Good morning. Good morning everybody. Thank you so much for joining us and good morning to our viewers on cspan im sarah and president of the alliance for Health Policy, and really pleased to be here today with phil pearce and worldwide, and to introduce the admiral brett who is the assistant secretary for Health Opinion hes our 16th assistant secretary for health in the the United States department of health an Human Services and as i understand it its now two Year Anniversary in the role he serves as a secretarys Principal Public Health and science advisor, and hes responsible for coordinating efforts across the administration to fight americas Opioid Crisis. He also oversees the the office of the Surgeon General and u. S. Public Health ServiceCommission Core. His office leads many Critical National initiatives including a historic new plan to end the hiv epidemic in america the physical afnght tbliens for americans, National Vaccine plan, with and across Agency Effort to improve the outcome of patients with Sickle Cell Disease as a pediatric Critical Care physician doctors who are bringing handle on Patient Perspective to his work with as assistant secretary and primary goal is leading america to healthier lives. So i want to thank again bill pearce i want to thank worldwide for partnering on this breakfast perspective on Health Policy and with that im pleased to introduce now admiral. Well thank you very much and im going to stand up if thats okay with everyone. Good morning, and it is great to be here joining you. Again, it has been two years now as they say in d. C. , the dayses are long but the years are short. And i can certainly agree with that. It has been quite a amazing two years with a lot of accomplishments and a lot of understanding of what we need to do. Get me slides up lees. Please and when we get our slides up thats okay. So im the 16th assistant secretary for health and that role has changed quite a bit over the years. It if you were with here in 1995, assistant secretary for health really ran the Public Health service. Meaning that everyones budgets everyones leadership fda cdc all came through the ash. Around that time, it was changed that the ash, assistant secretary for health in office really became a policy office. The principal policy advisor and science person within the office of the secretary. So and, how that is defined really depends on the individual who was in the office and how secretary views role. So im going to tell you a little bit about how we view the role with a new strategic plan. We believe our goal is to lead america to healthier lives and to provide a road map for a healthier nation. There are four component of that one that is very, very important is help trnches. We believe that key to improving America Health driving down the cost is transforming the current care system into a Health Promoting system and youll see how we with define that through program, policyies and frameworks. Secondly Health Response to respond to emerging health challenge. Whether were talking about hiv or opioids or methamphetamine issues, we need to lead those emerging Health Responses so nation is positioned and not looking in retrospect Health Innovation if we keep doing things weve always done were not going to get a different result so innovating, testing having hypothesis proven true or false are all part of what we do in order to leverage those new programs into major operational division. And finally, we have traditionally been and it is a very Important Role for us is to assure that health is not for some but health is for all. And major port of our portfolio is to advance health understand for everyone. Now how do we do that . If youre in cms you have a one trillion budget 1. 2 trillion budgets and if youre in cdc you know what they do, if youred a nih you have 40 billion in Research Money but how we really operate is really by the power of the idea. And to bring people together to convene them and to make change whats and to 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 most evidencebased science based information possible. Secondly, we convene partners this has a really exciting part of my position and very different than other parts of hhs so 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 part they aresthon profit organizations, faith basing organizations, altogether because nothing that were trying to accomplish is simple. It is not just all federal government approach but really all, all society approach. We develop novel initiatives. We do that with some of the shall amounts of grant money that we have. We test ideas and if those ideas work, and it is now required in my office that we have a transition partner. Because if something works for a group of individual, i dont it to be funded for five or ten Million Dollars for next ten years. I want to be 100 Million Dollar or a billion Dollar Program within cms that mange sure that that works and go innovate and finally organize and lead National Initiative to give an idea of some of the things that were doing that puts us together. Our office is leading a couple of president ial initiatives ending hiv epidemic in america and i will talk a little bit more about that. Our National Youth sport strategy. Were leading many initiatives that are president ial or National Level but were leading them not for the whole government but or for hhs, for example, combating opioids and sud. Our office in particularly myself as Senior AdvisorHealthy People 2030 it is the road map, report card for health in the activity and dietary guidance the vaccine plan, and National Hiv Aids plan, the viral hep had tights plan, a new National Action strategy for sexually transmitted infections. Et cetera, et cetera, et cetera, so a lot of really the strategy that will govern how the federal government and a the empire country goes are really being written through our office with all of the input from all of the people you seen. New initiative improving maternal l health, in a National Strike that is ji for tick born diseases you mean see much more of that coming up in the next few months and, of course, Surgeon General really functioning again as nations doctor being very vocal on a number of issues advisors like like marijuana advisor discussing danger of marijuana for use and for pregnant women and number of reports coming out this year. So what a i wanted to do in the remaining 14 or 15 minutes is just highlight give you very high levelover views of four differentics that come from here and ending hiv initiative. Number two, where we are with combating ohm yoidz and overdose crisis, number three, Sickle Cell Disease which is a personal passion of mine as a pediatric Critical Care physician and finally to talk about really my true love the Commission Core of the United StatesPublic Health service which im honored to lead with the assistance of the Surgeon General the deputy Surgeon General and all of the assistance Surgeon Generals. And then well have a good time having interactive questions. So it shall one of the benefits and, in fact, only benefit i think of a very long time for confirms is i had about nine months to really think about issue and to really understand issue ors that were not part of my normal practice. And one that astounded e me was the data, the fact that we have 40,000 new cases of hiv every year in the United States. I