuse<\/a> disorder . Adm. Giroir so let me answer two different ways. People with Substance Use<\/a> disorders require prolonged treatment, particularly those with opioid use disorder. The foundation of that care is medicated assisted treatment. We dont know how long anyone needs to be on medicated two ted treatment but months is too short, i think, clearly. Prolonged have a period of time particularly with moms with opioid use disorder so they can maintain treatment and and, of a relapse course, threaten their entire family structure. In terms of Maternal Health<\/a>, a very complex area. To change the nt conversation about, the conversation has been, number Maternal Mortality<\/a> and that is awful, right . Maternal mortality is awful but talking about 650 or 675 women a year. I want to talk about the 150,000 omen a year who have severe Maternal Health<\/a> problems around their pregnancy. I dont want to focus on deaths. But we focus on deaths need to look at the Overall Health<\/a> picture. Early. D to start this doesnt happen when the woman is in the hospital. We think a lot of the mortality morbidity is poor health overtime. E need to start, particularly with women and girls, and our office of population affairs, office of Womens Health<\/a>, together with the media Immediate Office<\/a> of the working to improve longterm Womens Health<\/a>. Thats the only way to crack the nut. If you look at Maternal Mortality<\/a>, its an important part, but a small percent out of 60 days postpartum. Ost of that is prepart up, peripartiu mrfshgs. Peripartium. One, we need to do opioid use disorder right. Umber two, we need to change the conversation about dealing with a mom when shes in the and tal and 10 centimeters fully dilated. You need to start upstream to make sure mom is going to be over a period of time or by the time they get in the delivery room, its not going to be well. I had my tell you, yesterday. Ddaughter my daughter, normal pregnancy. Care. Prenatal she hemorrhaged almost four eerts of blood in leerts of blood in liters of blood in 30 minutes. A center that was absolutely fantastic. An what they needed to do in emergency basis. But this can happen to anyone no matter who you are, whether you uniform, an assistant secretary or not. This is something we need to ake very seriously and were committed to making longterm sustainable changes that improve Womens Health<\/a> over a long period, not just when theyre in the delivery room. Giroir. Dr. Im lev with stat. Front, coronavirus senator tom cotton a couple of days ago suggested that the coronavirus might be kind of the manufactured product of a chinese lab, or that it was kind of, you know, some government funded push, initiative and my question is, what is the administrations messaging been in its briefings to lawmakers about the origins of the outbreak and the importance of the Public Health<\/a> they talkand how to their constituents about how to guard against the coronavirus or what they should know about it . Adm. Giroir yeah. We have no information whatsoever on this being a manufactured virus. The origin of the virus is still unknown. Theres a lot of work that has to be done. It probably has an animal like many of the coronaviruss do. The message has been pretty clear and pretty direct is that americans are not in imminent danger from this virus at this moment. There are only a small number of cases, theyve been identified, theyve been isolated and theres contact tracing, but this situation can change. Dynamic. And certainly if there is ultiple generational transmission in multiple countries, the u. S. Would be at risk of widespread coronavirus, think thats been very clear the messaging from secretary azar, from tony fauci, from bob redfield. What we have done with our policy is we bought time and important. Ally we have a very good diagnostic c. D. C. Vised by the there was some things that needed to be worked out and some of the controls in some of a good rols but its diagnostic test. We are in Clinical Trials<\/a> with medications. As you know hearing from tony fauci on an hourly basis there in the works based on our last 15 years. The time has bought us time to systems to spital increase preparedness, to improve our supply chains so very important the policies that have been implemented to, number one, either avoid a pandemic in the if it does come, because of sustained transmission i think that has been clear messaging. Stay tuned for secretary as our. He is leading the task force. He is a tremendously experienced leader. He has been through the with andemic you could not have better person leading this than my secretary. Inside Health Policy<\/a> you mentioned focusing on tackling stimulants in your issue of track tackling drug use. How is hhs addressing that . Thank you for asking that appeared i should have pointed that out. We provided significant Technical Assistance<\/a> to congress, and the president provided leadership. The state opioid response grants are now flexible. States can use them for methamphetamines and cocaine, as well as those who have opioid use disorder. That is very consistent with