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 Service Commission 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 Advisor Healthy 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 States Public 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 Sickle Cell Disease i took care of Patients Living with sickle cell every day and my Childrens Hospital in many times, in my icu. I think if you dont know anyone with Sickle Cell Disease it is of great pain. Of short lifespan only into the early fourth decade, and what is important about about it is patients with sickle cell live at the center of a lot of issues. Number one their quality of care is very poor. Less than 20 of children get the prescribeed pencillen less than 15 a of patients get hydroxy and theres inadequate Pain Management and it is people coming to emergency room for example do not get pain medications they need. Theyre thy highly disdiscriminated against but be on good side there are new medications but theyre very high cost. There is a potential for genetic cure, but there is inadequate 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 ten years within ten years this has been an entire hhs effort bringing in cms all of 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 responsed National Academy study coming out in march to create the First National Strategic Blueprint for action a for people l living with Sickle Cell Disease and again, we care about sickle cell because it is important disease but also because it is emblematic of all of the uncommon diseases that together make up about 10 of the Disease Burden within the United States. We have to fix this as a model but also for itself. On the global side, it is interesting that 300,000 babies a year in africa are born with Sickle Cell Disease, and 80 of them will die by their 5th birthday completely unacceptable. But it is very clear that if we do simple things like screening, penicillin and Preventive Care we can save up to ten million newborns by age 2050 so weve been not happy just working domestically we have other past year god a National Coalition and had our first meeting of the Global Coalition for Sickle Cell Disease to develop National Programs and sub Sahara Africa to reduce from 85 to he is than 5 act sponsored by World Health Organization very excited where this is going. The opportunity to save 10 million Children Worldwide by 2050. And final minute and a half i want to talk about United States Public Health service. Im here as the representative of the Commission Core of the Public Health service which i have the absolute honor and privilege of my life to lead im in an operational dress uniform because were on alert for corona virus 96 of us are ready to go and ill talk about our deployment. The Commission Core is the only uniformed, mobile, beauty bound group of Health Officers in the world. We go anywhere at any time for the Public Health needs. Whatever they are we started in 1798 with Public Health service we got into uniform in 1889 shortly after the first Surgeon General of the United States was established in 1871 and in 1912 Public Health service got a fairly substantiate increase this our in our powers. What we look like then in 1889 all men all doctors were now 55 women and most Diverse Service within the uniform services. Again we are uniform service just not an arm service. We have 11 categories not just medical but dents engineer, therapist, nursing pharmacist dietitian veterinarian Health Service and environmental officers over 6100 of us now with a new plan to expand to about 7500 with a new reserve core. What we do and this is last couple of minutes we are a deployable force in last six years weve had over 123,000 deployment days and a ill give you an xasm of where they are. We meet Critical Agency needs we talk about the cdc but their 900 uniform officers within the cdc about 3,000 of us work in Underserved Health care in indian Health Service bureau of prisons. In Homeland Security we also are fundamental to help disparity wore were working in hiv and wore in vaccination policy were ring working in sub substantiate use all across the country and finally in innovation engine. As an example in 2014, 2015, ebola officers provided direct care the only uniform service to provide direct care in africa and 27 hurricanes, 1800 officer as deployed. On the u. S. Southern border last year where i went four times over 500 officer as almost 7,000 employment days working to provide care particularly for children and women during the flu outbreaks and cuss testimony and border patrol. And finally as you might imagine were on front line of is 19 as well just iconic shots as of today we have 274 officers deployed. We will have over 300 today and were all over were providing leadership, operations, screen, quarantine, Case Management and a variety of Human Services. And that 300 is in addition to all of the officers who are already working the problem at cdc or at a any the of the other agencies. I love this shot this is at Travis Air Force base, we e get involved in the science but it is all about caring for people and very proud of this officer not only providing care but providing love and comfort,ings compassion it shall to a child who is under quarantine i think thats what were all about in service of health. So thank you for letting me provide those introductory comment, hopefully it will tee up some discussion for everyone and ill be happy to answer your question. Thank you so much so open it up for question and try to get to everybodys question so just ask when you ask a question please state your name and affiliation and keep your questions brief as possible. Let me start off by just asking where you left off around corona virus, can you give us your sense, youve given us how it is deploying can you give us a sense of how your office fits in with the rest of the government efforts right now to contain and deal with the corona virus epidemic, thanks. I would say our office is in a strongly supportive supportive role clearly the Leadership Structure