AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
The latest on mental health services for kids, the avian flu response, leadership changes at the CDC, plus updated FDA vaccine recommendations covered by AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
Find the latest news on H5N1 Bird Flu.
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Unger: Hello and welcome to the AMA Update video and podcast series. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Welcome back, Andrea.
Garcia: Hey. Thanks. It's great to be here.
Unger: Oh, we were off last week for the AMA Annual Meeting, where I know that Medicare payment reform was very, very high on the priority list coming out of that. And we'll continue to talk a lot about that but anything public health-related that we need to know right now.
Garcia: Yeah, there were a number of public health-related policies that came out of the annual meeting. I think the one thing to mention here is that the AMA adopted policy that says children's mental health and barriers to mental health care access represent a national emergency that requires urgent attention. And that new policy calls on the AMA to join with other interested parties to advocate for those efforts to increase the mental health workforce and to address this access to care issue.
Unger: We've talked about this before, but why don't we update folks on there. What is driving the need to create policy on this particular issue?
Garcia: Yeah, well, I think the statistics around this are pretty startling. And if you look at the CDC data, an estimated one in five children in the U.S. experience a mental health disorder each year. And as of 2021, suicide was the second-leading cause of death among children ages 10 to 14.
In addition to that, the Substance Abuse and Mental Health Services Administration reports that nearly half of young adults don't receive the mental health services they need. We're going to continue to track progress on this issue that we know is really becoming an epidemic. There were many other public health policies that came out of the Annual Meeting that we won't have time to get into the details of here. But they can all be found on the AMA website under Press Releases.
Unger: Thank you for that update. Another topic we briefly talked about a couple of weeks ago was speculation about the new head of the CDC. What's the news there?
Garcia: Yeah, so just this past Friday, President Biden confirmed what had already been widely reported and that was that he planned to appoint Dr. Mandy Cohen, who is the former North Carolina Health Secretary, as the next director of the CDC. As a reminder, Dr. Cohen will be taking over for Dr. Walensky when she steps down on June 30. We talked about before that this appointment does not require Senate confirmation, which means Dr. Cohen can assume leadership of the agency immediately.
That's going to change in the future, as Congress has passed legislation requiring the agency's director to be confirmed. But that won't take effect until 2025. The President in a statement noted that Dr. Cohen was recognized for being able to find common ground and put complex policy into action, and both of those skills will certainly be needed as she takes on this transition.
Unger: Indeed. What else do we know about Dr. Cohen?
Garcia: Well, she has experience in both the public and private sector, so that's something that certainly is not always easy to find. She's an internist. She's an executive at Aledade, which is a company that supports community health clinics and physicians.
But she also served during the Obama administration, including as chief operating officer and chief of staff for CMS. More recently, she oversaw North Carolina's COVID response. And she was a political appointee at the time in a divided state government, which is an experience that some public health experts have said could really translate well to the complexities of running the Atlanta-based agency that we know sits in the broader HHS. We also know that that first order of business is going to be overseeing that agency overhaul that Dr. Walensky started, which includes modernizing data systems and improving the agency's communication with the public.
Unger: Well, Dr. Walensky isn't the only one leaving the administration. Dr. Ashish Jha, who's been on this program before, has left, too. But his departure was much quieter. Is there anything we need to know there?
Garcia: Dr. Jha, I think, was a great addition to the administration in April of 2022. At the time when we really needed him, he brought really strong medical and public health expertise and was known for explaining complex issues in a way that people could understand. And I know you've talked to him personally on AMA Update.
With the ending of that public health emergency, the White House has closed down its COVID Response Team, which Dr. Jha led. So he'll now return to his post as the dean of the School of Public Health at Brown University. And he's reportedly already left the White House. His departure date was rumored to be June 15.
Unger: And a big thanks to Dr. Jha for his service there. Andrea, how long will COVID be handled at the national level now?
Garcia: So the COVID response will be directed by existing federal public health infrastructure, including the CDC and the Administration for Strategic Preparedness and Response, which falls within HHS. White House officials are looking for a leader for a new pandemic preparedness office. And according to an article in The New York Times, it's narrowed down that search to around half a dozen people. And a decision on that position is expected in the coming weeks.