our Overall Program<\/a> to allow states to do what they need to do to engage the issues within their state, as long as they are evidencebased. That is number one. There is flexibility with a major funding source, which is a huge issue that needed to be fixed. Dr. At samsung, already started large Technical Assistance<\/a> networks last year to demonstrate and educate how to treat methamphetamine use disorder. We are at a disadvantage because there is no medication treatment. This is a hell whole different ballgame. Nih and academia are working together closely. Of course, we are working very closely with dea and ondcp, the drug czar. We have to understand that 30 years ago methamphetamine was a closet industry within the United States<\/a>. People produced small quantities of it. It was not very pure. It was not very cheap. Now it is made in the hundreds of thousands of pounds at multiple different installations in mexico by transnational cartels. It is 100 pure. It is very cheap, and one of the most highly addictive substances on the planet. This is a whole new situation we are facing. I cannot overemphasize the seriousness of it and the attention it has gotten throughout the administration. Again, starting long ago, but in great seriousness about a year ago last march when we started the task force and briefed and started working directly with the white house. I wanted to followup on the there was some confusion yesterday about exactly how many people are in quarantine here now with a justive viral test versus in quarantine. If you have information on that, that would be great. You brought up the idea of Behavioral Health<\/a> workers and social workers working with these folks. The latest group that has come in for quarantine are they different groups . Are you saying issues, are you having to bring in more workers . What is the issue with that . Have anir i dont update from the numbers yesterday. The numbers are as they were. I will differ on that. There has been no change in the numbers from what was publicly reported yesterday from the number of positives that were understood while they were on the buses and the other asymptomatic people that were put in quarantine based on symptoms on the plane. I do not have updates as of today. We would expect that pretty soon. In terms of people coming over, they have just come over. We are changing some of the makeup of our teams we are deploying to have more Behavioral Health<\/a> and medical side as opposed to the Case Management<\/a> side. We do not have any indication or preliminary assessments of what the needs are, but one cannot can anticipate just mean is a commonsense individual that people who went for a vacation and then went became sauce , i thinko quarantine experienceual might stress during those periods of time. We want to make sure that is dealt with as well as possible. Again, the Public Health<\/a> service has Behavioral Health<\/a> teams. This is one thing we provide that nobody else really does. Campfires,deploy to the camp fire in california imagine what it is having a life in the next day your community is destroyed. Behavioral Health Issues<\/a> are very important. Resiliency, adverse childhood experiences. Our people are trained in that. I do not have assessment of what people that percentage of people have war need services. With the paid that will change and we will changed employment strategies to make sure those services will be provided and we will be getting direct input over that over the next couple of days from travis as well as lackland. Jackie lee from bloomberg law. Do you have any update on the president s executive order regarding the flu vaccine that he announced a few months ago . I dont have an update at this moment, but there will be updates soon. As you all know because you cover this area, while we are extremely concerned about coronavirus, as we have been discussing, so far there has been 26 million cases of ,nfluenza in the United States<\/a> and 14,000 deaths. This is a pretty good year. And year outr in is the existential threat to our country. So, the president understood that. I was in the oval office when he signed that executive order. I have a signing pen, a nice memento. Extremely take flu seriously. We will see an overall plan in a relatively short time coming out to implement the executive order. The assistant secretary for response and his agency are on point and have done great work. This is been a great interest of mine for a long time. It is not just making the vaccine, but scaling up, engineering, chemical engineering, making sure that is domestic, because as we see in any crisis, the first thing another country does is cut off the international supply. We have to be selfsufficient in terms of that. Again, from a Research Point<\/a> of view, and you probably heard tony felt she speak about this, Anthony Faucher<\/a> speak about this, we are making progress. We will have broad protective coverage. That will be a game changer. Dont see one tomorrow. It will not be next year, but there is tremendous Research Progress<\/a> in Clinical Trials<\/a> ongoing a potential