The 30-day review was submitted to Austin on Thursday.

Maj. Gen. Pat Ryder, the Pentagon press secretary, said portions of the review are classified but the department will release what it can of the review.

Austin has been scrutinized for keeping secret his prostate cancer diagnosis in early December, his surgery and his hospitalization on Jan. 1, when he began suffering complications from the procedure.

Ryder has acknowledged that he and other public affairs and defense aides were told on Jan. 2, that Austin had been hospitalized but did not make it public and did not tell the military service leaders or the National Security Council until Jan. 4. Only then did President Joe Biden find out.

It took another four days before the reason for his hospitalization was disclosed.

And while he transferred decision-making authorities to Deputy Secretary Kathleen Hicks during his initial surgery on Dec. 22, and then again when he was in intensive care in early January, he did not tell her why.

The review was directed on Jan. 8, by Austin’s chief of staff, Kelly Magsamen, and was done by Jennifer Walsh, the Pentagon’s director of administration and management.

In a memo released at the time, Magsamen said the review should include a timeline of events and notifications after Austin was taken to the hospital by ambulance on Jan. 1. She said it must examine the existing process for when a secretary transfers decision-making authorities and who should be notified, and make recommendations for improvement.

Magsamen’s memo also made some interim changes to vastly expand the number of people who must be notified in future transfers of authority and that they must provide a reason.

Officials have said that the reason has never been included in routine transfers. According to the memo, a wider array of officials will be notified, including the Pentagon’s general counsel, the chairman and vice chairman of the Joint Chiefs of Staff, the combatant commanders, service secretaries, the service chiefs, the White House Situation Room, and the senior staff of the secretary and deputy secretary.

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You most likely have seen it over the past couple of years. Your old friend from high school sharing that link that shows a new secret way to prevent COVID-19 that ended up being an ad for modern day snake oil. Yes health misinformation exploded over the course of the pandemic, overwhelming governments, public health authorities, and social media platforms looking to combat it. A new study looked into how well health misinformation is researched by these institutions and the methods they used to fight it. One of the study’s authors is Stefanie Friedhoff, professor of the practice at Brown University’s School of Public Health. She told Federal News Network’s Eric White what they found on the  Federal Drive with Tom Temin.

Interview Transcript: 

Stefanie Friedhoff So a while ago, we started looking at misinformation, COVID- 9 misinformation research to try to understand what lessons we could learn from all the interventions that were applied during the pandemic, and those that were actually studied so we could see what worked and what didn’t. We wanted to create an evidence based playbook for practitioners to understand how to deal with health misinformation. We found around 50 studies that researched this with real participants. We excluded things like studies that were modeling this because we really wanted to see the impact on people in those types of situations. And we learned that out of the 50 studies that we found, some misinformation remains a leading challenge, especially health misinformation. And we thought we should look at the research that’s available, especially studies that were done during the COVID-19 pandemic, when a lot of interventions were fielded, a new things were tried to understand what can we learn from them, How can we get better at responding to health misinformation and how do we know what works and what doesn’t?

Eric White Gotcha. So what types of intervention methods did you find that most public health authorities were using, and were any of them even effective?

Stefanie Friedhoff So to our surprise, we found that a lot of these papers used such different outcome measures and such different ways to look at the challenges that by and large, we couldn’t really compare the evidence. There were 50 studies which used like 47 different ways of looking at the pie. We looked at, for example, the misinformation that the studies put in front of people, and it was very different. Some studies looked at misinformation such as gargling with salt water will prevent you from getting COVID or curing COVID and others shared full blown conspiracy theories. So it was hard to compare that evidence. We did find some evidence for interventions that are called debunks. So after an item has been put out, that is clearly wrong, efforts to debunk that information in certain context will make people less likely to believe in the accuracy of that content. And then also accuracy prompts or nudges the ways in which people are asked to assess a piece of information, and after that are showed different types of misinformation. And the studies show that people are then less likely to believe in the accuracy of such content when they’ve been prompted previously to think critically about content.

Eric White Yeah. Is there a big push from a lot of health agencies in dealing with this problem? Because you don’t get into the medical field usually thinking about, oh, this is how I have to convince people not to listen to things that are definitely not good for them.

Stefanie Friedhoff Well, one key outcome of our study was that only 18% of the papers we could find on this topic actually measured any public health related outcomes, such as intent to vaccinate or self-reported mask wearing or intend to pay for an unproven treatment. If we don’t study the impact on public health, then we also won’t know what works in public health. What is clear is that not enough people from the public health world, both experts and practitioners, are included in the design of these types of studies. Responding to health misinformation has become a major part of working in public health. People were not trained for it. It is really a crisis that exploded during the COVID-19 pandemic. And people had to learn on the fly. There have been reports of Walker burnout because of this. There’s a lot of efforts going on to try to increase capacity to try to help people navigate these types of situations. It’s been particularly challenging when you are a local public health practitioner and you go to hearings and meetings as you should. You want to be in community. And emotions are high around these types of issues. But there’s a large and growing need to both support our public health practitioners as they take on this extra additional challenge that is really hard. And also for everybody who works in public health to play a role in cleaning up our information spaces.

Eric White Yeah. Can we discuss the big part of this, which is just the advent of social media? Back in the old days, all they really had to combat was ads in trademark publications and things like that. But now you’ve just got so many voices that are into the realm of public health. What affected the social media platforms have on these studies that you looked at?

Stefanie Friedhoff The challenge with social media platforms is that many of them don’t share their data. So we need to understand that a lot of these studies were experiments with people as opposed to watching what works and what doesn’t or what is playing out on social media in real life, in real time. We don’t have good enough data often to answer those types of questions. It is very clear that the world has changed dramatically from when we had a few very curated information sources to this wide world where everybody has a voice. And in general, we all know that’s a good thing. The social media companies now have a responsibility as this is common infrastructure. This is the information space as a public good that we share. And we’re really in the early stages of adapting to this technological change and trying to find ways to understand it, understand the harms regulated. As we know, there’s a lot of conversations and a lot of countries going on about how to best do this. But social media is the new place where most people get their information. We now have a generation that doesn’t Google necessarily to find information, and they search on TikToks and other platforms that they use. And those are important changes that we need to understand when we try to meet people’s information needs, when we try to get good information to where people are actually making sense of things in the world.

Eric White And that provides a nice segway into what is the main takeaway, which is that as the avenues for misinformation get more diverse, the ways to combat misinformation also have to get more diverse, and so do the studies that look into misinformation. So what does that mean by making the studies more diverse? What did you all have in mind with that?

Stefanie Friedhoff Well, our study also looked at what types of delivery mechanisms did the different studies use to share the misinformation. Was it text only? Was a text and a picture? Was it audio? Was it video? And what you learn when you look at that is that we’re mostly currently studying text and maybe image based misinformation, but we’re not studying video based misinformation. Only 6% of all the interventions that we looked at used video formats at all. Given the rise in the prominence of video and the increasing amount of video based misinformation that’s out there,  there’s a real need to improve our ways to look at this. More broadly speaking, we really don’t have good science right now to understand how misinformation truly impacts people. You could look at this the same way we look at a novel disease when it first comes out. It’s there and it’s creating some impact, but you don’t know exactly for whom and how and in which ways. And that is where our research needs to become much more granular and become much more elaborate. We need to invest in this type of research. We also currently have a gross underinvestment in this type of research. Doing this work will really also help us overcome some of the politicization because people are worried about censorship and who decides what is misinformation and what isn’t. And by being able to better articulate what the impact is on people, we believe we can also overcome some of these current challenges that come from just not knowing exactly what is going on.

Eric White And that’s a real important part when you were specifically talking about government run health agencies, just because the leadership can change on the whim of an election or an election cycle. So yet the politicization of health information is definitely key. Is there a way to put the toothpaste back in the tube with that one? Because it seems as if it’s becoming a more segmented section of what a certain political party believes and what another one believes when it’s really just health information, not it doesn’t matter what side of the aisle you’re on.

Stefanie Friedhoff Yeah, I do believe that government communicators and scientists all want to be humble in looking at this challenge. And we have seen this in the pandemic over and over when we present a sense of over certainty, then we get into trouble. And a good scientists know that evidence can change, especially on a novel subject. So we need to really distinguish established health information from things that are still in flux and where we don’t know enough. Most people don’t understand the difference between matured science or mature evidence and cutting edge science where we’re just discovering things. It’s really important for everybody who’s communicating in this space to make the difference very clear. Some things we know for sure. We know that vaccines work and how and we can explain those. And some things we’re not so sure. We may have a new vaccine and we’re just testing out how it is working and on which populations. And those things need to be very clearly shared with the public to maintain trust. One thing we should be mindful of, both as researchers and as communicators, is that as long as we don’t have a strong evidence base that shows us how and when misinformation is impacting people and the health behaviors, we want to be mindful and not overreach in claiming such impact.

