It has been the honor of a lifetime to serve as Secretary of this department. As I’ve said many times, this is the best job I’ve ever had, and I could not imagine more meaningful work than what we do at this department. I love HHS not only because of our mission, but because of the people who faithfully carry it out. I will miss this department, our work together, and all of you. From the bottom of my heart, thank you for what you do for your country. May God bless you all, the work of this Department, and the United States of America. Thank you.
Good morning, everyone, and thank you so much for joining us for today's State of the Department address.
As many of you will remember, we've done these events the past two years. Even as our department prepares for the busy transition of the next several weeks, we wanted to review and recognize the accomplishments of our incredible HHS team over this past year.
As you can tell from my background, this event is being broadcast not from the Humphrey Building in Washington but from the NIH campus in Bethesda, Maryland.
I'm grateful to the NIH team for graciously hosting us here today, because the security precautions being taken around the inauguration made it impractical to be in the Humphrey Building.
It's also appropriate to be here because the scientists at NIH have, alongside just about every single division of HHS, played a crucial role in our fight against COVID-19.
That extends from NIH's record-breaking and unprecedented work with BARDA and FDA on vaccine and therapeutic clinical trials to work with CDC to expand our understanding of the virus.
While this year has seen so many remarkable accomplishments by the men and women of our department, it has been an incredibly difficult year for many of us and for our country.
COVID-19 has dealt extraordinary economic damage, it has caused so many people to be isolated from family and friends, and it has now, as of this morning, taken the lives of nearly 400,000 of our fellow Americans.
This is a national tragedy. We have lost members of our own HHS family, some of whom put their lives on the line by providing frontline care in the Indian Health Service. Many other members of our HHS family have lost loved ones or friends.
I ask that we all take a moment to pause and mark a moment of silence for the nearly 400,000 Americans whom we have lost.
Each life lost to COVID-19 is a tragedy that weighs on us all. During this difficult time, we are fortunate to have the chance to combat this unprecedented crisis: through your daily work to save lives from the virus, to help patients get the care they need, and to support the health and well-being of all Americans.
Thankfully, we have so many reasons for hope—and we know there is an end in sight. We have hope because of the incredible results delivered by our colleagues at HHS, elsewhere across the federal government, and in the private sector: safe and effective vaccines that have been developed in record time and now been administered to more than 14 million Americans, with nearly a million more doses being administered on average every day.
We would not have these highly effective vaccines in substantial quantities if it were not for the work that so many of you have put into Operation Warp Speed. OWS built on the very early work done here at NIH and elsewhere, with the development of the Moderna vaccine beginning here just over a year ago.
We then married those remarkable scientific efforts to a set of capabilities from elsewhere in government and in the private sector. We drove early development and manufacturing by making pre-purchase commitments of more than $10 billion. We provided comprehensive support for vaccine manufacturing operations, enlisting private-sector advisors and logistics experts from the Department of Defense to ensure that production could scale up without a hitch.
DoD and ASPR bought the syringes, needles, and PPE needed to administer vaccines, and we ensured that no American would face any out-of-pocket costs for vaccination. Today, states are rapidly scaling up vaccine administrations with our help, leveraging partners like chain pharmacies and HRSA-funded health centers.
Similar work went into the therapeutics we now have for COVID-19, including two authorized monoclonal antibody therapies that we started supporting as early as last February. More than half a million courses of these treatments have now been delivered to states, and I want to encourage everyone to remember that these are an important option to help keep Americans at risk for severe COVID-19 out of the hospital.
We've also seen leaps and bounds in diagnostic development over the past year. Early work by ASPR helped major lab companies bring commercial tests to market for COVID-19 in mid-March. Through our testing working group, we coordinated the distribution of crucial supplies, like swabs and transport media, that states needed to keep their testing systems running smoothly.
In March, we stood up the Community-Based Testing Sites model, using regulatory flexibilities to set up drive-through locations across America, with many early sites staffed by members of the U.S. Public Health Service Commissioned Corps.
More than two-thirds of those sites were located in socially vulnerable areas, more than 3,000 of them remain under federal contract, and more than 7,600 sites total across the country have grown out of this model.