universal flu vaccine. There is a lot of activity in flu. I want to remind people, get your flu shot. It is your best protection along with good handwashing and hygiene because whether coronavirus is here or not, we know thousands of people will die of flu this year and we can prevent that. Do you have a more time exact timeline . Dr. Giroir i dont. For those interested, last year there was a detailed explanation of the flu vaccine [indiscernible] andrew if i heard you correctly, did you say you would like to get away from block grant approaches to funding substance disorders . Dr. Giroir i did not say that at all and if i said that it is not what i intended to say. State opioid response grants are essentially block grants. They provide money based on formulas to states to 12 state Health Offices<\/a> that go down to the community. Position, and it i think is the right one, we have to make sure it is based on an evidencebased way, that it can be proven to be safe, effective, and worthwhile for the individuals. Aside from that, we have purposely designed this to give great leeway to states to tailor their response to what they need within the states, because there is such a diversity. Some states are on their way down. Some states are on their way up. If you go west, it is mostly methamphetamine. In the woodland, it is a synthetic opioid. Throughout the country, there is polySubstance Use<\/a>. Toial determinants are going be very different in different places. We dont want to play wacko with the drugs. We want to get down to resiliency within the communities and the issues that may predispose people to Substance Use<\/a> disorder overall. All of these things are going to be different. Whether its the Mental Illness<\/a> and abuse Block Grant Program<\/a> there or the other grants, we troo to provide flexibility in the states that can tailor their programs to the needs of their individuals. The healing communities, very exciting, kentucky ohio, new yorks, massachusetts about 80 million per community with 15 counties per community to try to understand how all these things fit together in a resilient way so that the state, the local programs, how to bring in law enforcement, drug courts, communitybased programs, faithbased providers and sort of model systems, how to wrap these up with a bow to make sure theyre being delivered in the most effective way possible, possible. A very, very exciting study. Just got started. And again, kentucky, ohio, massachusetts and massachusetts, and new york, theyre anchored by academic centers. This is sponsored by the nih in conjunction with dr. Mccants in an exciting model moving forward and even though its geared towards opioids, its for the substance misuse program. Hi, im from the national journal. I wanted to ask you about an Interagency Agreement<\/a> you described to lawmakers last month regarding allowing researchers to continue studying fentanyl compounds which congress eventually extended. I was wondering if this could apply for other substances or only the fentanyl schedule one. And i havent seen this agreement made public in any official way other than your testimony. I didnt know in there were plans to publish it or propose it in any way. Thank you for that question. So, the background of the agreement which was really doing two things simultaneously. Number one is, it was absolutely essential to extend, and i do want to put my support for the permanent scheduling of fentanyl analogs, of which there could be several thousand and we cannot be in a position where drug maf manufacturers who are sophisticated could circumvent the law by making a different compound which could not only be as bad, but worse than fentanyl and congress temporarily and could avoid detection. Congress temporarily scheduled them for 15 months. We hope they will be permanent. Doing with that we were trying the Interagency Agreement<\/a> part. Doa, gcpoa you know all the acronyms, sat down and understand we want to ban the substances, but we need to facilitate research. And within the substances could be next naloxone, it could be a nonaddictive pain medication. If you dont have the ability to do research easily and facile fastly things that would find those. Never there were a number of provisions that were sent to congress that would allow the rapid descheduling of drugs should they look to be useful and not harmful and to reduce the scheduling for research purposes. And a number of administrative procedures that would improve the ability for research on schedule one drugs no matter what they are. So, for example, if youre already approved to do one schedule one drug, you dont necessarily have to have a complete inspection in the process over again to do another drug. Or if youre working in one laboratory, you dont have to have to have a complete have a complete inspection to move to another laboratory in your own group. A lot of Administrative Changes<\/a> that would make this beneficial. I do want to say that, you know, these are two very important issues and the interagency came to really an agreement about how to balance all things, the need to