>> Good morning, and welcome. I am John Auerbach, CDC's Director of Intergovernmental and Strategic Affairs, and the Federal Designated Officer for the Advisory Group to the Director of CDC or the ACD. We are thrilled to welcome you to the first meeting of the reestablished ACD. Upon her assumption of the role of Director of the CDC, Dr. Rochelle Walensky began the process to recreate this worthwhile federal advisory committee to assist her and the agency in addressing the wide range of public health issues that CDC faces. You will soon have the opportunity to meet the ACD members, to hear from Dr. Walensky herself as well as other CDC officials, and to observe the deliberations of the committee members as they take on their initial tasks. Now, let me turn things over to the Chair of the Advisory Committee, Dr. David Fleming. Dr. Fleming is a public health expert with many years of rich and diverse professional experiences, and we're delighted that he has agreed to take on this role. David?

>> Thanks, John, for that very kind introduction, and welcome, everyone, to this inaugural meeting of the Advisory Committee to the Director. Special welcome to Dr. Walensky, the Director of CDC, and to you, John. On behalf of all the committee members [inaudible], it is just an honor, and it's also so great to be here today. We're excited to have the privilege of working with the CDC in your critical role of advancing and improving the health of each and every one of us. And no small surprise - we have a packed agenda today. And so let's get started. Our first order of business is a Roll Call and a Conflict of Interest Disclosure. I'll go ahead and start, and then call on each of the committee members. So good morning. I'm Dr. David Fleming. Currently, I'm a Clinical Associate Professor at the University of Washington School of Public Health, and I have no conflict of interests. Dr. Adimora?

>> Good morning. I'm a Professor of Medicine and Epidemiology at the University of North Carolina in Chapel Hill. I have received consulting fees and my institution has received funding for my research from Merck and Gilead.

>> Thank you so much. Dr. Albert?

>> Good morning, everyone. My name is Michelle Albert. I'm a Professor of Medicine at the University of California in San Francisco, UCSF. I have no conflict of interest.

>> Good morning. Is Mr. Dawes on the line?

>> Good morning, everyone. I'm Daniel Dawes. I'm a Professor at Morehouse School of Medicine and the Executive Director of the Satcher Health Leadership Institute, and I have no conflicts of interest.

>> Thanks so much, Daniel. Ms. Gary?

>> Good morning, everyone. I am Cristal Gary. I am Chief Advocacy Officer for a healthcare system called AMITA Health. I also have 15 years of experience in state government as a State Medicaid Director and Deputy Governor of the State of Illinois, and I have no conflicts of interest.

>> Thank you so much, and welcome. Dr. Goldman?

>> Good morning, everybody. I'm Lynn Goldman. I'm a pediatrician. I am Dean of the Milken Institute School of Public Health at the George Washington University. And I do have a career history that includes being an epidemiologist for the California State Health Department as well as working at EPA. I don't have any conflicts of interest. However, I should disclose that as a dean, I have many faculty members who have funding from a multitude of sources, including the CDC. Thank you.

>> Thanks so much. Dr. Hardeman?

>> Good morning. I'm Rachel Hardiman. I'm the Blue Cross Endowed Professor of Health and Racial Equity at the University of Minnesota School of Public Health, and the Founding Director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health, and I don't have any conflicts of interest to report today.

>> Good morning. Welcome. Dr. Martinez?

>> Good morning, everyone. I'm a Professor of Psychiatry at the Dell Medical School, as well as the Executive Director of the Hogg Foundation for Mental Health at the University of Texas at Austin, and I have no conflicts of interest.

>> Thank you. Dr. Medows?

>> Dr. Rhonda Medows. I'm a family physician and President of Population Health at Providence. I'm also the CEO of Ayin Health Solutions. I have no conflicts to disclose. Thank you.

>> Thank you. Dr. Morita.

>> Good morning, everyone. I'm Julie Morita. I'm the Executive Vice President at the Robert Wood Johnson Foundation. I'm a pediatrician as well, and I have no conflicts of interest.

>> Thank you. Has Dr. Sachs been able to join the line yet? If not, we'll move on to Dr. Shah.

>> Good morning. I'm Nirav Shah. I'm an internist and on the faculty of Stanford University and Chief Medical Officer of Sharecare. I also serve on the boards of STERI, Kinsa, and Covid Act Now.

>> Thanks, Dr. Shah. Dr. Taylor?

>> Good morning. My name is Jill Taylor. I am a Senior Science Advisor at the Association of Public Health Authorities and a former Public Health Laboratory Director. I have no conflicts of interest.

>> Thank you very much. Ms. Valdes Lupi?

>> Good morning, everyone. My name is Monica Valdes Lupi. I'm the Managing Director for the Health Program at the Kresge Foundation, and I have no conflicts to disclose this morning.

>> Great, thank you very much. So I'm happy to say we have a quorum. We have everybody but one, and we understand the Dr. Sachs will be joining us shortly. ACD members, just as a reminder, during the Q&A sessions and discussions, please use your raise-hand feature, please keep your video on, and of course, as we always do, try to remember to unmute when you want to speak. So today's meeting is going to have two parts. The first will be a presentation -- a series of presentations to provide us with information on some of CDC's key programs and initiatives and priorities. Because we're new, these are going to be more introductory in nature, not yet with a lot of specific questions for us which will be our goal in future meetings, but there will be an opportunity for robust discussion. Each of those presentations will be followed by a Q&A session. In the second part of the meeting, we're going to direct ourselves towards work group formation. We'll be working to rapidly start up some of the important parts of our initial work with a special focus today on Health Equity. Could we go to the first slide, please? So our first speaker needs no introduction, but I'm going to do a short one anyway because it's such a great privilege to introduce Dr. Michelle Walensky, who's been providing such incredible leadership to CDC and this country for the past year. Dr. Walensky is the Director for the Centers for Disease Control and Prevention, the Administrator of the Agency for Toxic Substance Disease Registry and is the person who this committee advises. She'll be speaking with us this morning about aspects of current work - CDC's current work and current priorities. Dr. Walensky, thank you for joining us today.

>> Thank you so much, Dr. Fleming. Hello, everyone. This is truly a day I've been looking forward to since becoming CDC director just over a year ago. As I said during your orientation meeting, I'm so grateful you have committed to sharing your collective expertise with us at CDC. And I only wish I could have convened you sooner because there have been so many times in this first year when I would have welcomed having a trusted, knowledgeable, and independent-minded group to turn to for insight and recommendations. CDC has its outstanding employees who are skilled, dedicated and hardworking, and I benefit from their expertise every single day. And every day I have the privilege of meeting and learning from our many partners and partnership organizations. CDC also benefits from the advice of many federal advisory committees providing invaluable support to the agency on a wide range of topics including vaccination, clinical laboratory standards, injury prevention and tobacco control. But there are issues that extend beyond a single health condition or a single concern beyond just a single center or office. And for insight and recommendations on these issues, I will now look to you. We're now at the beginning of our third year of responding to COVID-19 pandemic, a response that requires enormous resources and dedication to the evolving science, as well as an unwavering commitment to protecting the public in a pandemic, which has underscored the impact of racism and inequity, the relationship of chronic diseases and infectious diseases, and the importance of properly funding the public health system. Thousands of CDC staff have been directly involved in our COVID-19 response with 2000 deployed across the United States and abroad in the last two years. They have developed guidelines and educational materials that have attracted more than three and a half billion views on the Internet. And they have helped achieve the major accomplishment of having over 210 million people in the United States vaccinated with their primary series. You will hear more soon about our COVID response from our Incident Manager, Dr. Barbara Mahon, later today, and you can certainly imagine the pandemic is consuming much of my time and focus. But while we respond as necessary to this extraordinary challenge, we also must be sure we do not lose sight of the other important work done at CDC, work that reflects our commitment to our mission to equitably protect the health, safety and security of every American, and our strategic priorities of securing global health and America's preparedness, ending epidemics and eliminating disease. Staff from every single part of CDC have participated in the response, many serving repeatedly for extended periods of time. They serve because they know this is a critical time for public health, representing perhaps the biggest challenge of our lifetimes, and they want to do their part. Yet for many, their time and the response takes them away from the important work that is their reason for being at CDC. And I am constantly aware of how hard this is. We've seen many public health issues worsen during the pandemic, including record high levels of obesity and tobacco use, increasing rates of HIV and other sexually transmitted diseases, worrying trends and rates of firearm violence and suicide, the growing impact of climate change and the staggering increase in opioid-related deaths. The pandemic has not stopped us from being on the frontlines of preventing and responding to these and many more public health issues. To build a stronger, more resilient public health system, many things are necessary. Among these we must strengthen our public health workforce, prepare for future health threats, both global and domestic, strengthen our public health laboratory infrastructure, modernize our data systems and address health equity in everything we do. Just as the pandemic has exacerbated public health issues, it has also exposed the weaknesses in our public health infrastructure and stretched that infrastructure to and beyond its limits. We've seen the impact of the chronic underfunding of the public health system at the local, state, federal, tribal and territorial levels. The pandemic has also laid bare the hard truth about health equity in this country, that those in marginalized communities have been disproportionately affected by the pandemic. And the result of the inequity will have a devastating impact for years to come. More clearly than ever before, we've come to understand the inseparable relationship between social and economic conditions, and the health and wellbeing of the public. And there are no easy solutions, but we have made progress in responding to the challenges. This year, we launched CDC's first-ever agency-wide Health Equity Science and Intervention Strategy called CORE. This bold and innovative approach is framed around the pillars of science, interventions, partnerships, and integral organizational change efforts. The inaugural Health Equity Strategy is catalyzing commitments from the CDC centers, institute, and offices, resulting in over 150 health equity planned action steps. In addition, we initiated agency-wide efforts to address the social determinants of health and to combat the health impact associated with climate change. These different efforts are actively underway, tapping the expertise and commitment of our extraordinary staff. We've created a new center to provide forecasting and modeling to threats -- of threats to the public. And we've dramatically strengthened our capacity to do genomic sequencing. With billions of dollars in new funding, we've begun to strengthen and modernize our data, public health laboratory and emergency preparedness systems. With a $7.4 billion investment from the American Rescue Plan, we now have the chance to build a stronger, more resilient public health system for the future, and make sure that the need for health equity informs everything we do. These changes and many others are benefiting the public now and will for decades to come. Soon, you'll hear more details from our senior leaders about how we're responding to COVID, advancing data modernization, strengthening our public health workforce, and making sure we are considering equity in everything we do. This is work we do not just for CDC. We're committed to supporting and strengthening the nation's entire public health system. The work you will do as part of this committee will have a lasting impact far beyond the walls of this agency. More than two-thirds of our funding is awarded to public health organizations at the local state, tribal and territorial levels. And these last few years have been extraordinarily difficult for our colleagues. They've truly worked 24/7 to protect the residents of their communities, tracking and analyzing outbreaks, targeting efforts to reach the highest risk populations, developing and implementing policies, hiring, training and working to retain staff, offering testing at countless sites, and of course, vaccinating, vaccinating, vaccinating, and boosting. It's heartbreaking that some of these folks have been criticized and threatened for their dedicated work, and still they have persevered. But along the way, we have lost some of the most experienced personnel to exhaustion, retirement and the private sector. And it's projected that the public health workforce is at a deficit of 80,000 people. We cannot allow this to continue. So today, I ask you to lean in and help us with the essential work of the agency. Initially, I ask for you to focus your attention on the promotion of equity. We've outlined in the Health Equity Terms of Reference Document the specific questions for you to address. With the formation of a specialized Workgroup on this topic, we request you assist us in the framing and implementation of CDC's CORE Health Equity Strategy, identifying innovative and promising health equity practices that align with its principal pillars. And I look forward to hearing the findings and observations that come from your deliberations in the coming months. When you convene again in May, I will ask you to form additional workgroups to focus on two other prioritized areas, data modernization, which is so very key to our future, and laboratory quality, safety and efficacy. And at that time, we will provide specific questions for your input and guidance on those issues. In addition to those topics, there will be others that will arise unexpectedly. Let me close by once again thanking each of you for your willingness to serve in this important capacity. You are here because we and I need your multidisciplinary expertise and deep engagement. And over the next few years, we will come to know each other very well. And I very much look forward to that. Thank you all so very much.

>> Thanks so much, Dr. Walensky. A whole lot going on. And it's very exciting to be here today. I just want to start off by thanking you on behalf of the committee for providing leadership to CDC. And also thank CDC for providing leadership to the country during this time. Please, please know how appreciated you are. I'm going to open up the floor to questions and answers. While we are doing that though, Dr. Sachs has joined the committee. And Dr. Sachs, would you please just do a brief introduction and also declare whether or not you have any conflict of interest?

>> Thank you very much. I have no conflict of interest. I'm a university professor at Columbia University and Director of the Center for Sustainable Development at Columbia University and very honored and happy to be on this advisory panel. Thank you.

>> Great, thank you so much. And the floor is now open for ACD. Members. Please raise your hand if you have a question or comment for Dr. Walensky. Let's start with Dr. Martinez.

>> Thank you, David. Thank you, Dr. Walensky. It's an honor to serve on the ACD. Definitely agree with everything you said. One question I have, and I'd like to hear your thoughts on -- I didn't hear too much about mental health. And I think that we can't have true equity without also addressing the mental health issues affecting us, and not just the public, but as you pointed out, the impact it's having on our peers and our public health employees.

>> Octavio -- Octavio, you cut out for a moment for some reason. Can you repeat just the last part of your question? I think we heard it but --?

>> Very good. David, sorry about the Internet issues in Texas. Just Dr. Walensky, I just wanted to hear about how mental health plays within health equity, as you're looking at it as we address the health equity issues you're asking us to address.

>> Yeah, first of all, Dr. Martinez, thanks for joining us. Thanks for raising that. I certainly didn't list all of the areas that need to be high priority, but mental health has to be one of them. We've seen it throughout this pandemic in the mental health of our health care professionals. And we've seen it in the mental health challenges associated with our public health workers and our youth and being out of school, and MMWR has actually reported high rates of suicide attempts among young women in our emergency departments, high rates of depression and anxiety and suicidal ideation among our public health workforce. NIOSH has just received a $20 million grant in order to look at education in mental health amongst our healthcare workforce, which I think is key. So all of that has to weigh into what we're doing in the future. I think we are first now going to start seeing -- even we've looked at the tip of the iceberg, but we are first now going to start seeing even more of the mental health challenges of this country. We coordinate with SAMSA quite frequently, collaborate with them. So that is going to be a key collaboration in this, and then working upstream in the prevention in the adverse childhood events in the Aces and the community and social determinants of health to try and work to do a lot of prevention of disease and mental health. So yes, that is - it's key for what we'll do -- what we are going to need to be doing in the future.

>> Yes, thanks. A really important question, Octavio. An important issue, as you said, Dr. Walensky. And next, Dr. Goldman.

>> Thank you, and thank you so much, Dr. Walensky. I think that we have all been very appreciative not only of your work, but each and every person at the CDC and in state and local health departments, who I think have worked so hard over the last couple of years and have been underappreciated, in my view, by the public, for their service. And so and then that includes everybody at the CDC. And I particularly have appreciated under your leadership the very holistic approach that's been taken, especially around the concerns for children, the fact that the decision-making has included the situation for all children, not just children who are well-to-do, but also children who have inequitable access to health care, inequitable access to education, making sure that they still have access to education, and also many of the social situations that are so important for the development of children. Then I think CDC has shown a tremendous sensitivity to that. You know, the moving forward, I'm going to echo some of what Dr. Martinez had to say. I mean, this has been a situation that challenges us at every level, whether it's mental health, it's worker safety and protection, environmental protection, the communicable disease issues. And I think that it's going to be a challenge for us, but I really look forward to the opportunity to be able to support you in any way possible, you know, to be building CDC. I think that the pandemic has just shown in our public health system has a lot of fissures in it, and really didn't have the support that it needed in the first place. And so, you know, we will build it. So thank you for the opportunity to help you.

>> Thank you very much for those comments. If I might just say, um, we've been thinking about even the next phase of this pandemic, it's been interesting to sort of say, we can count cases, we can count with some accuracy, but we can talk about that another time. But we can count cases, we can count deaths, we can count hospitalizations related to COVID, and so because we can count it, it feels like it's kind of under the lamplight, the lamppost, but the holistic approaches you talk about, if we sort of get to -- it's the safest thing for COVID, that doesn't necessarily mean that's the safest holistic thing for our children, for our community. And so we have to -- I think, early on, it was easy to count under the lamppost. But right now, we do need a holistic approach to all of the other things that we can't do, by virtue of the fact that we're being so safe, if you will, for example, for COVID. I continue to say in the COVID domain that we have to look to our hospitals as a barometer as to how we're doing. We certainly need our hospitals to be able to function, we need to be able to take care of acute medical needs, and chronic medical needs. Bu yes, that is key. I think mental health will be a part of that. But all other chronic diseases, child childhood education, childhood safety, all of that has to be a big part of what we do in the next chapter,

>> And perhaps some data modernization to accompany that as well. [Laughter]

>> Yes, please. [Laughter]

>> Next on the list is Ms. [inaudible].

>> Yes, thank you, Dr. Walensky for reviewing and providing us with those high-level updates. And also, you know, just sharing my gratitude for you and the amazing team that you have at CDC during the last couple of years in terms of response. I appreciate that you also acknowledged our local and state public health colleagues who are on the frontlines, and I appreciate what we have seen as a shift in thinking around direct funding of locals. And I wanted to ask a question because as a former health director in a large city, I can tell you how critically important it is to get those resources directly to our local health departments who have been on the frontlines. And so I was curious if you could say a little bit more about how you and your team are going to evaluate the value of this change in policy and whether it will be a model moving forward?

>> Yeah, maybe I can respond -- thank you for that -- and say two things. And I have reiterated to my team that this has to be a partnership. The first flags of a challenge happen at the local level. Something doesn't smell quite right. Or I've seen a case of something that doesn't feel quite right, or this is atypical of how it generally goes. And that's -- it's the local public health departments that give us those signals when we first see them, right? So we need to have a partnership, we need to be able to take them seriously, and then we need to be able to support them in both directions. This has to be a partnership. One of the things you know, in the last 10 years, and this will be our challenge moving forward, there is no question -- in the last 10 years, despite Zika, despite Ebola, despite H1N1, we were never able to form this big foundation of a public health infrastructure or public health workforce or public health data modernization, the laboratory infrastructure that we need, despite the fact that, you know, we had quite a few public health challenges. So I think that's the infrastructure that we're really going to need moving forward. As part of our public health workforce -- and I know you're going to be hearing from Dr. Simone in a little while, we've really been talking about scaling up the local public health workforce, and that is scaling up at all different levels. And it's making sure that they're as diverse as the communities that they serve, but also upskilling the workforce in ways that they haven't been upskilled before. We need genomic epidemiologists in our public health departments. And so we're working to make sure that we both provide resources, that we open those lines of communication so that they're more open, and then upskilling the workforce, and making sure we have a more diverse workforce. And that's a lot of the work that we have ahead of us. And we're behind. You know, we have fewer of them now than we did even before the pandemic started.

>> A huge challenge. Thanks for highlighting that. Dr. Sachs?

>> Thank you. Maybe I'm really continuing on that point. It seems to me that, from my perspective, at least, this has been a shocking two years of failure in the United States. And by the count of IMHE, we're at a million deaths, by other accounts, 900,000 deaths. I remember when I first heard the prediction that we'd reach 100,000 deaths, I thought, "Impossible, crazy, insane. Are we really going to do that?" And yet, even today, we're running at something like 2500 deaths a day, if I understand correctly. So this is, to my mind, a massive, massive debacle that we don't have any kind of shared social understanding about. For a lot of people, the pandemic's kind of behind. In fact, we're in a wave of in tremendous intensity, and who knows what the next variant, if and when it comes, will bring. So I wonder how we get a more comprehensive view of what needs to be done right now and what the lessons are of what has happened. I find this experience utterly alarming. Not just the shock of a pandemic, but the incapacity of the United States to get ahead of this until today. And when I make comparisons with the -- especially the countries in East Asia, they've had a completely different experience, maybe one-tenth the death rates. Also, we don't even -- I want to continue to look under the lamppost frankly, a little bit. We hardly talk about deaths in this country. We've had nearly a million deaths or a million deaths and Wall Street Journal hasn't noticed one, as far as I can see. They just want to keep the economy open and everybody, everything running, and deaths don't matter in the United States, but a million deaths is a lot of deaths, actually. And somehow, I don't feel we're on top of this. And I wonder how we can help. But it also seems to me CDC is going to really need to take a comprehensive retrospective of what the hell happened here. How did this get so out of control? And so I wonder whether that should be one of the working groups or how we can be -- how we can be helpful in this. All the issues you're talking about are extremely important, but we're still in the middle of the pandemic. And so I wonder how we can help in real time.

