CPSM1 health - Foundation of Supply Management Updated: 2023

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Introduction

Warren Buffett’s gift of more than $30 billion to the Gates Foundation roughly doubles the size of what was already the world’s largest private philanthropic endowment. The foundation has been increasingly active—and effective—in immunization campaigns against diseases such as malaria and tuberculosis. With the new donation, the foundation will likely have an enormous impact on global health issues, handing out a projected $3 billion per year in grants targeting a longer list of diseases. It also may become further involved in microcredit and agriculture projects. Experts expect the foundation to expand its resources significantly in global development issues, which increasingly intersect with health concerns. But they caution it will be challenged to spend the larger sums wisely.

How much money will go to the Gates Foundation?

Buffett’s gift represents the current value of 10 million shares of Class B stock from his company, Berkshire Hathaway. It is to be doled out in shares currently worth about $1.5 billion per year starting in July. The overall amount places the size of the Gates Foundation endowment at roughly $60 billion. It is currently spending an average of $1.5 billion per year on global health promotion and the gift nearly doubles the amount the foundation will spend per year in this area. It is not yet clear how much the foundation’s staff will expand from its current 241 members. Since 1999, the Gates Foundation has come to focus mainly on global health issues, where $6 billion of the $10 billion spent by the foundation has been directed.

How effective has the Gates Foundation been thus far?

Health experts credit the foundation with bringing new thinking and resources to the global health field, with an emphasis on scientific research. It is seen as especially promising in developing vaccines for diseases such as malaria and tuberculosis. The foundation has also spent hundreds of millions of dollars in grants to support the Global Fund for AIDS, Tuberculosis, and Malaria, an independent Swiss foundation. It has set aside nearly $500 million for the Grand Challenges in Global Health Initiative, which supports projects like research into blocking insects from spreading disease. The Wall Street Journal says the Gates Foundation usually seeks "strategic investments" with partners in areas like disease-treatment programs. John Sewell, a senior scholar at the Woodrow Wilson Center and former president of the Overseas Development Council, cites the foundation’s approach to expanding vaccinations through partnerships with pharmaceutical companies. Such partnerships make vaccines available to thousands of poor people while at the same time assuring funding for pharmaceutical companies that rely on profits for ongoing research and development. Vaccine funds supported by the foundation, Sewell says, "guarantee a purchase but are not a free ride for the pharmaceutical companies so there’s a lot of responsibility on both sides."

USA Today notes moves like designating $258 million last year for development of a malaria vaccine represent a shift in traditional philanthropy, which previously was involved mostly in distribution of drugs. Dr. Anders Nordstrom, acting director general of the World Health Organization, told the Los Angeles Times that Gates has stimulated "new knowledge, new products or just new thinking" on health promotion. "He’s galvanized international attention, particularly on vaccine research and on health in general," says Princeton Lyman, CFR’s Ralph Bunche Senior Fellow for Africa Policy Studies.

But for all its influence, the Gates Foundation is no replacement for—and is not as accountable as—the World Health Organization, says Laurie Garrett, CFR’s Senior Fellow for Global Health. She writes in this op ed that foundation isn’t going to "send scientists in spacesuits wading into Marburg outbreaks or lead a global response to pandemic flu. That’s the WHO’s job."

Is the Foundation likely to expand its areas of focus?

Experts expect the foundation to continue emphasizing global health promotion. Gates told a news conference after Buffett’s gift was announced there was an opportunity for finding cures for the top twenty fatal diseases. His wife and cofounder of the foundation, Melinda Gates, said finding a cure for AIDS is one goal. She also indicated the foundation will do more in agricultural development, saying "It’s hard to take [medication] if you don’t have food."

Sewell says an expanded focus on agriculture makes sense in much of Africa, where there are dire health needs and most of the population consists of farmers. He says infrastructure should be a priority. "Part of that is simply more organization and extension service," Sewell says. "Part of it is rather large [aid] areas like having roads where rural people can be reached and can get their crops out. And part of it is agricultural technology, having crops to grow in tough environments." Lyman says Gates may expand some of the information technology projects he helped launch in India and South Africa. "With this money from Buffett they should be able to move into much deeper, broader development issues," Lyman says.

What challenges does the foundation face?

Experts say the new money brings enormous challenges. Under the terms of Buffett’s gift, the foundation will be required by 2009 to annually spend the dollar amount of the donation, estimated at about $1.5 billion. Sewell says "speedy disbursement is not a good idea in the aid business" in part because some targeted countries don’t have the administrative capacity to absorb new assistance money. "They’re going to have to put money into building the capacity of [countries’] absorbing more money," says Sewell. Other experts say that with many of its health projects still in the development phase, the Gates Foundation still faces political and logistical obstacles to implementing its goals. The new challenges are seen as contributing to Gates’ announcement earlier this month that he will relinquish the daily responsibilities of leading Microsoft to focus on the foundation.

