POLITICO is partnering this week with the Milken Institute to bring a special edition of Future Pulse to the Milken Institute Future of Health Summit. We are taking readers inside one of the most influential gatherings of global health industry leaders and innovators as they tackle today’s pressing health challenges.

The need to keep the deadly hemorrhagic fever Ebola out of the United States is something everyone can agree on. But, as it stands, the Centers for Disease Control and Prevention doesn’t have the power to require states to report on the health of travelers from Ebola-stricken areas of the world, CDC Director Rochelle Walensky said at the Milken Summit.

That was just one example, Walensky said, of how a lack of authority impedes the CDC’s ability to keep Americans safe.

Walensky is on a bit of a speaking tour, making the case that Congress needs to grant the CDC more power to mandate that cities, states, counties and tribal authorities share data with it.

Right now, localities get to choose what to share and how to share it.

“It’s very, very hard to run a public health response that way,” Walensky said.

Speaking at a Bloomberg event earlier this week, Walensky listed additional examples of how the agency’s lack of authority to request data hinders its response to public health crises. The CDC cannot now aggregate state and local data on firearm injuries and deaths, she said, and the agency struggles to make recommendations on chronic conditions, such as hypertension and diabetes, due to the late and poor quality of reports it receives.

Walensky is unlikely to get the power she seeks from the new Congress, where Republicans critical of the agency’s response to the Covid-19 pandemic will rule the House.

Walensky backs the Improving DATA in Public Health Act, introduced by Sen. Tim Kaine (D-Va.) and Rep. Lauren Underwood (D-Ill.), which would give the CDC a way to aggregate uniform data that health systems at all levels of government could use.

Finding out how the mpox vaccine was being used at the beginning of its rollout was difficult without this authority, Walensky said. “It took us two months to work with 61 jurisdictions to get data use agreements for the share of the vaccine administration data,” she said.

Another authority Walensky would like to have: The ability to increase the pay of CDC employees responding to outbreaks, either in the U.S. or abroad. CDC employees are working in Uganda to fight the Ebola outbreak there, but Walensky can't give them hazard or overtime pay.

This is where we explore the ideas and innovators shaping health care. 

Georges Benjamin, executive director of the American Public Health Association, said it’s not just Congress that has stood in the way of a full-throated public health response to gun violence, and he called on colleagues to continue making the case that it needs one. “The lack of political will is not just among resource allocators and policy makers, but the general public,” he said.

Share news, tips and feedback with Ben Leonard at [email protected], Ruth Reader at [email protected], Carmen Paun at [email protected] or Grace Scullion at [email protected] 

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Today in our Pulse Check podcast, Grace talks about respiratory syncytial virus with Ofer Levy, a pediatric infectious disease specialist at Boston Children's Hospital and a member of the FDA's Covid vaccine advisory panel. Plus, Sen. Tim Kaine (D-Va.) on why he's optimistic there will be funding for long Covid in an end-of-year omnibus.

Shoring up Medicare, reforming the federal health insurance programs that serve low-income elderly adults, bolstering mental health care and combating obesity are some of Sen. Bill Cassidy’s concerns, the incoming ranking member of the Senate Health, Education, Labor and Pensions Committee said in a Milken Summit talk.

Medicare solvency: Cassidy, a Louisiana Republican, wants to explore “market-based solutions” to Medicare’s imminent insolvency. Those solutions would provide incentives to patients and providers to bring down costs.

Dual-eligibles: Cassidy is working on bipartisan legislation with Sens. Tim Scott (R-S.C.), Tom Carper (D-Del.), Bob Menendez (D-N.J.), John Cornyn (R-Texas) and Mark Warner (D-Va.) to better care for the more than 12 million people eligible for both Medicare and Medicaid.

Cassidy said outcomes for dual-eligibles are poor — despite huge costs.

“You need to align the incentives," Cassidy said. "Maybe the problem is we have two payers. It’s hard to align incentives when both sides are trying to shove the costs onto the other.”

Mental health: Cassidy said he’s continuing to push for his Mental Health Reform Reauthorization Act, which would reauthorize mental health grants that expired in September.

Cassidy helped create those grants with Sen. Chris Murphy (D-Conn.) in the 2016 Mental Health Reform Act.

“Although the program has worked, it has not worked for as many people as we wish it to. We’re trying to improve the program,” Cassidy said.

Obesity: Progress on obesity is difficult to come by, Cassidy said, characterizing it as a “hydra-headed monster.”