>> Yeah, you know, I -- one of the things I think that is so shocking to me during this time and just echoes what you said is how little regard we're giving to one another in this -- in this whole think we as society have given to one another. And we have more deaths now than we have had since the beginning of February 2021. And yet, I haven't been on a telebriefing in the last three weeks where people haven't talked about when we're going to relax restrictions. And so, you know, we have, I think we are reporting 640,000 cases a day, and over 2000 deaths on my last telebriefing. And the first question was, "When can we take off masks?" So it's -

>> And Rochelle, if I could say, the Wall Street Journal editorial today is the excessive restrictions and the loss of freedom. It's a kind of insanity in this country. Horrible, in my opinion, sorry to say.

>> Yeah, I don't know if folks saw the New York Times piece yesterday about what happened in 1918 with the flu pandemic, and how the most amount of deaths happened in 1920, when everybody was just sick and tired of it and had a complete disregard for the deaths that actually happened when they decided they were done, even though there were, in fact, more of them in that year than the year prior. And I think we're at risk of repeating that. So I certainly don't want to be there. But I do think that, you know, with a disregard for what exactly you're talking about, and I'd be happy to sort of think through were there decisions that were made along the way, was there science that we prioritized in one way or another that could have helped inform? Certainly, misinformation has been a huge problem here. Certainly the -- you know, and one of the things that I've been working toward and would be happy to have -- hear from my team too -- is to try and, you know, CDC has never been in a pandemic. There has never existed a CDC in the midst of a global pandemic the way there was in 1918. And how do we take what is the gold standard of CDC, and pivot to make sure we're making decisions in real time, providing guidance in real time, and sometimes making an advance of all the information that we would like because in the absence of a decision, you're making the decision anyway? And actually going after the most important science in order to make tomorrow's decision?

>> That makes total sense. Dr. Morita.

>> Dr. Walensky, nice to see you again. I extend my gratitude to you as well as all others have. Up until now you've just done an incredible job and the team you're leading has done incredible work. I do echo Dr. Sachs' comment regarding our willingness and ability to support you and in this COVID pandemic as well, that you don't -- shouldn't feel like you have to limit you -- our support of you for discrete projects, like data modernization, or health equity or the laboratory issues. So I think we are interested and willing to support. I'd also like to echo Monica's comments regarding local public health. As a former Chicago public health official for many years, I know the value and the importance of supporting -- the benefits of actually direct support to large urban areas and how we were able to respond better and be more nimble as a result of it. So just glad to support any discussions in that space as well. I do have a question for you. I want to applaud you for your CORE efforts related to health equity, because I think that is really important to be addressing it and look at it holistically. And I looked through the Health Equity terms of reference that was provided to us and noticed that the working group charge does not include the internal organizational change that you're working on. And I understand and appreciate the need for that as a CORE element, but also maybe request that you consider sharing with us updates on progress and what's happening, even if it's not a part of the charge. I think we'd be very interested in hearing about the progress that you are making in that space. So just want to acknowledge that and get that out there to consider moving forward. But again, thank you so much for all you're doing.

>> Thank you. Thank you so much. And maybe I'm absolutely -- we're happy to do that. And but one of the things I just want to say out loud. It has been when we announced in April last year racism as a serious public health threat, and when we announced that call for action and for CORE strategies, and I said to the group, I said to the agency, "I don't want to document the problem anymore. I want to know what we're going to do to fix the problem," right? Because we all know that there's everywhere we look, we can document the problem. And what was so inspiring to me and this was -- is a tired, battered agency over the last two years, but people were inspired by that effort. If they were talking about CORE, they were excited, and they were inspired, and everybody came to the table. And it was really interesting to see how unification over this common goal, which really was universally believed in, was something even in a moment where the agency was feeling hardship, people wanted to come to the table and do more and do extra and lean in. So I just want to make sure everybody sort of recognizes and knows how inspiring that mission has been for the agency.

>> We're going to be having a much more extensive discussion of the terms of reference later in the meeting. And we can look forward to that. I also just want to plug the reference to state and local health departments. As a former [inaudible] having worked both at the state level, and then as the health officer in Seattle and King County, it's nice to hear us talking about the public health system that's protecting this country. So thank you very much for that.

>> And if I might just say real quickly, you know, if we had had a pervasive local, state, local public health departments when it -- who was working in diabetes and working in nutrition and working in blood pressure control, when it came to vaccination, it would have been a no-brainer. You would have people who have been trusted and local and known and the people would have -- I think it just would have been easier.

>> You're absolutely right. We need to think how to fix that for next time. Yeah. Thank you. Dr. Shah.

>> Thank you. And thank you so much for your service, Dr. Walensky. This is building on Monica's question of it in terms of obviously, there's going to be a lot that needs to be done with state and local public health. What's your vision of how we engage and work with the private sphere, with payers, with health care providers? Clearly a big part of the solution and an opportunity as well? And how do we need to change over the next two, three years or even sooner to start to embrace the larger systems?

>> Yeah, I mean, I think that's a really key and important question. I think it's true at the public level, you know, through CMS, Medicare, and Medicaid. I think it's true at the hospital levels. And we're the only health system I think in a world where we have such siloed data from our public health partners versus inability to link to our hospital systems. I've had numerous conversations with Micky Tripathi at ONC to see about how we can mix our data. So I think that's even at a meta level. But a level we actually have to do both from a financing standpoint, from a data sharing standpoint. It's how we're going to get this whole thing to be interoperable.

>> Thank you.

>> I tried to get us through the introductions quickly to give us time, which we do have, but we probably have time for only a couple more questions. We may not be able to get to everybody. But can we go to Dr. Albert next please?

>> Thank you very much. Thank you, Dr. Walensky, for again, the incredible job you've been doing under a fair amount of duress and significant pressures from multiple different directions. And your leadership has shined pretty bright. I just have a couple of comments. The first is that as we think of our public health infrastructure and our responsiveness towards syndemics like COVID-19, I want to remind the audience that you know, chronic disease is a big deal. And a lot of this is being driven by cardiovascular conditions. And as we think about, you know, how we respond to future pandemics and syndemics, that we really, really need to, you know, strengthen our responsiveness and our underlying approaches to dealing with cardiovascular conditions, like you mentioned, blood pressure control, et cetera. And I just wanted to put that there -- out there because when we think about COVID, we -- and CDC traditionally has thought about responsiveness to infectious diseases. But if we can deal with thinking about how we respond to the underbelly of the number-one killer in the world globally, which is cardiovascular disease, I think we're going to achieve a fair amount. The second comment relates to embedding equity. If maternal health is not a core component of our responsiveness, then we're not going to be dealing with the health of the nation effectively, right, because the health of women, especially pregnant women, and pregnant people, and those of childbearing age, reflect, you know, our overall health. So we're going to have to deal with that. And then lastly, as we think about strengthening the public health workforce, we really need to re-envision what a successful medical workforce is, right? And a successful medical workforce also includes not moving the public health teaching and responsiveness into medical schools, and re-envisioning how medical students, as well as trainees across the academic life course of medicine actually are trained. And so I just wanted to put those comments out there for us to also lean into those three items. Thanks.

>> Thank you for all of those. If I could just briefly respond. Striking the maternal mortality challenges in this country that even when you correct for almost everything else, you still see this difference by race and ethnicity, which is just really striking. We're working on scaling up maternal mortality surveillance, and that will -- that is one of the foundations by which we can then work on surveillance in many other places, bridging some of our surveillance in sickle cell disease, for example. If we can do surveillance, that we should be able to do surveillance in many different other -- many venues and places. I'm working -- I actually have a meeting tomorrow with Tribal Nation about looking at maternal mortality in tribal nations, which hasn't yet had sufficient surveillance to be able to do that. So and that, by the way, is also a key priority for the secretary. So that is something that we're looking at very carefully. Cardiovascular disease, I think you're exactly right. You know, and I think that this is going to -- I mean, this intersects with race and ethnicity and our social determinants of health in such an important way. And in fact, moving forward with long COVID and the manifestations of long COVID and how many of those are going to look at cardiovascular health and pulmonary health and many other diseases. And we absolutely know that there will be more long COVID in people who've been more heavily afflicted by this disease, and that hasn't been even across the United States. And then finally, I just had a call yesterday with the American Hospital Association, and I would echo exactly what you're saying in medical school, but also in nursing school, because I think we need that not just in our doctors, but in all of areas of medicine in preventive health and public health. So yes to all of them.

>> Thanks so much, Dr. Medows. Excuse me. Dr. Medows?

>> Good morning, Dr. Walensky. And I'm going to start with thank you to you and everybody else at CDC. I cannot imagine what your day is like. And I cannot imagine where we would be if you were not there leading the charge. So thank you for that. I listened to my colleagues on this call, talk about all the important things that I agree we have to be able to address, mental health, children, right? Health equity, health disparities. We didn't talk about people with disabilities, but you know, that's included in the mix, right, of people we're eligible to take care of. But I also heard your opening comments about the departing workforce in public health, the chronically underfunded public health service. You know, I was a state health officer at one point during H1N1. And I thought that was bad. And it's kind of looks like COVID said, "Here, hold my beer. Let me show you be bad." My whole point is this is saying that I'm hoping that whatever we have built that we thought was a temporizing solution or fix outside of the traditional public health structure, we actually figure out which ones we can keep, formalize and build upon. And when we talk about actually trying to fortify public health, that we do it in a way that is not dependent upon old models, that it is only on new models that distribute some of the burden to healthcare industry, the healthcare providers, health services, check nontraditional partners, because I think that's what is going to take. The expertise [inaudible] in CDC, but we can actually form a foundation to support it in a much more efficient and more effective way. So thank you.

>> I couldn't agree with you more. And I will say, it's been interesting as you watch the coverage of, you know, the public health professionals are the ones who are scrutinized for their bad guidance or whatever it is that is said in the news, and the physicians are the heroes. I wholly agree the physician or the medical workforce -- I don't mean physicians, but the medical workforce have been doing heroic work over the last two years, but so have the public health professionals, and so we need to make sure that they are, you know -- we can't have people leaving our profession.

>> Here, here. We've got time for one more question. Mr. Dawes?

>> Thank you, Dr. Fleming. Dr. Walensky, let me also echo my words of thanks for your courageous and humbling leadership during this very dark and historical moment, and of course, to the entire team at the CDC for their work as well. So, you know, I was really excited to hear you say that the need for health equity informs everything we do. And again, a part of that courageous leadership was the declaration that you made about racism being a public health issue, that it was, you know, striking us, right, that we have to address that. So I wanted to ask you very quickly, since we've run out of time, you know, what efforts specifically, you know, on anti-racism are happening at the CDC? And how have you been engaging others to really shift the culture at CDC on this issue and Health Equity at large?

>> I don't necessarily want to short shrift that really important question, but I know that we're going to have a whole session later today to speak to this. One of the things that I think was really important is to be accountable for what, you know -- when we announced this in April, we said, "Okay, what is it that we are going to do to say that we are making incremental steps?" We are doing a lot of engagement within the agency. We have to be internally focused, we have to be externally focused in health, and then we have to actually -- you know, just sort of an anecdote. When I started, we had the beginnings of COVID Data Tracker, and the team has been extraordinary in putting together COVID Data Tracker. We couldn't report race and ethnicity on cases; we didn't even get it from the States. So I mean, just if you can't -- if you don't have line of sight, so now we have race and ethnicity from almost all states, we've had data use agreements in order to be able to do that. We have it for vaccination, we have it for booster, so now we can start figuring out where the efforts -- where is, where are our gaps? And what do we need to do to intervene? And how can we convey -- how can we intervene to make a difference? I'm proud to say that, you know, right now, our primary vaccination rates are about the same for all racial and ethnic groups. They are not for boosters, they are not for children, but primary vaccination, if you had asked us a year ago whether we would get to 80% of African Americans, 80% of whites and 80% of Hispanics, 80% of American Indian and Alaskan Native, would we have gotten there? You know, I don't know that everybody would have said we could have. And we did. We still have more work to do.

>> Absolutely. Thank you.

>> Well, thank you so much for engaging in this session. It's been incredibly informative. I've just been sitting here thinking to myself CDC is really dealing with three simultaneous challenges. You have the COVID pandemic that you're confronting and leading the nation in. You're at the same time continuing the full-time work that CDC has always been doing and was doing before the pandemic. And you're trying to rebuild and strengthen the underlying foundation of public health all at the same time. So I think you're going to need good advice, and we'll do our very, very best to provide it to you. Thank you very much for your time this morning.

>> Really grateful. I'm looking forward to an engaging day. Thank you so much, everyone, and engaging several years ahead.

>> Sounds good. Sounds good. We're going to move on now to our next presentation. If we could have the introductory slide for that? We'll go fast and furious this morning. Again, real appreciation to Dr. Walensky, and now we're going to hear about a very special initiative that CDC is working on, the Data Modernization Initiative. Dr. Dan Jernigan is leading that initiative. He's the Deputy Director for Public Health Sciences surveillance that CDC and just a great person besides I know him better said he's just perfect for this role. So Dan, I'm going to ask you to start out with your presentation, and then we'll have an opportunity for questions and answers. Over to you.

>> Great, thanks. So just making sure that you can hear me, is that correct?

>> Yes, we can hear you. You're coming through loud and clear.

>> Alright, great. Thanks very much for the opportunity to speak with you all. And also just on behalf of us at CDC want to also indicate how much we appreciate the leadership, the expertise, and the guidance that we're getting from Dr. Walensky. And so it's a very difficult time, but it is -- it's great to have her in that role. We really support her in that and thanks for her being there. If we could go to the next slide. I've been asked to talk about the Data Modernization Initiative. So this is a big thing. It has an ultimate goal which you can also refer to as a North Star, and that is to move our nation from siloed and brittle public health data systems to connected, resilient, adaptable and sustainable response-ready systems that can help us solve problems before they happen and reduce the harm caused by the problems that do happen. So, DMI is really helping to get better, faster actionable intelligence for decision-making. So this is a big goal. And from a lot of the comments that were just being discussed, there's so much that needs to be addressed. DMI is sort of at the center of a lot of those different needs that are being worked on right now, both from the near-term efforts because of COVID-19. But also, because of the very long standing issues that we have. We know that we've had siloed systems. We have siloed programs that get their own money that beget siloed software that then beget siloed activities at state health departments. We know we've had outdated skills among our workforce, that we know that public health has not really been a part of the healthcare ecosystem, the ecosystem that got improved with a lot of CMS support over the last several years for meaningful use. Public health was left out of that. We know that there are a lot of burden on providers as well. And then finally, there's just lots of older technologies that we have at state health departments, at the local level that make it very difficult to scale. And during COVID, just simply were not able to do what they needed to do quickly in order to respond. If you can go to the next slide. So you know, I've been at CDC for a while and have seen a lot of progress. But just nothing like that has happened here just in the last two to three years, really because of COVID. There's a lot of work that was started. But the acceleration of that work has been incredible. Just a couple of things to point out. We've seen a massive expansion of electronic case reporting in 2019. Before COVID, we had only 187 healthcare facilities and providers that were participating. Today, there's more than 10,000 to 200 nationwide that are positioned to rapidly deliver COVID case data from electronic health records directly to the state health departments. That means that those doctors or those providers don't have to fax something. There's a lot that needs to be done in order to use that data better at the state health department. But the means are in place now to get that scalable way of getting all reportable diseases to be automatic and electronic. A second thing that's in place is known as COVID-19 vaccination data flow and the development of a cloud-based immunization data lake and gateway. So this is how we solve the problem of how CDC could take in, analyze and visualize the incredible volume and velocity of data on vaccine ordering, delivery and administration. And through this solution, now, we're able to expand our vaccine effectiveness data and push data out to the public faster through COVID Tracker like Dr. Walensky mentioned. So these are things that are amazing. They -- we are able to collapse all kinds of immunization information in a de-identified way. But we're able to do that because of the emergency response. And so as we think forward about how the ACD can assist or provide input, one thought is how do we take what we're able to do now because of the COVID response, and turn that into new ways of doing it, new ways of data use, authorities, et cetera, that can help this kind of data that is broadly useful to still float after the emergency stops? Finally, with the COVID Electronic Laboratory Reporting, or the CELR laboratory data flow, that is an enormous amount of data that is coming in. When we started, Tony Fauci basically said, "Sometimes, Dan, when we asked to do the impossible, you have to do the impossible." And getting every laboratory result that was positive and negative from all of the healthcare facilities in the United States being funneled into a single place so that we can look at that information in near real time, that was nearly impossible. But that was done through the work of a number of folks at CDC and all of the state health departments that have made that happen. That is something that we never had before. But it shows that you can get data to flow in a way that makes it very useful, and in real time it can really help the response by giving that data quickly. If you go to the next slide. So what are we doing? Those are some things that I just mentioned that have been considerable changes, but we are currently listening and we're connecting with a number of different partners. There have been a significant number of reports that have been put out from various different groups and agencies on how CDC and the public health establishment can do better with data. So these listed here are some of those. And so we've taken that information. And we've been meeting with those folks. We've established a new consortium of different partners to get together. We met with folks just at the end of last year with a number of those that are listed here to get their inputs on how best to architect things, how best to put the data together, and identify what building blocks of accomplishable things can be done quickly so that we can start moving forward with as much as we can do. We have a balance of an issue here of needing to get things done for the response, but at the same time trying to respond to long-standing problems that are not going to be easily fixed and will take a while for those changes to occur. So with this information, if you could go to the next slide, is a set of priorities that CDC has put forward. And so if you go to the Data Modernization Initiative website, you can get the strategic implementation plan that is available on the website. And in that there are five priorities that are listed. With DMI We cannot do everything. DMI can touch on every part of public health, but we have to identify some specific things that we can do over the next several years with the funding that we've been provided. Those five things are building the right foundation, essentially getting the data in automatically, having a place to land. The second is accelerating data into action. So taking the data, doing more with it, being able to scale up more quickly, utilize data differently. The third is developing a state-of-the-art workforce, which Pattie Simone will talk about a little bit later today. The fourth is to support and extend partnerships, really looking at those policy changes and Data Use Agreement changes that need to occur in order for us to utilize the technology more capably. And then the fifth is to manage change in governance. Because what we're trying to do here isn't just a technology thing. There's a significant amount of culture that has to change as well. And just as in any large business, or any large administration, we have to be able to address these things now. If you go to the next slide. The first of the priorities that we have identified is building the right foundation. That really just means bringing public health technology to a level and standard that's already in place outside of public health. So you already have your cell phone. You can already get stuff from your cloud. You can -- it's already happening there. How do we make public health have those same capabilities that we enjoy all the time as outside of public health? So those are four areas there. The first is to automate real-time data collection. And so we've worked with a number of our partners. [Inaudible], NATO, CSTE, APHL, [inaudible] and HIMS. And with them they had identified a concept called Data is Elemental to Health which listed laboratory information, electronic case information, immunization information, a vital statistics information or death reporting, and also getting the data from the state public health department to CDC. We have been able to help put together ECR, like I mentioned before, the case reporting. The ELR vitals. We have submitted $200 million that have gone out to the states in order for them to improve getting real-time [inaudible] listed death registry data, and also working with our Immunization Services Division at CDC and with immunization information systems to make sure that that data can flow in a much more seamless way and in a more timely way so it can be used more effectively. In terms of cloud-based services, CDC has actually moved into the Azure environment, a cloud at CDC. Yes, it's the first time that we've done that at CDC. That was really accelerated with DMI early on through immunizations by putting that platform in place that now allows for that de-identified immunization data, the sharing of immunization data between IISs and the vaccine ordering and other requirements for the response. But we've established the dialogue around a North Star architecture. We recognize that there's technologies that will allow health departments to utilize the cloud, to utilize those services that help to be more sustainable and more efficient. But there are authorities and there are policies that may not or may not allow us to actually use that completely. So we're working to identify what are the different architectures that can be made available to state health departments through the DMI efforts that will help them but are also accounting for the variations in the different policies at those state health departments? And finally, by building that architecture that utilizes cloud, utilizes shared services, we can get rid of those silos of those surveillance systems that CDC currently pushes down to the states by changing the arrangement of how they work so that all the data and all the systems are using the same kind of platform. Next slide. We're the second priority of accelerating data into action. This is really about taking that data that's available and doing things differently with it. So for one is a focus on rapid outbreak response. At CDC, we have been using -- at CDC -- excuse me, it's across the USG. We have been using HHS Protect, which is a Palantir platform that is used as a common operating picture. So that's basically data of record, analyses and forecasts of record that are in one place so that everyone can have access to it and then make decisions based on the same data. That approach is something that we have been meaning to have at CDC for a while. With DMI we're able to really push that forward and have these kinds of systems not just for COVID, but for other pandemic or outbreak-prone programs at CDC so that they can work in that environment in peacetime. And then when there is a need to go to a multi-state or national response, that same system can scale up without us having to switch around and redo things and start using Excel spreadsheets again. In terms of forecasting and outbreak analytics, Dr. Walensky mentioned that we have stood up a new center for forecasting outbreak analytics. That started at CDC that does some initial work with Omicron and are currently building right now. But really, what we want is to be able to use artificial intelligence and machine learning in these kinds of predictive analytics, that allow us to do more with our data, have a better sense of what's happening in the near term, but also scenario modeling in order to see what's happening in the future. That really, again, it's a culture change at CDC where we begin to see not my data, but our data. And once that data is available and accessible, then multiple tools that are shared can be used at CDC, that those same tools and services can be made available to our state and local partners. Linking and opening up data, certainly the open data standards and open data efforts that the federal government is going through DMI is helping the agency to meet those needs. And then finally, connected public health and health care data. Last week, we had a CDC Foundation all-day meeting on the future of public health, on data. And at that there were a number of efforts described of what we're doing with standards development agencies like HL7 to help build those kinds of standards that allow for you to share information in the same way that you are able to open up an app and share information with other people outside of healthcare. So with this, we're trying to say, "Let's develop those standards that helped bring public health into the healthcare ecosystem where insurers and pharmacists and doctors are able to communicate in a secure environment without causing any problems with patient confidentiality." Public health, state, local need to be a part of that same ecosystem. So that's what's being addressed with standards in that space. On the next slide. The third is developing a state-of-the-art workforce. I won't spend a lot of time here since you'll get a significant amount of data on that from Pattie Simone. But working on recruitment, training, on forecasting of the workforce needs, and then through significant resources being provided to state and locals. Next slide. And the fourth of those priorities, it's supporting and extending partnerships. And again, this is where we would look to ACD to help us with framing some of these things or coming up with suggestions about what kinds of policies will allow for better data sharing, what kinds of authorities might need to be in place. What do we need to do as we approach the end of the public health emergency in some of the ways that we're collecting information and the kinds of things that we can do with technology now will be changed because of the changes in the policies. Also increasing transparency, working on data use agreements, and then collaboration. Like I mentioned, the consortium that we're developing now to have people from public health partners but also those from industry, healthcare, and others helping to support us and give us information on how best to move forward. Next slide. The fifth is and final one is managing change and governance. At CDC, we've actually completely changed the way we do our governance, our information technology and data governance. We want to be sure that we have incentives that help people to want to move to a more shared environment and a shared way of doing software development. But we also need to have those teeth, if you want to think of it that way, that says that this is the enterprise-wide approach that we're taking. Your program, your data requests, or your software development is not approved in this current environment. And so having that kind of governance at CDC is critical, but setting a broader governance for that healthcare, that public health ecosystem that it has to do with what the states have with their systems, with CDC has, how we share information, how data can go through an intermediary like the APHL AIMS Hub or report stream. That kind of an environment needs to have rules around it, and agreements, and also a trusted network. So there are things that we're working on with the Office of the National Coordinator, Micky Tripathi, to help define what that trusted network looks like so that we can make data sharing between healthcare, public health and between public health safe and in an environment that allows us to use the capabilities that are there now for our healthcare partners. Finally, last slide. So while it's important to understand, you know, certainly what we've done with DMI so far, and what our plans are, as a part of these strategic priorities, you know, what's going to be different because of DMI? When the next emergency happens, we really are planning and hoping to have a foundation for data sharing across all levels of public health for coordinated, scalable and timely case investigation and management reporting, shared analysis capabilities for rapid identification of trends within and across jurisdictions, including forecasting and social determinants of health, a prepared data science workforce and decreased burden on the data reporters in our public health sending information to CDC. I think the last slide is just some possibilities of what we think would be good conversations to happen as we go forward. I think at the next of the meetings of leaders in May, there is planned to be a focus on data modernization. Some potential topics of interest to discuss at that would be the public health data ecosystem architecture. And that's referred to that in the first of the priorities. But really, they're saying, "Are there solutions that would be acceptable to state and local health departments that would help locals to have their information the same time a state gets it, and ways that the federal government can get appropriate information in more real time so that we have a much better view of what's happening? And when an emergency happens, we're able to have those systems and networks in place that allow for us to share data, when we really need to do something different." The second is the future of data and surveillance after COVID-19. We're currently counting every case. Dr. Walensky mentioned this. Is there an alternative way? Is there a representative geographically and sociodemographically to collect information from electronic health records across the US, that would allow us to get that kind of information in an automated way without the burden of trying to get every case and having every hospital report multiple different kinds of data? The third would be integration of health care and public health. And that's where the connection of standards working with ONC, working with standards development organizations and state and local partners who are working with them on that area, how can we make sure that public health can be a part of that healthcare ecosystem? And then finally, like I've mentioned a few times, those policies for data reporting, for sharing and use, some of those are authorities, some of those are data use agreements, some of them are regulations, some of them are CMS incentives. Some of them are conditions for participation. There are a number of those that aren't technology but are things that really make us do data modernization. And so with that, let me stop and hand it back to you, David, and see if there are questions.