Is there concern that the value of shares owned by Gates and Buffett will decline?

About two-thirds of the assets (PDF) of the Gates Foundation are in bonds, indicating conservative management. Gates has requested managers of the fund to target a 5 percent return each year, to be used for program grants. Buffett, one of the world’s shrewdest investors, has kept his assets in Berkshire Hathaway stock. Buffett has stressed the stability and long-term growth aspect of Berkshire shares. Still, it is not unprecedented for a major philanthropist to see his stock plunge. Media mogul Ted Turner pledged $1 billion to UN causes in 1997 and then saw his personal wealth plummet when the value of his Time Warner shares declined precipitously. Turner paid out half his pledge within about five years, but following the slump in his fortunes in 2002, the board managing the gift decided the remainder should be disbursed over ten years rather than five as initially planned.

Have private foundations had an impact on global welfare?

In the 1960s and 1970s, the Rockefeller and Ford Foundations played important roles in spurring the Green Revolution, in which developed countries transferred agricultural technology to peasants and farmers in Asia, eliminating the threat of famine in many countries. Another prominent private group is the Soros Foundation, a major donor to human rights, civil society, health, and democratization causes. Funded by George Soros, the foundation has been accused by some authoritarian governments in the former Soviet Union of interference after revolutions in Ukraine and Georgia and Serbia, countries where his organization has been active.

Dr. Curt LaBelle has been investing in healthcare companies for over 18 years, and now serves as the Managing Partner of the Global Health Investment Fund (GHIF).  GHIF is a social impact investment fund, which manages manages ~$108M and was initially structured and backed by the Gates Foundation and JP Morgan in 2012. As Bill Gates detailed in a talk announcing the fund with Jamie Dimon, GHIF is one of the pioneers of global health investing, focused on a ‘double bottom line’ of health outcomes and financial returns. The fund targets $5-15M investments in innovative global health companies, and alongside the Gates Foundation, is backed by the IFC, GSK, Pfizer, Grand Challenges Canada, KfW and Merck, among others.  GHIF’s work in product development is used by the World Bank as a case study as to how to effectively expand access to quality and affordable health care.

Since launch, and under Dr. LaBelle’s leadership, GHIF has invested and exited numerous high-impact global health companies, saving and benefiting thousands of lives.   The impact of several investments GHIF has made, at scale, are below:

Dr. LaBelle has served as a board member or global access chair for several successful healthcare and pharmaceutical companies, including KAI Pharmaceuticals (sold to Amgen), Sirion Therapeutics (sold to B&L and Alcon), Impulse Monitoring (sold to NuVasive), Eyenovia (sold to EYEN), IanTech (sold to Zeiss) and numerous others. Dr. LaBelle was previously a Managing Director at Tullis Health Investors and a Vice President at Investor Growth Capital.  He holds a BS in Economics from Brigham Young University, and MD and MBA degrees from Columbia University. I had the pleasure of recently sitting down with Dr. Labelle to discuss his career, the Global Health Investment Fund, and his thoughts on impact investing.

Kevin Harris: Could you walk me through your background and experience in healthcare investing? What led you to become involved in GHIF?  

Curt LaBelle, Global Health Investment Fund: Following an undergrad at BYU, I earned an MD/MBA from Columbia.  Before joining GHIF as Managing Partner, I had a 15 year career in venture investing in healthcare companies.  I jumped at the opportunity to join GHIF following a phone call out of the blue from an executive search firm hired by the Gates Foundation, and believe the fund is an incredibly unique opportunity combining venture and impact investing.  

Bill Gates, through the Gates Foundation and with partners including the IFC, had already put GHIF together with outside capital. They were looking for someone with a traditional venture investing background to manage the fund, and generously brought me in.

Harris: Could you detail your investment methodology and process?

LaBelle: We only invest in companies developing innovative products that can be used in settings with limited resources.  Much impactful and innovative medical technology is never brought to market outside of the US & Europe, because there’s generally going to be less of a financial reward for doing so.  That’s where GHIF comes in. We identify high impact health outcomes, generally involving a new medical technology or drug. We then do two things:

Firstly, we screen whether the product serves a need in low-resource settings, like sub-Saharan Africa or India, where I just returned from.  Secondly, we screen whether the product has compelling financial prospects. Fortunately, if a product fails this second test, but we find it sufficiently compelling in terms of the first, we can send the opportunity to our colleagues at the Gates Foundation, who can pick up low-return but high-impact projects.