Federal purchases and strategic allocation of hundred of millions of rapid tests have now helped nursing homes, Indian Health Service facilities, schools, colleges, and other crucial infrastructure track the spread of the virus. Eighteen diagnostics from BARDA-supported partners are now available under emergency use authorization from FDA, and these partners have shipped more than 79 million test kits across the country. NIH's RADx initiative has now invested nearly half a billion dollars into the development and manufacturing of remarkable new testing technologies, including the first at-home test that can be purchased and used without a prescription.
As I mentioned, some of the early response required putting boots on the ground. Members of the Public Health Service Commissioned Corps and ASPR's National Disaster Medical System oversaw quarantines for Americans who were repatriated safely from Wuhan and from the Diamond Princess and Grand Princess. Working alongside ACF staff and the Department of Defense, they provided care and met the needs of those arriving on our shores.
When New York's healthcare system was at risk of being overwhelmed in March and April, HHS personnel were there on the ground to support the field hospital at the Javits Center, constructed with Federal Medical Station supplies from the Strategic National Stockpile, or SNS.
While the SNS was not built to meet the demands of a nationwide pandemic, it rapidly distributed 90 percent of its PPE to states in the early days of the crisis. Then, with FEMA's help, we helped ensure that PPE supplies from around the world were flown here and routed where they were needed most. Then, this summer, we undertook a total modernization and overhaul of the SNS, creating a next-generation stockpile that covers more of our potential needs during a pandemic, has much deeper reserves of those supplies, and has full visibility into medical supply chains and hospitals' needs.
That new visibility into PPE needs is linked up to a much broader project we undertook, HHS Protect, to bring all of the COVID-19 data sets that the federal government has into one place, available for easy use by federal and state decision makers.
Throughout the crisis, HHS scientists and public health experts have worked incredibly hard to educate Americans with the best scientific guidance we have. That's included more than 4,500 guidance documents published by CDC, complemented by more than 1,500 CDC staff who've deployed in the U.S. and around the world to advise governments.
Communities of color have suffered vastly disproportionate impacts from COVID-19, with American Indians, Alaska Natives and Hispanic Americans 3.3 times more likely to be hospitalized than non-Hispanic white Americans, and Black Americans 3 times as likely to be hospitalized. As I mentioned, we've ensured that testing is available in vulnerable areas, with more than 98 percent of HRSA-funded community health centers offering testing. The Office of Minority Health launched a $40 million cooperative agreement with the Morehouse School of Medicine to create a strategic network that will disseminate accurate and useful information in communities of color. NIH launched the Community Engagement Alliance Against COVID-19 Disparities, which is combating misinformation in communities of color and working to boost confidence in clinical trials.
All across HHS, we've undertaken comprehensive efforts to expand the capacity of our healthcare system to care for patients. We've cut back paperwork dramatically, issued waivers for hospitals to deliver care in new settings, and dramatically expanded access to telehealth as a way to expand capacity and provide safe access to care.
The telehealth revolution has been remarkable. Since mid-March, an average of 1.1 million Medicare beneficiaries have used telemedicine services each week, over 65 times higher than before the pandemic. To ensure that Americans with opioid use disorder can maintain access to medication-assisted treatment, SAMHSA worked with the DEA to ensure that these medications could be delivered through telehealth and by mail.
To help support our healthcare providers, Congress has allocated $178 billion for a Provider Relief Fund—and, well, that's about all they did to guide that effort. It was entirely in our hands how to distribute that money and ensure it went where it was needed most. HRSA has done that with remarkable speed, and we've been able to focus these funds on the providers hardest hit and in greatest need. The provider relief funds come in addition to the tens of billions of dollars in emergency funding allocated by Congress that just about every grant-making division at HHS has sent out in record time.
Our human services divisions have been engaged in the fight against COVID-19 too. The Administration for Community Living had its grants budget increased by more than 40 percent, allowing us to leverage our network of community service providers to help older Americans and Americans with disabilities have access to groceries, trips to the doctor, and other services they needed to stay safe while social distancing. ACF delivered a huge range of flexibilities for childcare providers, Head Start programs, and child welfare systems, with Head Start being featured in a recent CDC study on how they've provided safer in-person services.