about has been set up with secretary azar running task force and cdc has expertise in normal role. Our role has been advice, recommendations, assessments but also to understand where we need to provide support in the kind of support that is needed. Again, we have as of today well have 300 officers in the field. Whats needed at Travis Air Force base or the air force base that evolved over time from a human support mission to more of a medical mission. We have individuals, you know, leading the Operation 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 a supportive role and i have a doctor with a lot of Infectious Disease experience and again, behind all of the things you see on headlines are usually people in a blue uniform qhor doing a lot of work with direct patient care in Case Management it is very important you cant just take care of a person you have to really manage them. What are they needs how do they talk to their family . How do they get their services together. What happens with their job, their education, so opposed to justing being there with a stethoscope which is important, behind a face mask also trying to deal with and care for human side of the equation. So we have social workers Behavioral Health therapist Behavioral Health team as this evolve youll see more and more Behavioral Health components as people remain quarantined or afraid i was just is in puerto rico, working with those who were displaced by the earthquakes. And theyre clearly but medical needs but there are 12 earthquakes day that requires Health Component thats why we have support teams. Thank you. Any questions, yes . And yeah hi im shannon first and reporter today, can you talk a little bit about Sickle Cell Disease and what initiatives are there about, and can you say what the mission of nathan, the National Academy is task force and when that report is expected sure. So the first about issue of Sickle Cell Disease is to build a coalition and we have the first true federal Interagency Working Group because liking thinking it is not a simple solution. It is a complex solution that deals with social determines of health and Delivery System it dealses with attitude it deals with stigma and emergency medicine we work with close partner like American Society of humantology. So a lot of our initiatives have been number one, education webinars, specific rams to educate emergencying technicians. Everywhere i go we speak about it and new program to state Medicaid Programs to create new ideas about how to get people on the medications they need particularly hydroxy. Were working with herrsa to build Delivery System that are improved. A lot of children, most children are well taken care of in Childrens Hospitals. When they transition like so many children with complex diseases into the adult system they kind of get lost, right because theyre in a cuddled peed whereat trick Childrens Hospital environment. So working on those transition of care with Community Health centers to puns how they can really be an important provider. Working with project echo, to actually teach people and teach people many their practices how to work with patients with Sickle Cell Disease so just a lot of things across the board and youll see a lot more coming this year. Weve expanded Data Collections weve gone cdc had two states data collection, we have expanded what to nine now covering 32 of patients with Sickle Cell Disease. We have letters out from cms talking about Pain Management of sickle patients how they need to be exempt from opioids. Theres been a huge amount of activity which i think is going to culminate into Delivery System changes. The National Academies report is due in march. We started this a year and a halving ago and we wanted power of the National Academy to make their own assessment and it will be an arguably nonpolitical theyre above all of the politics. We certainly gave them everything they needed. We funded them everyone participated but we have no idea what the report is going to say. So it has a completely objective report that will give us Important Information and again it is important about sickle cell but i look at sickle cell as a model for all of the uncommon diseases that are going to have very extensive therapies where people get poor quality of care and how do we fix that . Theres not enough patients for everybody in prime care to know what to do. But together they 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 really care about patients with Sickle Cell Disease. Theyve really bared a tremendous burden for multiple decades and it is time for them to also share in the benefits of the innovation and science that many of the rest of us have. Are you are you recommending any payment molds to Medicaid Programs in terms of how it can start. Weve had multiple meetings with everyone in cms and were exploring them right. Theres because we are exploring how to deliver care best for patients who theyre not enough specialist to see them all. But a lot of them fall through cracks go into emergencies so we clearly are exploring payment but model mechanisms anding nothing else to tell you now but we really think that theres a way forward working with Community Health centers particularly as they overlay in community where there are many Patients Living with Sickle Cell Disease. But yes we have active discussions try to unction how do we solve this, this issue that is not been solved or even addressed by another administration and make that example to build on for People Living with uncommon diseases. Thanks. Thank you. Okay soy just keep your hand up if you would if you have a question. You had a question . I do have one, sure. You mentioned Maternal Mortality i noticed in president budget theres a section to encourage states to expand medicaid to a year. For women who give birth but specifically for women who have addictions was there there was kind of a movement to expand medicaid for longer for women post birth. Where did you pick that narrow population do you have data to show a lot of these Maternal Death and disability