schedule these, but the need to preserve the ability to do research. The first part is done temporarily. It needs to be permanent. The second part has not been done at all and we want to look to lawmakers to change the statute and to support the provisions that we all as interagency provided to them that would guarantee the ability to do these and other compounds. Thank you for asking that. The latest about health the latest the latest People Without Health Insurance<\/a> has been increasing for a few years. Is that a challenge to address some of these, Maternal Health<\/a>, Substance Abuse<\/a> disorder, and people at risk for the issues or already experiencing the issues that dont have Health Insurance<\/a> . Dr. Giroir so general question, of course, its very important and its part of our Healthy People<\/a> indicators, the percentage of people who have Health Coverage<\/a>. It cant just be Health Coverage<\/a>, it has to be real Health Coverage<\/a> that they can use. If their Health Coverage<\/a> and 7,000 deductibles, that doesnt help you in order to get care. Yes, of course. We want people to be discovered, we want but they want to be covered with programs that can actually be useful to them. And again, im not as much on the Health Insurance<\/a> side, you know, theres groups that certainly work with that at hhs, but Health Coverage<\/a> is important, but it has to be effective Health Coverage<\/a>. Until that is done on a legislative side, were going to be doing lots of this i think so to support it in other ways. State opioid response grants. Some of those are being used to fill the gaps for people who do not have coverage. Ive showed you for the program, we estimate probably 150,000 people in the country who have an indication for prep, but have no coverage whatsoever and therefore, our agreement is for 200,000 individuals. So you know, this is a very complex issue about how to provide care for the most number of people thats effective and affordable and accessible to all. Thats the goal of the administration, as again, i think its a goal of everyone in general. Its Healthy People<\/a> objective. Until we do that, were going to try to plug the holes as best as we can within our Health Programs<\/a> by supporting Community Health<\/a> centers, Ryan White Program<\/a>s, all the kinds of things that we do. To follow up on the hiv issue. Dr. Giroir yes. The statistics you showed on your slides, it looked like the low hanging fruits might have been the missed opportunity in the last months. Dr. Giroir yes. Are there actually on the ground initiatives to tackle things like that . Dr. Giroir yes, there are. Much of the money that you see so, first of all, in fiscal year 19, even though there was no dollars through the Minority Aids Initiative<\/a> fund, thats from my office, we put 33 to work. 33 million so every one of the jurisdictions, that would be the 48, san juan, washington d. C. In the seven states that have a high rural burden, that was also very important, all submitted elimination plans. Theyre working right now with c. D. C. With our office of Infectious Disease<\/a> policy to make sure those are correct. We did four jump start sites to implement those. East baton rouge baltimore city, called dekalb, georgia and the Cherokee Nation<\/a> located in oklahoma to get that started. Money will be sent to local Health Departments<\/a> within those jurisdictions so they can hire the work force they need in order to reach the people who have been unreached. We can work with the Physician Community<\/a> and the Provider Community<\/a> which we are doing, but were going to have to have innovative solutions. These are the people that are hard to reach. This means people working with the community and this is a yes, we started. Fiscal years 20 just got started. Some of the money will be out soon. I think the cdc money comes out in june. That will get to the local departments to fund their health plans. Working with Community Based<\/a> organizations is very, very important. We had the Advisory Committee<\/a> Council Meeting<\/a> and we had one in jackson, mississippi and we , saw the Excellent Community<\/a> work. We also were in miami seeing places like latina salude, which is a Community Organization<\/a> and Community Gathering<\/a> place that makes it comfortable to get health care, to get tested, to get your drugs that you need. So, again, yes, yes, yes. But the key, as you pointed out, is we have to reach the people who dont get tested, both through formal means, but we have to meet people where they are and thats going to be through a lot of informal means, by mobile testing, by testing within the community, at every opportunity. If you are positive we want you into care immediately. Certainly the statistics say within 30 days, but we would like it within a day or two. And then secondly, if youre at risk and you test negative, to be counseled on Risk Mitigation<\/a> and also started on prep. Theoretically we could end the outbreak tomorrow. We have the effective drugs, we have the effective diagnostics, we have the effective prevention measures. This whole plan is