The incredible thing is that, for all of the achievements this department has delivered on COVID-19, you have not lost sight of our many other priorities.
Each year, this speech and our annual report, which will be published later today, has been focused around the five goals in our strategic plan: reforming, strengthening, and modernizing our healthcare system; protecting the health of Americans where they live, learn, work, and play; strengthening the economic and social well-being of Americans across their lifespan; fostering sound, sustained advances in the sciences; and promoting effective and efficient management and stewardship of the department.
You've continued to deliver action and results on these goals, even while putting such a focus on our COVID-19 response. The annual report I mentioned will provide a much more comprehensive sampling of achievements from this past year, but I want to go through some highlights right now.
Three of the key priorities that I laid out upon becoming Secretary fall squarely within the first goal, of health system reform: transforming our system to pay for health and outcomes rather than sickness and procedures, lowering drug prices, and addressing the high cost of health insurance. On each of those, we continued our progress this past year.
We delivered on so many of the key elements of value-based transformation that I laid out back in early 2018: We finalized the historic interoperability rules, to give patients seamless access to their health information. We launched major new models to pay for value, like multiple opportunities for primary care providers to take on risk and share in savings by keeping their patients healthy.
We finalized historic reforms to regulations under the Stark Law, the Anti-Kickback Statute, and 42 CFR Part 2, allowing providers to put patients at the center and focus on their needs rather than regulatory compliance. Our Office for Civil Rights also published a draft rule to bring these same principles to HIPAA's privacy rule. Starting two weeks ago, on January 1, hospitals finally have to be transparent about their prices, with meaningful information easily available to patients about actual costs. In the coming years, insurers will be required to disclose information to you about what you'll owe for a healthcare service, before you go get that service.
This past year, we also put the finishing touches on our transformative drug pricing agenda. We finalized a rule, effective next year, to replace a broken system of kickbacks negotiated by middlemen with a system where negotiated discounts—which average 30 percent in Medicare Part D, nearly $40 billion a year—have to be passed on to the patient at the pharmacy counter.
We launched a mandatory model to reduce dramatically what Medicare pays for physician-administered drugs, to bring balance to an area where foreign countries have been freeriding off of our programs and America's seniors for too long.
On insurance, starting past year, employers can now use what are called Health Reimbursement Arrangements to give employees tax-free dollars to purchase health insurance of their choosing. This expands the options customers have and, I believe, could help transform the insurance marketplace in the years to come.
The Indian Health Service also took major steps forward on the quality and accessibility of the care it delivers. As of the end of 2020, 100 percent of IHS's hospitals are accredited by CMS and the Joint Commission.
In one of the key steps we've taken to transform rural health under an action plan laid out by our rural task force, IHS announced the historic expansion of its Community Health Aide Program from Alaska to the whole nation.
One of the key focuses of our work to protect the health of Americans, our second goal, has been combating our country's crisis of opioid addiction and overdose.
Your work helped deliver the first decrease in drug overdose deaths in more than two decades in 2018. But, toward the end of 2019 and in 2020, overdose deaths started to rise again.
This is just more reinforcement that we need to double down on what works: connecting Americans to medication-assisted treatment and combating stigma around addiction, which I committed to doing soon after arriving at HHS in 2018.
We've delivered some impressive results: The number of Americans receiving medication-assisted treatment has risen by at least 38 percent since 2016, and the share of treatment programs offering MAT has risen substantially.
Opioid prescribing is down 32 percent since January 2017, and prescriptions of naloxone are up 502 percent. Last year, we'd already begun pivoting to address the rise in overdoses from stimulants as well, by ensuring that states can use the $1.5 billion in opioid grants Congress has appropriated for SAMHSA to address this challenge too.
Substance abuse so often interacts with mental illness, and all of you can be proud of the new focus this department has put over the past several years on serious mental illness. While the number of Americans living with serious mental illness has been rising, we've worked with states to deliver new access to treatment, and we've promoted proven, evidence-based treatment options.