>> Great. Thanks so much, Dan, for that presentation. It's really, really exciting work. I'm going to open this up to the floor for questions. We have about 10 minutes or so. But just wanted to express our real willingness to work with you on this initiative and our appreciation for you all considering creating a Workgroup to help advise you over the long term. And as you said, we'll be working on that between now and the May meeting and to discuss that more intensively at our May meeting. We do have a number of questions. Let me start with Dr. Jill Taylor.

>> Dan, it's really good to see your face, hear voice. And it's incredibly exciting that we're doing this now. We've wanted this so long. Two things that I think you didn't mention. One is the role of academia in public health, and especially, you know, sequencing of variants. I mean, academia has played an incredibly important role. There are also many academic institutions that have set up labs for testing. So just want you to keep that, you know, in the picture. The second thing is global. You know, you've talked about connectivity. But we're a small world now. So are we -- is part of the Data Modernization Initiative to connect to global data streams?

>> They're both great questions. I think on the first piece, as a part of the American Rescue Plan support that we received, a portion of that went toward the standing up of the Center for Forecasting and Outbreak Analytics. And a portion of that was distributed to a network of academics to help with an evaluation of the best algorithms, evaluation of new technologies and tools, identification of potential biases in algorithms that might lead to unfair health equity issues. There's a suite of things that are specifically funded out of that to the academic groups. We are working through the standards development organizations where a number of the academics are participating with regard to DMI in its sort of general sense. For the sequencing piece, as you know, there is a fair amount of the A and D funding that is going to be supporting a lot of that. So we're working closely with [inaudible] and his group with the funds that they have set aside to help build that cloud infrastructure for the sequencing data. That's a -- we're working on that closely. So the [inaudible] and a number of others are working in that space. The academics' participation in it, really what you're getting at is how do we broaden public health so that it's not just the public health lab, or just the public health department. And so part of that is getting the connectivity with data so the data can be easily more shared, but also trying to find out different ways of doing things. And so I think through the consortium, through our engagement, we've met with Amazon, Microsoft, Google, Mayo, a bunch of different folks trying to see how do they do things? How is it that we can use data we don't think about as public health data to help expand, you know, understanding social determinants of health? But also, how do we -- how do we use, you know, wearables? And how do we -- how do we get that other part of data that is out there that can help us? And academics can help with that, and so that that is a part of the overall plan. The last piece was on global. I won't go into depth, but there is American Rescue Plan funding that has been provided to the Center for Global Health where they are working on an overall plan on how to improve health systems strengthening which of those data systems in -- outside the United States, but also those connecting pieces of putting data together from various different countries. That's -- we think it's hard in the United States. [Laughter] It's really hard outside the US. And so our Center for Forecasting and Outbreak Analytics is working closely with the new hub. It's been stood up in Berlin with WH, but also with our colleagues in the UK and in other countries more bilaterally, to improve the connection of that real-time data or that sort of situational awareness data, as well as supporting some health systems trickling through the global ARP DMI money.

>> Thank you again.

>> Dr. Morita.

>> Hi, Dan, nice to see you again. Thanks for all your hard work throughout this pandemic. I was -- this is the second time I've heard your presentation. And it's just really incredibly meaty. And there's so much that you're planning to do, and it's really impressive to see. And I'm really looking forward to working with you through this committee. I think I have a couple questions or maybe comments more than questions. You've talked a lot about the sharing of data, especially with the private sector and healthcare systems. And I wonder about how you're thinking about as it relates to sharing data across other federal government [inaudible], because as we talk about social determinants of health, and the sources of data and information that can inform that kind of work, it just seems like they would be a potential partner and a great source of information. So that's just one thought. And the other thought that I have is really related to equity, because I think that there's probably -- so there's a working group for equity. There should be a Venn diagram of where the data -- this data modernization effort is and where the equity work is because I think there's a core element of how we build up this modernized data infrastructure, and making sure that it is equitable, both in the way we -- always collection analysis, use of data, et cetera. So just wanted to raise those issues as well. And I look forward to having the opportunity to work with you as we move forward.

>> Okay, that would be great. And so just, you know, I presented the five high priorities that we're doing from the strategy. Across that we've identified six use cases or six organizing drivers of it, kind of pulled together all those different pieces toward a single view so that you can make sure that you're getting some accomplishments represented. One of those is looking at the collection of data from multiple sources in order to address health equity issues. I think that gets at some of what you're talking about. So there are ways to improve the identity, the use of other data, so transportation data, 211 data. There's all kinds of things, you know. We are trying to do a review of what local health departments currently use. And the answer is they use everything. [Laughter] And so, you know, figuring out what is it that's going to be the most useful data that we could provide to them from different sources. Maybe Google has data, maybe it's transportation, or whatever. Having platforms where they can use that data and making that data accessible to them will save them time and allow them to be able to identify this SDOHs in prevention schemes from that. With regard to DMI and the health equity, or SDOH activities, we are coordinated at CDC with the CORE program, which you'll hear about later today. When they get to that you'll see there's a DMI column in there, in the framework that they have, and that for that, we have people that are assigned to help identify that. There's standards that we're working on with ONC about [inaudible] standards for SDOH. Other things, Disability is now proposed in the new US coordinator for interoperability, et cetera. So standards, systems, questionnaires, all of that is a part of the discussion. And we'll be able to do some of that with what we're trying to do.

>> Thanks so much, Dan. We have some speakers coming up later in the agenda who have fixed times when they can be with us, so I'm going to have to be a little bit of a time cop here. We can take about five more minutes of questions if people are willing to take about five minutes off their break, which I'm going to decide that we're going to do. But if you could be very brief. Dr. Goldman. You're unmuted.

>> Sorry. I want to thank you, David. And also thank you, Dan, for that presentation. I think that this is a very exciting area that you're moving forward in. And I'm very impressed with the quality of the planning. I think a couple of things I would note. I mean, one is that, you know, the experience has often been after a major pandemic or crisis that there's something given across the nation to every public health department, a new computer system, Internet connectivity, whatever. But nothing has been done to create a sustainable system that actually puts in the hands of the state and local health departments the expertise that's needed to keep that current and keep that at the cutting edge. And that's why we had people sending faxes to each other because that was at the cutting edge like 20 years ago. And when they were all given a fax machine, probably, and I'm not - I'm not being sarcastic. That really did happen, I think. I really think that this is a two-way street. And when in the work that I do, there are people in healthcare who really want to address social and environmental determinants of health. But their records don't include variables that are relevant to that. They need public health's help with developing standards around how you actually collect that information, or they're not going to be able to address it in healthcare. And maybe you know, what you don't know, you don't know. And that's that, I think, is the fundamental issue that I am confronted with when we try to do things in public health with EHRs. The other point I would make is that and Dr. Taylor mentioned, you know, universities do all kinds of things. We're doing a lot of work in data science and genomics. All, you know, supported by the NIH, but it provided a platform for what we did during the pandemic, even though it was for NIH research projects. But we haven't had the benefit of that kind of relationship with CDC. And including with training. We're training people in health data science, but not for you guys. And so I think that that's the other thing worth considering. Thank you. [Inaudible]

>> Excellent. Dr. Martinez.

>> Thank you, David. Dan, great presentation. Nice to meet you virtually. I agree with Dr. Morita's points about health equity. And Lynn Goldman's points about the social determinants data points, which I wanted, just to support because I was going to comment on that, but they covered it. The other one, though, is even down in the weeds about the categories we use for demographics. They do not really represent the diversity of this great country and ensuring that that is also happening. So when we aggregate data, there's the ability to then disaggregate it and be able to say, what is actually happening to say like, get these Americans across this country? Just pointing out that we want to ensure that we have that capability. So kudos to your team. Thank you.

>> That's a big one. But yeah,

>> Important issue. Dr. Adimora?

>> So first, thanks very much for that great presentation and for your service during this time. But you know, so this is a sort of a very naive, basic, perhaps stupid question. But it's my understanding -- in fact, I know that there's great variation in the local level and the capabilities of various local health departments and even among states, and I know that you're going to provide some funding and some training. But how exactly are you going to get some of these more basic people, or areas with more basic skills and resources enough up to speed to create the foundation that you're talking about?

>> Yeah, so part of that is going to be addressed, I think, with Pattie in the workforce discussion. It's following. But to your point, there are capabilities now where you can build and deploy something where it's in somebody else's cloud, and we can update that. And they don't have to worry about it. So when we talked about the North Star architecture, we're trying to say, is there maybe three kinds of architecture that we want? One where somebody takes care of everything themselves, one where we provide them the same kinds of services, but they manage it in their own environment. And the third, maybe there's a CDC-hosted environment where certain parts of the US just don't have the capabilities. They don't have the people. They don't have the technology. Can we provide that to them similar to how you are able to do all kinds of stuff like ordering an Uber on your phone? You don't need to know anything about the map, the person, the verification. It's all taken care of for you. So there's some of those kinds of services that could be provided so that locals don't have to do some of those things, ways of analyzing data, ways of verifying data, things like that. But we would hope those building blocks of services and standards could be identified and implemented as we go forward.

>> Thank you.

>> Great question though. And last question, Dr. Albert.

>> Thank you very much. Nice to meet you, Dan, virtually as well. My question pertains to the stakeholders. In the presentation, I did not see anything about the public as a stakeholder, as opposed to being just an end user being a more upfront user of this of data modernization, right? Because to put the data into action, ultimately, you have to get buy in and for the equity component, the trust and who's seeing the data, and who's, you know, packaging the data becomes a very, very important, you know, part of this. So I was curious about how the public would be a [inaudible].

>> That's a good one. We tend to return to our familiar partners, our public health partners, our healthcare facilities, that kind of thing. There's two parts there. One is to the general public. The other is the individual. And so you know, as we move toward distributed medicine, you know -- you get your entire health record you can get on your phone, now -- we have to be thinking about how the individual participates in public health, especially when they're going to be doing their testing at home. They're going to be doing their medical visits at home. How do we make sure that we're either a part of that or that public health is considered in that ecosystem, so that we can monitor what's going on? But also can we use that to provide information back either to a population or to an individual that helps them to change the behaviors that they have for public health, but also for them to participate with us so that we understand better about what their needs are? So that's a part of it. But in terms of just getting that stakeholder involvement, we don't have a specific public representative in our consortium at this point, but that's a great point for us to think about how better to assure that we're getting the public's input and the individual's input into what is traditionally a closed group of healthcare and public health, folks.

>> Wow, thanks so much, Dan, for this great presentation. And for spending that time with us today. This work is so critical. And we just look forward to working with you to provide ongoing advice and serve as a sounding board for where your work is going into the future.

>> Great. Look forward to it. Thanks.

>> Great, thank you. We can go the next slide, please and our next presentation. I'm really delighted to be able to have this next presentation on the public health workforce efforts. And we're going to be hearing from Pattie Simone who's the Director of the Division of Scientific Education and Professional Development at CDC. But she's also taking -- been given the lead at CDC for this incredibly important workforce initiative, including the substantial resources that have been made available. So Pattie, over to you.

>> Thank you, David. I'm really excited to be with all of you today to talk about two new things that we're going to be doing to support workforce development. I think this follows really nicely from Dan's presentation because we need the right workforce to support data modernization. And we also need better data and systems to support workforce development. And like the enterprise approach for modernizing CDC's data systems, we're initiating an enterprise approach for workforce development to ensure we have the right people with the right skills to respond to evolving public health issues, both here at CDC for our own workforce and for the public health workforce and state and local jurisdictions. Next slide. So as has been mentioned already a few times, the work -- our public health workforce is our first line of defense against disease outbreaks and other health threats. And yet decades of underinvestment has undermined the public health workforce with both shrinking numbers and capacity. COVID has highlighted the critical role of the public health workforce in responding to emergencies and shown us the consequences of that underinvestment. There are various estimates of the staffing deficit, including the recent staffing up report, which is Dr. Walensky referred to which estimated the need for an additional 80,000 full-time staff just to provide the minimum public health services. But next slide. Let me talk about rebuilding the public health workforce. We can't just talk about staffing. We need to include all parts of workforce development, such as recruitment, hiring systems, fellowships, and other pathways, training and upskilling, data to understand what is needed and diversity. And yet, next slide, public health has fallen behind in many important areas of workforce development. For example, skills have not kept up with changes in technology. We don't have the systems and data to assess and monitor what's needed. There are issues with diversity, and hiring barriers exist at federal, state and local levels. Funding is just the first step in solving these problems. But even with increased funding, substantial barriers remain. Next slide. The American Rescue Plan specifically addresses expanding the public health workforce. The ARP policy, which was announced in January proposed expanding the public health workforce by 100,000 to address the needs of COVID and build long-term capacity. The legislation passed in March provided $7.66 billion to the Department of Health and Human Services for expanding the public health workforce. And some of these funds have been allotted to CDC. Next slide. We are now at a critical juncture. And looking forward, we have a great opportunity to make important progress in workforce development. While we can't make up for 20-plus years of infrastructure erosion overnight, there are critical issues on which we must make progress. We can think of the way forward for state and local public health as a three-pronged approach, build, bridge, build and sustain. First, we have to bridge with innovative interim solutions to address urgent needs. Building on lessons learned during COVID, we need to implement a combination of interim solutions such as through public-private partnerships. Bridge solutions can help in the short term, while we learn to -- learn more to understand what is needed and identify solutions for the long term. But then we need to apply what we learned to build the public health workforce with hiring. So let's say we're talking about the need for -- to stay in the public health workforce, we're going to need reliable ongoing federal funding and a commitment at the state and local levels. Let's go to the next slide. Here are two examples of bridge activities, which include CDC Foundation funding to hire staff to be placed in jurisdictions building on a successful smaller program that was done in 2020. And a two-year funding through the Crisis Cooperative Agreement to support staffing, including school nurses. Next slide. There are three examples here of building the public health workforce, which include a five-year program to fund disease intervention specialists in jurisdictions to support contact tracing and outbreak response for COVID and more broadly. And we are very excited about Public Health AmeriCorps for a new pathway program in partnership with CDC. Grants will be made to organizations who can recruit and place over 1000 members per year in public health jurisdictions and who reflect the communities they serve. We will also be expanding some of our most successful CDC internship and fellowship programs such as EIS, the Epidemic Intelligence Service, and other programs where young professionals are placed in public health jurisdictions to support response activities and help build capacity. Next slide. To begin to move us to a more sustainable approach, for the first time CDC will have a new grant program focused on public health workforce. This is a unique opportunity to address workforce needs broadly across the jurisdiction, rather than categorically by disease as funding is usually awarded, and there will be a focus on building a workforce that represents the communities they serve. I also want to emphasize that rebuilding and sustaining the public health workforce can't rely on federal funding alone. It will also need a commitment from state and local jurisdiction to -- jurisdictions to develop plans to spend the large amounts of federal funds already awarded, address systemic barriers that have led to the current state, and develop plans to rebuild and sustain the public health workforce long term. We recently completed a series of listening sessions to get input from jurisdictions and other partners to inform the design and focus of this grant to make sure it's -- the program can be successful. And before I go to the next slide, I just want to talk about some of the things we heard during these sessions. We had six sessions with external partners, with 156 people from 100 different organizations, more than 100 organizations. Some of the things we heard are, we need to maximize flexibility to allow jurisdictions to determine the greatest needs for the funds in their jurisdiction, to structure the grant to complement existing mechanisms to prevent duplication, to support retention strategies, including loan forgiveness, to prioritize training for the existing public health workforce, to develop a central platform or forum for grantees to share programs, best practices or other resources in order to facilitate collaboration, to extend the length of the grant as long as possible, to streamline requirements for grant application and reporting to reduce unnecessary administrative burden, and to support partnerships between public health entities and academic institutions such as the Academic Health Department model. One challenge is the need to collect, analyze and use more comprehensive data about the public health workforce. So to help address this, we are co-sponsoring a new Public Health Workforce Research Center with HRSA. It will be funded as part of the recent Notice of Funding Opportunities that was posted on January 14 through the HRSA Health Workforce Research Center Cooperative Agreement Program. The priority topics for the Public Health Workforce Research Center include things such as workforce composition, data and needs, methods and analytics, scientific research, including identifying evidence-informed strategies and interventions. So I do think the data on the public health workforce is a bit more challenging in many ways than the health workforce, which has licensure and certification data. But we do think this is a really important step to address the need for this data building on some of the recent work by development at de Beaumont Foundation and others. Next slide. So we're at a time of great opportunity. There's a lot of funding, but now we have to deliver. It is not as simple as having money to hire. We need to modernize antiquated hiring systems and conduct comprehensive workforce planning. We need to focus on professional development, mentorship and training for the needed strategic and technical skills. We need to work with academia to give more students applied learning experiences to better prepare them for jobs in public health, and also figure out how to get more public healthcare graduates to choose public service and jobs in governmental public health. Through pathways like Public Health AmeriCorps, we can reach a more diverse group of students who previously never considered a career in public health. We need to strengthen recruitment with a focus on diversity and health equity and address the important role of student loan repayment and loan forgiveness for public service. We also need to provide opportunity to hear from jurisdictions who have had some successes in these areas to share best practices and lessons learned with others. And as we design the new workforce grant, we want to incorporate those lessons and gather other input to make the grant successful and contribute to sustainable solutions. Okay, now I wanted to briefly describe a new enterprise approach for the CDC workforce. Next slide. In October 2021, we launched the new CDC Workforce Governance Board. This is an enterprise approach to workforce development with the goals to help ensure that workforce development efforts are coordinated, strategic and based on the best evidence. Effort should also learn from and build upon existing programs and address diversity and equitable access for staff across the agency. Dia Taylor, who is CDC's Chief Human Capital Officer, and I co-chair the board, with members representing a variety of workforce experience and expertise. The initial focus of the board was to solicit proposals and make recommendations for using some of the ARP funds to expand CDC fellowships that I mentioned earlier. Next slide. We are now starting the process for the board's strategic work. Like the process for Data and Systems Governance, the ongoing work of the board will be to provide strategic oversight to agency workforce development initiatives. It will support agency strategic priorities, including a special focus on diversity, data science and leadership development, provide best practices for programs across the agency, develop a strategic framework for CDC workforce development, and guide decisions for investments in workforce development programs. Just to say that we have a lot of challenges, but also tremendous opportunities right now. And I think the future is bright. The steps we take now will have an impact for years to come. And I look forward to hearing your questions and comments.