are tied to Substance Abuse disorder . So let me answer two different ways. People with Substance Use disorders require prolong treatment particularly those with opioid use disorder. The foundation of that care is medication to assist to treatment. We dont know how long anyone needs to be on mings assisted treatment but two months is too short clearly i think we need a prolonged period of time particularly for moms with opioid use disorder so they can maintain treatment and not have a relapse and, of course, threaten their entire family structure. If in terms of Maternal Health, it is a very complex it is a complex area. What i want to change the conversation about the conversation has been number one about Maternal Mortality that is awful. Right Maternal Mortality is awful but youre talking about 600, 7500 women a year what about 50 of women a year with severe Maternal Health issues around their pregnancy because i just dont want to focus on death well focus on death but we need to focus on Overall Health picture and we need to start way early. This does not happen when a woman is in the hospital. We think that a lot of mortality and the morbidity is as a result of poor health over time. So question need to start particularly with women and girls in our office of Population Affairs or office of women Health Working together with the medias office of the secretary is working on longterm plans to improve Womens Health thats the only way to crack the nut. If you look at a Maternal Mortality it is an important part but only a small percent actually occurs outside of 60 days postpartummen and one that are late are called cardiomyopathy resulted of tension so longer geekier answer but use it right. Number two we need to change the conversation about just dealing with a mom when shes in the hospital and ten centimeters fully dielated you have to start upstream to make sure mom is heament over a period of time or bit time they get in the delivery room l. It is not going to be well and let me tell you, i had my second grandmother granddaughter yesterday my daughter normal pregnancy, great prenatal care if she was the not in a center she would have been part that have statistic she was in a center that was absolutely fantastic did what they needed to do in emergency basis. But this can happen top thin. No matter who you are whether youre in uniform or assistant secretary or not so this is something we needs to take or very seriously and were really committed to making longterm sustainable changes that improve Womens Health over the long period not just when theyre in the delivery room. Hey doctor with corona virus front senator tom cotton a couple of dayses ago suggested that joe that virus might be kind of the manufactured product of a chinese lab or that it was kind of, you know, some government funded push that initiative sen question is what is administration messaging done in briefingsings to lawmaker about origin on of the outbreak, and performance of Health Messaging how they talk about constituents about how to guard against corona virus or what they should know about it. We have no information whatsoever on being this being a manufactured virus. The origins of virus is still unknown. Theres a lot of work that needs to be done. It probably has animal origin as many of the corona viruses do but a lot more work that needs to be done to really understand. I think the messaging has been pretty clear and it has been pretty direct is that americans are not imminent danger from this virus at this moment. There are only a small number of cases theyve been identified. Theyve been isolated theres contact tracing. But this situation can change. It is very dynamic. And certainly if there is multiple generational transmission in multiple countries, the u. S. Would be with at risk of widespread corona virus. So i think thats been very clear the messaging from secretary azar from tony, from bob field what we have done with our poll is weve bought time and time is really important. We have a very good diagnostic test devised by cdc and you know there was some things that needed to be worked out and a some of the controls but it is a good diagnostic test were in Clinical Trials with antiviral medications as you know from hearing tony almost on a daily basis on hourly basis there are vaccines in works based on last 15 years. At the time bought us time to work with Hospital Systems to increase preparedness to improve our supply chain. So it has been very, very important. The policies that have been implemented to number one either avoid a paimed in the u. S. Or if it does come because it is sustain transmission elsewhere, were going to be much more prepared for it than we would have been two months ago. I think thats been clear messaging and that continues to be the message but stay tuned for secretary azar, hes leading task force hes a tremendously experienced leader has been through this with pandemic flew couldnt been through this without my secretary. Health policy you mentioned focusing on tack pling stimulant and strategy to tackle drug use. I know state officials last month told congress they want more flexibility in using grant money to tack pl cocaine and meth in their states. How is hhs addressing that . We provided significant Technical Assistance to congress and a, of course, the president provided leadership that the state ohm i did response grant with the current appropriations are now flexible so states can use them for methamphetamine and cocaine as well as for those who have opioid use disorder, thats a very king the with our Overall Program to allow states to do what they need to do to to you engage issues within their state as long as theyre Evidence Base sod thats number one. Theres flex, the a major funding source, which is a huge issue that needed to be fixed. Secondly, doctor alley cats, the system secretary at samsa already started large Technical Assistance Networks Early last year. To demonstrate and to educate or how to treat particularly methamphetamine use disorder. Were at a disadvantage because