 

The post What can be done in the public-health sector to combat misinformation? first appeared on Federal News Network.

After more than 30 years at the National Institutes of Health, the next guest has been recognized by the Senior Executives Association with the 2023 Spirit of Excellence award for diversity, equity, inclusion and accessibility. The Federal Drive with Tom Temin talks with National Institute of Neurological Disorders and Stroke executive officer Maryann Sofranko.

Interview Transcript: 

Tom Temin And let’s begin with your main job, and that is executive officer of the institute. What does the executive officer do? Sounds like you keep the trains running for the scientists.

Maryann Sofranko For sure. So I would say that the executive officer role is really the infrastructure that does support the science that’s done at NINDS. We basically support all of the administrative services from funding the science to purchasing the supplies and equipment needed for the science to ensuring that our investigators can travel and making sure that the funding goes out to our extramural investigators. So we do all the administrative work behind the scenes to keep things moving forward in advancing the science.

Tom Temin There’s something about NIH that keeps people there for entire careers or decades at a time, isn’t there?

Maryann Sofranko I think so. I think it’s the mission. How can you not get excited about the mission of really moving science forward and the whole bench to bedside concept where we actually are doing the research on site, as well as funding it in our extramural communities. And then you see that translate into health improvements across our nation and across the world. So it’s a really exciting mission for sure.

Tom Temin All right. So let’s get to the SCA award that you got, the Senior Executives Association, the Spirit of Excellence for Diversity, Equity, Inclusion and Accessibility. I know that’s a administrative policy word, and it’s sort of pasted all over the place. What does it mean to you at the Institute and in your work?

Maryann Sofranko Yeah, in my work at NIH, I also wear another hat, and that hat is the business liaison to our Project Search program. And Project Search is really a program that is a training to work program for young adults with disabilities. So being able to really spearhead and lead that program as part of the business partner at NIH is really, really rewarding. We have our numbers in that program are pretty substantial. Over the 13 years the program has been at NIH, we have had over 100 interns that have come through the program. And the program, as I mentioned, is really a training to work program where we as the business liaison piece, provide rotational opportunities. So really on the job training for interns. And it is 30 week program where they get three, in addition to classroom activities, they get three rotational opportunities to really learn skills, kind of hone skills so that they are really ready to work at the end of that program. Not everyone gets hired, but our numbers are really high. We have about a 78% higher rate out of that program. And so really being able to bring those young adults into the work environment is amazing and it truly diversifies our work environment in so many different ways.

Tom Temin What are the techniques and strategies you have for getting the raw material in the people themselves to the program? How do you reach out?

Maryann Sofranko We are one of the partners in that three prong program. We actually partner, which is our local adult rehabilitation partner, as well as Ivymount. And there’s actually a process by which people apply to be part of this program. And the program we have some sister programs and one in Montgomery County with the government and one at the Smithsonian in D.C. And so we partner with them to bring each about six interns per rotation cycle into the program. So it’s usually somewhere in the ballpark of about 18 to 20 interns per year get selected out of many, many that apply.

Tom Temin Sure. We’re speaking with Maryann Sofranko. She’s executive officer of the National Institute of Neurological Disorders and Stroke. She’s also the recipient of the 2023 Spirit of Excellence Award for Diversity, Equity, Inclusion and Accessibility from the Senior Executives Association. And the idea of disabilities or those with disabilities, that itself has become a wider field in recent years, hasn’t it?

Maryann Sofranko Absolutely. And the goal of the program that we were just talking about, Project Search, is not only to ensure that young adults with disabilities are trained so that they can be employable, but also that program actually teaches life skills so that we are creating an environment where people can start to live on their own and have the life skills to do so. So it’s really a comprehensive program to support this young adult population.

Tom Temin And we understand for many years the government has hired people that are sight impaired or blind, or hearing impaired or deaf, and we understand the types of accommodations. Especially technically, but also socially that have to be made for people like that. But lately in this kind of relates to the institute itself, the neuro diversity has come in to the lexicon and people that are neurodiverse tell us the scope of that, what it means and how those people get accommodated.

Maryann Sofranko Well, at NIH in general, we provide accommodations across the board for any staff who need them. So there’s a process by which they can go through to get accommodations, and it’s through our Equity Diversity and Inclusion office. And I think that NIH is probably one of the best employers out there looking across our organization to see how we can accommodate people so that we can diversify our staffing population. And those accommodations range, as you mentioned, from software that helps someone who can’t see as well as others to software where someone can speak into it. We provide anyone that needs an accommodation, we provide equipment, we provide chairs, furniture, whatever the need is. We definitely go above and beyond in trying to make sure that we can accommodate our staff.

Tom Temin But someone who might have autism at certain levels or a type of neuro diverse or neuro disability, I don’t know what the correct word is.

Maryann Sofranko Intellectual disabilities. That for sure was the focus of Project Search. Most of our interns that actually come through that program are intellectually disabled. So being able to match their skillset with the needs that we have and we actually have employment coaches on site who can look at our processes and break them down so that they can identify bits and pieces of processes that then the interns can do. And that actually frees up some of our other staff time to do things at a different level. So it’s a win-win. We’re able to take activities off the plates of staff that can work at a higher level and identify those activities and figure out really effective ways for the interns to plug and play their.

Tom Temin Is it also so that people that might have intellectual disabilities have like super capabilities in very narrow areas?

Maryann Sofranko Absolutely. Absolutely. We definitely find that some of our interns that come through the program have unique skills and we’re able to tap into those skills and figure out how to make them work. I mean, we have one intern currently who is really amazing with data. Although he struggles in some other areas, he’s able to manipulate data, analyze data, and provide really good solid data platforms so that then someone with the expertise can kind of summarize that and put out a really nice product with the data that’s being mined there. So we definitely tried to hone and we have experts, we have instructors and project search employment consultants who are able to really work with the interns to tap into what their unique skills are, as well as train and teach them new skills. So it’s a really nice program where we’re able to match up interns with positions that really fit their skillset.

Tom Temin It sounds like you have two passions, then one for the work on behalf of the institute itself and the other for this program that really benefits all of NIH.

Maryann Sofranko Yeah, absolutely. I started out in administration at NIH, and I’ve been there doing this work for over 30 years. But for sure, Project Search is a passion of mine and I love to see positive outcomes. And we work really hard with our rehabilitation provider as well as our instructors from Ivymount to make the program really successful. And thus far we’re continuing to expand. The program originally was founded in the Clinical Center at NIH. And it was, as you can imagine, pretty hospital centric in terms of hospital operations really lend themselves well to most of the skills that you’re going to see. But we have expanded it into the institutes and we’ve tapped into that unique skill set that you’ve talked about with some of the interns to be able to do work that is at a higher level. And so for sure, a passion, love to see it grow, love to see it be successful.

The post NIH health executive also a diversity champion first appeared on Federal News Network.

While the total number of deaths decreased overall, suicides among active-duty troops went up slightly, fueled by significant spikes in the Marine Corps and the Air Force. And because the active-duty force is smaller now, the rate of suicides per 100,000 service members inched up, according to U.S. officials.

The officials said the suicide rate for the National Guard and the Reserve decreased a bit. The relatively stable numbers across the force come on the heels of a sharp drop in suicides in the Air Force, the Marines and the Navy from 2020 to 2021, and a similar decline for Army soldiers in the first six months of 2022.

Officials spoke on the condition of anonymity to describe the findings before the report’s public release. They said that due to the decreasing size of the active-duty force, they believe the rate of suicides, rather than the number, is a more accurate measure. More broadly, they said the changes in the suicide rate were not statistically significant and they are not enough to determine yet if prevention and treatment programs are working.

Instead, defense officials said the long-term trend still points to increasing deaths, although the relative stability in the numbers for 2022 gives them some cautious encouragement.

Historical similarities in who dies by suicide and how they do it continue. Young, male troops still make up the vast majority of the suicides — at 93%. And 70% of the time, troops use a firearm. But the department has so far shied away from any major gun safety changes.

An independent committee recommended earlier this year that the department implement a series of gun safety measures to reduce suicides in the force, including waiting periods for the purchase of firearms and ammunition by service members on military property.

