114: How Federal Agencies Can Work Together

ROBERT JOHNSON:

This is Public Health Review Morning Edition for Tuesday, February 8th, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.

Continued public confusion over testing, booster doses, and medications could be improved if two federal agencies thrown into the spotlight by the COVID-19 pandemic could find a way to work more closely together. That's the view of Dr. Josh Sharfstein, a former public health official in Maryland and principal deputy commissioner at the FDA from 2009 until 2011. His view explained in a recent New York Times guest column is today's morning conversation.

You want the CDC and the FDA to work together. Are you saying that they're not doing that right now? Or they could just do a better job of it?

1. JOSHUA SHARFSTEIN:

Well, I think the CDC and the FDA exist in different worlds. And in different positions I've interacted with both of them, so I have a sense of how they exist, you know: FDA exists in an ecosystem of people trying to sell products, and people advocating about products and patients; and CDC exists much more in the world of governmental public health, local public health, state public health. They have different statutes that tell them what to do, they report to different subcommittees in Congress. The mentality is a little bit different, and I think we see that coming together—it's not something they do regularly all the time.

JOHNSON:

How would you suggest they try to pursue this goal of working together better?

SHARFSTEIN:

Well, I think that they certainly have a common mission and, particularly with COVID, they are working together for the American people. And right now I think that it's sort of like parallel play—you know, they're sitting next to each other, doing things, checking on each other. But it's not quite cooperative play—I'm a pediatrician, so I'm giving some pediatric terms here—where they're actually building something together.

And I think when they're really important common tasks, like getting the right tests and explaining to people about the tests or having a coherent message on booster shots, they should take a step back and say, "Can we not just do things in our own way and talk about it, but actually do things together?"

JOHNSON:

If they could do this, what would be the benefit to public health?

SHARFSTEIN:

Well, I think, you know, be good for decision-making. But I think what's really obvious is that it would be very helpful for clear and compelling communications: you know, to be able to coordinate decisions and therefore be able to coordinate on communications; be much more transparent, I think, answering questions that people really have.

And one example about that is the vaccines for kids under five. And I can't tell you, there are a lot of things that make me stop in my head, but the thing that makes me stop my head the hardest these days is when there's critically important news coming out about, you know, something the parents really care about, and you don't really hear from any government official in those stories. It's people who know, it's the companies, it's everyone except the public servants who are really trusted to look out for kids. And I think that we can do a lot better than that.

JOHNSON:

In your article, you urge them to get out of their own corners and work more closely together. But what happens if they're not able to accomplish that?

SHARFSTEIN:

Well, you know, I think there are a lot of great people at these agencies who are doing incredible work, working unbelievably hard during the pandemic, and I don't want to take anything away from what CDC and FDA have accomplished. You know, I think it's really a question of what more they could accomplish if they're able to find areas to really work on together.

JOHNSON:

The link to Dr. Sharfstein's article for the New York Times is in the show notes.

The Safe States Alliance recently surveyed public health departments to understand how they've been able to implement equity approaches to their injury and violence prevention work. Executive director Richard Hamburg says many have had challenges along the way.

RICHARD HAMBURG:

According to the survey, 81% of respondents report they're incorporating equity to some degree; however, many struggled to provide concrete and tangible examples of how they specifically incorporated equity into their IVP work. The examples provided by the evaluation participants demonstrate that most injury and violence prevention programs are in the early stages of incorporating equity into their work.

JOHNSON:

The Alliance report identifies technical assistance opportunities to help programs address health inequities. There's a link to the report in the show notes.

Finally today, many states and territories are finding ways to help people living with intellectual and developmental disabilities manage their care despite the pandemic.

Pennsylvania's deputy secretary for the Office of Developmental Programs, Kristin Ahrens, says telehealth has been a critical tool in that work.

KRISTIN AHRENS:

For the IDD population, often physicians and specialists may struggle with really understanding and meeting the needs of a person with very complex needs who has IDD. The availability of telehealth really could expand and greater access to the people who have this specialty in IDD and make sure that where we have rural areas, we don't have those specialists, that people still have that access to that specialty.

JOHNSON:

I hear more from Deputy Secretary Ahrens in a new episode of the Public Health Review podcast, coming soon everywhere you stream audio.

That'll do it for today's report.

Be sure to join us again tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.