theres no medication assisted treatment. Theres no reversal agent so this is a whole different ball game. The fda and nihing working together very closely to support academia industry to develop new drugs so we cant have medication assisted treatment. And, of course, were working very closely with dea and the drugs. We have to understand that 30 years ago methamphetamine was a closet industry within the United States. People produced small quantities of it. It was not very pure. It was not very cheap. Now, it is made in the hundred it is of thousands of pounds at multiple different installations in mexico by transnational cartels. It is 100 pure, it is very cheap. It is one of the most highly addictive substances on planet. So this is a whole new situation. Were facing i cannot overemphasize seriousness of it. And attention it has gotten throughout thed a administration again starting noting long ago but in great seriousness when we started task force and briefly started working with the white house. With ap want i wanted to followup on crowe that virus and there was confusion about about about exactly how many people are in quarantine here now with a positive viral test versus just in quarantine if you have any information on that that would be great and then you brought up idea Behavioral Health workers working with folks this latest group come in for quarantine is is a very Different Group than previously quarantined people are you seeing issue and having to bring in more workers whats the situation with that . I dont have an update on numbers from yesterday that numbers are as they were and im going to defer on that. S thrg been no change in numbers from what was publicly reported yesterday about number of positives that were understand while on buses and other asystematic people that were put in quarantine based on symptoms on plane so i have no update as of today. We would ask that pretty soon in terms of people coming over again they have just come over were changing some of the makeup of our team were deploys to have more Behavioral Health in more medical side opposed to the casing management side. We have no indication or preliminary assessments of what the needs are. But one can anticipate that just being as a common sense individual that people who went for a vacation and then became subject to quarantine because of pandemic with great circumstances lots of work from japanese government. But i think any individual might experience stress during those periods of time so we want to make sure that thats dealt with as well as possible. And again the Public Health service has Behavioral Health teams this is one thing that we provide that nobody else really does. If when we deploy camp fires to the camp fire in california, just imagine what it is one day you know having a life and then next day your entire municipality is destroyed Behavioral Health issues are very, very important. Resiliency childhood experiences again our people are trained in that. So i have no assessment you know what a percent of people have what or need services but were anticipating that will be a need and will change our deployment strategy somewhat to make sure that those services will be provided and will be getting direct input over that over next couple of day. Are from both travis as well as lackland. Jackie lee from bloomberg, law. Do you have any update on the president war of regarding international or the flu vaccine . The denounced few months ago . So dinner i dont have an update at this moment but there will be updates very soon. As you all know because you covered this area, while we are extremely concerned about corona virus as weve been discussing, so far theres been 26 million cases of influenza in the United States 250,000 hospitalizations, and 14,000 deaths and this is a pretty good year. In terms of the number of deaths, so influenza really year in and year out is the threat to our country. So the president understood that. It was in the oval office a when he signed that executive order. Actually had a signing pen that was really nice memento. But we have to attack flu extremely seriously, and you will see in overall plan, strategy in a relatively short period of time coming out to implement the executive order. Bob along with his barr tay agency are on point for that and done greating work and this is an interest of mine for a long period of time. It is not just nation the vaccine but it is scaling up so it is engineering and chemical engineers all of the things that vaccination product making sure thats domestic as we see in any crisis first thing another country does will be cut off International Supply but we have to be selfsufficient in terms of that and again from a Research Point of view, and youve heard tony speak about this. We are making realing progress in a, quote, universal flu vaccine one that may not be absolutely universal. But it will mitigate the need to have seasonal vaccines every year. So theyll have broad protective coverage that will be a game changer. Once that is here, dont see one tomorrow not going to be next year but theres tremendous Research Progress in Clinical Trials ongoing on potential universal flu vaccines. So theres a lot of activity in flu i just want to reminding people get your flu shot, at your best protection along with good hand wash and hygiene, because whether corona triers is here or not, one thing we know is thousands of people will die of flu this year and we can prevent that. Did you say you would like to get away from the idea of block grant approaches to Substance Abuse, to funding Substance Abuse disorders . I did not say that at all. If i said that thats not what i intended to say. The grants are essentially block grants. They provide money based on formulas the states, to the state Health Offices that go down to the community. Our position which i think is a right wing is we need to assure the money is used in an evidencebased way. So whats being used can be proven, has been shown by scientific and medical evidence to be a safe and effective and worthwhile