>> Thanks so much, Pattie. That was a great presentation and just such important work. I'm really happy that that you're doing this. The floor is open for questions for Pattie. Ms. Valdes Lupi.

>> Pattie, good to see you. Thank you so much for walking us through that framework that you described in terms of bridging, building, and sustaining. I had a question about the sustaining updates that you shared in the piece that I might not have heard but would be interested in your take on this. It isn't exactly the best environment to recruit in. I thought it was a bad environment during the great recession, and we were doing mass layoffs at the state health department. And it's even worse now given all the hostility and threats that our health department staff are facing. The one segment though I wondered if you could speak to that has really stepped up during the pandemic -

[ Inaudible ]

-- community based.

[ Inaudible ]

-- communities that are being served. I wonder if you could say a little bit more about that in terms of community based workforce? And this is really, you know, beyond - it CHWs, but everyone who's helped in terms of testing and tracing, [inaudible] and vaccine efforts. And so could you say a bit more about how you're thinking about workforce and building skills among community-based members?

>> Right, so thank you for that. It's obviously a very, very important part of this work. It's -- so the grant that I'm talking about will be to public health jurisdictions. It will be a competitive grant. It will go to states and other territories and local will be eligible for this. Locals will be eligible for this funding. We're building in pieces so that some of the funding will go locally for some of this effort. So all of that -- the specifics of how that's going to work haven't been completely worked out. But that is clearly an important goal for the way the grant is going to be done. This also will complement another number of other efforts where there are more specific funding for different types of community health work. I think that the - -- the nice thing about this grant is that it can help fill in the gaps where there's other -- where other funding opportunities are not filling. So it can be based on what the jurisdiction thinks are their most important gaps and complement the other types of funding that they are receiving for some of these things. So yes, so community workers are important and are definitely all -- I guess last thing I would say is that the grant will allow for all types of workers to be hired. It's not going to be specific about different job categories or whatever. It should really ideally be based on a comprehensive assessment that the jurisdiction has done and what their needs are. You know, the ability for the jurisdictions to do that right now, it may be, you know, better in some than others, but it will allow for whatever the needs are, including things for foundational capabilities, such as maybe you need grant specialists, or people to help with communications, or things that don't always get funded within the categorical funding. So it should be able to support those kinds of roles as well.

>> That's great. Great question. We have about three questions in queue. We'll stop it at those. If I asked you to be as brief as possible, succinct as possible. That would be great. Octavio? You may be on mute.

>> How about now?

>> Yes, we can hear you.

>> Very good. Pattie, great presentation. And this plan is not just a numbers game but is also about the skill sets needed for the 21st century. One of those is really the skills of community engagement. You're looking at ensuring that happens. It's about the values and also, the different models out there. Those community engagement skills were some of the things we identified that was what was lacking during this pandemic early on. And even unfortunately, still now in the Presidential Task Force. Because the public health workforce needs to -- with our different communities in partnering with communities of color. So just wondering if you could comment on them.

>> I think that's critically important, I think if this funding would certainly support any efforts that jurisdiction wants to do in that area. Also, we'll have some funding to work with public health partners to provide technical assistance and other resources. So figuring out the best -- things that people don't have that they need, and how we can help facilitate that as another way. But yes, that's really going to be important to achieve the goals of this grant, for sure. Thank you for that.

>> Thanks. Thanks. Ms. Gary?

>> Yes, thank you. Just wondering if you could speak a little bit to how far down the pipeline you're looking with many of these efforts. I understand the urgency of addressing the immediate workforce needs, but also, you know, the point of, you know, kind of the long-term sustainability of making sure we have younger people that are choosing to go into this, so is a college level, high school level, or, you know, kind of looking along the pipeline broadly?

>> Right. So the grant itself is really focused on either trainees that are working in the community that could have a pathway to employment, or to -- for the workers -- for new workers themselves, or for the current workforce in those jurisdictions. However, lots of other things that we're doing are looking to address those things. And, in fact, in my own division, we do some work with, for example, middle school and high school teachers to help with curricula, and think -- to help them think about public health and learn public health, you know, introduce public health even at an early age. And so that's just one example. We have other types of student programs. But, yes, we need to be thinking about pathways and, you know, getting people to think about public health as a potential career as early as possible. And we have a number of efforts to do that, even though maybe won't be specifically in this particular grant. Thank you.

>> Thanks, Pattie. Dr. Hardeman, last question.

>> Thank you. Thanks for the presentation. You know, as someone who sits in a school of public health and, you know, educates students in the future public health workforce, we have seen enrollment in our School of Public Health at the University of Minnesota increase during the pandemic. You know, the Fauci effect has definitely impacted us. But what we also have noticed is that and this was a part of the comment, I think, maybe it was Octavio mentioned that, you know, the community engagement skill set. And I would also add to that, the need for an antiracist framework for, you know, training the future public health workforce is critically needed. And so thinking about how do we work sort of more closely with all of these institutions that are training this public health workforce to really make sure that that's happening? And I'd love to just sort of hear your thoughts there. And also, I think it's something you know, that the Health Equity, you know, Working Group can also, you know, tackle and someone else had mentioned, sort of this Venn diagram of all of the, the ways that the CDC's conversations overlap with the work that we'll tackle in the Health Equity Group. And then the other piece of it I was just going to mention is, you know, I was happy to hear you mentioned the exploration of loan repayment. I think it's critically important to think about that as we do the work of building this pipeline and supporting a diverse public health workforce. Thank you.

>> Thank you. I think, partnership with academic partners in helping think about curriculum, preparing the students as they are in their -- during their education, and helping us in our other types of training, make sure we have the right curriculum for community engagement and diversity and health equity is really important. I think there's room for that in some of the work that we're doing. But I think the advice from all of you on that, too, would be really helpful and agree that it's an integral part of the other diversity and health equity work that you all will be tackling. So look forward to hearing about that. Thank you.

>> Pattie, thanks so much. And please come back to this committee as we can help and you have questions that some outside perspective would be useful on. We're really very, very interested in this. We realize it's the underpinning for much of what our public health system is going to be able to do. So thank you. And thanks again for your presentation today. And the good news is that we are at our break, and we have checked with our speakers after the break, and they can delay by five minutes, their time. And so we'll go ahead and take the full 30-minute break at this point and start up promptly at 20 after the hour. Thanks so much, folks, and we'll see you in 30 minutes.

>> Dr. Medows, Dr. Martinez, Dr. Taylor, Miss Gary, Mr. Dawes, Miss Valdes Lupi, Dr. Hardeman, Dr. Shah, Dr. Adimora, Dr. Morita. I believe that is all I see in my screen. One, two, three.

>> And I'm back. I'm back as well, guys. This is Debbie.

>> Okay, so I believe we have 13 members of the ACD on, David, and we have a quorum. So I'll turn things over to you.

>> Thanks so much, John. And thanks so much to the committee members. I hope you enjoyed your break. And thanks for returning. Through the magic of Zoom, we can avoid a roll call. It's so nice, because we just look to see who is here. So that's great. We do want to get on with the next part of our presentation because the speaker does have some time constraints. So let's go ahead and do that. If we could put the next slide please? Well, it's really my pleasure to introduce Barbara Mahon. Barbara Mahon is the Incident Manager currently for the CDC COVID-19 Response and will be updating us on that response. CDC rotates through Incident Managers. And so there have been several in this role during the pandemic. She may tell. She took on this several months ago and has been doing just an incredible job. So thanks very much, Barbara, for joining us today. And I'm going to turn it over to you for your presentation.

>> Thanks, David. And I'm happy to be here. This -- it's exciting to be speaking at the first meeting of this committee. If you could go ahead and go to the first slide. So you can go to the next one. So the pandemic is, as you all know, roaring on its way. Globally a total of almost 365,000 confirmed cases. I'm sorry, 365 million different places globally and 5,600,000 deaths to date. And we know this is an undercount, especially in Africa, which looks like it's in much lighter blue on this map. Next slide please. In in the US, COVID cases have increased rapidly since the first Omicron case was reported on December 1. And case counts are currently exceeding the peaks from last winter. Hospitalizations. So you see that in the blue graph, or purple graph. Hospitalizations are also increasing but not at the same rate as the cases. If you compare the size of the peaks, you can see that it's really disproportionate. We've been seeing in recent days, these are data from January 26 to 27. And we've been seeing widespread decreases in cases and hospitalizations across almost all states in the last several days or week or a week or so. Next slide, please. And then in terms of deaths, it's similar to the hospitalization rates. We've seen an increase the number of deaths in recent weeks, but the rate of death has not increased as rapidly as the number of cases. Next slide, please. And to put all that together, this is a graph that I think is really helpful, which shows the national trends compared to the winter 2021, 2020 to 2021 peak last year at this time. So what this slide shows is the cases -- case incidence in purple, hospital admissions in orange, and deaths in blue expressed each of them relative to their peak in December 2020. And so what you see is that really until the time of Omicron, all the way on the right-hand side of this graph, they were tracking together. But now for the first time during the Omicron surge, we're seeing a real decoupling with cases much higher, but hospitalizations lower, and that's even lower. Next slide, please. So moving on to vaccination. This is just some information about our domestic vaccine uptake. We now have vaccinated three-quarters of the entire US population. That's including children who are not yet eligible for vaccination, so at least three-quarters of - three-quarters of the population has received at least one dose. And while that is very far from everything we want to accomplish, it is a pretty remarkable achievement. And I think it's just worth noting and celebrating. Sixty-four percent of our population is fully vaccinated. And 64% also of those who are over 65 have had a booster or additional dose. There's been a lot of attention and effort, and I would say really pretty remarkable success in reaching a groups across our population equitably. Far from perfect, but there's been a lot of progress since the beginning of the vaccine program until now. Next slide, please. In terms of global vaccine uptake, another pretty remarkable achievement, more than half of the total global population has been fully vaccinated. And 61% of the total global population has received at least one dose with more than 10 billion doses of vaccine administered. The US has -- is donating 1.2 billion COVID-19 vaccines and is supporting 70 or more countries to receive and administer these vaccines. And as the access to vaccine supply has increased globally, we've shifted CDC efforts from vaccine preparedness to implementation and are working on planning, improving vaccine confidence and demand in all the -- you know, many different populations that we're working, supporting vaccine safety monitoring and supporting evaluations of vaccines and vaccination. So this is remarkable. But we must acknowledge uneven progress, and there is still quite low coverage in many low-income countries and in the Africa region. So this is not a total success, although it is still a pretty remarkable achievement. More work to come here. Next slide, please. I wanted to spend just a minute on our COVID vaccination guidance. You know, in some, the guidance is that everyone ages five and up should be up to date on their vaccines. And you've probably seen over the last weeks and months recommendations coming out for ever younger age groups and for boosters and for additional doses. I'm not going to go into the details on those, but on the next slide, I did want to just spend a minute on the definitions of "fully vaccinated" and "up to date." Can we go to the next slide please? So we've updated this terminology recently for clarity, as vaccine recommendations get more complicated, and also to be consistent with the way we talk about other vaccines that are given, you know, whether to travelers or routine childhood vaccines or adult vaccines. So consistent with the standard terminology, "fully vaccinated" means that a person has received a complete primary series. So that would be two doses of one of the mRNA vaccines, or one dose of the Johnson and Johnson vaccine. "Up to date," on the other hand, means that a person has received all the recommended doses for them. And so there's going to -- up to date is going to depend -- whether a person is up to date will depend to some extent on their age, their health status, their own vaccine history. And this is again the same as other vaccines. Those of you who have tried to figure out what -- whether someone is up to date on pneumococcal vaccine, for instance, knows that this can get to be quite individualized. And so the up-to-date language allows us to have a common currency for understanding whether someone is due to have a vaccine or not. Next slide, please. So, in the next several slides, I wanted to give you a quick tour of Omicron. And on the next slide, I think you are all aware of the history. It emerged -- it was actually first detected in Botswana, but first reported by South Africa in November, and we saw the first -- we identified the first case here in the United States on December 1. We have worked quickly to answer a number of key questions regarding Omicron. In terms of its transmissibility, the severity of disease, escape from vaccine or immune protection, how well our diagnostics are working, how well therapeutics are working. And at this point, we really know a lot of the answers to these questions. So next slide, please. In terms of the prevalence of Omicron, this is our genomic surveillance, Nowcast, which is updated weekly. Each one of those vertical bars is a week, and the orange represents Delta, the purple represents Omicron. Omicron now accounts for 99.9% of US cases. And as you can see, it overtook Delta as the primary variant in really just a matter of weeks. Same pattern as it's been seen in a number of other countries. We are monitoring the sublineages of Omicron, including the sublineage BA2 that has gotten some media attention in the last several days, and the sublineages are currently aggregated within Nowcast, but are also being tracked separately. Next slide, please. In terms of severity, I wanted to highlight this study. A number of -- a number of studies from a number of countries have shown that on a case-by-case basis, Omicron is presenting with less severity than previous variants. But I wanted to highlight this study in particular. This was a study that from the CDC's new Center for Forecasting and Analytics, that was conducted in collaboration with academic investigators using data from Kaiser Permanente Southern California. And it was a very important study conducted very quickly. It was published actually, more than two weeks ago, or posted more than two weeks ago. And so what you see in the left panel, the purple is the is Delta of this by proxy, infections with non S gene target failure, and the green is Omicron, which does display S gene target failure. And what the left panel there shows is that there was a lower probability of symptomatic hospitalization, of ICU admission, of mechanical ventilation, and most of all of death in those infected with Omicron versus Delta. And then in the right panel, it's showing the length of stay. You see really a substantially shorter stay for Omicron than for Delta. On the next slide, in terms of immune escape, there are multiple laboratory-based studies that show many-fold reduction in neutralization, from both vaccine and infection-induced immunity. And these figures are pulled from just one of those studies. In each of these panels, the red bar on the right-hand side is Omicron. And you can see how much lower the neutralization is than for other variants. I won't go through this in detail, but I think the pattern is clear to all of you. On the next slide, thankfully booster doses do restore neutralizing titers against Omicron. So although the currently authorized vaccines offer less protection against infection due to Omicron compared to previous strains and previous variants, they do still provide some benefit. But the booster really restores the titers close to what they were -- neutralizing titers close to the levels for previous variants. So focus on the right panel, where the red part of the figure is the Moderna vaccine, and the blue is the Pfizer vaccine. And you can see how the times-three titers are much higher. That's the people who've received two doses and a booster are much higher than the times-two titers, which are people who've received just the primary series. Next slide, please. And indeed, clinical data have borne out that vaccine effectiveness is lower for Omicron than for Delta, and also that it substantially improves with a booster dose. So this figure is pulled from one of the initial papers that came from the UK which had their Omicron surge started a couple of weeks before ours. And you can see, I just want to point out, you can see that the Omicron is the gray circles. You can see that it's lower than Delta in the black squares really throughout. And at that -- the waning over time is more marked for Omicron than for Delta. But in the right-hand panel, you see people who have had a booster. So these are people who had their primary series with Pfizer, and then had a booster with either the Pfizer or Moderna mRNA vaccine. And you see that the vaccine effectiveness, while still slightly lower for Omicron than for Delta is really quite good and high. So let's move on to the next slide. We have also -- we also have released a lot of good data showing the same patterns in the US. This again, I'm pulling these figures from just one of several recent reports. These are incidence data that are collected from 25 US jurisdictions, and they show the case incidence on the left and the deaths on the right. So starting with the left-hand panel, you can see that throughout the entire period, and this is going back a number of months, the case rates have always been highest in unvaccinated people. That's the black line. During the recent Omicron period, you see cases increasing across the population, including in the fully vaccinated people. That's the dashed blue line. And also in people who've received a booster. That's the lowest dark blue line. But you can see that there's a really marked difference, markedly lower for the fully vaccinated people and even more so for the boosted people. Looking over on the right-hand side, you can see that there's an even greater difference in death rates. This is actually -- there's actually a 68-fold difference in death rates in people, lower in people who have received -- were up to date with a primary series and a booster. Then there are a number of other US studies that I am very proud of that I'm not going to show you today in the interest of time. Let's go on to the next slide. So in terms of therapeutics, the three antivirals that are authorized for therapeutic use in the US are all effective against Omicron, but only one of the authorized monoclonal products, So sotrovimab retains activity. And there's also another monoclonal, Evusheld, that's approved for pre exposure prophylaxis for immunocompromised people. Next slide, please. And this slide is showing the results of studies looking at neutralization with monoclonal antibodies. In these panels, Omicron is in red. And if you look at the bottom panel, one from the right, that's the sotrovimab panel, and you can see that it does in fact neutralize Omicron quite well, as opposed to the other products that are authorized in the US. So this slide includes some products that aren't authorized in the US, but for all except Evusheld that are authorized in the US, you just see that red that looks like a flatline, not being neutralized at all. Next slide, please. So CDC has emphasized in our messaging around prevention of Omicron that we do know what works to prevent COVID. And we've been emphasizing vaccines, masking, ventilation, testing and adherence to quarantine and isolation guidance. And let's go on to the next section. I wanted to spend a few minutes talking to you about some of our -- where we're looking to the future. So future considerations. So next slide. So first, continued and improved surveillance. We are, of course continuing to collect and analyze actionable data about the pandemic, emphasizing timeliness and really increasingly looking ahead to future needs. And I'll leave -- I know you have these slides. I'll leave -- I won't go through them in detail. But I just want to emphasize that this is very - we're very much thinking about the Data Modernization Initiative here, and also about innovative strategies like wastewater surveillance and how those will be integrated for the long haul. Next slide, please. Another important focus for us is on increasing vaccination coverage, including supporting efforts for all eligible individuals to be up to date on vaccines, and preparing for availability of vaccines for children under five, which is anticipated to happen at some point. We don't know exactly when. Next slide, please. There's a lot of effort that's going into continual reassessment of mitigation and prevention strategies based on incoming data, adjusting them as necessary in the context of currently circulating variants, and currently in current case incidence. nd just as important partnering across the US government to ensure that there's ample access to those mitigation strategies for everyone in the population. Next slide, please. I know that you as a committee are going to be focusing on quite a bit on equity. And so I wanted to mention in this context, that equity has been a major focus for the CDC COVID response. We have a Chief Health Equity Officer with a large and active staff that's engaged across all the task forces of the response with other US government departments, with public health, with jurisdictions and with many, many community organizations. Some of their recent achievements include developing and launching the CDC COVID-19 Response Health Equity Strategy to guide equity efforts in the response, creating the what we call the HEAT, the Health Equity Action Tracker to serve as a central repository of information for use across CDC and to respond to requests for information about related to health equity issues, standardizing the collection of health equity-related data within COVID Data Tracker to increase information available to decision makers in the public. Reviewing communication processes to ensure cultural appropriateness for intended audiences and to promote inclusive non-stigmatizing language, and then publishing our findings of our efforts. Next slide, please. We are working to develop and effectively communicate guidance changes to reflect needs at the current stage of the pandemic. We have at times gotten ahead of our communications. They've not always gone as smoothly as we would like. We are -- we are working to learn the lessons that are available to be learned and to continuously improve. Next slide, please. And then finally, at this point in the pandemic, we all feel that it's time for CDC and public health partners in the country to be working on integrating COVID into routine public health practice. At CDC, this is going to mean the eventual transition of COVI- related activities to their, quote unquote, home programs. We're beginning to plan for when this time comes. We are certainly not standing down the response. But this is a huge response. And planning for this transition is a journey. And we are starting on that journey now and hoping that we will be able to complete that journey at some point. And I think that's the end of my comments. We can go to the next slide. Yep. And I'm happy to take questions about what -- about aspects of the response, what's happening with COVID, et cetera. And I will do my best to answer them.