The panel said the department should also raise the minimum age for service members to buy guns and ammunition to 25 and should require anyone living in military housing to register all privately owned firearms. In addition, the panel said the department should restrict the possession and storage of privately owned firearms in military barracks and dorms.

Last month, however, Defense Secretary Lloyd Austin released a new campaign to address suicides in the force, and the department chose not to implement the key firearm changes suggested by the panel. Instead, the Pentagon said it would “incentivize” secure firearm storage, provide more storage locations and do more public education on how to safely store guns — similar to steps that officials have talked about in the past.

The Defense Department officials said there are a number of legal challenges to enacting some of the gun safety measures. They said the department has been working on the issue for several years and believes a better, modern education campaign tailored for the young military audience can help.

In addition, they said there are restrictions on doing an anonymous survey on the matter to glean more information from the force and determine what would be effective changes. They said the department hasn’t ruled out taking additional steps in the future.

Austin, however, did agree to enact a number of other recommendations made by the panel, including efforts to modernize suicide prevention training, expand counseling, reduce the stigma of seeking mental health assistance and increase the number of staff and health providers.

The Defense Department has been grappling with widespread shortages of mental health personnel and a difficult push to reduce the stigma of seeking help. A number of military bases have also enacted a wide array of new programs, which range from required counseling visits to stress relief education and recreational outings.

The new report found that family stress, including relationship problems and behavioral health issues, are common factors.

Suicides among family members differ in that more than half of the spouses who die are female. And while there are far fewer male spouses across the military, at just 14%, they represent 48% of spousal suicides.

According to the latest data, there were 492 suicides among active duty, Guard and Reserve troops, down from 524 in 2021. And suicides among family members dropped from 202 in 2020 to 168 in 2021. The family death totals are a year behind the service member data, because they come from the Centers for Disease Control and Prevention.

For the active duty, there were 331 suicides in 2022, compared with 328 in 2021. Of those, Army suicides dropped from 175 in 2021 to 135 in 2022. The Marine Corp saw the biggest increase, from 43 to 61, followed by the Air Force, which increased from 51 to 64, and the Navy went from 59 to 71. The Space Force had none.

The Army National Guard also saw a large decrease, from 105 to 82, while the Air Guard remained the same, at 15. The Reserves dipped from 76 to 64, with only the Air Force Reserves showing an increase.

___ The national suicide and crisis lifeline is available by calling or texting 988. There is also an online chat at 988lifeline.org.

The post The number of military suicides dipped in 2022 as the Pentagon works on new prevention programs first appeared on Federal News Network.

Removing the fuel is a key step toward shutting down the Red Hill Bulk Fuel Storage Facility as demanded by the state of Hawaii. The November 2021 spill poisoned the Navy’s water system serving 93,000 people in and around Joint Base Pearl Harbor-Hickam. The leak continues to threaten an aquifer used by Honolulu’s municipal water utility to serve 400,000 people on Oahu.

“I want the community to know that my team and I understand the enormity and the significance of this mission,” Vice Admiral John Wade, the commander of Joint Task Force-Red Hill, said at a news conference.

Work to drain the 104 million gallons (394 million liters) remaining in the tanks was scheduled to begin on Monday.

Each tank is 250 feet (76 meters) tall and 100 feet (30 meters) wide. Gravity will feed fuel into fuel lines connected to the lower part of the tanks. The fuel will then flow downhill through pipelines for 3 miles (4.8 kilometers) to a tanker ship waiting at Pearl Harbor pier. It will take more than two days to fill each tanker.

Wade said it would take three months to remove 99.9% of the fuel. Then, work will begin to remove a residual amount of an estimated 60,000 to 70,000 gallons that will have accumulated in low-point drains and bends. That work is expected to be finished in the spring.

The moment is bittersweet for Lacey Quintero, whose Navy family was among the thousands who suffered health problems after drinking contaminated water in 2021. She’s happy the fuel is being removed but the operation has stirred memories as the two-year anniversary of the spill approaches.

“The timing of it, coupled with the dangers that are present during defueling — there’s fear,” she said.

She’s concerned that more fuel could spill into the Navy’s drinking water well and poison the aquifer. She’s also worried about possible explosions.

Quintero and her husband, who is in the Navy, and their two children moved to Hawaii in November 2021 from California. They fell sick soon after moving. Her youngest, who was then 3 years old, vomited uncontrollably. The entire family complained of diarrhea and itchy skin. Quintero’s arms and legs went numb and she struggled with chronic fatigue.

Her husband is still stationed in Hawaii but they have moved to private housing off base which uses Honolulu municipal water. Yet she still suffers from stomach pains, migraines and skin issues. She has PTSD.

“I have flashbacks of feeding my daughter this poison soup and watching her vomit it up,” she said.

Quintero is one of 6,750 claimants seeking compensation from the U.S. government for what they experienced. Their attorney, Kristina Baehr, said claims for the first group of six plaintiffs were due to go trial in March.

The state of Hawaii ordered the military to drain the tanks after the 2021 spill, saying they posed an imminent threat to the aquifer underneath. The Department of Defense challenged that order in court, but eventually acquiesced. It’s spent the past year repairing the tanks and pipes so the fuel can be safely removed without additional leaks.

For years the military said the tanks were vital to national security and resisted calls to close the facility or to move it. Military officials repeatedly reassured the public that Oahu’s water was safe — even though the tanks had a history of leaks.

The spill upset a broad cross-spectrum of Hawaii, and precipitated a crisis for the military in the islands. Many Native Hawaiians have been angered given the centrality of water in Hawaii’s Indigenous traditions.

A Navy investigation pinned the cause of the spill on a series of mistakes.

First, operator error caused a pipe to rupture on May 6, 2021, when fuel was being transferred between tanks. This caused 21,000 gallons (80,000 liters) of fuel to spill. Most of it flowed into a fire suppression line and sat there for six months, causing the line to sag.

Then on Nov. 20, a cart rammed into the sagging line, releasing 20,000 gallons (75,700 liters.) A team thought they recovered all of this fuel, but they missed about 5,000 gallons (19,000 liters) which flowed into a French drain and from there into the drinking water well.

The Navy reprimanded three now-retired military officers for their roles in the spill but didn’t fire nor suspend anybody.

The post US military to begin draining leaky fuel tank facility that poisoned Pearl Harbor drinking water first appeared on Federal News Network.

The work of our next guest has spanned 40 years and helped save lives. For that work at the National Institutes of Health, he’s a finalist for the Paul Volcker Career Achievement Award from the Partnership for Public Service. Federal Drive with Tom Temin spoke with Dr. Rocky Feuer, the Chief of the Statistical Research and Applications Branch at the National Cancer Institute.

Interview Transcript: 

Rocky Feuer So I founded and I currently lead a consortium of simulation modelers, I’ll explain what that is. Actually, for the last 23 years, we have over 200 investigators at over 30 academic institutions, and it’s called the Cancer Intervention and Surveillance Modeling Network, or CISNET for short. And it has really fundamentally changed how U.S. cancer screening guidelines are developed. So we’ve helped to support the US Preventative Services Task Force, that’s an independent panel of experts in evidence based medicine sponsored by ARC, to set and revise screening recommendations for long breast, colorectal and prostate cancer. So, for example, we help support the task force in a recent draft recommendation to start breast cancer screening at age 40 instead of 50, and a final recommendation for colorectal cancer screenings to start at age 45 instead of 50. And so you have the task force insisting that to thank if your doctor tells you to get a colonoscopy five years earlier than you would have otherwise, and it is really a good thing.

Rocky Feuer Before CISNET screening recommendations were based on what was called evidence reviews. These are systematic reviews of all known studies, but direct evidence from studies wouldn’t be sufficient to distinguish all the relative benefits and harms of a very large number of possible screening regimens. That’s age to start screening, age to stop screening, how often you should be screened. And that sometimes comes to hundreds of different combinations. You couldn’t do studies on all of those combinations. So population decision modeling, we simulate millions of people’s individual lives. We simulate the year they were born and what risk factors they were exposed to. For example, men born in the 1920s, many of whom fought in World War Two when they handed out Cigarettes’ to the GI’s, had the highest smoking rates of any generation of Americans. So they had higher lung cancer screening rates. And then if at what age did cancer start to develop in somebody’s body when the cancer would have caused symptoms and been diagnosed in the absence of screening, what type of treatment they would get and what age they would die of either their cancer or some other cause. And then over this, we superimpose many different screening schedules on their lives to see how things might have turned out differently. These are kind of called counterfactual situations. What if you didn’t have screening? What if you had screening that started at 40? What at 50? What if you had it every year? What would if you had it every other year? And then we accumulate all these results and determine the set of screening schedules that produce the most benefit in terms of lowering death rates and the fewest harms, for example, false positive screening results per number of screens conducted.