Assuming we can check both of those boxes, we dive into the clinical data, benchmark its outcomes to those of existing therapies, consult experts, run financial models and get to know the management teams.  Process wise, this is very similar to the work of other healthcare investors That said, some of these products are not necessarily greenfield medical technologies, but are substantially less expensive than existing solutions, enabling their availability in low-resource settings where they otherwise previously would not be deployed.  

Harris: Could you walk us through a accurate investment from research to exit?  

LaBelle: IanTech, a company that manufactures a micro-interventional cataract surgery tool, is a good example of a recently acquired investment of ours. I had known its founder, Dr. Sean Ianchulev, for many years and had previously invested in other companies he had been involved with.  

As part of our prior research into how we could maximize the impact of each dollar we invested, it had become clear that unnecessary cataract-induced blindness was a major issue in developing countries.  In countries with better access to modern medicine, advanced cataracts largely do not exist in the population at large. Not only do cataracts negatively impact the lives of afflicted individuals, but socially and economically strain the families and communities of the impacted individuals.  Female family members are often socially or culturally induced into the roles of caretakers for the afflicted, which has a significant knock-on economic impact on the entire community. Tens of millions of cases of cataract-induced blindness are unaddressed, because the traditional surgery based method of treatment is both expensive and requires a sophisticated medical infrastructure that simply does not exist in much of the developing world.

IanTech invented a device, the MiLoop, which is simple to use, inexpensive to make, and produces excellent clinical outcomes.  Following our analysis of the product and due diligence on the company, we examined whether there was a market in the US for such a device.

We learned that there is a push for less invasive, “lower energy” cataract surgery to better preserve the tissue around the lens often disturbed by the ultrasound energy involved by more invasive phacosurgery. IanTech’s device used no energy and could be used in advanced cases that would traditionally require hazardous amounts of ultrasound energy in treatment.

We determined that IanTech serves a massive need in the developing world but would also be attractive to physicians in high-income countries.  As I had worked with Sean before, IanTech was comfortable working with us and open to the Global Access Commitments we require when we invest in a portfolio company. GHIF invested in July 2017, and the company was sold in December 2018 to Zeiss at an attractive multiple of the original valuation.  Sean and I continue to co-chair the Global Access Committee and have worked to train caregivers in India, Ethiopia, Tanzania, Panama and elsewhere on the technology.

We believe IanTech’s device will enable millions of people to see who would otherwise be destined to suffer a life of blindness, empower their (mostly female) caregivers, and unlock extremely limited medical resources to be more impactfully deployed elsewhere.

Harris: How do you source potential portfolio investments?

LaBelle: The global health research and technology industry is small,  and as a result, many of our deals come from those with whom we have worked before.  As discussed, IanTech is a good example of this, given my years of history and trust of Dr. Sean Ianchulev.

We also work closely with the Gates Foundation to evaluate projects and companies they have supported in the past.  We have a continuous back and forth, that has led to numerous investments on both our parts. In addition, we receive referrals from our committee members and investors, and proactively track companies developing products in areas of interest to our fund.

Harris: What led to the loss-sharing guarantee mechanism that undergirds GHIF’s fund?  

LaBelle: When the Gates Foundation was initially structuring the fund, the concept of impact investing was extremely novel and there were no existing funds involved in the healthcare space.  As a result, investors were skeptical of its financial prospects.

To address this, the Gates Foundation offered loss protection, so that investors would feel that the downside risk of the fund was mitigated. Given our exits to date, we do not believe we will need the loss protection, but it was helpful in our launch of the fund.

Harris:  Has your investment process significantly evolved over time?  If so, how?  

LaBelle: We are better at quickly determining the global need and prospects for products now and have expanded our network of experts who can help us in our diligence process.

Given my almost two decades in the space, the basics of the financial process have not changed meaningfully from what you would expect. The companies we’ve worked with have been at different stages of growth and have had different business objectives in mind,  so we’ve employed a range of investment structures to meet the financing needs of the companies. However, what has stayed consistent across each GHIF investment is our focus on the double bottom line mandate.

Harris:  How do you measure ROIC with regard to health outcomes?  

LaBelle: The start to quantifying the impact of our health outcomes is breaking out two distinct categories, lives saved, and lives improved, and then rigorously defining as quantitatively as we can the impact our investment could have on those outcomes.  Many of the investments we look at are by nature difficult to compare, so having a reasonable fluency of the base rates, disability adjusted life years, and the statistics behind the health outcomes of the wide universe of heterogeneous technologies and drugs is crucial.  

Harris:  How does GHIF measure the social impact of its investments?  How has this methodology evolved over time? 