>> Barbara, thanks so much for that fantastic presentation. Can you just let us know -- I know you're on a tight time limit. About how much time do you have for questions?

>> I have about 16 minutes.

>> About 16. Okay, perfect. Let's go to Dr. Adimora then.

>> First, thank you. That was great. A comment and a question. So my personal recommendation is that the term "fully vaccinated" be sort of retired as soon as possible and moving to just up to date, because I think it really is too confusing for the public to hear both terms. And what the real interest is, of course, up to date. So that's just a suggestion. The next thing is I was just curious about with all the home testing, how will it be -- how will those feed into the data concerning the number of cases, the case surveillance? I mean it's obvious we can check hospitalizations and deaths, but as people start to test themselves, how will that work? In terms of data?

>> Yeah, those are two excellent question. So first, regarding up -- regarding fully vaccinated and up to date, you know, it's a complex issue, more complex than for other vaccines because of the fact that there's a number of regulations that have been issued by other parts of the government that depend on that language. So that is somewhat outside of CDC. CDC doesn't, hasn't, you know, we're not the primary players in that space. But we think that at this moment, the up-to-date language, but what we're focusing on the up-to-date language and are expecting that over time, that's going to be increasingly, you know, what everyone uses, but there are these broader considerations around fully vaccinated that limit how quickly we can move with changing that language. Regarding the home tests, we've been in -- we've had a number of discussions with jurisdictional partners, health departments and others. And there's pretty you -- pretty much a kind of consensus across the state and local health departments and in CDC, that we don't think that -- well, you know, some states, the states have the ability to allow people to notify the health department of their positive test. We don't think that those data are going to be particularly useful for national surveillance. We think that we can follow the important trends, the important burden outcomes, based on the testing -- the surveillance strategies that rely on non-home tests, and in particular, the, the medically important outcomes, which hospitalizations, but not just hospitalizations. Also, you know, people who seek medical care, people with long COVID, people with [inaudible]. You know, all of those outcomes that are of most importance for public health action to try to prevent. We think that we're going to be able to track those through -- track those very well actually attract the, you know, trends well, with surveillance strategies that are more similar to the strategies that we have used for influenza. So I think that for the home test, the most important thing is for people to have good information about what to do if they get a positive test. For them to be -- to know that, you know, they should let their contacts know. They should, they should read what the isolation guidance is, how they would access treatment, if they would benefit from treatment. That they should let their healthcare provider know. But we're not currently pursuing avenues to incorporate those tests into national surveillance.

>> Thank you.

>> Great. Thanks so much. Dr. Goldman?

>> Hi, Barbara. And congratulations, by the way, for the many, many things that you've accomplished since you've been in this position. I have to agree with the comment, by the way about up to date, and then we don't have to change everything that we're saying every other week. But I do think that I mean, I, myself have some skepticism actually about what you just said. And in terms of, you know, making this more like influenza surveillance. I mean, if we could have a consistent regular way of having, you know, sentinel sites where we're tracking trends, and we're basing the national data on that, that would be great. But right now, our data are extremely inconsistent and variable from place to play. S it's very hard to get our arms around denominators. And as you pointed out, you know, if the immunization efficacy, the denominator is really important. You know, to be able to say what is the rate of hospitalization, you have to know how many cases you had. So you're just hearing, you know, hearing a little skepticism on my side. You know, in general, I think that those of us on the outside not just in academia but in other, you know, corners of public health, that, you know, if there are things we could wish for in terms of communication, I can mention two things. And one would be that when a big change is made in policy, that somehow under the surface right away, CDC shares the science that underlies it, because sometimes it seems that there's a policy change and the science isn't visible. And then right away, there are people in the media who are detractors who are saying, "What's the basis? We don't see the basis." And I think it undermines the credibility of the policy. And then a week or so later, we see the science. And so, you know, to be able to unfold that in real time, which is not, I know, the way CDC has traditionally operated, but I think it's important. The other point I'd make is that it feels sometimes that resource limitations guide policy instead of the other way around. And what I mean by that is, if CDC thinks we need certain kinds of tests, more rapid tests, if the CDC thinks we need better masks to say that, even if we don't have that, and drive the availability of that, instead of based on availability, hold back and say, "Well, it would be great if you could have an N95, but you really don't have to do that," kind of statements, which to many of us, you know, in the field, then make us feel that CDC may not be telling us straight what you really believe. Right? So thank you.

>> Yeah, thanks. I -- all of that is very well taken. And I have to say that the I've heard similar comments before, you know, regarding the communications. I'm, you know, 100% in agreement that the way some of the things would have rolled out is not the way we aspire to roll them out. Absolutely not. Regarding surveillance. We've actually put quite a bit of time and thought and are in this sort of, I would say that the middle of the beginning, or maybe the beginning of the middle of discussions with jurisdictional partners about surveillance strategy going forward, and are definitely thinking that sentinel surveillance, you know, using, you know, platforms like COVID-Net, or jurisdictions that are able to, you know, to do the kind of linkage that you saw in that slide, that that's -- that's really the fundamental, you know, kind of, sort of looking forward, taking advantage of, you know, data modernization areas where the, you know, the denominator can be pretty well enumerated, and the numerator can be pretty well understood. So I think that when I say flu-like, what I really mean is that, you know, there's this sort of, you know, patchwork makes it sound patchy. It's not patchwork. There is a bouquet of surveillance strategies that give us the information that we need about, you know, overall case trends, severity in pediatrics, severity in pregnancy, hospitalizations, deaths, and having tailored, you know, effectiveness of vaccines, effectiveness of therapeutics and, you know, variability across geographies, all of those things that we need to know for public health practice. But you don't -- as I always say, you don't need to count every raindrop to know how hard it's raining. So, you know, that that, I think, more strategic approach to surveillance, to answering the questions that we need to answer I think will serve as well.

>> Thanks, Barbara. We have about six minutes left to get you out, I know. And we have three questions. We'll try to get through all of them. Dr. Albert?

>> Thank you very much. I have a science as well as messaging question. You know, certainly basic immunology has taught us that, you know, there's the antibody response, and there's a memory cell response. Much of what we focus on is the antibody response. And I wonder whether or not as we think about vaccine messaging going forward and the sustainability of any efforts, whether you think that there's any value to pasting in the, you know, memory cell response with the antibody response in terms of the question?

>> Yeah, yeah, you are. I mean, I totally agree. There's, there's also the T cell response, which we also know is -

[ Inaudible ]

Yeah, yeah. So I think that, you know, we do see, as you well know, measuring memory B and T cells is substantially more difficult than measuring antibody levels. And that's why vaccine manufacturers and others look at antibody responses. And they're, you know that they're certainly not -- they certainly have their use, you know, neutralize -- these studies for looking at neutralizing antibodies have been able to yield useful information very quickly. But I totally agree with you. It's incomplete. And when the studies that look at all arms of the immune system come out, we often find that the answer is just a little bit different from what we thought we knew from the neutralizing -- or even not just finding antibody studies alone. So totally agree with you. I think that those will remain research tools, rather than more than kind of general public health tools, but very important research tools that will need to be continued, reinforced, and not -- I mean, they -- I think, sometimes they get the press also focuses even more on antibodies than the scientists do. So there's that sort of communications piece as well around the whole immune system. So yeah, thank you for the comment.

>> Great question. And great answer. Mr. Dawes.

>> Thank you so much. And, you know, for those of us who have been working in marginalized, minoritized, and under-resourced communities, you know, we've been dealing with issues from vaccine hesitancy to issues of access and equitable distribution. And I'm really curious, because one of the things that we've been doing is trying to get information out as close to real time, as soon as we can get that from you all and others. And so I understand that the vaccination demographic info that you've shared is publicly available at the national level. But is there a plan to release that information at, you know, at the state and perhaps county level?

>> Yeah, I'm going to need to get back to you on that. I see those data. But I don't know whether they're on COVID Data Tracker yet. So let me look into it. And I can send an answer to Dr. Auerbach to send to you.

>> Thank you.

>> That would be great, thanks. Last quick question, Dr. [inaudible].

>> Thanks so much, Barbara. My question, I guess, as a pediatrician, I'm watching the childhood vaccine coverage levels, and concerned about the COVID-19 uptake in the five to 11 year olds, and also anticipating the vaccine will be approved for use in younger children soon. Based on my past experience working in immunizations, I found that to be incredibly helpful and useful to leverage the pediatrician/family practice relationship with parents. And I'm wondering if you're planning to double down or intensify the efforts to leverage those relationships? Because I feel like we've had great success with childhood vaccines a lot based on those relationships and wondering what the CDC is thinking about trying to optimize the coverage in that in those age groups.

>> Yeah, thank you for the question. I'm also a general pediatrician, spent many years in practice, and so you are singing my song? Yes, we are. For you know, for the planning for the youngest kids, the six months to four year old, we're even more than for the five to 11, we think that the medical home is going to be you know, absolutely critical. And really, I think that that's going to be the -- this is going to be -- you know, it's a very different rollout than for the adults where, you know, everybody wanted it right away. And we had the mass back sights and the just incredible numbers of vaccines being administered very, very quickly. I think that for the kids, like, we'll get there, but it's going to take some time. They're going to go into their pediatrician or their family practitioner or their, you know, nurse practitioner, and they're going to have the conversation, and those conversations are I think in many cases over -- you know, sometimes right away and sometimes over time, but going to end up, you know, as we know, for all other vaccines, it's that strong recommendation from the trusted caregiver that really moves the dial. So I'm expecting the same for pediatric vaccination.

>> Great, Dr. Mahon. Thanks so much for your time and your expertise. We will let you go to your meeting. I know that's coming up but invite you back at any time because this is just the beginning of this discussion.

>> Thank you. Great. John did not think I was going to get through those slides in 20 minutes, but -

>> -- well, you never surprise me anyway.

>> All right, thanks so much. Bye-bye.

>> Great, I don't know about the rest of you, we're going to be transitioning to the second portion of our meeting. But that analogy about drinking from a firehose I think applies to what we've just been through. Lots of issues, lots of opportunity, I think, for our future meetings as well. So this is just in my mind whetting our appetites of it. But we do want to now move on to the second portion of our meeting, which is beginning to flesh out elements of our work coming up, including our workgroups. Now, as you've heard from Dr. Walensky, CDC is initially asking us to create three workgroups, one on Health Equity, one on Data Modernization, and one on Laboratory Quality, Safety and Efficacy. I believe I'm safe in assuming we're all in favor of moving forward with the process to begin forming these groups, but just wanted to be sure, so please speak up if by chance you have any high-level concerns about beginning down this path. Great, then we'd like to begin today by focusing more specifically on the Health Equity Workgroup. We're going to start off with a panel discussion about CDC's current work, and then move to a more specific discussion of the proposed terms of reference. And as I mentioned to the ACD members in an email leading up to speeding, we have some really good news. And we owe a big, big thank you to our ACD members, Daniel Dawes and Monica Valdes Lupi. Daniel and Monica have graciously agreed to help facilitate the Health Equity Workgroup by serving as co-chairs and allowing all of us to get off on a running start. So thanks to both of you. And now let's get off on that running start by going to the next slide. We're going to begin this session with an overview of current CDC work on health equity with a panel presentation. We're actually going to go through the entire presentation before having a question and answer period because some of the issues that you might have may be answered by subsequent panelists. But please write your questions down. And while we can have a more extended discussion after the entire panel. Leading that panel, we're really lucky today to have Dr. Debra Houry who is the Acting Principal Deputy Director at CDC and will start us off on this journey. So over to you, Deb.

>> Great, well, thank you so much. And I really want to thank all of you for serving on the ACD. Your participation and recommendations are critical to protecting the health of the nation. And I could tell from your questions earlier how robust this discussion will be today around health equity. So I'm going to provide an overview of CDC's commitment to health equity, and then turn it over to my co-presenters to go more in depth, and as mentioned, we'll hold all questions until the end of this panel. Next slide. Under Dr. Walensky's guidance last spring, CDC launched the CORE Health Equity Science and Intervention Strategy, which is an agency-wide strategy that aims to integrate health equity as a foundational element across all our work, from science and research to programs and from partnerships to workforce. As you can see on this slide, we aim to cultivate comprehensive health equity science, optimize interventions, reinforce and expand robust partnerships, and enhance capacity and workforce engagement. This work is so instrumental to advancing and protecting the public's health, and at CDC we are committed to bringing together partners from various sectors to really gain this collective expertise and form next steps and create a shared commitment to reduce health inequities. Next slide. So Leandris will go into more detail. But I wanted to just highlight that all CDC divisions was part of this charge were asked to submit their CORE goals over the summer. And this resulted in over 150 goals. And we are now turning these goals into an accountability structure, agency wide and division specific metrics and an external communication plan. Next slide. The 159 goals fit into seven overarching health equity themes that focus on things like building CDC's strengths, as we just heard about from Dan Jernigan earlier, you know, using a lot of our surveillance systems, but to capitalize on these, not just understand the markers of health disparities, but also the drivers of inequities. And this range is to what Robin Bailey will speak about on building a diverse and inclusive workforce and improving our internal DEIA infrastructure. Next slide. Through integrating health equity into the foundation of all of our work, we have identified several activities that are needed, including leveraging our current work, coordinate across the agency, and facilitating transformation. CORE builds off of the vast amount of health equity work already taking place across the agency including in programs and agency workgroups and CIOs. And while many of the efforts listed here work deeply on health equity, they may also extend beyond the realm of CORE. There's also different entities throughout the agency such as Social Determinants of Health Workgroup and Office of Intergovernmental Affairs that help ensure that the CORE team is coordinated internally with other agency players and with key partners. Next slide. So to provide additional information on the CORE initiative, we'll hear from four leaders in this work, Dr. Leandris Liburd, Dr. Aletha Maybank, Mr. Robin Bailey, and Dr. Demetre Daskalakis. And following the panel and the question and answer period, we'll again hear from Leandris who will be joined by the DFO John Auerbach, and the presentation of the proposed terms of references. So with that, I'm honored to turn it over to Dr. Leandris Liburd who is the Director of CDC's Office of Minority Health and Health Equity to present on cultivating CDC's Commitment to Achieving Health Equity.

>> Thanks, Deb. And good afternoon, everyone. And let me add my appreciation to all the others that have been shared. In my excitement about the convening of the ACD, and I couldn't be more thrilled to learn of the co-chairs for our upcoming Health Equity Workgroup. If we could go to the next slide. Since its inception of the framing, content, and coordination of CORE have been jointly led by the Office of Science, the Office of Minority Health and Health Equity, and the Office of the Associate Director for Policy and Strategy, and I am pleased to share this presentation with Dr. Becky Bunnell who is the Director of the Office of Science, and Dr. Robbie Goldstein, who is Senior Policy Advisor in the Office of the Associate Director for Policy and Science. Leading with Health Equity Science that we define as investigating the underlying contributors to health inequities and building an evidence base that will guide action across the domains of program, surveillance, policy, communication, and scientific inquiry to move toward eliminating rather than simply documenting inequities. CORE, when fully integrated into our public health system can transform our practices and accelerate progress in achieving health equity. Next slide, please. To give you a sense of our timeline over the last year, following the launch of CORE in April, all CDC divisions were asked to submit their CORE goals by the end of July. And after a rigorous process of review, feedback and resubmission, we compiled the goals on a Power BI platform for synthesis and crosswalk. Next slide please. As Deb previously mentioned, the 159 goals fit into seven overarching health equity themes. Building on CDC strengths, many focused on using our surveillance systems to better understand not just the markers of health disparities, but also the drivers of inequities. And other goals were focused on building CDC's health equity data capacity, and leveraging our skills and analysis, statistics, modeling and predictive analytic approaches. Almost all divisions prioritize building the evidence base for health equity science, and many goals were focused on developing health equity interventions that can be scalable at the national level. Key partnerships were identified and including many outside the traditional lanes of public health like HUD and the Department of Transportation. Some goals focused on enhancing coordination across federal agencies, and state and local departments of public health, and others focused on building a diverse and inclusive workforce and improving our internal DIE&A infrastructure. Next slide. CORE goals are ambitious and intended to transform how we pursue our mission. Here are two examples of CORE goals submitted by the Infectious Diseases Community of Practice. This one states to address data gaps and harmonized data systems across the National Center for Immunization and Respiratory Diseases to ensure 100% of surveillance systems include a standard set of relevant health equity data elements aligned with agency standards or are implementing a plan to do so by December 2024. Next slide. And you'll hear more about this from Dr. Daskalakis. But the National Center for HIV AIDS, Viral Hepatitis, STDs and TB Prevention, will sustain their efforts to end the HIV epidemic with this goal. Reduce racial ethnic disparities for ending the HIV epidemic, key indicators, including knowledge of HIV status, living with HIV while virally suppressed, and PrEP coverage for individuals recommended for PrEP among programs supported by the Division of HIV Prevention by December 2025. Next slide. The transformative potential of CORE can only be realized if we bake it into all that we do. And toward that end, the CORE leadership team organized and co-led four sprint teams that were given a relatively short period of time to establish foundational definitions, health equity science principles, measures of accountability and strategies for monitoring, and health equity guidance for notices of funding opportunity that structure how non-research programs are designed and funded. Next slide. Beginning with the definition sprint team, a group of health equity subject matter experts created a glossary of health equity-related terms to support consistency and how terms, definitions and criteria are used across CDC. Next slide. The Health Equity Glossary is a living document drawn from the literature and based on terms and definitions frequently used in health equity discourse. Eighty-five terms were identified and placed in three categories, general health equity, race and racism, and diversity, equity and inclusion. Many of the terms represent nuanced and complex concepts that are difficult to capture in a single definition. And considerable amounts of time was spent reconciling conceptual and practice debates related to some of these terms. Next slide please. The Notice of Funding Opportunity or what we call the no [inaudible] team, was charged with making concrete recommendations for edits and other modifications to the existing novel template for non-research. And what we hope to do is to guide [inaudible] authors in how to effectively integrate health equity science and interventions in the structure of the program design. Many of our CIOs have already championed a focus on the integration of health equity and [inaudible], and the work of the sprint team builds upon existing success of the CIOs. Next slide. CDC can amplify our programmatic impact through our scientific work, including our work in surveillance, evaluation, laboratory implementation, science and research. And to that end, we formed a cross - a CORE cross-agency health equity science sprint team. From the grounding definition that I shared with you earlier, this sprint team developed principles and key considerations for Health Equity Science, to guide CDC scientific work to ensure that it is actionable, that it distinguishes markers from drivers, and that it employs appropriate methods, and that it moves towards eliminating health disparities. These are critical at every stage of the scientific lifecycle from conception to implementing public health practice. Next slide. To ensure accountability and to monitor progress toward our goals, CDC has a four-component plan for CORE. First, we have a milestone monitoring dashboard that uses a simple red, yellow, green approach for each division milestone. CIOs and divisions will complete their first round of milestone monitoring this spring, and then continue every six months. This will be supplemented by qualitative success stories, and a small number of annual agency level metrics. Interactive dialogue sessions are planned with each community of practice every six months to allow for open dialogue to address barriers and coordinate strategies. We will employ a continuous improvement approach with this accountability plan and revise it as needed after the first round, but we expect that this plan will provide both internal accountability and monitoring as well as externally-facing examples of CORE progress. Next slide. CDC's CORE commitment to health equity positions the agency to pursue new opportunities to eliminate long-standing and persistent health inequities. But to achieve such a bold strategy will require pristine coordination and timely communication both internally and with our partners. Achieving our goals to reduce health inequities will challenge us to find new ways of working together, and how we think about what we do. Our next speaker, Dr. Aletha Maybank, will speak to the centrality of equity, diversity, inclusion and accessibility in the success of the CORE framework. Dr. Maybank?