to bridge the theoretical to the practical. Its hard to get all of those tools and technologies weve had for the past four decades to work. It would be great to have a vaccine and another medical miracle, but barring that, we can do this now. Just a matter of implementation, resolve and putting everybody working on the same page and im very excited to be able to lead that initiative along with some of my great colleagues like bob redfield, tony, spent their lives doing this. This has not been my lifes work, but its an opportunity to has to be taken now. On health preparedness, i wanted to see as far as that goes and as far as the supply chain goes, what are you seeing right now as the key challenges in that area, those areas and in that area those areas and then what are the focus or priority at this point . Dr. Giroir so i want to defer to assistant secretary cadillac on this since he runs the hospital preparedness program. Weve had 15 years of formal pandemic planning and as was messaged last week, its time to put those plans into effect. While it is not influenza pandemic, people have a lot of the same indications. The plans we have been preparing for for the past 15 years are really meant to be put into place. There are interagency calls, calls with the health care system, working directly through all their regions to work on this. I will defer to any specifics on what the challenges are. I think you can probably know we have had briefings on, and i have seen it yesterday, what is our supply chain like everything is moving through the pipeline well. I will defer about the specifics of pipeline challenges to the secretary. Time for one or two more questions. Health questions you talked about addressing Better Health<\/a> outcomes for women with substanceabuse disorders. Theres interested in extending medicaid for all that. Capitol hill is considering a bill to do that. Is that the conversation hsm and having not just for women with Substance Abuse<\/a> disorders but for all women who just had a baby who are on medicaid . Dr. Giroir there is 90,000 people in our department. I dont run cms. You are cms. Not involved directly in those conversations. Our aspect regarding health is to provide the science and evidence behind what needs to be done. And again i want to go back to what i said earlier is that it we doubt have women who have good hypertension control, good physical activity, the kinds of issues that lead up to a normal pregnancy were going up more and more problems. We have been trying to supply the science for that. The late mortality and late Maternal Health<\/a> again its a small percentage but it is , primarily something called cardiomyopathy, which is an abnormal generation of muscle in the heart that seems to be linked to hypertension but a lot of genetic factors. There is probably a lot we can do about that. There are conversation about everything within the department. Im not personally involved with the medicaid extension conversation aside from ou oud which is my area of , responsibility as Senior Advisor<\/a>. Thats a great move to do that because again two months is too short, three months is too short. We need to cover a a prolonged period of time because they need to be for longer period of time. We had a couple more. I have another about the coronavirus. Dr. Giroir yes. The centers for Disease Control<\/a> prevention has started testing people show up with flulike symptoms testing for the coronavirus. Is that because the mighty concerns that the virus may be spreading in ways that airport screening has been able to detect . Well, we have to have a multilayered approach, right . You know what you know. You dont know what you dont know. The screen a program that is there is was looking for defense. This is a big world with billions of people. There could be multigenerational transmission in a in a couple of countries right now so it is highly prudent to have a layered approach that not only screens the people we know are high risk but also screens individuals who are flu negative in those cities to make sure that if it is circulating we need to know that as soon as possible. So i think that is an absolutely prudent necessary approach so that we could make sure the American People<\/a> and leadership know if there is circulating coronavirus here how would you know . Im sorry is that how they do it . Once to test negative for the flu but still some of these there some symptoms then they would speeders as i understand thats the protocol because obviously if your fever and a respiratory symptom right now, and the United States<\/a>, you have the flu. But if you are flu negative edge of the symptoms, it could be other viruses. Its very prudent to test for coronavirus in a screening way so that if this does begin to circulate we have canaries in the coal mine so that we understand that is circulating and their triggers a whole different set of different issues for medication. That we want to be in as early as possible. We dont want this to be circulating for for a long time and nobody knows about it. The opioid use, there have been a couple efforts in