Rocky Feuer So when I started this consortium, I knew that simulation models contently be very valuable in this area, but they really had a serious credibility issue in some circles. Independently developed simulation models taking on the same problem often resulted in radically different results that were just very difficult to reconcile because there were so many complex and subtle differences between the models. So people felt, Ok, you get whatever result you want, and this greatly hurt the credibility that these models. So in CISNET we took a different approach. It’s a collaborative group of modelers for each cancer site with multiple independent models for each cancer site, but then they work together and tackle the same problems in a very systematic way. They share common inputs and produce a common set of outputs, and they get to understand each other’s models. So when the results are similar, it brings real credibility to the results. And when they differ, the reasons for these differences can be systematically evaluated. So this approach greatly improved the credibility of this type of modeling. And it’s not only become a critical tool in developing new screening guidelines, but are also used in other ways, for example, to understand the contribution of past advances in prevention, screening and treatment to national cancer trends and to project cancer rates into the future as a function of the uptake of some of the newest advances. And then importantly, studying the sources of health disparities in cancer rates and what might be done to reduce them. So this consortium has really, yeah, changed the game a little bit in terms of screening guidelines and other ways to evaluate at the population level what’s occurring and why it’s occurring and to project into the future.

Eric White So using this technique of modeling, I’m just curious on what went into the models themselves. Was it data that you all gathered from certain cancer sites or are numerous amounts of cancer sites and then you were able to replicate the results and that’s what you’re saying added to the credibility because it was showing that, Ok, yes, if we do X, then Y happens every time. Sort of deal.

Rocky Feuer Yes. Well, first of all, if the models got the same answers then we feel that way. But we use every possible data source, population based cancer registry, and I could talk a little bit more about that, is the backbone of the research. But we use national surveys of screening rates and  smoking rates. We have something called a smoking history generator. We use national surveys from 1965 to the present to reproduce by birth cohorts smoking histories of individuals when they started, when they stopped, how many cigarettes’, and that’s an input into the models. We use screening studies because they kind of what’s called dip into the preclinical cancer and we could see how fast cancers are growing before they become symptomatic and how many people. We also use autopsy studies, there’s a number of studies where people die of other causes and then they might like biopsy their colon very closely and see how many of these people have polyps as pre-cancerous lesions, how many of colorectal cancer that’s been done for prostate cancer and other cancers. So we use every possible data source and then we  calibrate the models based on that. And then in the end run, maybe there’s a new trial that occurs and we use the models to see if we could predict what the trial showed or if we could predict national trends and rates, and then we could decompose those rates. So we look on and on and on for all the different data sources. And what the models do is sort of synthesize all the data and then the comparative modeling, because people could take different approaches and get different results. But when they come together or if they don’t come together because we’re working together closely, we could understand the differences between the models.

Eric White Gotcha. Ok. And those discoveries that you talked about lowering the recommendations for screenings of colon cancer, things of that nature, have there been any population based discoveries that you all have made through these modeling systems?

Rocky Feuer So, yes, for just for example, in lung cancer screening, we use a criteria for if you’re eligible for lung cancer screening, we don’t screen everybody. We want to screen mostly fairly heavy smokers because because and we use a criteria called tac years. How many years to just smoke? Times how many packs a day you smoked? And African-American individuals tend to have similar pack years to white individuals, but they tend to start a little bit later in life. They don’t initiate at the same time, and their cessation is usually a little bit older. So they might have the same pack years, but it’s shifted to an older age. And we know from different studies that if you accumulate those pack years at a little bit at an older age, even though you have the same pack years as somebody else, you have a higher risk of lung cancer. And the lung cancer screening recommendations didn’t take that into account. So it created a health disparity. So what the new round of lung cancer screening recommendations, they lowered the threshold for being eligible for lung cancer screening to fewer pack years to accommodate, in general, more people. But especially African-American individuals who might have the same pack years as somebody else, but have a higher risk because they accumulated those pack years at a higher age. So that’s an example of a very careful study of the population based data and then how it translates into something like screening recommendations.

Eric White You all factored in advancements in treatments and screening procedures. I’m wondering what you think of advancements in screening technologies or the data accumulation technologies. Do you foresee a future where you’re having even more factors coming in that you’re able to make the model even more predictive and more accurate?

Rocky Feuer Well, yeah, Let me just talk a little bit about our population based cancer registries and how that data has radically improved over time. So cancer registries, that part of the program I work on correlates the population based cancer registry. Cancer registries collect data on every cancer that occurred and defined geographic region. It’s usually a state and really form the backbone of population based cancer statistics. And when I first started at the National Cancer Institute in 1987, our registries covered only about 10% of the U.S. population. And today, the National Cancer Institute in the Centers for Disease Control collectively have registries covering the entire U.S. population.

The post This Rocky has been knocking-out cancer for decades, using statistics first appeared on Federal News Network.

It’s no longer the relentless killer it was 40 years ago, but HIV is still around and still infecting people. And it remains a focus of the Health and Human Services Department’s Health Resources and Services Administration (HRSA). For an update,  Federal Drive with Tom Temin spoke with the Director of the Division of Policy and Data for HRSA’s HIV/AIDS Bureau, Michael Kharfen.

Interview Transcript: 

Tom Temin And as we speak, the nation is observing a particular day, isn’t it?

Michael Kharfen Correct. Sept. 27 is National Gay Men’s HIV Awareness Day. Why we consider every day HIV Awareness Day. On Sept. 27, we make the point to raise awareness about HIV stigma, encourage HIV prevention and treatment among gay, bisexual and other men who have sex with men.

Tom Temin And although HIV potentially can infect anyone, it is still that population you just described that gets most of the cases, fair to say.

Michael Kharfen So it is correct to say that HIV can affect anyone. But about half of the people with HIV are gay or bisexual men who have sex with men. And that somewhat stems from the origins of the epidemic here in the United States. But we have a very diverse epidemic. And so our message is, while today or focusing on gay, bisexual and other men who have sex with men, we still encourage everyone to get tested, know their status, and if they are HIV positive, to connect with care and treatment, to live a long and productive life.

Tom Temin And as we said at the outset, HIV doesn’t necessarily need to lead to the killer, which is AIDS, correct? I mean, it sounds like that is largely under control. What is the status?

Michael Kharfen So that is correct. We’ve made tremendous advances in medical treatment today. You can take one pill a day to be able to treat your HIV. And we know from the Ryan White HIV AIDS program that about 90% of the people who are enrolled in our program actually achieve viral suppression, which is our goal, because then the virus is considered undetectable. And what we have learned through science is that undetectable means that you cannot transmit the virus sexually to your partner. We also call that undetectable equals untransmittable.

Tom Temin Got it. And you mentioned the program. What is the program officially and how does it work?

Michael Kharfen So the program is the Ryan White HIV AIDS program. We’re now in our 33rd year of being able to serve people with HIV and those affected by HIV in the nation. We serve about half of all the people, 576,000 people who are living with HIV in the United States. And we offer a comprehensive system of care for medical treatment and medications to also support services like care coordination, nutrition, transportation, housing assistance, and other needs that individuals with HIV can live very high quality well-being and achieve their individual success.

Tom Temin And you mentioned that there are drugs now available. In fact, I think you see them advertised on television. Every drug in the world seems to be advertised on television these days during the newscasts at night. And I’m old enough to still watch them. But are these affordable in general or these are not super expensive types of things. What has been the advance in the medicine and the treatment side that makes it affordable?

Michael Kharfen So the medication has gone through various different formulations in ways that can make it very simple and easy for people to take. We now even have something called long acting injectable, which means you can get one shot a month and that’s all you need to do in order to treat your HIV. So the medications are covered under all health insurance plans. Also, of course, public health insurance plans like Medicaid and Medicare. But if someone doesn’t have insurance or is underinsured, the Ryan White HIV AIDS program does provide medication assistance. We call it the AIDS Drug Assistance Program, to ensure that anyone who needs it can have access to these lifesaving medications. And to that point, what we’ve known from the advances in medications that if somebody is diagnosed with HIV, they can live a standard life span. If they are taking their medication every day and are seeing their medical providers on a regular basis and taking advantage of the supports that they need.