>> Thank you, Dr. Liburd. Thank you all for listening in today. And a pleasure to be here with you today to speak about some of the work that I'm helping to advise on as it relates to how we really drive external change work that we want to do from the inside. And so many folks know that, you know, if we don't look internally to how we understand a staff and teams, and how we potentially are driving inequities, and how we really can help support, advance equity, and change our mental models around that, we aren't really going to influence equity. So it's really a -- it's an inside-outside strategy. And that inside strategy is absolutely about the technical pieces of doing the work. But it's also about what are the cultural shifts that need to happen at the institution and organization? So I am going to talk a little bit more about kind of the internal focus that was asked earlier, I think by Dr. Morita, of you know, what are we doing to enhance the culture and capacity of equity, diversity, inclusion and accessibility, not only just with the workforce, but also the workplace itself? Other just important distinctions that I like to elevate that, you know, the work is framed, usually as DEIA. And I think that that is fine. But I think it's really important that we understand that distinctions. And really, this is really driving equity. Equity is more about power and talking about shifts in resources, allocation of who's making decisions and opportunities around that. Diversity and inclusion are absolutely critical and important in terms of belonging and how staff feel. But we also have to see what's driving and where power is really happening and where it's not allowed to happen within our institution. The other piece, which I mentioned kind of before, it's not just about the technical aspects, it's about the cultural shifts. And it's about how we're driving all aspects of our work beyond just the workforce, but also in addition to communications and marketing and data, and any publishing and policy. How is equity being embedded in those spaces as well? And then lastly, I'll say that we are leading with the context of race and racism. As you heard earlier, you know, last year was announced our -- that racism is a public health threat by CDC, which is absolutely phenomenal, and that, but that's not to the exclusion of other identities. And I think it's really critical that we have an intersectional lens as we move forward with this approach. And so we're definitely engaging around gender identity, sexual orientation, as well as people with disabilities as well. Next. So this is a model that comes from the Government Alliance for Racial Equity. The good thing about doing this work at this point in time, and I'll honestly say that there are many folks and hundreds of folks across the country and in terms of governmental institutions that have embarked upon doing this internal work. I came from New York City Department of Health, as many people know, as well as from the Suffolk County Department of Health and engaged a lot with [inaudible] forward to really lead in using these types of models. And so this is a model of transformation. I'll go through it quickly. And so you see the normalized. So it's about how do we create spaces within the institution that normalizes conversations about power and privilege, and identity? So a lot of that means that we have to have some levels of training, training as it relates to knowledge as well as skill building, and create more spaces of which becomes more psychologically safe and actually safe to have these kinds of conversations. It might not be comfortable, but we need to have the space to have these conversations. That's the normalized part of it. The organizing is understanding that it's going to take clearly more than one person, more than top leadership to really drive this work, and really create change and shifts across the entire institution. So what's the accountability, engagement and the action infrastructure that needs to happen to really drive change? And us really figuring that out is absolutely critical, and some of it has absolutely already been started at CDC. And then operationalizing is what are the tools that we need to have in our hands in order to challenge our mental models on a day-to-day basis? There's a Racial Equity Toolkit on the GARE website that I've used very much. But it's also how do we use our own data and metrics to help support and drive change within the institution? And then lastly, you can see the circle around, that often gets left out of the conversation, but was brought up earlier in this conversation about supports as it relates to mental health. Our trauma-informed supports are really critical as you're starting to go through this work at an institutional level, because conflict can arise. Conflict has already existed. Trauma has already existed, especially for a space like CDC that's been going through so much. So we have to make sure that those supports are available. Next? So our -- this is our draft vision. So we're working towards, you know, creating and putting forward our strategic plan for this internal work that we're doing. And so our draft vision is CDC envisions an empowered and high-performing workforce that thrives in a culture of mutual acceptance and trust that recognizes our differences, where every employee experiences satisfaction, belonging, and just treatment in an environment rooted in equitable, transparent policies and practices, thereby fully enabling us to accomplish our shared public mission, public health mission. We are working on guiding principles. These principles actually come directly from the guidance that was provided from the administration a couple of weeks ago. And we are now kind of working towards what else do we think is important to really also identify just specific values, such as trust and collaboration, accountability, but then also, what are these guiding and operating principles that are also key in order to make sure that we're all on the same page as we move forward to do this work? Next. Normalize, I mentioned before is a lot about again, the training opportunities and those experiences. Not enough in order to create transformation, but absolutely critical and important. So so far, there's been several efforts as it relates to training. We have a cohort of staff champions that have gone through equity and diversity and inclusion training from across sector, across the organization. We're getting ready to launch next week our two-day training for senior leaders and key champions on race from the Racial Equity Institute and Groundwater Institute. NIH has also kind of used the same folks and same collaborators as well. We will be creating guidance on how to create and write equity action plans, which I'll talk about in a second. And then we'll be learning and launching more training opportunities through our CDC University, again, to build knowledge, but as well as skills. Next. So organize. What is the budding kind of accountability infrastructure that we do have? When you look in the center of this at the green part of it, every single week, there's a group of us that are engaged and we're meeting to talk about the different components of the work as it relates to the internal organizing and driving change. You heard from Dr. Liburd. There's Dia Taylor from HR, Reggie [inaudible] from the EEO Office, senior advisors, myself and Robbie Goldstein. And then our two executive sponsors. We have identified two executive sponsors, Deb Houry, who you just heard from a little while ago, our Principal Deputy Director, and our COO, Robin Bailey, and then we also have communications which will be engaged as well. To the left of it is who was kind of doing the cross and kind of entire agency, excuse me -- action planning and plan development at this time. So we have a cross-enterprise team that is made up of folks and representatives from all of our CIOs, and all of our offices and centers. We have HR and EEO Office all engaged in kind of drafting the initial plan. And we are working on revising and strengthening that plan as we speak. Ultimate accountability clearly is the CDC director, and the executive sponsors. And then implementation is going to be the senior leaders and the senior leadership teams. And then going to the right-hand side is the COI action planning. So the more local level action planning that needs to happen, right? So I just gave you kind of, we're going to do this larger enterprise plan. But then each of the CIOs and our centers and offices are going to be responsible for doing their plans as well. And they have support teams and leads and accountability within each of the centers. Next. And then operationalizing the tools. So we have an intranet site. It's the Better Together site that really supports communication. Communication is absolutely key during the [inaudible] transparency, so our teams need to know what each other is doing, what they can do, where they can learn, where they can pick up tools, who they can connect with. So communicating and making sure that that is very accessible is absolutely critical. We have a Health Equity Guiding Principles for Inclusive Communication that was put out earlier this fall. We will be providing written guidance, again for the developing of the action plans. And then the action plans themselves. So I've already mentioned again, we'll have the CDC Internal Strategic Plan that will be done in the springtime, and then our CIOs and that the more local level units will be also held accountable to submitting action plans by fall 2022. Next. And so this is just a pictorial. This is just another look at it. And then I'll just add within the action plans, and the strategic plan, the four areas of which we're holding accountability at this time are around leadership and commitment to how you show up as a leader, and holding accountability, communications, as well as workforce equity clearly, and then what are the cultural shifts as well that you were doing within your particular CIO is also extremely important. And all of that will be -- will flow up to the larger HHS DEIA strategic plan. Next. Then next, I will turn it over to Robin Bailey, who is our Chief Operating Officer.

>> Good afternoon. I'm Robin Bailey. I have the honor and privilege of serving as Chief Operating Officer in arguably the world's premier public health organization. I've been in the role for just over three months. And I have over 30 years of leadership experience in multiple federal organizations to include the United States Air Force, Forest Service, Food and Nutrition Service, and the Internal Revenue Service. It is both an exciting and critical time to be at the CDC. First, I would like to acknowledge the CDC legacy, the important tireless work of our staff, and recognize the CDC as a great place to work. I also accept there's always opportunities for improvement. So upon my arrival, I pose this question. At this point in our storied history, what can we, this leadership team, do that will have a profound and sustained impact on our organization? Accordingly, I've spent my days conducting deep dives, listening and learning from leaders, management and bargaining unit, employees, multiple employee resource groups, reading reports and using other data sources to help inform my thinking around this important question of what can we do? I have concluded our most -- I've concluded our most important and pressing opportunity with the greatest return on investment is deliberately investing in our people. This fits squarely in my wheelhouse as I have a passion for transforming cultures and developing people. Through my experiences, I have gained an appreciation for the complexities associated with this work and effort required to sustain this level of change. As I've heard, as you've heard from my colleagues, we have multiple balls in the air in our working to address barriers to our collective success. My remarks today are limited to the E in CORE and is focused on enhancing our capacity and workforce engagement. As Dr. Maybank just shared, we will use our DEIA strategy to build the internal capacity to cultivate a multidisciplinary workforce in a more inclusive environment resulting in policies and practices for broader public health impact. From our perspective, we cannot fully achieve that outcome without addressing our workforce and workplace opportunities. My colleagues have shared insights about much of our journey today, highlighted some of the great work our teams are doing and how this fits into our CORE Human Health Equity Strategy. Under E, we will transform our culture through workforce engagement and deliberate leadership in workforce development. Our DEIA strategy will intentionally roll the work of our Equal Employment Office, Human Resources Office, our CIOs' feedback from our employee viewpoint survey, and the MB715, into an integrated CDC-wide strategy that will ensure accountability, transparency, consistency in both our message and actions, and the best use of our strength and limited resources across the agency. This approach will keep us focused while addressing many of the cultural practices and procedures that are limiting our effectiveness. This strategy will seek to re-examine silos of excellence in favor of more enterprise-wide workforce and workplace strategies that will help us consistently deliver on our employee value proposition. We're in intense battle for talent with competencies required to meet the demands of a world-class public health organization. To further complicate this issue, research in our experiences indicate finding top talent has never been harder. We must compete and win in this environment. So our strategies and actions must be precise. Our strategy will address the needs in development of our current workforce, while attracting a diverse pool of candidates for the future. As we tell our story and hire new talent, we will continually enhance our composition by attracting diverse talent at every level. We have ways to make that happen at the entry level. But we need your support by sharing new partnership opportunities aimed at helping us find more opportunities to encourage mid- and senior-level public health professionals to compete for CDC opportunities. Our premier organizational status and global reach are not enough to meet our hiring objectives. Partnerships are key. As we attract new talent, we must have the right environment to retain them and enhance our DEIA strategy. Internally, we will employ a deliberate enterprise-wide system for developing leaders at every level. This framework will include classroom, experiential developmental assignments, and a coaching culture to sustain. This will include career maps and opportunities for those who believe they're in dead end or career-limiting opportunities. Where employees start should not dictate where they end or how far they can go in their career. This approach will address many of the issues cited during our employee listening sessions, as well as in the Federal Employee Viewpoint Survey, which is an annual survey that measures employees' perceptions of whether and to what extent conditions characteristic of a successful organization are present in CDC, and in the MB715, which requires agencies to take proactive steps to ensure equal employment opportunities for all employees and applicants, as well as employee listening sessions conducted over time. We have mounds of data to guide our steps and actions. Employing this approach will also help our employee value proposition as we seek to attract and retain a diverse talent pool. Various sources indicate the most important pillars of an employee value proposition that has proven to attract and retain talent are composition, compensation, benefits, career advancement opportunities, impact and contribution to the world as well as culture. These further indicate we are focused on the right levers given our global mission and contribution to the world. We will holistically consider all of our applicant pools, internships, fellowships, Title 42, Title 38, and Title 5 and devise strategies that attract and retain those investments. As you know, federal hiring can be complex and frustrating for those who have not been exposed to the laws, rules and regulations. It is quite challenging to navigate. And when we use this opportunity to drive different DEIA outcomes in CDC, we will carefully study the data and ascertain our return on investment from our various internships and fellowships. We will use those findings to determine the best options and opportunities for engagement with the Office of Personnel Management, to secure ways to protect our investments. We need special appointing authorities to help attract and retain segments of our applicant pools. To be clear, the Office of Personnel Management is an independent agency charged with managing the US Civil Service. So they can -- so they have the authority to grant special hiring authorities. These determinations can be made when there's a shortage of candidates and/or a critical hiring need for a position or group of positions. We have a strong platform to build on. And considering all of our internships and fellowships and the number of people in leadership roles who were Epidemic Intelligence Service fellows. We're going to be more deliberate about these investments, looking for all opportunities and potential talent sources, to make more strategic investments and provide clear expectations to all who participate in these programs. Putting potential leaders through a deliberate set of experiences provides us with more clarity on what we can expect as an organization relative to the pipeline of talent available for key roles in our organization, and what our employees and fellows can expect from a career in CDC. Again, my experience has taught me that great cultures attract great employees, and our employees are the driving force behind achieving our Health Equity Strategy. Nothing of real value happens without our employees. So this deserves our full attention. Next, you will hear from Dr. Daskalakis on how to implement or how we are implementing equity work at the division level. Thank you.

>> Thank you, Mr. Bailey. And thank you for having me today at today's Advisory Committee meeting, I'm really excited to get to talk about the work we're doing in the Division of HIV Prevention that I direct to advance health equity. So I want to start by just saying the DHP, the Division of HIV Prevention is amid a culture shift, as we're working to really actively promote and exemplify an antiracist culture, and a culture of inclusion and diversity in all domains. And as Dr. Maybank said, from inside out. So we recognize that as a division, we have to normalize the conversations that we have about race and racism and work diligently to name and address the root causes of the inequities that we experience that we have in our own lives. And therefore, how it affects our work to improve the lives of those that we serve, who are living with or otherwise affected by HIV. Next slide, please. So we know all too well from various stories that some groups of people experience a higher burden of HIV than others, and that really do have poor HIV prevention and care outcomes. This fusion slide just gives the story in one place. There's higher HIV incidence among gay and bisexual men. Black people in the US have a higher incidence. Hispanic people have a higher incidence. There's gaps in the use of pre-exposure prophylaxis, with Black persons and Hispanic persons having significantly less coverage than White. There are lower rates of viral suppression among American Indian and Alaskan Native persons, as well as Black persons in the US. And there's a higher HIV prevalence among men who have sex with men and other gay bisexual men and transgender women. Additionally, people who inject drugs are experiencing more HIV outbreaks. So it doesn't just stop at our end at specific communities. There's also geographic differences and disparities. And you can see, again, the darker the area in the country, the higher the rate of diagnosis of HIV, so you can see a clear disparity in the South. With that said, I need to be clear that when we look at our story of HIV, racism is a major barrier to what we're doing in prevention, care and treatment services in the United States. And I know that that really applies to many other programs here at CDC. The DHB vision is to address it head on, because public health is, and as we've heard over and over, must be antiracist. So while in recent years, we've been talking about the importance of social determinants, such as housing, social services, geography, education, we really also need to acknowledge and get comfortable talking about systemic racism as a major barrier to assessing the very things that keep people healthy. That is our CORE first step; it is addressing the root cause. And although we can't fix deep-seated issues like systemic racism overnight, we really can commit to creating programs and doing research that is equitable, that focuses on addressing stigma, improves access to healthcare, and really important in the HIV space as well -- sees people as people and not just their infection or disease. And we can commit to monitoring our collective impact and making sure that as we've heard throughout the presentation today, we hold each other accountable for our progress. Next slide, please. So to accelerate our progress, the federal Ending the HIV Epidemic, or EHE initiative, is working to overcome the barriers to HIV prevention and treatment in 57 areas of the country now hardest hit by the epidemic. So when I think of EHE, or Ending the HIV Epidemic, it is at its CORE a health equity intervention that adds resources to areas and communities with greater need. These Ending the HIV Epidemic areas, in fact, account for two-thirds of new infections among Black and Latino individuals in the United States. And each of the communities that we have engaged in this initiative has created a tailored local plan focused on these populations to help reduce HIV and the disparities that drive it. Next slide, please. In addition to EHE, the Division of HIV Prevention encourages the use of what I call the status neutral HIV service framework, which takes into account a whole-person approach and puts the patient ahead of their HIV status or the person seeking services ahead of their HIV status. So this approach is designed to help eliminate stigma, drive down health disparities, and dramatically decrease new infections in the United States. So just to walk through it briefly. HIV testing opens the door to treatment and prevention, regardless of the status. So treatment, if you live -- are living with HIV prevention, if you're someone who could benefit from those services. It is wrapped in attention to syndemic infections and other syndemic conditions, thinking about some of the social determinants of health, and allows the opportunity to deliver service and support services to individuals not only based on their status, but what their needs are as a whole human and what their needs are to achieve what they believe to be their optimal health. So it is one of our strategies to address all of equity on both from the perspective of race as well as the other priority identities that we work with every day in HIV. A status neutral approach to care really is designed to help people achieve and maintain their best possible health, while closing gaps in HIV prevention, diagnosis, care and treatment. So again, the approach is really focused on a whole-person strategy and improves health equity by really adding services that address social determinants of health and not just looking at here's a pill that prevents HIV, or here's a pill that treats HIV. How can we support people to stay engaged in the biomedical interventions that we know work and will ultimately end the HIV epidemic? So CDC is investing in innovative approaches to the delivery of HIV prevention and care services. And that status-neutral framework is really going to be a piece of our future in terms of how we design our services, again, by not focusing on status, and by focusing on facilitating the ability of people to get what they need, so that they can actually focus on their HIV-related health and other health. Next slide, please. So although health equity is at the core of all of our DHP work, I wanted to just highlight several HIV-related activities that are specifically aimed at addressing health equity. So one revolves around HIV criminalization. So last year, the Division of HIV Prevention and my center published a commentary in The Lancet, encouraging states to align their HIV criminalization laws with science and to revise the application of these laws for the sake of people with HIV and for the public's health. Policing of these laws are often go along racial lines. So really, it is a critical step in really addressing the environment in the state so people are able to get HIV testing without fear that there could be other retribution or other unnecessary threats to their -- to their health and wellbeing. Additionally, our Division of HIV Prevention in Communities of Color postdoctoral fellowship program has a mission to recruit, mentor and train investigators to conduct domestic HIV prevention research in communities of color. Right now DHP currently has three. Programmatically DHP is working to accelerate efforts for achieving health equity through targeted funding, strategic community engagement, and really, again, expanding investments where they're needed most. So as part of our CORE work, we award $400 million per year to help departments for integrating HIV data collection and prevention efforts. Those awards really focus a lot on identifying and serving populations and geographic areas of greatest needs. Additionally, on the Division of HIV Prevention has a great history of directly funding community-based organizations that have credibility, experience, and are trusted voices and a long history of being responsive to and also meeting the needs of Black, Latino and other disproportionately affected groups. So that's our flagship community based organization opportunity. We also have another which we're particularly proud of, which is the comprehensive high-impact HIV prevention projects for young men of color who have sex with men and young transgender persons of color. So these specifically find about 30 community-based organizations to do this work in populations who are over represented by an HIV, both from the perspective of their race as well as their identity as gay, bisexual, or other men who have sex with men, or transgender persons. So really is another great example of an equity intervention of adding resources where there is higher need. Next slide, please. We also work to make sure our messaging also reflects this. So I'm just going to highlight briefly our Let's stop HIV Together program. So to help reduce HIV stigma and encourage people at risk for and with HIV to seek out testing, treatment and prevention services, that whole status-neutral package, CDC works with community partners to design and also deliver education and awareness campaigns as let's -- such as Let's Stop HIV Together. So we, in fact, have a funding opportunity that really focuses on community voices that help us spread this word in a way that is very contextual and appropriate for the folks we serve. This is a combination of 12 years of research and implementation. And the Together campaign really focuses on integrating resources developed from all audiences, to make sure that connections can be made to meet the needs of anyone accessing our campaigns, regardless of their HIV status. So this is another example of a status-neutral intervention, a status-neutral communication package that really addresses the folks who are overrepresented in our epidemic. Next slide, please. So beyond talking about DHP, I also wanted to highlight the work that's happening in our center at the National Center for HIV, Viral Hepatitis, STD and TB Prevention. So there's a very exciting equity initiative happening there. So though there has been lots of work that's going on for many years to advance equity, this specific initiative is really working to accelerate and break new ground by being intentional and systematic to integrate equity into all that's done at the center. In the center -- in the center initiative, there's work to ensure a workplace culture that's inclusive, collaborative and antiracist, and one that encourages all staff to engage in dialogue about racism, and other systems of oppression. It also is working to establish workplace policies and practices that further increase diversity, really work to ensure fair and equitable opportunities for advancement and ultimately, with the goal of eliminating discrimination. It will also work to continue to conduct data-driven staffing assessments. So one of the really great innovations is a dashboard where all divisions are able to see the demographics of their staffing. So really critical in making a plan that visibility is really helpful, both on the center level as well as on my level of division to have a clearer view of what you're seeing. Additionally, the center is conducting internal workforce activities to transform culture and increase workforce diversity. And again, progress is being tracked, and we're reporting it regularly to the staff. We are also working to refine our systems and processes for designing funding and evaluating research programs, policy and partnerships to ensure they're intentionally systematic and consistent on addressing the social and structural causes of disparities. So that is really a lot of really decades of successful work that is coming together in a strategy to further accelerate and create an even stronger foundation to achieve some bold goals in advancing equity and reducing health disparities. So we're going to go back to that division. Next slide, please. We're also looking internally in the Division of HIV Prevention and our processes and practices to make sure that we are really striving to be a more equitable division. We could -- we are committed to working with our leadership and teams to ensure that there are equitable opportunities for advancement and strong mentorship in place for staff seeking to advance their careers. So last year, we launched a series a series of division-wide town halls and fireside chats centered on race and equity with really impressive participation. We've seen really impressive efforts from our branches to normalize conversations and generate actions to address systems of racism, sexism, homophobia, xenophobia, transphobia, and all of the other isms and phobias that really are barriers to our work at DHP and beyond. We have also established an internal workgroup comprised of 30 representatives from every office and branch in the division, and we call that an equity change team or a change team. So this graphic just demonstrates all of the change teams that feed into our Office of Health Equity. And in fact, the team, which is led by our DHP recently reorganized Office for Equity, has already developed an equity plan that is in close alignment with our center's equity initiative plan and concentrates our efforts in three focus areas. A, we've got focus on workplace culture, B, workplace policies and procedures, and C, research, policy, programs and partnerships. Additionally, I want to share our three CORE goals that we submitted to the agency, which I think you saw one of them from Dr. Liburd, which is reducing HIV-related racial and ethnic disparities through our Ending the HIV Epidemic program. Additionally, our second and third are developing and enhancing strategic partnerships designed to advance HIV-related equity work in communities. And our third is integrating evidence-based interventions and best practices to reduce disparities into all DHP-funded programs. Next slide, please. So this is an iterative process. And as Dr. Maybank taught me in New York City, you've got to trust the process. So I'm going to tell you some of the work that is coming soon, or that we are working on now. So we will continue to implement our DHP Equity Plan and are working to really establish our reporting cycle for the over 60 planned activities, which will be summarized in our progress report. We're going to continue our division equity town halls to address and discuss trauma challenges and opportunities as they relate to racism and equity. I'm really excited to also tell you that we're going to be using the GARE tool to examine how we can improve our major funding activities and other programs. So I think you've heard about it from Dr. Maybank. GARE stands for Government Alliance on Race and Equity. So these tools will help us ensure that our activities are examined through a racial equity lens that really checks programs for fitness. So we're in the formative stages, and we'll have more information in the coming months. But our first up program is going to be our large health department flagship. So really excited to put that through the acid test to make sure that we're moving in the right direction. We also plan to increase leadership capacity to engage in equity work. So last fall, our leadership completed a three-day training called Undoing Racism. That training addressed both the visceral and really harmful impact of racism from both a historical context and also from current real, real, really lived experiences not only of the folks who facilitated, but also of the folks who participated. So again, while not a perfect training, we're at least afforded a space to have these really tough conversations and determine what's next for our division. We also plan to expand the training for all supervisors and members of our change equity teams this year to as Dr. Liburd said, "bake equity into all we do." Thank you for the opportunity to present. I think I'm handing it back over to the Chair. Thank you.