state legislatures recently, indiana i think failed to extend the Sunset Program<\/a> on Syringe Exchange<\/a> there and West Virginia<\/a> theres a pending bill that would outlaw Syringe Exchange<\/a> programs. Just wondering if you could share your view currently as to what role Syringe Exchange<\/a> should play in Harm Reduction<\/a> in combating the or the crisis . Dr. Giroir yes, we have been very vocal that comprehensive Syringe Service<\/a>s programs, also called Needle Exchange<\/a> programs, are an evidencebased intervention that works and we support them. We support the implementation. They do a couple of things. Number one is they clearly decrease hepatitis c virus transmission and hiv transmission. But more and poorly this is an unwrap into gear. The statistics pretty clear. We publish them. Surgeon general publishes them. I talk about them just about every talk, the people in her services program, a conference of program, this is not just drop your need ofcom you get counseling, on ramps, have about 300 increase chance of entering longterm recovery of people who dont. We are strong supportive of Syringe Service<\/a>s programs. I cannot comment on a specific state or local Community Whether<\/a> issues are, and i wont. But as an evidencebased program, they are fully supported and all of my Regional Health<\/a> administered or which with all the states within the region to try to make sure they know the evidence is strong supportive of these programs. And again one of the threats to eliminating hiv is to have clusters that are outbreaks around iv drug use. Its not just opioids. Its methamphetamines. When you have 50, 100, 200 cases surrounding that, we cannot deal with that. We have to stop that. Syringe exchange is good way to do. We have been very clear. Weve been supportive of that. This is not based on any ideology or anything else. Its just what the evidence shows. And i will say we do not believe that the evidence supports quote safe injection or supervised injection facilities. We dont think the evidence is there. We want to support things that are evidencebased like Syringe Service<\/a>s programs, not based on ideology but based on evidence, what the science shows us. Ok. Assistant secretary, you have covered a a really wideranging group of topics here on Public Health<\/a>, so i want to ask you if theres anything you havent had a chance to share yet with the group as sort of a final question, give you the last word. Dr. Giroir so i do want to point out because there was huge a lot of press about the mortality rates in 2017, that in 2018 the longevity for americans actually went up. The mortality rate went down. The preliminary numbers and thats the first time in four years. In 2019 the first first two quarters of mortality rates have dropped dramatically. And while no one thing, we are not at the top of the oecd nations, we are going the right direction. And in all of you know it out of what to make sure the people who are watching out in tv land know that medical care is important. Access to healthcare and called healthcare is critically important, but thats about 20 of your health outcomes. The other 80 by the social determinants of health and your health behaviors. We really need to focus, i thought wed get more questions on that, and we are focusing. The economy helps. There was a study that said, just recently that if an auto plant closes in your Community Threats<\/a> of opioid mortality go up by 90 within that community. So, these social determinants are very, very important, and i think our mortality rate going down is a result of programs that we have, but also about the overall milieu of addressing social determinants like the economy, like employment, like cms now focusing on standardized set of understand what social determinants will impact your health as well as our unprecedented work on behavior, whether that smoking cessation, whether this exercise with the activity guidelines, the National Sports<\/a> strategy. Things are starting to turn. Im never going to spike the football because theres an infinite amount of work yet to do. I have tried to point out some of the issues like methamphetamine threatening our drug Overdose Deaths<\/a>, but were going in the right direction and im very excited to be able to be here and is sort of the on point in this very exciting time. Thank you so much, administrator giroir. Ill turn over to bill now. Bill again, thank you very much for coming by. I want to thank everybody for once again coming by to breakfast. Thank our cspan viewers and cspan. We hope will have another good event soon by another policymaker like administrator giroir, and until then we will see you again. Thank you. Thank you. [captions Copyright National<\/a> cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] , chronic president ial candidate Mike Bloomberg<\/a> his sixth visit to virginia over the weekend, speaking to supporters at a campaign organizing event in richmond. He was interrupted by protesters at times during the event. [applause] bloomberg thank you for coming. 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