Your work has also made a huge difference in combating the epidemic of youth use of e-cigarettes, which has risen faster than we've ever seen use of any substance increase. In September 2019, FDA announced its plans to prioritize enforcement against e-cigarettes illegally on the market with flavors that appeal to children, forcing these products off the market.
According to CDC and FDA's National Youth Tobacco Survey, the number of youth using any tobacco product dropped from 6.2 million in 2019 to about 4.5 million in 2020. While we still have so far to go, that's down about 28 percent, a remarkable one-year drop.
This past year also saw the national launch of our initiative to end the HIV epidemic in America by 2030.
We delivered implementation grants to the 57 jurisdictions that account for more than half of the new HIV infections in America each year, and we added new convenient ways for uninsured Americans who are at risk for HIV to access PrEP preventive medications.
Our department also helped bring an end to the second-largest Ebola outbreak in history this past year, using therapeutics and vaccines supported by NIH, delivered in the eastern Democratic Republic of the Congo—one of the most unstable and challenging areas on the planet for public health work.
You've also delivered results on one of the most costly health challenges we face, kidney disease. Since we launched the Advancing American Kidney Health initiative in July 2019, we've delivered more change on kidney care than we'd seen in decades: two new payment models to prevent kidney disease, promote transplants, and encourage alternatives to center-based dialysis; new accountability for organ procurement organizations that's projected to make thousands more lifesaving transplants available each year; new support for heroic living organ donors; and a series of prize competitions that have attracted dozens of innovators into the kidney space to work toward an artificial kidney.
I want to make one final point around public health. This past year, Americans became well acquainted with the amazing institution that is the U.S. Public Health Service Commissioned Corps, whether because of their heroic work filling gaps on the frontlines of the pandemic, the Surgeon General's role as a public voice, or the testing briefings from Admiral Giroir—although, still, nobody on cable news seems to be able to get his name right.
But when I arrived here in early 2018, there were some in the administration who believed the Commissioned Corps had become obsolete. We fought hard to preserve this service, and they have now played such a crucial role during the pandemic, with more than 4,300 officers deployed over the past year, everywhere from Japan to New York City. Today, the Commissioned Corps is a stronger, more agile, readier force than ever, and Congress has helped set them up for the future by officially authorizing the creation of a Ready Reserve force.
This past year also saw progress on a number of the key human services priorities that we set out. ACF's All-In campaign with governors and states on adoption has driven real results, with our most recent data showing a record high level of adoptions and a steady decrease in foster care numbers.
We've also made it a priority for our programs to aim toward independence and help Americans secure the economic and psychological benefits of employment. Last year, ACF's Office of Family Assistance launched a first-of-its kind interagency initiative to bring together three major workforce development programs: ACF's TANF cash welfare program, the Department of Labor's WIOA [wee-owe-ah] programs, and USDA's SNAP work programs. With 11 states already signed up, this effort aims to help Americans who've been disconnected from the workforce find sustainable employment, and it's now being used to address the economic impacts of the pandemic as well.
We also made real progress on bringing healthcare and human services together, recognizing that health challenges can often be inextricably linked to social challenges like poverty and housing insecurity. ACL held a first-ever conference bringing together community service providers with healthcare payers, to help them work together to address these challenges. ONC and AHRQ worked to make it easier to integrate data on social determinants into health records.
We've also sustained our commitment to protecting conscience rights and religious freedom. Last July, the Supreme Court upheld, by a vote of 7-2, our regulation to provide exemptions from the contraception mandate for employers with religious or moral objections to it, including many organizations that help deliver healthcare and human services to the most vulnerable among us, like the Little Sisters of the Poor. That work extended abroad, too, with the historic signing of the Geneva Consensus Declaration, an unprecedented commitment by the United States and 35 other nations to protecting life, the family, and national sovereignty around the world.
As I mentioned to start, the components of HHS that drive scientific research have played such a crucial role in our fight against COVID-19. It is no exaggeration to say that the end to this pandemic is much nearer because of the work of our scientific colleagues at NIH, BARDA, and elsewhere to build a biomedical research enterprise that can so rapidly develop countermeasures.
The success of Operation Warp Speed and of mRNA technology, which underlies the Pfizer and Moderna vaccines and was pioneered by NIH, should help reinvigorate our optimism about the frontiers of medical science and what we can do when we bring together the public and private sectors to tackle the toughest challenges.