>> Thanks so much for that presentation. And thanks for that entire panel. Wow, lots and lots of information. We're going to take a pause here before we go on to the terms of reference to see if there are any questions that - or comments that you all have relative to the information that's been presented. Please, and as I say that, we're going to talk about the TORs in a minute. So if you have questions or comments about that, let's defer that, and also Dr. [inaudible] real work life is intervening. And I know she has to go off to a meeting with the Secretary at the top of the hour. But let's see if there are questions right now. First, Dr. Medows.

>> Hi. Those have been pretty detailed and amazing presentations. And I know how complicated and how long the struggle has been. I'm hoping that when we talk about health equity that we are making sure to include all populations impacted. We paste -- we place a lot of emphasis on race and ethnicity, but we also need to make sure that we are including gender identity, immigrants, impacts from diverse religious groups who suffer from some of the disparities and some lack of social services as well. And making sure that we include again, people with disabilities who may be shut out including those with mental health disabilities. Then finally, I saw a lot of work that you have already been laying out, all the data, the analytics, the education. I want to make sure that when we are building these plans, we are focusing heavily on interventions, measuring the effectiveness of the interventions, standardizing a concise way of measuring our performance, and then sharing those best practices so we don't all have to recreate them new every single time. So it may be -- it may require stepping away from some of our traditional public health partners, going into healthcare, health services, et cetera. And to be able to do all of that, but I want us to make sure that we move beyond the promising words to action. Thank you.

>> Great comments. Thank you so much. Mr. Dawes?

>> Sure. And following Dr. Medows, you know, first I, too, want to thank you, Dr. Liburd, for your leadership at the CDC and advancing this health equity agenda. And of course, to all of you, Dr. Maybank, and team for a very informative discussion. So I wanted to really hone in on a point that I heard Dr. Maybank talk about, which is operationalizing these frameworks and theories, and I think, you know, what you all are doing is really moving us in that direction. And by my count, why I'm really excited is because of this fact, right? We have now as a country, entered the fourth period of a great awakening for health equity and justice. Never before have we been able to address these upstream factors that I heard this morning from Dr. Walensky and ensuing speakers. And I think this is incredible that we are really going towards the root causes of these health inequities. And so I wanted to really ask, you know, in terms of how you operationalize as you move forward, what are some of the resource challenges you may have to operationalize, to get moving, if you wanted to share what those resources are, or any of the challenges or gaps that you may encounter or have encountered that we need to overcome to move the agenda.

>> So I'll start the conversation if that's okay. So I think we've been really heavily focused on building a plan, being comprehensive, trying to anticipate some of the barriers, but never losing sight that this will require some additional resources. I also want to mention that there's work that is already underway in the agency that we are actually kind of I'm going to say increasing, expanding, enhancing. So for example, wanted to mention some of the specific activities in addition to what Demetre mentioned around addressing racism and health, which is a new focus. And that should see a renewed focus in our agency. And so we have a Racism and Health website. Dr. Maybank talked about the training that will be underway. We're also going to reactivate the Racism and Health Workgroup which is a scientific workgroup that was established some time ago that has not been active. And our National Center for Chronic Disease Prevention and Health Promotion, this year is going to implement the Reactions to Race module with 22 states implementing that module this year. And lastly, I'll just mention that the Pregnancy Risk Assessment Monitoring System, one of the surveillance systems in the Division of Reproductive Health has added questions about racism into that system. So those are things that we are doing with our current resources, building upon our current systems. And certainly anticipating that in the future, we will need additional resources to fully implement the CORE strategy.

>> Thanks, Dr. Liburd. Let's take the three questions that are remaining and then we can move on to the terms of reference. [Inaudible]

>> Yes, thank you so much. And again, echoing what, what Daniel said, Leandris just really appreciative for all the work that you've done over many years and really excited about helping to support the inside-outside work as Dr. Maybank had described in accelerating all the activities that have been underway and have been foundational. You know, one thing that struck me, Dr. Daskalakis, is you were reviewing the Office of Health Equity for your division. I was just curious how many offices of health equity actually exist across the CIOs. And if that is part of the effort to sort of lean on the internal expertise so that you're not having to reinvent the wheel. So I'm excited to see GARE and other tools and resources that many of us with city and state health departments have used in our own practices. So are you looking at that? I'm just curious about how many offices similar to the ones that Dr. Daskalakis is in exists, and how that bubbles up in terms of learning across the CIOs.

>> Dr. Liburd, would you like to answer that one?

>> Sure, I can give you an estimate. I think across at least five or six of our national centers, we have people at both the CIO level as well as at the division level who have the title of either Associate Director of Health Equity or Health Equity Lead. We're also seeing that role emerging some of our deputy director offices, as in the Deputy Director for Noninfectious Diseases. That office has someone with that full-time responsibility. So we're seeing more and more of these offices and positions emerge across the agency.

>> I think to the point just to add that, in agreement for what you're saying, [inaudible] as I can't see the last part of your name, so I apologize. But it does provide an opportunity to have some level of coordination and then truly shared learning opportunities. They've really helped drive and push change in a way that hopefully is more aligned and not in totally disparate places all across the CDC. So that's something that we are working towards, again, increasing understanding where the opportunities are in terms of infrastructure for coordination and accountability. But we definitely are able to start, you know, connecting and tapping into the offices of equity that are evolving.

>> Thanks so much. Dr. Martinez.

>> Thank you, David. Volume, okay?

>> Yes.

>> Thank you. Great presentation by everyone. really tremendous work that the CDC is doing. So I greatly appreciate that. It makes me think of one thing, especially when it comes to operationalizing what's happening internally at the CDC. Of course this is true for all organizations across the board as well. How are you dealing with what we know as the minority [inaudible], where the work is expected to be done and falls on the shoulders of minorities themselves, often uncompensated, and not recognized nor truly valued? Because really, what we need is for the dominant part of the sector of our society to make the changes. That's where the power and privilege lies. So I'm just -- I'm just wondering how you guys are addressing that? I didn't hear it called out. And I may have missed it. So, if so, I respect that. But I'd love to hear how you're also taking that into consideration.

>> Who would like to answer that from the panel?

>> I was going to suggest that Robin speak to that. But I can assure you that in our meetings that Dr. Maybank mentioned, we are very, very sensitive to that issue. But Robin, if you'd like to speak more specifically.

>> Thank you. Yes, one of the things that's really important. We are going to have work streams that are going to be made up of the workforce. The individuals who are engaged, the individuals who have specific things that they want to call out, so that we will have opportunities to put things in place to change outcomes that we have in [inaudible]. I think the work that we have to do has to be centered around our people, and what they believe needs to happen in order to feel value, to feel that there is transparency, to feel that they have the opportunities. And that's why the deliberate development element of this is going to be so important. Because it will provide for opportunities for people who potentially feel that they have not had those opportunities, and then open it up in a way that has a roadmap so everyone can see what those opportunities are, and how they may guide their career in being more engaging around performance management element. And so everyone understands as they are working through a process, that they have goals, aspirations, what kind of jobs should I be trying to get to for developmental purposes? What kind of training do I need to get into it? And we're going to be paying attention to that. They're going to have a voice throughout this process. Because I think someone mentioned the whole notion of beyond promising words to actions. They hopefully will hold us accountable for the commitments we want to make in this space. Very, very serious about that. And those employee workgroups are going to be very much a part of that, to include those with disabilities as well. Across the board, everyone having an opportunity to feel that not only will you get an opportunity, but you have an opportunity to thrive in the organization. And organization throughout should be representative of those opportunities so people could see those too.

>> Really important issue and call out. Thank you. Thank you all. Dr. Taylor.

>> Hi. So I'm a lab person. And so I'm a little out of my element here. So please excuse me if I come across as naive. But it was fascinating to me to listen to Demetre talk about the HIV field. Hi, Dimitri. In New York City during the early well say the first year of the pandemic, they did an enormous amount of work building on what they had learned during HIV to get care and testing into the community. And [inaudible] clinics, mobile vans, things like that. And I think when you think about the two and a half years of the pandemic, one of the good things to come out of the pandemic, if you can think of anything good, is the advances in technology, and the proliferation of rapid tests. Now, you know, rapid tests, they're not as good as the lab. They're not as sensitive as the lab-based test. But the problem at the moment is that we haven't learned how to use them properly and in the right context. But we're going -- there's going to be rapid tests for all sorts of diseases beyond COVID. And so it presents an opportunity here to focus on the accessibility part of DEIA and builds on what's been learned in HIV to improve access to testing and care. I think it's very - ironic is not quite the right word, but when you think of where we were in the '80s, and where we are now with HIV, and the fact that we really should be using HIV as a model for how to improve accessibility to healthcare for so many diseases. That's just a comment.

>> Great point. Thank you, Dr. Taylor. So a more complete document outlining the terms of reference for the Health Equity Workgroup was provided to the ACD members in advance of today's meeting. We're now going to have a discussion of that document. And that's going to be led by Mr. Auerbach and Dr. Liburd. So you two folks are on at this point. After that, we will then open it up for a more extended opportunity for questions and discussions about the workgroup activities.

>> Well, thanks very much, David. And the members of the panel are going to stay on the call because there'll be involved in the discussion. There may be questions that arise by members of the ACD that involve people who have already spoken. But Dr. Liburd and I are now pleased to provide you both with an overview of what goes into the workgroup process and a brief summary of the content of the terms of reference, the document that identifies the topics on which CDC is seeking your guidance and insights related to equity. And each of you has received a copy of the terms of reference, although I know you haven't had a lot of time to review it. Following our presentation, we're really eager to hear your thoughts as well as any questions you have regarding its content. Next slide, please. Within the Federal Advisory Committee Act, the rules that govern the formation and activities for workgroups are defined, and these include the purpose of a workgroup being to provide assistance to the parent committee, which in this case is the ACD, of which you are members. And in doing its work with regard to topics and questions that the agency, in this case, CDC, identifies as part of the parent committee's tasks. Given the specific charge to a workgroup that's always outlined in the document known as terms of reference, workgroups are generally expected to do a deep dive into a topic performing tasks that would be challenging for the ACD members to accomplish on their own. And this involves often the need to identify subject matter experts to bring onto a workgroup who can assist in the process. A workgroup actually reports to the ACD itself, not to the agency, so in this case, not the CDC. Therefore, the observations, conclusions and/or any work products from a workgroup ought to be considered by the ACD, which will itself decide if and how they will be offered to the CDC. On each workgroup, there must be at least two members of the ACD. And they need to be involved in overseeing and helping to lead the activities of the workgroup. And in addition to that, there needs to be a designated federal officer at each of the meetings. Workgroups are generally limited in size. In the case of the Equity Workgroup, it's capped at 15 members. And workgroups can and usually are enhanced by the addition of non-ACD subject matter experts. And the method for selecting these members may vary. Workgroups can utilize either open public meetings or non-public meeting formats, unlike the ACD, which must always meet in public. And let me turn things over now to Dr. Liburd to go more into the specifics within the terms of reference that you've received. Dr. Liburd?

>> Next slide, please. So the purpose of the Health Equity Workgroup is to provide input to the Advisory Committee, to the directors John already said, on agency-wide activities related to the scope and implementation of CDC's CORE strategy. Our commitment to health equity includes but is not limited to refining and establishing national data systems that assess and monitor racist health and other drivers of health and healthcare inequities, identifying and supporting the implementation of strategies that establish and sustain antiracist systems of public health, identifying policy levers that advance health equity, and identifying multi-sector and fostering multi-sector partnerships that accelerate the elimination of health inequities. The Health Equity Workgroup will provide advice and recommendations on the effective execution of the CORE Health Equity Strategy across the agency, and ultimately influencing the agency's work with State, Tribal, Local and Territorial departments of public health, and our other constituents and partners. Next slide, please. We will greatly benefit from the expertise of the Health Equity Workgroup in addressing these and other questions. Just to give you at some examples. What will CORE need to be successful? We heard questions about resources, and what are potential barriers? How can a health equity and all policies approach be advanced? And what are minimal data elements for surveys and surveillance systems, and you heard a lot about our thinking already from Dan Jernigan. Next slide, please. So CORE is a bold and comprehensive undertaking, and we want to have a strong start. So the Health Equity Workgroup will roll up its sleeves with us and bring new eyes to aspects of the strategy that we may have missed. For example, what are potential unanticipated barriers to CORE implementation? And how can they be minimized? But we also want to hear from you as you get much more familiar about all of the goals that have been shared. What are the best three agency-wide CORE goals that we can adopt that -- and most important changes that we need to make to advance the CORE strategy? Next slide, please. So thank you in advance for helping us move this work forward to cultivate comprehensive health equity science, to optimize interventions that tend toward equity and to foster, reinforce and expand robust partnerships. And as already indicated by Dr. Walensky earlier today, we are happy to provide updates on our progress in achieving a diverse, inclusive and equitable CDC workforce, which is the E in CORE. John, back to you.

>> Thanks very much. Next slide please. So to give you a sense of what the expectations are, or at least the hope with regard to the formation of the workgroup we'd like to hear back from the workgroup at the May ACD meeting what its work to date has been, the progress it's made. And if it has any observations to share. We do expect that the first meeting of the ACD probably wouldn't occur until March though given the steps that need to be taken to get it off the ground. Overall, we expect to see a written deliverable in six to nine months to give you some framework for expectations about when we'd like to see a document. We think that there should be a minimum of three virtual meetings between its formation and the presentation of a deliverable. But obviously, there would need to be work in between those virtual meetings. CDC will offer support to the working group. I'm sure that's a concern to you. We'll offer both logistic support. And we'll have knowledgeable people who can help in terms of taking on some of the preparatory tasks so that the workgroup can dive into the work most effectively. You also have noticed within the terms of reference that there are a number of different questions that are included, too many to take on initially. And so we as you heard from Dr. Liburd, anticipate that just the first three set of questions will be the ones that should focus the attention initially of the workgroup. There may be a second phase for addressing those other items. And we would discuss that. We would bring that back for a discussion with the ACD. Next slide, please. Following this meeting, David and I will survey the interests of the membership of the ACD in participating in any of the three workgroups that we've mentioned, we want to know your interest in the Equity Workgroup, the Data Modernization Workgroup and the Laboratory work groups. And again, as a reminder, there must be ACD, at least two members of the ACD in each one of those work groups. Now, with regard to the Equity Workgroup, we will also begin a process to select the non-ACD members to that workgroup. And we will do this by having an open process with an announcement that occurs within the Federal Register, where people can nominate themselves or others to be members of the workgroup. And that will be done with the identification of the specific skills and expertise that would be needed by the non-ACD members to accomplish the tasks that are identified in the terms of reference. And as I said, we predict the first meeting will occur in March because it will take some time to go through the process of selecting those non-ACD members. And finally, before turning things back over to you and to David, let me offer some guidance on the discussion of the terms of reference. While CDC has drafted the terms based on its identification of need, we thoroughly encourage and look forward to your comments and recommendations before the document is finalized. Rather than wordsmithing the document during the meeting itself, we propose that we will take a -- make a record of all the observations, take them into consideration in revising the terms of references needed. And then following the meeting, we'd also welcome any additional comments from individual ACD members that can be sent to David and to me, and then we'll work with you to revise and finalize the terms of reference before the working group meets. We handle it this way to ensure that the activities will be within the agency's strategic priorities and mission. And now over to you David, and to the members of the ACD.

>> Thanks very much, John and Leandris. So let's go ahead and open this up. Now, as you've heard, my goodness, this is a critically important area of work. And it's really, you know, both an honor and somewhat intimidating to take it on. But we can do it because of its importance. It's also quite ambitious. And so you've heard that there is the ability to focus and prioritize as we move forward and in getting information and recommendations back to the ACD and to CDC. I would like to go ahead and open it up now for comments or questions or observations that committee members have on the terms of reference. And as John's mentioned, this is not our only chance. We can also provide additional comments after the meeting. But are there initial observations, questions or issues that ACD members would like to raise at this point? And I see Dr. Morita, please.

>> I just wanted to thank the panel. I didn't get a chance to comment earlier, which is great to hear from all of you regarding all the work that's happening already, and great to see some great people, wonderful people I know from the past, we've done some great work in equity already. So that's one thing. But then the other thing, it's a simple question. You reference the three -- top three questions with the questions that the workgroup will be charged with, and I can't -- is it the order -- in the order that's on the terms of reference? Or was the order that was listed in the presentation?