Cassidy said lawmakers should consider creating incentives for food-stamp recipients to purchase healthy food by, for example, providing more money if it’s spent on nutritious meals.

The Biden administration’s new moonshot creator, the Advanced Research Projects Agency for Health, has a high bar to meet, Rep. Anna Eshoo (D-Calif.) said at the Milken Summit.

That bar is “a cure,” said Eshoo, who has championed the new agency.

Priorities detailed: ARPA-H Acting Deputy Director Susan Monarez outlined four areas of focus for the agency:

1. Broadening the realm of possibility by imagining what the future of health care could look like unencumbered by current technological limits
2. Targeting scalable innovations in manufacturing and distribution
3. Thinking about prevention by anticipating health threats
4. Building resilience in health care systems so they can respond better to a novel disease outbreak like Covid-19

During the panel discussion on the agency’s development, current and former staffers from the National Institutes of Health and the White House Offices of Science and Technology Policy had a slightly different take on how ARPA-H can succeed: through failure.

“If our agency isn’t failing occasionally, it’s not taking big enough risk,” said Tara Schwetz, the NIH acting principal deputy director who helped stand up ARPA-H.

“If you’re gonna fail, fail fast,” said Michael Stebbins, who served as assistant director of former President Barack Obama’s Office of Science and Technology Policy.

Chris Austin, former director of NIH’s National Center for Advancing Translational Sciences, said the Defense version of ARPA-H, the Defense Advanced Research Projects Agency, has succeeded by setting absurdly ambitious goals. “Nobody expects to get there,” he said. But when the program ultimately fails, it still gets close: “The consolation prize is still amazing.”

The dashboards on cases, hospitalizations and deaths that sprung up during the Covid-19 pandemic were a source of fascination, and sometimes horror. The White House Office of National Drug Control Policy hopes its new dashboard will put a similar spotlight on drug overdoses.

“If you think about COVID, for example, you could look to your phone to look at how many cases there were in your county, your state, your country,” said Rahul Gupta, the director of the drug control policy office, at the Milken Summit.

But until the launch this week of a drug overdose dashboard, there was nothing similar, Gupta said, “for an epidemic that has claimed more than a million lives for the last two decades.”

The overdose dashboard displays real-time data collected from emergency services agencies on:

• nonfatal overdoses.
• naloxone administrations.
• average emergency response time.
• the percentage of people not transported to medical facilities. 

It’s the first time the federal government has collected this kind of data, Gupta said. The metrics offer a new window for public health officials to understand gaps in treatment and prevention.

Gupta said his office hopes to add data on race and ethnicity to the dashboard soon. Originally an epidemic taking place primarily in white, rural communities, the overdose problem is now hitting urban, non-white communities. The CDC released a report this year that found increasing rates of overdose deaths among Black and American Indian and Alaska Native people.

Read Krista Mahr’s story on the dashboard for more.

The Milken Summit panel on artificial intelligence that Ruth moderated hit on all the tough questions about what needs to happen for AI to improve health care.

Eventually, that will happen, said John Halamka, head of platforms at the Mayo Clinic, who bet money that in five years it will be considered malpractice not to use AI alongside colonoscopies to prevent colon cancer.

Still, a lot stands in the way, including a lack of patient trust and technological standardization, and uncertainty about regulation and where AI will have the greatest utility.

AI has not yet delivered on its promise in health care, as Ruth and Ben wrote earlier this year. However, there are plenty of ideas for how it could:

• The Coalition for Health AI has released guidelines for how health care AI could be better standardized and validated. The document calls for an AI implementation guide, a national registry of AI algorithms, and an accreditation lab that would validate algorithms. 

• Halamka called for a public national registry where algorithms would be listed with information about their performance.

• Flatiron Health’s director of quantitative sciences, Blythe Adamson, said that validation has to be done on a continual basis. “Bias creeps in over time,” she said. “Performance deteriorates over time.” 

• Joe Franklin, a former adviser at the FDA who’s now head of strategic affairs for clinical studies platforms at Alphabet’s Verily health tech business, said there’s also a role for the FDA in helping to validate algorithms. The agency has already issued guidance for the development of software as a medical device. 

Next year, Halamka said the Coalition for Health AI, which works with the FDA, HHS, NIH, and the White House Office of Science and Technology Policy, will have more to share on how best to move forward.
CLARIFICATION: An earlier version of this newsletter may have been unclear about which policy issues are of greatest concern to Sen. Bill Cassidy.