Tom Temin We’re speaking with Michael Kharfen. He’s director of the Division of Policy and Data for the HIV AIDS Bureau at the Health Resources and Services Administration, part of HHS. And let me ask you this. Between the infection and the onset of a disease, which could be, I guess, still potentially fatal. What’s the mechanism by which people can discover an infection and therefore get these modern medicine? That will keep it suppressed and in effect, disappear.

Michael Kharfen So testing is the way to do that and to test on a regular basis, which is at least once a year we recommend testing. So there’s many different ways to get tested through your medical provider, through community based testing locations. And even now there’s home testing available to determine your status. And we’ve now taken this new approach, which we call status neutral, which is a approach where these start with the test and then you learn what your status is. So if you’re HIV negative, then we encourage you to look at prevention options such as pre-exposure prophylaxis or prep, which is the taking of an HIV medication once a day safe, easy to use, and that prevents you from getting HIV. And if your result is HIV positive, then we want to connect you right away to care, including as much as starting your treatment that very same day because the medications are so safe and so effective that we can start you that same day that you learn your diagnosis to get on your treatment.

Tom Temin And over the years, has the approach that the United States took in the federal government granting and the health research apparatus, which is pretty big, took to develop these drugs that are now, as you say, widely available and work quite well and are safe. What have been the lessons learned that can transfer to other viral types of diseases? Because it looks like whatever is going on with the COVID virus, which I imagine is an utterly different branch of virology than the HIV virus. But are there any lessons learned that can transfer here?

Michael Kharfen Well, actually, there are. In fact, one of the reasons why we were able to get a COVID vaccine so quickly is because many of the researchers working on it were part of what is known as the HIV Vaccine Trials Network, which is run by the National Institutes of Health. So we already had a research platform here in the United States that could look at options around addressing viruses. In fact, that Trials Network is working on an HIV vaccine. And then there’s also, NIH supporting trials that are going on right now on a cure. And so what we remain optimistic that and encourage that this science could lead us to that point of having a vaccine and or a cure. We also believe that we have the tools today in order to achieve what we call the end of the HIV epidemic. In fact, we have a national initiative called Ending the HIV Epidemic in the U.S. And with the combination of these terrific medications that with somebody with HIV, it means they suppress the virus to undetectable. And medications that can prevent someone getting HIV. That combination will enable us to make HIV rare and have anyone living with HIV to live a full and healthy life. And HRSA is a key part of that initiative. We’ve supported 49 different jurisdictions in the country, which represent about half of all the new HIV cases in the United States. And so we believe that many of the lessons that we’ve learned from the Ryan White HIV AIDS program can be transferred to communities across the country and even intensified in areas that remain. We can accelerate our efforts towards ending the epidemic.

Tom Temin And the final question, it’s still an epidemic in other parts of the world. And what demand do you have for learning and knowledge from some of the nations that still suffer from it in a much greater degree than the United States does now?

Michael Kharfen HIV is still very much present, globally. Of course, we’ve been very fortunate to have programs like PEPFAR, the President’s Emergency Plan for AIDS Relief, which has been made tremendous advances in getting access to HIV medications and in countries across the world. And that kind of collaborative effort, which is also a hallmark of the Ryan White HIV AIDS program, which is what we partner with community based organizations and states and cities. That same premise has been part of PEPFAR and the Global Fund and other efforts that are making sure that people have access to medications, that they have access to medical care and the services that they need to support themselves in making sure that they are able to take that medication and be able to lead productive lives.

The post Not just a disease of the late 20th Century, HIV/AIDS still gets federal attention first appeared on Federal News Network.

The agency’s approach is based on the storied Defense Advanced Research Projects Agency (DARPA), known for its role in developing the internet, stealth technologies and advancing vaccine technology that helped speed the development of COVID-19 vaccines.

But as laudable as ARPA-H’s goals are, there are bear traps to avoid if the agency is to succeed. As dean of a major medical research institution along with a perspective of having worked inside the National Institutes of Health, here’s what I see as the biggest hurdles the nascent agency will need to clear.

First, the agency needs to avoid the tendency, often difficult among government agencies, to reinvent the wheel. ARPA-H envisions project managers tasked with identifying a difficult health challenge and then finding the best academic and industry researchers to solve the problem. So far, so good. But the truth is, many of the most pressing questions are already front-of-mind at the NIH and other leading research centers.

ARPA-H must start its search by looking to these powerhouses for the projects that will meet the agency’s remit and benefit most from its support to get innovative products to market faster. Similarly, by keeping channels open with major academic medical centers such as Duke, ARPA-H will have access to scientific and technology experts when assembling its teams.

A close connection between ARPA-H and NIH will have another benefit — one that was highlighted both during the race to find HIV therapies and more recently COVID vaccines — it will further promote collaboration between NIH’s laboratory-based expertise and institutions and industry with clinical trial capacity and know-how. Put simply, this kind of team science is how real-world solutions are developed. Steady and dependable funding for both is critical and necessary.

Second, the agency must plan for bureaucratic practicalities now. If ARPA-H’s goal is research that results in clinical applications such as a new diagnostic test or drug, eventually it means getting the Food and Drug Administration’s approval. To avoid delays, ARPA-H needs to involve the FDA early to streamline the path to approval. This will be particularly important in incentivizing commercial partners who will see approval as imperative to success and eventual insurance coverage. And when it comes to the private sector, ARPA-H should cut red tape now and accelerate industry participation by hashing out the sharing of intellectual property and institutional credit.

Third, ARPA-H must think big. One of the most important lessons-learned from the pandemic was the need for a national data-sharing infrastructure. Medical centers caring for a deluge of COVID patients were technically hampered and unable to effectively share information, set up research models, or enroll patients in early trials. ARPA-H should prioritize projects that will build this infrastructure. It is not only essential before we face a future health crisis, but also in allowing the rapid testing and reporting of new therapies.

Fourth is crucial for the long-term success of the agency and public policy tied to science. ARPA-H must do its part to regain the public’s trust in science – having been significantly damaged in the wake of the pandemic. This means clearly communicating its mission to the public in ways that are both accessible and meaningful to people.

The great news is that ARPA-H is pointed in the right direction. All it needs to do is assemble the best and brightest, create the path and get out of the way.

Dr. Mary Klotman is executive vice president for health affairs at Duke University, as well as dean of Duke University School of Medicine, and chief academic officer for Duke Health.

The post How a new federal agency for scientific breakthroughs can succeed first appeared on Federal News Network.

“We really didn’t see that it was dangerous at the time,” she said. “It was just part of the mission. So we had to get it done.”

But then her sinus problems began, only worsening after she returned home, where she sometimes found herself gasping for breath at night. She remembered thinking, “This wasn’t who I was before I got in.”

Although Leger already received disability benefits for post-traumatic stress, migraines and a hip fracture, it wasn’t until President Joe Biden signed legislation known as the PACT Act last year that her monthly payments expanded to take into account the impact of the burn pits. Now 34 years old, Leger and her fiancé have moved out of a cramped townhouse and into a larger home in a suburb of Tampa, Florida, where their four children can each have a bedroom.

“I still wake up pinching myself,” she said.

Leger is one beneficiary of the largest expansion of veterans assistance in decades, and the administration is racing to sign up as many people as possible as the first anniversary of the law approaches. Although there’s no deadline to apply, anyone who files a claim or simply signals the intent to do so by Wednesday could collect payments retroactive to last year if the claim is approved.

Under the law, certain cancers and ailments are presumed to be connected to the burn pits that were used to dispose of trash and potentially toxic materials. For veterans who served during the Vietnam War, hypertension and other conditions were added to the list of problems presumed to be caused by exposure to Agent Orange, which was used by the U.S. military to clear vegetation.

Biden will mark the law’s anniversary at a Veterans Affairs hospital in Salt Lake City on Thursday. According to administration statistics, the Department of Veterans Affairs has received nearly 786,000 disability claims under the PACT Act, processed almost 435,000 and approved more than 348,000.

About 111,000 veterans who are believed to have toxic exposure have enrolled in VA health care since the law was enacted. In addition, more than 4.1 million veterans have completed toxic screenings, which are questionnaires to analyze their potential exposure and determine whether additional tests are required.

Implementing the legislation has proved challenging for the VA despite hiring new staff to accommodate a historic influx of claims. The backlog is about 266,000, meaning waits of at least four months for claims to be processed, and the list is expected to grow to 450,000 in October and 730,000 in April. During a recent oversight hearing. Sen. Thom Tillis, R-N.C., expressed concern about “bad trends.”

Veterans Affairs Secretary Denis McDonough said his agency is doing better than expected based on internal projections and is using new technology to process claims faster.

