ARPA-H must think differently and leverage technology

The Biden administration announced the creation of the Advanced Research Projects Agency for Health (ARPA-H), an organization to be housed within the National Institutes of Health (NIH) with a mission to bring medicine the kind of revolutionary research ideas and methods that led to the advent of the Internet and GPS.

While innovation is desperately needed in medical care – and DARPA, the US Department of Defense agency on which ARPA-H draws inspiration, offers a compelling model – the last two years of the pandemic have revealed that ARPA-H should focus radically different from what is proposed.

Although nascent, ARPA-H’s current plans are to invest in research into cancer, Alzheimer’s disease, and diabetes, among other diseases. This disease-focused approach can yield new drugs, detection methods, and therapeutics for conditions that already benefit from significant research funding and ongoing investigations at NIH. It wouldn’t change the fact that the United States ranks 42nd in the world in terms of life expectancy, has the highest suicide, infant and maternal mortality rates among industrialized nations, and has alarming disparities in health among blacks, Hispanics, Native Americans and other marginalized communities. , with a 20-year longevity gap based on where you live — your zip code, not your genetic code. In fact, as we have seen with breakthrough COVID-19 vaccines, medical innovations alone – without the public health infrastructure in place to deploy them effectively – risk leaving vulnerable communities behind and exacerbate health inequalities.

Instead, ARPA-H must fund breakthrough public health technologies that can improve health outcomes and equity today and modernize our public health infrastructure for decades to come. Here are five such examples:

  1. Pandemic response and surveillance: A key to mitigating COVID-19 was “last mile” delivery innovations such as drive-thru testing and pop-up vaccination clinics, but we could go much further. At present, we lack accurate numbers of COVID cases because home testing is expensive and lacks connectivity to public health services. ARPA-H could fund second-generation home tests that are much cheaper to produce and connected. It could also fund new vaccine delivery modalities such as vaccine patches that could be self-administered, simplifying their administration and potentially reducing vaccine hesitancy.
  2. mental health crisis: Less than half of people with mental illness receive appropriate treatment), and deaths from despair, including drug overdoses, suicide, and alcoholism, are the leading causes of death in the United States, with rates alarming among young people. The PHQ-9, the most widely used screening tool for depression developed more than two decades ago, fails to diagnose 12-15% of people with this condition and requires the administration of a professional health, a barrier for at least a quarter of Americans. ARPA-H could fund breakthrough technologies to analyze data collected from smartphones, voice calls, and text messages and generate signals that people may be depressed, anxious, or at risk for suicidal or murderous behavior. It could also fund new interventions that improve mental health resilience and help tackle mental illnesses such as depression, PTSD, schizophrenia and bipolar disorder using technologies such as digital avatars and coaches. trained mental health professionals with evidence-based best practices to help improve our exhausted mental health. Workforce.
  3. Disease prevention and behavior change: The tripling of obesity rates over the past two decades may result in the first generation of Americans not being as healthy as their parents. ARPA-H could tackle obesity and type 2 diabetes at the population level by funding artificial intelligence (AI) health chatbots designed for and by vulnerable communities and, for people in the he other side of the digital divide are community health workers who support people in their homes and neighborhoods using advanced decision support software.
  4. Social determinants of health: Forty percent of health outcomes in America are determined by social determinants of health – factors such as education, housing, transportation, and food security that are upstream of the traditional health care system. The problem is multifactorial, but one of the challenges is matching an individual’s needs with available social services. During the pandemic, we learned that we could program mRNA into vaccines, but we couldn’t help people figure out where to get vaccinated or tested in their neighborhood. The same kind of information gaps exist for finding housing and legal aid, food banks, low-cost transportation, and drug assistance programs. ARPA-H could invest in digital mapping of community resources so that accurate data is available to any healthcare provider or anyone seeking to meet an individual’s social needs and help overcome barriers to care. health.
  5. Public health communication: COVID-19 has revealed how mistrust and misinformation can hinder the most advanced medical advances. ARPA-H could invest in harnessing new social media tools and advanced analytics to help public health professionals identify and break chains of transmission and contain “epidemics of misinformation” while disseminating effective prevention messages on a large scale. Additionally, there is an estimated 17-year gap between science and services in the dissemination of research findings into clinical practice. In the digital age, that should be a nanosecond. ARPA-H can develop innovative strategies to accelerate the adoption of best practices.

ARPA-H is extremely promising, but as COVID-19 has unveiled, we cannot afford to keep doing the same. NIH should further embrace DARPA’s high-risk, high-reward strategies for finding transformative solutions by funding some of its disease-focused research. However, by focusing on issues of underfunding that impact health from multiple diseases and require inter-agency as well as cross-sectoral collaboration, we can put the “H” in ARPA-H and advancing health for all.

Shantanu Nundy, MD, is a primary care physician in Safety Net and Chief Medical Officer of Accolade. She is the author of “Care after Covid: What the Pandemic Revealed is Broken in Healthcare and How to Reinvent It”.

Susan J. Blumenthal, MD, MPA, is Senior Medical and Policy Advisor at amfAR, The Foundation for AIDS Research, Senior Health Policy Researcher at New America, Visiting Professor at the MIT Media Lab, and Clinical Professor at Georgetown. and Tufts University Schools of Medicine. She is a former US Assistant Surgeon General and a retired Rear Admiral.