Oversees the office of Surgeon General and u. S. Public Service Health commission core. And theres a historic new plan to end the hiv epidemic, the National Vaccines plan and across Agency Effort to improve the outcome of patients with Sickle Cell Disease. The doctor brings patient han handson to his work and leading americans to healthier lives. I want to thank again bill pierce and worldwide for partnering on this breakfast perspective on Health Policy and with that im pleased to introduce now, admiral giroir. Well, thank you very much and im going to stand up if thats okay with everyone. Good morning and its 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. Its abouten quite an amazing two years with a lot of accomplishments and understanding of what we need to do. If i can get my slides up, please. Well, when we get our slides up, thats okay. So i am the 16th assistant secretary for health, and 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 that everyones budgets, everyones leadership, cmf. Fda, c. D. C. All came through the ash. Around that time, it was changed that the ash, assistant secretary for health and the office, really became a policy office. The principal policy advisor and science person within the office of the secretary. So and how thats defined really depends on the individual who is in the office and how the secretary views the role. So im going to tell you how we view the role with the new strategic plan. We believe our goal is really to lead america to healthier lives and to provide a road map for a healthier nation. There are really four components of that. One thats very, very important is health transformation. We believe the key to improving americas health, driving down the costs is transforming the current sick care system into promoting a Health Care System and well define that through our policies and frameworks. Health response, to respond to emerging health challengesment whether were talking about hiv or the opioids, we need to lead the Health Responses so the nation is not looking into retrospect. Health innovation, if we keep doing things the way weve always done were not going to get a different result. Innovating, testing, having hypothesis proven true or false or all part of what we do in order to leverage those new programs into major operational divisions. And finally, we have traditionally been, and its a very Important Role for us, is to assure that health is not for some, but is for all. And a major part of our property is to advance Health Opportunities for everyone. Now, how do we do that . If youre in cmf, you have a 1 trillion budget. 1. 2 trillion dollar budget. If 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 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. To bring people not only from within the government, but state and local partners, private partners, commercial partners, nonprofit organizations, faithbased organizations and altogether 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 developed novel initiatives and we do that with some of the small amounts of grant money that we have. We trust 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 or 10 million for the next 10 years. I want it to be 100 million or a billion Dollar Program within cmf to make 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 and our office 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 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 StatesHealth 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 time interacting and 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 40,000 new cases of lihiv in th 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 hhs and talked to people like tony fouchy 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. 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 africanamericans, american natives and second all the retro therapy. When i started in pediatrics, there was no therapy for hiv. Then there were therapies, 30 pills a day, with water, without water, with food. There were toxicities. 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 all the 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 have this is both an 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 7 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, undedetectible by means and respond to every new hiv infection as though its a sentinel event so we dont have clusters around iv 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 1600 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 pharmacists, cvs, 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 292 Million Dollars for new funds for hiv for the initiative that we asked for and in the president s 2021 budget that just came out. That budget had the request that we needed with 716 Million Dollars in new funds, distributed in 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 were talking about hiv, 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. And the same people are working on them and theyre integrative and synergistic. Lets start with overdoses, start with good news. In 2018 overdose morality was reduced 4. 1 . The first reduction in Overdose Deaths if about 28 years, through the combined efforts of everyone. Again, in the federal government, state, local, private, Community Organizations 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. It overtook prescription opioids as a cause of death and overtook heroin and in a month or two will take over cocaine. Methamphetamine is the fourth wave. Im sure well get into this in the q a, this isnt over and the numbers we have are in jeopardy if we dont deal with methamphetamine as a single drug and also the underlying causes of use disorder in 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 meth amphetamines. I started a Task Force Last march and weve been working on that. Support regions, and trying to get more realtime actionable data, and we have a partnership with millennial health. And so we understand where carfentanil is and methamphetamine and realtime with 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 expanding through inservice 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 grant 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 icu. I think if you dont know anyone with Sickle Cell Disease, its a disease of great pain, shortened life span, only 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 individual get hydroxyrhea. And people are coming to the emergency room, for example, do not get pain medications they need. And theyre highly d discriminated against. Proven in the literature. On the good side, there are new medications at 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 NationalStrategic 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 emblemmatic of the disease burden, 10 in the United States. 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 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. We have not been happy working just domestically. Weve over the past year developed the National Coalition and at our first meeting, to develop National Programs in sub Saharan Africa to reduce morality from 80 to less than 5 and this was cosponsored b