“Am I satisfied? I’m not,” he said in an Associated Press interview. “Until every veteran in this country knows what is available to him or her, and has come in and filed a claim, and then we’ve awarded that claim for him or to her, I won’t be satisfied.”

Despite the growing backlog, the VA has kept up its outreach efforts. It has spent $7.5 million on advertising, including a billboard in New York’s Times Square, and hosted events around the country. Comedian Jon Stewart, who played a leading role in pushing for the PACT Act, has chipped in by posting videos on social media.

“The VA could have slow rolled it to make their job easier,” said Allison Jaslow, a former Army captain who leads the advocacy organization Iraq and Afghanistan Veterans of America. “But to their credit, they didn’t.”

Jaslow said the department is “doing a pretty incredible job given the influx of claims that came in.”

The outreach is paying off. Eli Feret, a 36-year-old former Army captain who lives outside of Denver, said he did not apply until a few days ago. After expecting a more archaic process, Feret said he was “pleasantly surprised” that he could complete his claim on his smartphone in a half-hour.

Cole Lyle, a 33-year-old former Marine corporal in Alexandria, Virginia, who leads the advocacy organization Mission Roll Call, made a similar decision. “I was getting barraged by Jon Stewart on Twitter and a couple other folks, and I thought, I really ought to file,” he said.

“I see the growing backlog not as a good thing,” he added, “but I think it’s a good thing that veterans are, in fact, applying.”

For a moment last year, it looked like the PACT Act might not get approved. The legislation unexpectedly stalled when Republicans balked, leading some advocates to start camping outside the Capitol. Biden had contracted the coronavirus and could not visit in person, so he sent McDonough with pizza and he talked to the veterans over FaceTime.

The pressure campaign worked, and Congress passed the measure. It was a bipartisan success but also a personal victory for Biden, who has long believed that his eldest son, Beau, developed fatal brain cancer from serving near burn pits in Iraq as a captain in the Delaware Army National Guard.

McDonough sees the PACT Act as a turning point for the VA, making the nation’s largest health care system more agile, robust and competitive.

“The president has been very clear to us that this new law can be the largest expansion of VA benefits and care in the history of the VA,” he said.

The legislation authorized the VA to expand its facilities through 31 leases, and it is pursuing them in 19 states. VA employees can now receive higher bonuses and more help with student loans than before. There are additional incentives for recruitment, retention and relocation.

In the past year, the VA has expanded by more than 21,000 health care workers and 4,300 employees for processing benefits.

But officials said the process remains too slow. Bringing on a new health care worker can take several months as the VA checks backgrounds and certifications, a delay that can lead candidates to find jobs elsewhere.

McDonough said the agency is not “where we need to be,” adding that “we’ll keep working on that.”

When former Army National Guard Sgt. Iona Bussiere turned 40 last year, she had her first mammogram and discovered breast cancer — stage 3 on one side, stage 2 on the other.

Since then it has been a blur of treatments, including months of grueling chemotherapy — “for the last three weeks I was like a zombie,” she said — and a recent mastectomy. Bussiere, who lives in Providence, Rhode Island, is starting radiation and expects to be taking pills for years to come.

Under the PACT Act, breast cancer is presumed to be caused by serving in proximity to burn pits. Bussiere said they were “everywhere” during her deployments in Iraq and Kuwait.

Although she wishes that the VA had started providing cancer screenings earlier, she said the benefits also provide “a lot of relief.”

“I’ve heard horror stories about people who get cancer and are unable to work and the bills are piling up,” Bussiere said.

Marcellus Beasley, 60, served in the Air Force during the first Gulf War, when he was based in Turkey and traveled to Iraq. He said there was always sand, dirt and smoke, sometimes from burn pits. When he blew his nose in the mornings, black stuff would come out.

“It’s almost like you worked in a chimney,” he said.

Beasley found the VA cumbersome and frustrating after he left military service.

“You always thought the VA was against you,” he said. “Like, they didn’t want you to get paid.”

But he said recent changes have made services more efficient, particularly at his location in Wilmington, Delaware, where a worker helped clue him in about the PACT Act. He applied for help with his psoriasis, a skin condition, and his disability benefits expanded.

“It’s been a huge impact for me,” he said.

It is not just veterans who receive benefits through the PACT Act. More than 16,000 surviving family members have submitted claims. One of those who have qualified for compensation is Ailyn Colby, 59, whose husband, Glenn, died of colon cancer six years ago.

He was 51 years old and a former major in the Rhode Island National Guard who served in Iraq.

“He never really talked to me about his experience because maybe I would worry too much about him,” said Colby, who lives near Hartford, Connecticut.

After his death, she filed for survivor benefits and was denied, describing it as “a horrible experience.”

But when she reapplied under the PACT Act in April, the claim was approved.

“I thought, they still remember the family,” she said.

The post Veterans see historic expansion of benefits for toxic exposure as new law nears anniversary first appeared on Federal News Network.

The lawsuits seek to hold the United States accountable for creating obstacles to health care access for a population that advocates say has a higher rate of infertility than the population at large.

Both suits attempt to obtain in vitro fertilization coverage for military service members and veterans who don’t fit the Veterans Affairs definition of infertility, which is limited to married, heterosexual couples.

In a release, West Point graduate and Army veteran Renée Mihail said she has seen many friends and colleagues struggle with fertility after serving in the military.

“This is not just a coincidence; Our service has seriously impacted our ability to build families,” said Mihail, a law student intern with the Yale Veterans Legal Services Clinic.

The lawsuit in Manhattan federal court against the U.S. Defense Department and the Department of Veteran Affairs said infertility is pervasive in the military community, with research revealing that contributing factors include combat-related injuries, exposure to toxic chemicals and environmental hazards, sexual assault and post-traumatic stress disorder.

According to the lawsuits, thousands of active military members and veterans face discriminatory and arbitrary reasons why they are rejected for appropriate treatment when they try to start having a family.

The lawsuit said those seeking in vitro fertilization coverage, the most effective treatment for infertility, are rejected if they are single, an unmarried couple, in a same-sex relationship or are a couple with the same reproductive organs, or if they lack proof that infertility is related to their service.

It sought a judge’s order to find that it is discriminatory and unconstitutional for the United States to reject treatment based on sex, sexual orientation, marital status or on the cause of the infertility.

In Boston, Air Force veteran Ashley Sheffield sued the Department of Veteran Affairs, saying she was rejected for in vitro fertilization treatments because she is married to a woman.

“I’m shocked and disappointed that the VA is denying me and other veterans IVF benefits because we’re in same-sex marriages,” Sheffield said in a release. “We are entitled to equal treatment, and we should no longer be treated as second-class citizens.”

Defense Department spokesperson Nicole R. Schwegman said in an email that it would be inappropriate to comment on ongoing litigation.

A spokesperson for the Justice Department did not immediately respond to a request for comment.

The post Veterans sue US Defense and Veterans Affairs departments to get access to infertility treatments first appeared on Federal News Network.

The numbers issued Tuesday by the U.S. Small Business Administration inspector general are much greater than the office’s previous projections and underscore how vulnerable the Paycheck Protection and COVID-19 Economic Injury Disaster Loan programs were to fraudsters, particularly during the early stages of the coronavirus pandemic.

The inspector general’s report said “at least 17 percent of all COVID-EIDL and PPP funds were disbursed to potentially fraudulent actors.” The fraud estimate for the COVID-19 Economic Injury Disaster Loan program is more than $136 billion, which represents 33 percent of the total money spent on that program, according to the report. The Paycheck Protection fraud estimate is $64 billion, the inspector general said.

In comments attached to the report, a senior SBA official disputed the new numbers. Bailey DeVries, SBA’s acting associate administrator for capital access, said the inspector general’s “approach contains serious flaws that significantly overestimate fraud and unintentionally mislead the public to believe that the work we did together had no significant impact in protecting against fraud.”

The SBA inspector general had previously estimated fraud in the COVID-19 disaster loan program at $86 billion and the Paycheck Protection program at $20 billion.

The Associated Press reported June 13 that scammers and swindlers potentially swiped about $280 billion in COVID-19 emergency aid; an additional $123 billion was wasted or misspent. The bulk of the potential losses are from the two SBA programs and another to provide unemployment benefits to workers suddenly unemployed by the economic upheaval caused by the pandemic. The three initiatives were begun during the Trump administration and inherited by President Joe Biden. Combined, the loss estimated by AP represents 10% of the $4.2 trillion the U.S. government has so far disbursed in COVID relief aid.