for the individuals. Aside from that we have purposely designed this to give great leeway to states to tailor the responses to what they need within the states. Theyre such a diversity. Some states are on the way down, some states are on the way up. If you go west its mostly a methamphetamine problem. New england is bolstered synthetic opioid like fentanyl. All throughout the country theres polySubstance Abuse mixed so its very, very different. Social determinants are going to be very, very different in different places. We dont just want to play whackamole with the drug. We want to get out to the resiliency within the communities and the underlying issues that may predispose people to Substance Use disorder over all. All these things are going to be different so whether its the Mental Illness and Substance Abuse Block Grant Program or the state opioid response grant, we try to provide intentionally flexibility within the states that can tailor their programs to the needs of their individuals. The healing communities, very exciting. Kentucky, ohio, new york, massachusetts, 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 local programs, how to bring in law enforcement, drug courts, communitybased programs, faithbased providers and sort of model systems to how to wrap all these up with a bow to make sure theyre being delivered in the most effective way possible. Very, very exciting study. Just got started. And again, kentucky, ohio, such as its in new york, they are anchored by academic sectors. This is sponsored by the nih in conjunction with samsung in a very exciting model moving forward samsara. Its for the overall Substance Abuse disorder problem including social. Im from the national journal. I wanted to ask you about in your interagency could you describe to lawmakers last month regarding allowing researchers to continue studying essential compounds which congress eventually extended. I was when if this could apply to other substances or if its just for the fentanyl compounds like schedule one . I hadnt seen this agreement public in any fish with other than to testimony. I didnt know if there plans to publish it or proposed it in any way. Thank you for that question. 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 a fentanyl analogs, of which there could be several thousand and we cannot be in a position where drug manufacturers who are very sophisticated can circumvent the loss by making a different compound that not only could be as bad but could be worse than fentanyl and may avoid detection. Its very important we do that. Congress temporarily scheduled them for 15 months. We hope they will be permanent. Together with that we were trying in the Interagency Agreement part was dea, doj, ondcp, you know all the acronyms, sat down together to really understand, we want to ban the substances but we need to facilitate research. In that group of substances could be the next improvement naloxone. They could be a nonaddictive pain medication, and if you dont have the ability to do research easily and fast we will never find those. The were a number of provisions suggested and sent to congress that would we do many things, e allow the rapid descheduling of drugs should they look to be useful and not high harmful. Also to reduce the scheduling for research purposes. A number of administrative procedures that would improve the ability of researchers to do research on schedule one drugs, or the matter what they are. So, for example, if youre approved to do one schedule one drug you dont have to have a complete inspection in the whole process over again to do another drug, or if youre working in one laboratory you dont have to have a complete inspection to move to another laboratory within your own crew. Just a lot of Administrative Changes that would make this beneficial. I do want to say that these are two very important issues and interagency came to really an agreement about how to balance all things, they 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 an interagency provided to them that would get you the ability to do Effective Research on these and other compounds. Thank you for asking that. Will the latest the rate of People Without Health Insurance has been increasing. Is that a child was to addressing some of these, Maternal Health, Substance Abuse disorder, as people articulate risk for these issues are already experiencing the issues that dont have Health Insurance . General question, of course, its very important and as part of our Healthy People indicators, the percentage of people who have Health Coverage. It cant just be Health Coverage. It has to be real Health Coverage they can use. If their Health Coverage and their 7000 deductible that doesnt help you in order to get care. So yes, of course, we want people to be covered. But they wanted to be covered with programs that can be useful to them. And again im not as much on Health Insurance side. Theres groups that work with that at hhs, but Health Coverage is important. It has to be effective Health Coverage. Until that is done on a legislative side, we are going to be doing lots of things to support it in other ways. State opioid response grant some are being used to fill the gaps for people who did not have coverage. Ive showed you for the prep program we estimate the 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. 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. That is the goal of the administration as again the goal of everyone in general. Its Healthy People objective but until we do that we are going to try to plug the holes as best we can with it are Health Programs by supporting Community Health centers, Ryan White Programs, all the kinds of things you know that we do. To followup on hiv issue. The statistics you should on your slide and look like the low hanging fruit mightve been the missed opportunities of the seven in ten who it seen a position in the previous 12 months. Are there on the grant initiatives being started to tackle things like that . 