Officials have also worked in recent weeks to preserve funding for one of Dr. Jha's signature initiatives, and that's the COVID-19 development program, known as Project Next Gen led by HHS. That's a $5 billion program that aims to deliver new vaccine technologies that are more durable than those currently available COVID vaccines. We know that also federal regulators are expected to authorize another round of COVID booster shots later this summer in an effort to prevent that winter surge.
Unger: Speaking of vaccines and boosters, we've had more news on that in the past week. What has the FDA said about fall vaccines?
Garcia: So last Thursday, FDA's advisory panel VRBPAC met and came out with a recommendation that vaccine manufacturers should be targeting that XBB variant in the new COVID vaccine to be available in the fall. That would move us away from the existing bivalent formula, which we know protects against Omicron and the original strain of the virus. We've talked here about XBB variant, and that continues to be the dominant variant this summer. If FDA agrees with the recommendations of its advisory committee, it would kickstart that manufacturing of millions of vaccines.
Unger: Now we talked in past episodes about the movement toward some kind of annual vaccine. Is there still hope that we're going to get there?
Garcia: I think that's still the goal. But discussion last Thursday did not address which populations should be offered the latest vaccine or how often people should receive it. That's something that we expect will come later.
I think it also remains unclear whether or when the vaccine makers or the FDA will examine the potential effects of administering multiple vaccines in the fall, so the flu vaccine and we know there are also the new RSV vaccines that are going to be becoming available. However, it's important to have discussions in agreement on the formulation of the updated COVID vaccine now. As we know Pfizer, Moderna and Novavax have all made it clear that they're going to need time to make tens of million doses in time for the fall.
And we heard Dr. Peter Marks, who is the FDA'S vaccine lead, also point out that the winter may bring further evolution of the virus. So it's something we're going to have to continually watch and maybe evolve. Right now, we're expecting those new formulations of the COVID vaccines to be available by late September.
Unger: All right. Well, we will continue to track that. And I know we'll also be talking with Dr. Sandra Fryhofer, the AMA's ACIP liaison, next week. But as we know by now, COVID isn't our only concern. We've also been hearing more about avian influenza or, as it's more commonly known as, bird flu. What do we need to know about that, Andrea?
Garcia: Well, U.S. public health and clinical partners continue to monitor and respond to that global outbreak of the highly pathogenic avian influenza A, which is H5N1. In November, the U.S. surpassed the previous record for the number of birds affected, making this the worst domestic outbreak of avian influenza in poultry, with more than 58 million poultry affected in the U.S. to date. We know there have been 13 human cases that have been reported globally, including one in the U.S., and that's between January of 2022 and June 1 of 2023.
We have six of those individuals were hospitalized, and two tragically died. In response to this, though, the CDC is now encouraging testing for influenza among people with severe respiratory illness. The agency is also requesting that during late spring and summer months, that influenza A positive samples from patients in the ICU that are not subtype in clinical labs be submitted to state or local public health labs for subtyping.
Unger: Why is this so important right now?
Garcia: So it's really a critical step for continued surveillance of H5N1 in the U.S., as well as variant influenza cases, especially in the summer when influenza testing, we know, may not be as routine as it is during flu season. And exposure to poultry and swine may increase during agricultural season. As a reminder, human infection with any novel influenza A virus is nationally notifiable.
It should be reported to the CDC, as well as your state or local public health authorities immediately. Although the CDC has said that the overall risk to human health is low, influenza viruses, we know—we've talked about here before—are unpredictable, and the situation can change rapidly, which means that we need to stay vigilant. We'll also drop a link of the description of this episode, a link to more details on how physicians can stay up-to-date on this.
Unger: Andrea, thanks so much for that information. We'll keep an eye on that as well. That's it for today's episode. Andrea, thanks again for being here.
We'll be back soon with another AMA Update. In the meantime, you can find all our episodes at ama-assn.org/podcasts. Thank you. Have a good week. Please, take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