The federal government has now reported $276 billion in potential fraud, a figure that aligns with the AP’s analysis.

Gene Sperling, a senior White House official overseeing pandemic relief spending, said in a interview Tuesday that 86% of the fraud, or potential fraud, in the emergency loan programs happened during the first nine months of the pandemic when President Donald Trump was in office.

“$200 billion is a very big number, but this, again, should be remembered as potential fraud,” Sperling said. “We think the amount of likely or actual fraud is significantly less, significantly under $100 billion, perhaps around $40 billion.”

But he added, “whichever it is, it’s unacceptably high.”

The SBA inspector general, Hannibal “Mike” Ware, said in a statement Tuesday that the report “utilizes investigative casework, prior (inspector general) reporting, and cutting-edge data analysis to identify multiple fraud schemes used to potentially steal over $200 billion from American taxpayers and exploit programs meant to help those in need.”

Ware, in an interview with The Associated Press earlier this month, said these latest fraud figures won’t be the last ones issued by his office.

“We will continue to assess fraud until we’re finished with the investigations on these things,” Ware said. That could be a long while. His office has a backlog of more than 90,000 actionable leads into pandemic relief fraud, which amounts to nearly a century’s worth of work.

SBA issued its own report Tuesday detailing anti-fraud measures it has adopted. The agency’s administrator, Isabella Casillas Guzman, said in an emailed statement that the report outlines “the effective measures added to fight fraud and hold bad actors responsible.”

SBA previously told The Associated Press the federal government has not developed an accepted system for assessing fraud in federal programs. Previous analyses, the agency said, have pointed to “potential fraud” or “fraud indicators” in a manner that conveys those numbers as a true fraud estimate when they are not. For the COVID-19 Economic Injury Disaster Loan program, the agency said it’s “working estimate” found $28 billion in likely fraud.

Fraud in pandemic unemployment assistance programs stands at $76 billion, according to congressional testimony from the Labor Department’s inspector general, Larry Turner. That’s a conservative estimate. An additional $115 billion mistakenly went to people who should not have received the benefits, according to his testimony.

The Biden administration put in place stricter rules to stem pandemic fraud, including use of a “Do Not Pay” database. Biden also recently proposed a $1.6 billion plan to boost law enforcement efforts to go after pandemic relief fraudsters.

Bob Westbrooks, a former executive director of the federal Pandemic Response Accountability Committee, said in an interview the $200 billion number is “unacceptable, unprecedented and unfathomable.” Westbrooks published a book last week, “Left Holding the Bag: A Watchdog’s Account of How Washington Fumbled its COVID Test.”

“The swift distribution of funds and program integrity are not mutually exclusive,” Westbrooks said Tuesday. “The government can walk and chew gum at the same time. They should have put basic fraud controls in place to verify people’s identity and to make sure targeted relief was getting into the right hands.”

The fraudulent payouts have consequences, said John Griffin, a finance professor at the University of Texas at Austin’s McCombs School of Business,.

Griffin and colleagues said i n a new paper that pandemic relief fraud inflated house prices.

The study found that people who fraudulently obtained Paycheck Protection loans were more likely to buy a house than people who got legitimate loans, and housing prices increased 5.7 percentage points on average in ZIP codes with high amounts of fraud during the pandemic, even after controlling for other factors that affect home prices such as land supply, prior house price growth and the ability to telework. For a $400,000 house, that would add $22,800.

The study also found increases in consumer spending in ZIP codes where people received high amounts of fraudulent funds, which may have fueled inflation more broadly, Griffin said Tuesday.

“If you paid too much for your house because fraudsters pumped up the house prices in your ZIP code and then your house price ends up going down, you could be the victim of an unintended consequence of fraud,” he said in an interview. “It’s another reason why we should care about fraud.”

—

McDermott reported from Providence, Rhode Island.

The post The Great Grift: More than $200 billion in COVID-19 aid may have been stolen, federal watchdog says first appeared on Federal News Network.

FDA’s decision came one day after an agency panel of outside advisers supported the recipe change. The agency told vaccine makers to provide protection against just one omicron strain, known as XBB.1.5.

Today’s shots include the original coronavirus and an earlier version of omicron. They do still help prevent severe disease and death even as XBB variants have taken over. But protection gradually wanes over time and was short-lived against milder infection even before the virus, inevitably, evolved again.

The three U.S. companies that make COVID-19 shots said this week they had geared up to make the formula change, in anticipation of making many millions of doses available for the fall. One company, Pfizer, said it could have at least some doses ready as early as next month.

The Centers for Disease Control and Prevention will eventually decide whether to recommend the shot for nearly all Americans or just for certain high-risk groups.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The post Next round of COVID-19 shots in fall will target latest omicron strain first appeared on Federal News Network.

Vaccine requirements for federal workers and federal contractors, as well as foreign air travelers to the U.S., will end May 11. The government is also beginning the process of lifting shot requirements for Head Start educators, healthcare workers, and noncitizens at U.S. land borders.

The requirements are among the last vestiges of some of the more coercive measures taken by the federal government to promote vaccination as the deadly virus raged, and their end marks the latest display of how President Joe Biden’s administration is moving to treat COVID-19 as a routine, endemic illness.

“While I believe that these vaccine mandates had a tremendous beneficial impact, we are now at a point where we think that it makes a lot of sense to pull these requirements down,” White House COVID-19 coordinator Dr. Ashish Jha told The Associated Press on Monday.

Deeply polarizing at the time and the subject of numerous legal challenges — many of which were successful — the vaccination requirements were imposed by Biden in successive waves in late 2022 as the nation’s vaccination rate plateaued even amid the emergence of new, more transmissible variants of COVID-19.

More than 100 million people at one time were covered by Biden’s sweeping mandates, which he announced on Sept. 9, 2021, as the delta variant of the virus was sickening more people than at any time up to that point in the pandemic. Biden had ruled out such requirements before taking office that January, but came to embrace them to change the behavior of what he viewed to be a stubborn slice of the public that refused to be inoculated, saying they jeopardized the lives of others and the nation’s economic recovery.

“We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us,” Biden said at the time. The unvaccinated minority “can cause a lot of damage, and they are.”

Federal courts and Congress have already rolled back Biden’s vaccine requirements for large employers and military servicemembers.

Mandates remain for many employees of the National Institutes of Health, Indian Health Service and Department of Veterans Affairs — which implemented their own requirements for healthcare staff and others independent of the White House — will remain while those agencies review their own requirements, the administration said.

Over 1.13 million people in the U.S. have died of COVID-19 since the pandemic began more than three years ago, including 1,052 people in the week ending April 26, according to the Centers for Disease Control and Prevention. That was the lowest weekly death toll from the virus since March 2020.

“COVID continues to be a problem,” Jha said. “But our healthcare system or public health resources are far more able to respond to the threat that COVID poses to our country and do so in a way that does not cause problems with access to care for Americans.”

He added, “Some of these emergency powers are just not necessary in the same way anymore.”

More than 270 million people in the U.S., or just over 81% of the population, have received at least one dose of a COVID-19 vaccine, according to the CDC.

For more than a year, U.S. health officials have been eyeing a long-term response to COVID-19 that is more similar to the approach to influenza, with updated shots yearly targeted at the latest strains of the virus — particularly for the most vulnerable. But fewer than 56 million people in the U.S., or 17% of the population, have received a dose of the updated bivalent boosters that became available in September 2022 and provide better protection against the omicron variants that remain in circulation.

“We don’t have a national mandate for flu vaccines in the same way, and yet we see pretty good uptake of flu vaccines,” Jha said. “The goal here really is to continue to encourage people to get vaccinated, but I don’t think mandates are going to be necessary for getting Americans vaccinated against COVID in the future.”

While federal mandates are ending, Jha predicted that some employers, especially medical facilities, may decide to maintain their COVID-19 vaccination requirements. He noted that the hospital where he practices has had a flu vaccine requirement for employees for 20 years.

Jha dismissed concerns that the ending of the international traveler vaccination requirement would increase the risk of a new variant from overseas entering the U.S. Biden has already rolled back virus testing requirements for both American citizens and foreign travelers to the U.S.

Jha said the U.S. was already protected by a traveler genomic surveillance program, which, for instance, tests for different virus strains in aircraft wastewater.

“We think that we are much more able to identify if a new variant shows up in the United States and respond effectively,” he said. “And I think that’s what makes the need for a vaccine mandate for travelers less necessary right now.”

The post US to lift most federal COVID-19 vaccine mandates next week first appeared on Federal News Network.