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 fund, that is from my office can we put 33 million to work. Work. So everyone of the jurisdictions, that would be the 48, send one, washington, d. C. And the seven states that have a rural garden. That was also important come have also been elimination plans. They are working right now with cdt and with our office of Infectious Disease policy to make sure those the creek. We did four jumpstart sites to implement and those. East baton rouge, baltimore city, dekalb georgia and the Cherokee Nation located in oklahoma to get that started. In the president s come in the fiscal fiscal year 20 budget much of the cdc money will be sent to local Health Departments within those jurisdictions so that they can hire the workforce they need in order to reach the people who have been unreached. We can work with the Physician Community and the Provider Community which we are doing but we are going to have to have innovative solutions. These of the people who are hard to reach. This means people from the Community Working with the community. This is a really local solution, so yes, we have started. Fiscal year just got fiscal year 20 just got funded. I think we will be awarded, i think thats correct, and that will get to the local departments to find their health plans. Working with committee based organizations very, very important. We had our President Advisory Committee Council Meeting and went one in jackson, mississippi, and we saw the xo commute to work. We were in miami seeing places like latina salute, which is a Community Organization and Community Gathering 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 that we have to meet people where they are and thats going to be to a lot of informal means, by mobile testing, by testing within the community at every opportunity. If you are positive, we want you in the care immediately. Certainly the statistics say within 30 days but we would like it within a day or two secondly, if you are at risk and you test negative, to be counseled on Risk Behavior mitigation also to be started on prep. Theoretically we could end the outbreak tomorrow. We have the effect of drug. We have the effective diagnostics. We have the effective prevention measures. This will plan is to bridge the theoretical to the practical. Its how to get all those tools and technologies weve been developing for the past four decades to work. It would be great to have the vaccine. It would be fantastic to have 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. Im very excited to leave that initiative along with some of my great colleagues like bob redfield, tony fauci who spent it allies doing this. This is not been my life work but its an opportunity that has to be taken now. Follow up on Health Preparedness for coronavirus. I want to see as far as that goes and as far as the supply chain goes, what are you seeig now as challenges in those areas . What are the focus can priority at this point . I want to defer to assistant secretary cadillac on specifics about this since he runs the hospital preparedness program, that we have had 15 years a pandemic planning formal pandemic planning. And as was message to last week its time to put those plans into affect. While this is not implemented pandemic, it is a respiratory virus that as much of the same treatment implications, people have lung disease, pneumonia. The plans weve been preparing for over the past 15 years i really meant to be put into place. In her agency calls, calls with healthcare system, working directly through all their regions to work on that. Im going to for finding specifics of what the challenges are. I think you can probably know that we, as you bet briefings on and ive even seen it yesterday, with our supply chain like him what is our pbe like, any drug shortages, no drug shortages now. Everything is moving to the pipeline very well but im going to defer about the specifics of pipeline challenges to secretary cadillac. Followup on Maternal Health questionnaire and they hhs hast of interest in this area. You spoke about addressing Better Health outcomes when with Substance Abuse disorders. Theres been a lot of interest in extending medicaid for all women. Capital is considering a bill to do that. Up to when you pick is at the conversation hhs has been havin having, for all women who just had a baby who are on medicaid . Theres 90,000 people in our department. I dont run cms so i am not involved directly in those conversations. Our aspect regarding health is to provide the science and evidence behind what needs to be done. Again, i want to go back to what i said earlier is that if we dont have women who have good hypertension control, good physical activity, the kinds of issues that lead up to a normal pregnancy, were going to have more and more problems. We have been trying to supply the site for that. The late mortality in the late Maternal Health, again, its a small percentage but it is by most of the 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. Theres probably a lot we can do about that. There are conversations about everything within the department. Im not personally involved with the medicaid extension conversation aside from oud which is my area of responsibility and Senior Advisor and to think that the great move to do that because again too much is too short, three much is too short. We need to cover for for a prod period of time because inmates he probably needs be for longer periods of time. I have another about the coronavirus. The centers for Disease Control and prevention has started testing people who show up with flu like symptoms inside tent cities testing for the coronavirus. Is that because there might be concerned the virus may be spreading in ways that airport screening hasnt been able to detect . We have to have a multilayered approach, right . You know what you know. You dont know what you dont know. The Screening Program that is there is looking for events. This is a big one with diligence of people. There could be multigenerational transmission 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. I