NIH has also leveraged its clinical trial networks to support vaccine development, and they've constructed an unprecedented adaptive clinical trial program, called ACTIV, which is testing various treatments for COVID-19 in partnership with more than 20 biopharmaceutical companies, academic institutions, and numerous government agencies.
While so much of our scientific work this past year has been focused on COVID-19, NIH has also continued to deliver results in other areas. New progress has been made on Alzheimer's and on forms of cancer that had been resistant to treatment. To address the dearth of new treatment options in recent years for serious mental illness, NIH launched a new Accelerating Medicines Partnership, or AMP, to support new treatments for schizophrenia, following partnerships already launched for Alzheimer's and autoimmune disorders. These AMPs are a bit like Operation Warp Speed in that they bring pharmaceutical companies and public researchers together in closer cooperation than usual, identifying specific strategies and targets that they can pursue together.
We also saw four NIH researchers awarded Nobel Prizes in 2020, including Dr. Harvey Alter, who has been an intramural researcher at NIH for more than five decades, where he and colleagues discovered the hepatitis C virus.
Finally, we've continued to make real improvements in how HHS is managed and run. As part of OIG's mission to protect taxpayer dollars, they and DOJ delivered the largest-ever healthcare fraud takedown this past year, involving more than $6 billion in alleged losses to federal healthcare programs—setting a new record even amidst the challenges of the pandemic.
Each of the initiatives launched under ReImagine HHS have now been transitioned to permanent homes, and a number of those efforts have yielded truly significant results and garnered government-wide recognition. Thanks to the Reinvent Grants Management initiative, HHS has now become a designated grants services provider for the entire federal government. The principles of the Buy Smarter initiative helped ASA to bundle a dozen IT services contracts into one, saving $700 million over the next twelve years. All of this occurred at a time when we were making a historic number of grants, delivering countless program changes to adapt to the pandemic, transitioning to telework, and supporting the HHS family through these challenges.
All of these achievements, and all of the work you've done on COVID-19, are a tribute to your dedication to public service and to our shared mission.
When I first addressed all HHS staff back in February 2018, I mentioned four values I believe we should all bring to executing on our mission: integrity, teamwork, courage, and discipline. I believe that, together, we have successfully applied those values to our work.
You have helped make this department, over the last several years, an island of integrity and professionalism, following the science and evidence where it takes us, on issues from opioids and HIV to COVID-19.
Teamwork has been absolutely essential to all of our successes. While we have robust policy debates within this building, team spirit requires that, when we settle on a policy, we all need to be rowing in the same direction.
When we've done that, like on Operation Warp Speed or sweeping department-wide initiatives like kidney health and HIV, we've gotten incredible things done.
Courage has defined this team in so many ways. We've undertaken incredibly bold initiatives over the last several years: transforming how we pay for healthcare in America, reordering the prescription drug marketplace, and launching ambitious public health initiatives like ending the HIV epidemic in America.
Finally, this team's discipline has been relentless and unfailing. Many of you have worked late nights, early mornings, and lots of weekends, both throughout this year and in more ordinary times.
Many of you, especially those involved in direct care or emergency response, have had so little time off this past year.
Over the past few years, I believe no other domestic department has sustained a more round-the-clock dedication to our work than we have.
When I leave tomorrow, you will continue the vital work that HHS does, as the stewards and leaders of our department.
Changing administrations is no simple task during ordinary times, let alone during a pandemic. We've had hundreds of meetings now with President-Elect Biden's team, intent on handing over the reins to the Biden administration in the most seamless way possible. I am grateful not only for the hard work that many of you are doing to prepare for an orderly transition, but how you're executing it with excellence.
It has been the honor of a lifetime to serve as Secretary of this department. As I've said many times, this is the best job I've ever had, and I could not imagine more meaningful work than what we do at this department.
I love HHS not only because of our mission, but because of the people who faithfully carry it out.
I will miss this department, our work together, and all of you. From the bottom of my heart, thank you for what you do for your country. May God bless you all, the work of this Department, and the United States of America. Thank you.