But the directives would be funded out of existing commitments, possibly including last year’s laws financing infrastructure projects and building computer chip plants. That likely means their impact would be limited and possess more of a symbolic weight about what’s possible. The Democratic president was far more ambitious in 2021 by calling to provide more than $425 billion to expand child care, improve its affordability and boost wages for caregivers.

“The executive order doesn’t require any new spending,” Biden said in remarks at the White House. “It’s about making sure taxpayers get the best value for the investments they’ve already made.”

Biden also has called for more money for the care economy in his 2024 budget plan, drawing a sharp line with Republicans, who are seeking limits on spending.

Susan Rice, director of the White House Domestic Policy Council, told reporters on a phone call that the order shows that Biden isn’t waiting on Congress to act.

“The child care, long-term care systems in this country just don’t work well,” Rice said. “High-quality care is costly to deliver. It’s labor-intensive. It requires skilled workers. Yet care workers, who are disproportionately women and women of color and immigrants, are among the lowest paid in the country.”

The order seeks to improve the child care provided to the offspring of federal workers, including military families. It plans to lower costs for families that are part of the Child Care & Development Block Grant program. Military veterans would get better home-based care. And the Department of Health and Human Services would raise pay and benefits for teachers and staff in the Head Start program.

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Given everything that happened in the pandemic of 2020, one would think the government would have learned a thing or two about bio responses. It has learned a lot, actually. But there is more work to do, according to the Government Accountability Office (GAO). For more, the Federal Drive with Tom Temin talked with Chris Currie, GAO’s director of Homeland Security and Justice.

Interview transcript:

Tom Temin And this latest report on bio response. Is it more a review of how the government did in plans that date back to 2018? In some extent, there’s plans that go back to the George W. Bush administration for bio response, or are there new learnings and things that they can do fresh recommendations? Tell us what’s going on here.

Chris Currie Well, what we wanted to do in this report is so much has happened leading up to COVID and, of course, during COVID. And so we wanted to issue something talking about our biodefense work over the last decade or so and some of the key challenges. And I think one of the big concerns we have is that there has not been really a comprehensive after action done post-COVID, which is understandable, I think everyone’s kind of ready to move on from COVID and get on to the next thing. But there were huge problems before COVID. COVID then, illustrated a lot of systemic weaknesses in our system for preparing and responding to these types of events. And then, it’s really important that we just try to follow up on these gaps and close them before the next pandemic happens.

Tom Temin Because I know the GAO has an eight-step program, for want of a better word, on how you actually do lessons learned. Everybody talks about lessons learned, but you’ve got an eight-step process for that. Sounds like that’s what you’re prescribing for the government.

Chris Currie Absolutely. The great thing about real events like this happening is you can learn lessons from them and prepare the next time. Unfortunately, that’s really hard to do. We’ve seen this in past disasters where there’s comprehensive after action review and reporting done, which requires a lot of time and resources. And often the gaps are not closed because, again, it’s sort of human nature to move on to the next event, not close the prior gaps. So that’s what we’re really advocating, needs to be done.

Tom Temin In some ways, maybe a lesson learned is post-9/11, which was the other catastrophic event, you might say, of this century, barely into the century. And there were commissions and studies and books and so forth. But you could say the government changed a heck of a lot, in the national way of thinking about terror attacks and mass destruction attacks did change. This was slow rolling, and yet it killed a million people and not just a few thousand. Not just, but you know what I’m saying, that maybe that’s a good model. 9/11 response for the COVID response, would you say?

Chris Currie I think that’s a good comparison. Very different events, but with 9/11, there was a lot of follow through with the 9/11 Commission and 9/11 Commission Act, the legislation that reformed how the government prepares and does intelligence gathering and things like that. That’s a good comparison, because I think that’s what’s needed in this case. For example, federal roles and responsibilities were a confusing part of the COVID response, especially up front. Who was responsible? Was it [Center for Disease Control and Prevention (CDC)]? Was it [Department of Health and Human Services (HHS)]? Was it FEMA? Eventually, they developed over a number of months a strategy and a structure to best respond to it. But that took some time to figure out, based on how COVID was actually playing out across the country. But if you look at today, we haven’t really gone back and reevaluated those roles and responsibilities and made any systemic changes to our system, in response and to prepare for the next event.

Tom Temin Do you think that one of the problems of the post facto era is that this took place, the pandemic over two administrations, that frankly hate each other’s guts. And without asking you to take sides, I wouldn’t do that. But could that be part of the paralysis here for stepping up to looking at this in a commission objective kind of way?

Chris Currie We’re all aware of the very politically contentious discussions around certain things that happened during the pandemic, like mask wearing and lockdowns and things like that. I do think that complicates in the ability to look at this holistically and see how we need to change our planning for the future. But I will say that across administrations, for example, in 2018, the Trump administration had issued the National Biodefense Strategy. The Biden administration, just recently in October 2022, issued a new strategy and a new update. There’s some differences between those, but in terms of how the federal agencies need to work together across the administration, the executive branch, to prepare, there’s a lot of similarities. For example, under the old strategy, HHS, in working with [Department of Defense (DoD)] and [Department of Homeland Security (DHS)] and USDA, was supposed to be the lead in coordinating across those departments to figure out what resources were needed for biodefense, where efforts needed to be placed. A lot of that is the same today. It’s the same agencies that have to work together to prepare for these types of things. I think one of the challenges has been accountability, though. Any time department agencies have to work together on something big like this, it’s very hard for them to make each other do certain things or spend money in certain ways. And that’s why leadership at a higher level is necessary, whether that comes from [Office of Management and Budget (OMB)] or the White House. And the Biden administration reinstituted the pandemic planning office within the National Security Council, that’s a good step to oversee some of these efforts. But in many ways, some of the challenges still exist. Like, how do we determine where resources are needed across such a huge enterprise? That’s still a challenge that we face.

Tom Temin We’re speaking with Chris Currie, director of Homeland Security and Justice issues at the Government Accountability Office. And I’m thinking it’s probably likely that the people at the operational level, whether they’re in FEMA or in some unit of CDC or HHS, they probably know one another. These communities tend to get small when you get down to the operational level and know exactly what has to be done. The sclerosis really is at the political and leadership level.

Chris Currie Yeah, and I think it’s important. It’s true, at the agency level everyone knows each other and they work together. And especially during COVID, they’re very much aware of what processes need to be put in place and how this might play out again in another pandemic in the future. I think what’s important is over time, the structure, resources and authorities match that. So a good comparison, I like to use, is after Hurricane Katrina, when the federal response was not what we wanted it to be. So there was legislation, major changes in federal policy around how you respond and what authorities you have to respond to a disaster. And I think, this is the same type of thing that’s necessary now, post COVID is. What lessons have we learned? And then, what changes do we need to policy to prepare for the next event so we can handle it the way we want to?

Tom Temin And state and local governments, state and municipal government, county government. That’s got to be a big piece of any kind of response nationally.

Chris Currie It’s a huge piece. It’s a huge piece in disaster response. And that is well ironed out at this point between the federal government, state and locals. How that response is going to work in a natural disaster, how resources are going to be shared, how funding is going to be provided from the federal government, well ironed out and tested through real events and through exercises. And I think this is no different. COVID is a disaster in and of itself. Another pandemic or a bio event is very similar. So, for a long time we’ve questioned why there is not a similar sort of structure and authority structure like there is in the disaster world, in the pandemic or biological event planning world. And I think there should be.

Tom Temin Because you don’t want people thinking of it like those signs on highways. This is an emergency escape route. You see these faded signs on crowded highways and you realize even city streets, this is the escape route. In a real disaster, it would be absolutely jammed with traffic. You’d be sitting for 6 hours at the first traffic light. That’s what you want to avoid.

Chris Currie Yeah. And I think the hard part about pandemics and situations like this is, they don’t occur very frequently, or at least that’s the perception. So, my fear is that coming out of COVID, people see this as it’s a once in every 100 year kind of event. We don’t have to worry about this again, we can move on to other things. That type of thinking is concerning to me, because another thing could pop up and it could happen again in a couple of years.

Tom Temin So any new recommendations? And if so, who are they aimed at?

Chris Currie So no new recommendations in this product that we just issued last week. It’s really just a combination of all of our prior work and reiterating some of these things. I will say, 21 of our 29 recommendations we’ve made in this biodefense space are still open. And part of that’s, because of how big and sweeping they were and how difficult they are to implement. So we still think those are critical to implement moving forward, and there’s still a lot of work to do. So we’ll be holding the agencies accountable for that over the next few years.

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