think that is an absolutely prudent, necessary approach so that we could make sure the American People and leadership know if there is circulating coronavirus here, or else how would you know . Is that how they do it . Once you test negative for the flu but still have somebody through similar symptoms, then they would as i understand thats the protocol because obviously if your fever and respiratory symptoms right now and the United States, you have the flu. But if you are flu negative and you have 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 then it triggers a whole different set of different issues for meta giddy mitigation that we want to be in as early as possible. We dont want this to be circulated for a long time and nobody knows about it. Back on the all pure juice, there been a couple eifert state legislatures recently, indiana i think fail to extend the Sunset Program on Syringe Exchange and in West Virginia there is a pending bill that would actually outlaw Syringe Exchange programs. Just wondering if you could share your view currently as to what role Syringe Exchange should play in Harm Reduction and combating Opioid Crisis . Yes, we have been very vocal that comprehensive Syringe Services programs, also called Needle Exchange programs, are an evidencebased intervention that works, and we support them. We support their implementation. They do a couple of things. Number one is they clearly decrease hepatitis c virus transmission and hiv transmission. But more important this is an onramp into care. The statistics are pretty clear. We publish them, Surgeon General publish them, cdc publishes them. I talk about it just about every talk, the people in her a conference of program, this is just not dropping you ofcom you get naloxone, counseling, you get on brands, how about a 300 chance, increased chance of entering longterm recovery and people who dont. We are strongly supportive of Syringe Services programs. I cannot comment on whether issues are and i wont but as an evidencebased program they are fully supported and all of my Regional Health administrators are weak with all states within the region to try to make sure they know that the evidence is strongly 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 opioid. Its methamphetamines. When you have 50, 100, 200 cases surrounding that, we cannot deal with that. Where to stop that. Syringe exchange is a good way to do it. We have been very clear we have been supportive of that. This is not based on any ideology or anything else. This is what the evidence shows. I will say we do not believe the evidence supports quote safe injection or supervised injection facilities but we dont think the evidence is there. We want to support things that are evidencebased likes a range of services programs, not based on ideology but based on evidence, what the science shows. Okay. You have covered a really wideranging group of topics here on Public Health, so i want to ask you if theres anything that you havent had a chance to share get with the group as sort of the final question, did you the last word. So i do want to point out because those huge amount of press about the mortality rates in 2017 that, come in 2018 the longevity for americans actually went up. The mortality rate went down. The preliminary numbers from, thats the first time in four years. In 2019 the first two quarters of mortality rates have dropped dramatically, and while no one thing, you know, we are now at the top of the oecd nations. We are going in the right direction. I know all of you know it but i want to make sure that people who are watching out in tv land know it, that medical care is important access to health care and quality healthcare is critically important but thats about 20 of your health outcomes. The other 80 of the social determinants of health and your health behaviors. We really need to focus and i thought we would 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 rates of opioid mortality go up by 90 within that community. So the 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 addressing social determinants like the economy, like employment, like cms now focusing on standardized sets of understanding what social determines will impact your health, as well as our unprecedented work on behaviors, whether that smoking cessation, whether thats exercise with activity guidelines, the National Youth sports 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, but we are going in the right direction and im very excited to be able to be here and sort of the on point in this very exciting time. Thank you so much, admiral giroir. Ill turn it over to bill now. Again, thank you very much, admiral come for coming by. I cannot want to thank everybody for what to get coming by to breakfast. Thank our cspan viewers and cspan. We hope we will have another good event soon another policymaker like admiral giroir, and until then we wont see you again. Thank you. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] students from across the country told us the most important issues for the president ial candidates to address, climate change, then violence, teenage vaping, college affordability, Mental Health and immigration. Were awarding 100,000 in total cash prizes. The winners for this years studentcam competition will be announced march 11. Cspan, your unfiltered view of government. Created by cable in 1979 and brought to you today by your television provider. We are live on cspan2 for a conversation with Party Leaders on ways to engage nonvoters. Head of the president ial election. This event is hosted by politico and the knight foundation. Live coverage here on cspan2. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] will once again where live on cspan2 waiting the start of the conversation with Party Leaders on ways to engage nonvoters as the president ial election looms. This event hosted by politico and the knight foundation. Live coverage here on cspan2. [inaudible conversations] [inaudible conversations]
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