could not believe that. Because we have the tools, the technology, this disease has been with us for such a long period of time and i ask the question, why do we still have 40,000 new cases of hiv in our country every year . And when i got to hhs and talked to people like tony and bob around the table, and admirable mike, i found that the answer a was 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 it shall over 50 of new cases occur in only 48 jurisdiction within our country not 3,000 but 48 plus washington, d. C. And san juan puerto rico. So we e can have a targeted effort that could really work on where the major focus is and it is also a demly slightly effective africanamerican indian and alaskan natives, of course, you know we know how to target and to work with those community. Secondly antirett viral therapy. When i started as a pediatric intensive care physician there was no therapy for hiv. It was then there were therapies you took 20, 30 pills day every four hours every eight hours with food, water not with food. They have a lot of toxicity and they were not effective. Now we have multiple single pill a day regimes that are all highly effective with very low side effects. We have preexposure, so aside from a number of prevention strategies, about we have a pill a day that can over 99 of sexually transmitted hiv infections and finally we have proven model of care. Like the Ryan White Program that achieves in the most difficult challenging population that have all of the social term limit of health going against them a viral suppression is rate of now 87 . Really quite remark public given the population. So this is really the time. This is a shocking chart i try to put this up for physician and health care 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 a potentially spreading the virus before it is diagnosed. One in four people at least 7 years before theyre diagnosed. One in five people are diagnosed with aids with advance disease just like i would having diagnosed them, you know, 20 years ago, 25 yearsing ago and a seven in ten people saw a Health Care Provider in the 12 months prior to diagnosis but fail to be diagnosed so clearly you understand our opportunity but also our challenges to get people diagnosed early and put into care. So the plan is, and its not a fantasy it is a true plan based on epidemiology and on what we understand based on sophisticated models and we believe that we can achieve a 75 reduction in new hiv infections within five years and 90 reduction in ten years. We do this by employ all of the tools that we know now dont it need a medical miracle to diagnosis people as early as possible to prevent by using preventive measures including prep to treat all of those because we know that treatment is highly effective maintaining normal and we know that treatment is prevention undetectable is untransmentable to respond to every new hiv infection as it is a event so that we can have clusters particularly around iv drug use. Im proud that we can negotiate the donation of prep from gilead for up to 200,000 unensured people per year for 11 years. This could be upwards of a 20 billion donation. Very important because if youre ensured or have Government Programs prep can be available to you. But at a cost of 1600 to 2,000 a month if youre unensured that would be have very about, very difficult so absolutely free. And we have also secured Partnership Agreements with major, major pharmacy outlet it is cvs walgreens and health mart to district at no cost were very excited about this. This was started in december, and its going right now. And finally you know the president s budget in 2020, this was 291 Million Dollars in new funds for hiv for the ending initiative exactly what we asked for. And a in the president s 2021 budget which just came out again again that budget request that we needed was 716 Million Dollars in new funds districted in that way happy to answer any questions but were getting resourceses that we need. We Hope Congress supports the president s budget to give us tools that we need to end the epidemic. I also want to make it clear that although were talking about about hiv here, they are epidemics that come together with Substance Use disorder hepatitis c virus, and sexually transmitted infections that my office is quite conveniently writing all of the plans. You will see them separate plans but same people are working on them so theyre liely inti integrated and cant fix the other we have to approach this in a holistic way. Lets tack about overdoses. Let me start with the good news. In 2018, overdose mortality was reduced by 4. 1 . The first reduction in Overdose Deaths in about 28 yearses. This is through the combined efforts of everyone again in the federal government, state, local, private, Community Organizations, working together. The actual age adjusted mortality down 4. 6 . Theres no Silver Bullet all programs have to keep working together. What i would like to make point out here although top line numbers look good depending where you are on state it might not be so great for you and latest mortality map that is six months behind because it take about about 6 month toes get all a of the death certificates collected and if youre in a state thats blue your mortality is going down and we have michigan, illinois, pennsylvania, down 10. 4 . But across the country it is not always a same. California is mortality is up over 13 and new mexico 20 , delaware 18 , and when we get in the q and a we can talk about what were doing that and clearly in fourth wave, i think our brand of this fourth wave last march but fourth wave is clearly methamphetamines. Methamphetamines about about six months ago overtook prescription opioids as cause of death and just this month it overtook heroin as a cause of death within our country. Within a month or two well overtake it will overtake cocaine. Methamphetamine is the fourth wave theres many things were doing about it im sure well get into the q and a question but i want this to be in everyones mind that this isnt over, and numbers we have are in jeopardy if we dont deal with methamphetamine. As a singling 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 to make sure people use Evidence Based approaches but allow state and localities to really pick among those Evidence Based 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 evidence like medication to treatment but give a great deal of flexibility. My priorities moving forward directly attack methamphetamine and weve been working on that support regions with rising mortality, try to get real time action public data like we have an agreement with Partnership Agreement with Millennium Health that were getting all of the drug testing results, from across the country at 3,000 centers to understand where car is is and new analog where methamphetamine is popping up. So we can work in real time with the Public Health services so improve and expand Healing Community study 350 Million Dollars by the nih focusing on four communities how to have solutions and specific policy Initiative Like expanding services program, working in emergency rooms, mat in and out of 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 graduate based solutions to get the right work force about, the right incentive and right Delivery System. Third topic Sickle Cell Disease 100,000 americans live with