>> The order in in the presentation? So I can have -- I'm happy to go back to those. So what will CDC need to do to be successful in CORE implementation? And what are the best three agency-wide CORE goals and most important changes to advance CORE? Our second is, what are potential and anticipated barriers to CORE implementation, and how can they be minimized? And then the third is, how can CDC accelerate work on health equity at the [inaudible] or State, Tribal, Local and Territorial levels? So those are the three questions we'd like to address kind of coming out of the gate is actually it would be the emphasis - the [inaudible] emphasis initially on first three topics.

>> Thank you. Thanks for clarifying.

>> Thanks, Dr. Liburd. And you can see that those are very important and broad questions. And so there is going to need to be -- because there's a lot of flexibility within those questions, and but also the need for the Workgroup to prioritize even within those, what are the most important outside recommendations that can come back to ACD? And then to CDC? I think we probably can go back to the gallery view for all of us so we can see each other, and Dr. Martinez.

>> Question more in the weeds, being coming off another task force, just recently. So a couple of questions in relation to how the work will be done. The fifth, the non-ACD members of the Workgroup, I'm assuming these are going to be additional subject matter experts. How will we be -- how will they be chosen? And how will the rest of the ACD weigh in on that? Two, the federal folks here, our CDC colleagues? Are they considered if they're worth the Workgroup, are they part of the 15? And will they be or will there be a consulting group on the Presidential Health Equity Task Force? HHS was able to provide a consulting group that helped with the federal folks to put -- to get the work done, David, so the writing, you know, the curating of data and in research and all that. So just curious, I know, it's down in the weeds already. But it's such an important Workgroup. I'm just wondering how that's going to be handled.

>> Yeah, let me take a quick shot at that, if that's okay, John, and then you could tell me how I'm wrong and tell -- give people the truth. But first off, I do think that one of the most critical factors that makes the workgroups successful, as you've said, is to have adequate support. And so I would think about the support that the CDC provides a sort of Executive Secretariat kind of level, because it's also critically important that both because the fact rules and because of what we want to do that the actual recommendations themselves are developed externally by us, as opposed to any perception that CDC is creating recommendations that then the committee is approving. So it's a little bit of a balance there. But quite clearly, the support for the preparation of the report is critical, and perhaps a [inaudible] John can speak to that. Second small comment is that we really would encourage people, to the extent that you have time and interest to participate in one or more of these workgroups. The addition of additional outside members is going to be based in part on the expertise from within the committee that volunteers to be part of the process. We'll take a close look at that, and then see are there critical domains that beyond the members who are able and willing to participate would be needed and that will be used as a guide for the selection of the outside members. John and Leandris, any other comments?

>> Just to complement what you were saying, David, in terms of one of the questions that Dr. Martinez mentioned. When we are projecting the cap on the size of the workgroup at 15, that does include the members who would be ACD members. So if there are three, four ACD members, then the number would go down to 11, or 12, for non-ACD members too, if we went to the full 15. With regard to the process, we do want this to be an open process. We want to make sure that people have an opportunity to participate in not just this workgroup, but the other workgroups. So we do want to have a process that involves a public announcement and an easy way for people to either nominate themselves or others to participate. That said, with regard to this workgroup and other workgroups, we really will look to the ACD members to suggest people that you know of who may be valuable members of the workgroup. So a starting point would be to encourage you to consider who those non-ACD members might be that could make a valuable contribution in addressing the gaps in the specific skills that David was mentioning. And once we get all of the applications that come in, we haven't quite determined what the review process will be. But it will be a process where we look at the specific needs of the workgroup that have been identified, and then try to match that with the applications. And I think we can discuss whether and how to involve ACD members and taking a look at those applications as well, if that would be the wishes of the ACD.

>> Just one final quick point. We are looking very much to CDC for that Executive Secretariat function and the subject matter expertise. Federal folks, including CDC are not official members of the workgroup. They're support. Dr. Shah?

>> Thank you. You know, a reflection and a question. This work is certainly internal in the sense that it's focused on what the CDC can and will do to advance equity and DIEA. And to the extent that it will be informed by external forces, given the expertise of the working group and others who contribute, it might also be an opportunity to influence the outside world beyond the CDC considerably. And I'm thinking specifically of all of the ESG movements going on right now. I won't use acronyms as much as the CDC. ESG, environmental, social and governance issues that corporate boards are looking at that aren't really a lot of Americans paying attention to it and trying to figure out how do we take this force, this really important opportunity to advance equity? And I don't know that they have the answers. And I think that the CDC, as experts in measurement can do this work not only for themselves, but with a little broader lens, create the kind of opportunity for others to be fast followers. And I don't know if any of this work should be thought of in that line or not. So my question is, really, how much are we really about internal focus? Or are there opportunities to think broader and influence not only America, but the world in some of this work?

>> So I'll start by saying that, you know, we're first of all needing to get our own house in order and our leadership structures and to make sure that we have the rigor that we need in order to be a changemaker in the larger public health enterprise. And we mentioned a number of times multisector partnerships. And those partners, I think, by definition, will be external, you know, to the agency and represent different sectors. And so again, as we are implementing CORE, we will have those opportunities to engage with others outside of the agency, but also ultimately, our work lands well outside of our own doors and walls and around the country and working with governmental departments and public health. And also not to forget we have a Center for Global Health that has people all around the world, and they are also participating in the CORE strategy. So it won't just stay with us. It's going to start with us. We want to make sure that what we roll out is good.

>> It'll be a great force multiplier. Thank you.

>> Thank you. Dr. Medows?

>> Just a quick process question. He said we can join multiple workgroups which is good, yay. My OCD heart [inaudible], but for process wise any of the products deliverable and reports will be reviewed by the full council before they're published, is that correct?

>> That's absolutely correct. The working group process is to develop reports, and in particular, maybe one of the most powerful parts with reports, are specific recommendations to CDC. And those are brought to the ACD in full committee, and ultimately voted upon by the, by the ACD committee itself, before going to CDC.

>> Perfect. Thank you, guys.

>> Other comments or questions at this point? I know this is a lot. And again, my appreciation. I think this is a little bit of you know, there is a track record for how to do this that has been successful in other work groups. And it is also a little bit of us as a committee figuring out how to make this work as effectively as possible as we go forward. I mentioned to both Daniel and Monica that we don't have to just -- it's been my experience, though, with ACD, that less is more, that to the extent that we can really focus and prioritize on some of the most important elements of advice to CDC that oftentimes, that that's a useful way of elevating those things that are most that are most important. And I don't want to put either Monica or Daniel on the spot, but either of you have any comments before we move to the next part of the discussion? And no is a perfectly acceptable answer.

>> I'm excited to serve in this role with Daniel and I'm even more excited that we have such a great committee to lean on. So look forward to following up with you all.

>> But I would just say ditto to what Monica has said. It's exciting, and I'm excited to move forward.

>> Thank you both. And I know that this is a commitment. But you know, one of the things that we -- so thank you, and to the other ACD members, please think about your interest and willingness to participate in all of these work groups. Again, from my past experience, in some ways, these are the most fun and rewarding parts of being on the committee. That is a commitment of time. But don't be shy. And we would like to assure you that if you express interest in participating that that's what will happen. So this is a really open opportunity for you to decide what parts of our work going forward are the ones that you're able to spend this time on. I'd like to briefly now move us -- we can have a less complete discussion, but just wanted to open up the floor for any comments or suggestions about the other two working groups that we've been asked to create, you know, on data modernization. And on laboratory issues. Obviously, we're in a much earlier phase with these two working groups. We do not have terms of reference. And so there's not a lot of questions that we can ask at this point for which there are answers. But if there are particular issues that you have, that you feel would be important for CDC and us to consider as we're creating the terms of reference between now and our next meeting, this would be one of the good times to raise those. There'll be other opportunities as well. But we did not want to move beyond the working groups without at least providing an opportunity, if anyone had high-level thoughts on either data modernization or the laboratory excellence working groups to make them at this point. Lynn?

>> Yeah, I do. I thought both of the presentations were really wonderful. And it's obvious that the scientific staff at the CDC has already put considerable amount of thought and effort into these two areas. And so what I -- what I've asked them for in terms of indicating that these are areas where they'd like to see us get engaged as a working group is, you know, as people looking in from the outside and giving them advice from the outside, where are we able to add value? Which is unlikely to be that we simply tick through everything that they're doing and say, "That's great, that's great, that's great." But where can we have the opportunity to really make a difference by providing an outside perspective? So if that could be passed along to them, I'd really appreciate that because they're doing great work. But I don't think that we're going to add a lot if that's all we end up saying at the end of the day.

>> Really good comment and that's not all we're going to say at the end of the day but keeping this top of mind is important. Ms. Gary?

>> I just wanted to build on a point that Dr. Morita made earlier today, which is kind of that Venn diagram between these different work groups and you know, how equity really needs to be a through line across many of them. And so as those workgroups are being developed, you know, kind of thinking about where equity fits in and how this committee or workgroup might be able to contribute to that. And really vice versa.

>> Yeah, excellent. These aren't -- these are not siloed areas. And so we get to keep that in mind. And there's a lot of potential synergy here, including the synergy as we tackle these issues sort of in parallel, making sure that our -- we're talking to each other so we can see those opportunities. Thank you for that. Dr. Shah?

>> One of the cross-cutting issues that we haven't really discussed is funding and sustainable funding. What I'm worried about is that we get our next version of the fax machine, and we stick with it for the next 20 years. And for all of these three important issues, we clearly need to figure out how to do that at scale in a way that breaks some of the barriers that we've had, and we continue to face. The challenges are real. It's the elephant in the room. And whether it's its own workgroup, or some sort of approach that's consistent and thoughtful across all of these three important work groups is probably important.

>> Really excellent. Yeah, you're absolutely right. And you know, we're in this odd time right now, as you're aware, because of COVID. Some resources that were not previously available, have been made available, but knowing the extent to which those are sustainable, and strategies for creating sustainability will be key issues. Thank you. Thank you for that. Any last comments before we move on? I know it's been a long day. If not, then let's move on. And we now we'd like to move into the public comment portion of our meeting. Members of the public are offered in advance through a notice in the Federal Register, the opportunity to provide comments of up to three minutes in length at each meeting, including the meeting today. Today, we'll have three individuals speaking to us. I'd like to now ask those individuals to hit the raise-hand feature on your Zoom screen so that our staff can easily identify you. And when you're called on to please, to speak -- please make sure to unmute yourself. Our speakers today -- our first speaker today will be Dr. Michael Fraser, from the Association of State and Territorial Health Officers. Dr. Fraser, are you on the line?

>> I am. Good afternoon, Dr. Fleming.

>> Good afternoon.

>> Thank you for allowing me to speak. It's great to see so many colleagues. I'm Mike Fraser, the Chief Executive Officer of the Association of State and Territorial Health Officials or ASTHO, and it's also wonderful to see so many of our alumni on this committee. I wanted to comment on behalf of our organization that represents state and territorial health officials across the country. Briefly this afternoon, first by thanking the director and the CDC staff for its unwavering and untiring leadership in this most unprecedented pandemic, and to thank the committee members for offering their expertise to the director to bring CDC all of your expertise and insight. States, our primary partner for the agency, and we are extremely invested in the agency success, as are all of us on the line. At our recent board meeting, our board of directors approved five priority areas for ASTHO to work on as a partner and advocate and a resource. Almost all five of these mirror the conversations that we had today. They include health and racial equity, workforce development, sustainable infrastructure improvements, data modernization, interoperability, and promoting evidence based on promising health practices and public health practice across the country. These five priority areas will be our guide for technical assistance and advocacy on behalf of State and Territorial Health Officials and our partners. And it's, I think, serendipitous, but also no coincidence that they do mirror the conversation today because these are the most pressing issues, I think, impacting the public health system in our country. So we look forward to working with the agency and with the committee on these priorities and with our members. I just want to offer three other comments before I conclude. First, we urge the director and the agency to quickly identify a sustainability pathway for the $2.25 billion through the CSTLTS mechanism to states for vaccine disparity work. This is a grant program, one of the only grant programs to address disparities in health equity that's available to states. This grant expires after two years. And without a sustainable funding strategy for the future, we fear that this important work, a lot of which involves community engagement, and the employment of community health workers in states will stop. And that would be a shame given the priority we're all placing on equity work. Second of all, we urge the director to consider opportunities to collaborate with national associations like ours, in support of a formal structured official, either in-progress review, or hopefully after action review of the COVID response for the last two years. There has not been since the beginning of this pandemic. And he's structured formal engagement between the national associations, our members and CDC, specifically on the COVID response, and the issues we need to address in a state-federal partnership, anticipating the next one and debriefing on the current one. I believe this is urgent. It shouldn't wait till the end of the pandemic is, quote/unquote, over. And certainly the agency has been listening to states, certainly the agency has had listening sessions with states, certainly the agency speaks daily with states, but there is a formal process to facilitate and to stage these three views. And we believe it's really important that we commit to that together. And finally, in considering the working groups that the committee is forming, we would like to suggest that priority be given to at least one or two current state health practitioners to help inform the work that is going on on the ground today. In addition to the wonderful and very talented alumni who stay current and engage with us, though. We believe this will provide a voice of the field that would be important for the committee to include in its recommendations to the director. Thank you all. It's wonderful to work with you. And it's wonderful to work in public health at this historic time.

>> Thanks, Dr. Frasier, for those excellent comments. We appreciate you taking the time. Next would be Dr. Stephanie Mayfield. From the organization Resolve to Save Lives. Stephanie, I hope you're on the line.

>> Yes, I am. Thank you Dr. Fleming and Advisory Board members for allowing me to present some comments today. I'm here as a senior advisor to Resolve to Save Lives. With US partnerships, Resolve to Save Lives is a global organization focusing on saving 100 million lives from cardiovascular disease and preventing epidemics. Much of what I have to say aligns with what we talked about earlier how COVID-19 highlighted the stark inequities in the United States and across the globe. And now we must address the gaps COVID illuminated and transform our public health system to meet our current and future challenges. Three points, please. First, we must have sustainable and equitably distributed funding for CORE public health systems to prevent, detect and respond to public health threats here at home and abroad. It is vital we establish a budget exemption for these critical public health functions through a health defense operations designation. Current supplemental appropriations are by nature temporary. We must ensure that the investments made in our CORE public health infrastructure and health security programs are maintained and used to prevent the next pandemic. This HDL designation would exempt critical health protection funding from the spending caps, so our public health agencies, especially CDC can protect us. Second, we should strengthen and expand public health infrastructure through a whole of government approach that addresses not only pandemics and infectious diseases, but chronic conditions such as hypertension. Improved blood pressure control saves more lives on a population basis than any other clinical intervention. Moreover, hypertension is a leading cause of premature death, leading contributor to changes in life expectancy, and hypertension is a leading cause of Black and White health disparities. One in four Blacks 18 years and older has uncontrolled hypertension compared to one in seven Whites, all too high. There are many levers that the federal government can pull to address hypertension ranging from implementing interagency salt reduction strategies to increasing support to state and local groups for community-led programs that address hypertension across diverse public and private sectors. Third, work with the Centers for Medicare and Medicaid Services on two areas. One, support and all-payer including Medicaid sustainable, quality driven, comprehensive, team-based primary care model consisting of integration of pharmacists and community health workers to address hypertension. And two, collect and report local jurisdiction blood pressure control demographic data for equity-based interventions. Thank you for this opportunity to present comments.

>> Thanks so much Dr. Mayfield, for those, for those points. Really, really very much appreciate you taking the time. Now our third speaker is Adriane Casalotti from the National Association of County and City Health Officials. Adriane?

>> Hi, thank you all. I want to reach out thank the director for her comments, the wonderful presentations from other CDC staff, and the engaging conversation of the Advisory Committee today. We're incredibly pleased that this group has been reconvened. And to see former NACCHO members on the committee and active. I am Adriane Casalotti, Government and Public Affairs for NACCHO. I represent the leaders and staff of our nation's nearly 3000 local health departments. I wanted to associate myself with the comments that were made previously. And focus just re-up Dr. Fraser's comment about incorporating [inaudible] current local health officials from different sized communities and the work of the advisory committee and task forces to ensure that's informed by the current moment. We appreciate the conversation today and the focus on public health partnerships across CDC, state health departments and local health departments. This peer to peer to peer relationship has never been more important. To be honest, there have been a lot of challenges at local health departments stemming from decades of disinvestment, but also the polarization and sheer workload of the pandemic response with which you all are so familiar with. That being said, we're excited for many of the initiatives discussed today and really see equity as the through line. You chose key policy efforts. Our workforce, public health infrastructure, including sustainable disease [inaudible] funding to fill the gaps left by disease-specific silos, and data modernization, which line up so well with what you've been talking about. Each of these pieces can lead to a more -- to health departments that are better able to respond to health disparities and promote health equity, both in having the data that you need to target your programs and make them efficient and effective, as well as to have the people in the seats who can build relationships and sustain those relationships with different corners of their communities. So that we're not trying to build those up in the middle of a crisis. But we have trusted messengers, and trusted methods of communication. We also want to - and all of these areas are so much new that we can do. We wanted to lift up the fact that we need to start -- we need to put a priority in for those health departments that are most under resourced. We know their need. There's needs everywhere, but the pandemic has shown us we really are only as strong as our weakest links. And it's hard and oftentimes the folks that are hurt -- the health departments that are hardest to help are the ones that we kind of say we'll get to later. And we never get there. When we really won't be moving our nation forward in health and safety without addressing this piece. We stand ready to work with you, and to engage public health practitioners in this work. And also to ensure that the local health department perspective is included in not just the outcomes of the work, but also the strategy and how to get there. Thank you so much.

>> Thanks, Miss Casalotti. Yes, our public health system is in partnership. And we're -- in order for it to be strong, we all need to be strong. Thank you for making those points. Okay, that concludes the public comment session. And we are now in that final wrap-up phase. You'll be relieved to know I'm not going to spend a lot of time here because we've had a long day. I think my overwhelming reaction is wow. This has been a fantastic meeting, a really great way in my mind to reinvigorate -- start off and reinvigorate the ACD. I'm not going to do a long recap, but it was so good to hear from Dr. Walensky, and to hear from CDC staff earlier in the meeting about what some of the current priorities are. Obviously that's something that we're going to continue to hear about over time. It was great to get to start on our actual work and begin to talk about the creation of these work groups. And thanks so much for your input and for your participation in those groups as we move forward. Most importantly, though, I wanted to give my thanks, thanks to all the people that I'm looking at on the screen here, my fellow members. And thanks to CDC, including most importantly, John Auerbach, who I'm going to give the last word to in a minute. But this really has been, I think, a really good start of a partnership between our committee and the CDC to be able to move us forward. I am going to now turn this over to John. Before I do that, no pressure but just did not want to finish the meeting without giving any of the people that I'm looking at an opportunity to make any last comments, last word on the day today. Thanks, Rhonda. Yeah, it's a good meeting. Great, John. Pass goes to you.

>> Thank you. Thank you. Ditto to everything you said. Thank you so much, ACD members. I know it was not easy getting here. You were so patient with us about all the preparations that go into an appointment to [inaudible]. Thank you for your dedication and commitment to getting here today, as well as for your rich and deep involvement today in the discussions. I want to just take a minute to say thank you to the CDC staff that worked so hard to put this together, that you all may want not want to put your cameras on. But if you do, there's Carrie Caudwell. There's Bridget Richard. There is Heather Dennehy, and there is Tiffany Brown. In addition to that, Gladys Llewellyn and Dee Gardner, from our Strategic Business Initiative gave us the training and the expertise. We're grateful to all of them. They work behind the scenes to make this happen and to go successfully. We took very good notes about the areas that you said you wanted to pay some more attention to, and we will incorporate your feedback into the planning of the next meeting and the meeting after that. We expect that and hope that the next meeting, the meeting that will be in May, will be in person. You know, we can't predict; we've learned that through COVID. But our hope is that it will be possible for you all to travel to Atlanta for the next meeting. And we think that will be very beneficial in terms of creating an esprit de corps, your getting to know each other better, and operating as a very effective body of experts. We will follow up on all the action steps mentioned, including the soliciting your interest in the workgroups, working to get the other members solidified that are on the Equity Workgroup and planning that very first meeting. And we'll also follow up by developing the terms of reference for those two other work groups, the one on laboratory and data modernization and those draft terms of reference will be sent to you in probably in the next month or two. So in closing, just thank you. And a special thank you to you, David. What you members may not know is David has spent a countless number of hours on the phone with us in the planning and in the various preparations that go into creating, recreating [inaudible] an advisory group to the director. I know I speak on behalf of Dr. Walensky when I say thank you, Dr. Fleming, and thanks to each of you on the ACD. We're so grateful, and we know that your contributions will be very significant in terms of advancing the priorities of the agency. So much appreciated.

>> Thanks, John. And with that, we are adjourned.

>> Thank you.

>> Bye-bye.