LaBelle:  In assessing impact, we are able to focus both on the lives we save and the lives we Improve through our investments.  In healthcare, it’s likely easier to measure impact than in other fields because we often have wide datasets relating to the efficacy of therapeutics and the course of untreated diseases.  To return to the example of cataracts, we could reasonably rely on existing research to model out the negative impact of cataract-induced blindness both as an impairment of quality of life and on the loss of income of the afflicted and their caregivers.

We can use straightforward math to determine the number of lives likely saved or improved for pharmaceuticals and vaccines. For devices used to address something like cataracts, we know that each time it is used, a life is improved, making data gathering the most important part.

We also assess the expected dollars spent per life saved or improved as part of our diligence to ensure that we stay focused on affordable innovations that have the potential for widespread and meaningful impact in low resource settings.  

Harris:  A accurate IFC report detailed your “double bottom line” of social impact and financial results?   How does the fund deal with inevitable friction between the two?  What is the ideal blend between the two?

LaBelle: We ultimately have to address both with every investment, so we frequently pass on financially attractive deals that have unclear impact potential due to cost, distribution or indication issues. Unfortunately, there are also companies we pass on investing in because we can’t confirm their financial viability in a way that convinces us we can make a profit from our investment. This leaves us with a pipeline of investments that solidly check both boxes, meaning that we do not have to compromise on social impact or potential financial returns.

Harris:  What have been your biggest investment successes with GHIF?  What have been your biggest mistakes?

LaBelle: Our investment in IanTech has been our biggest success to date financially, followed closely by our investment in EuBiologics, which is now a public company selling millions of oral cholera vaccines worldwide.

We also eagerly anticipate the sale of a priority review voucher for a drug recently approved by the FDA to treat River Blindness, which would also be a tremendous financial and impact story for GHIF.

We are fortunate to have had only one significant company write-down from our 12 investments, which reflects the careful assessments in our due diligence. That failure came not from the poor performance of the drug we supported (tribendimidine for soil-transmitted parasites called helminths), but because the control drugs in its clinical studies performed much better than they had in previous studies.

Such surprises inevitably occur in drug development, often due to tightly controlled clinical studies that often don’t reflect the reality of patient adherence to drug protocols.

Harris:  How much of your capital is currently deployed?  How scalable is your current investment methodology and at what scale would social impact returns diminish?

LaBelle: We have completed our portfolio construction phase and have money earmarked to further support existing companies, but not for the inclusion of new companies. Our deal flow is strong and we believe a far greater amount of capital could certainly be deployed in healthcare focused impact investing.  The total addressable market in global health is enormous, particularly in therapies and diagnostics, which are extremely capital intensive. We currently fill a gap that is not addressed by government funding, charitable foundations or venture capital. The GHIF model pioneered the concept of a market-led approach to a segment of global health product development that was previously only thought to be achievable through philanthropy. We’re pleased to be a proof of concept showing that true impact investing in healthcare is achievable and sustainable through investor driven capital.

Harris:  At what point did the Gates Foundation become involved with GHIF?  How does GHIF’s work complement that of the Foundation?

LaBelle: The Gates Foundation initially structured the fund and provided most of the loss protection. Gates believes that the Foundation can support early, high-risk product development, while GHIF can support companies more mature in their development that need help with late-stage development and commercialization of their products. The Foundation’s hope is that the success of GHIF will inspire other funds to support investments in companies developing health products for the global market.

Harris: What are the most promising accurate projects you’ve invested in?

LaBelle: Our last investment was in Alydia Health, which has a life-saving device to treat postpartum hemorrhage, a leading cause of maternal mortality and morbidity. We are currently enrolling a pivotal study and would like to see the product on the market within two years.  

Harris: What books would you recommend to investors interested in learning more about impact investing?

LaBelle:  I’m currently very focused on addressable blindness, and have been inspired by the Aravind Eye Hospitals in India and their work to offer free care, which is detailed in the book ‘Infinite Vision’ by Pavithra K. Mehta and Suchitra Shenoy.  

• Blueprint Medicines focuses on developing precision therapies for genomically defined cancers and blood disorders, with two approved drugs and multiple ongoing programs.
• The company's stock has risen by 25% since the previous analysis, supported by strong financials and promising Phase 2 trial results for avapritinib in treating ISM.
• Avapritinib, the active compound in Ayvakit/Ayvakyt, aims to treat indolent systemic mastocytosis (ISM), a rare hematologic disorder with limited treatment options.
• The PIONEER trial showed statistically significant improvements in symptom scores and quality of life for ISM patients treated with Ayvakit, positioning the drug as a potential game-changer in ISM treatment.
• Despite anticipated FDA approval for avapritinib, the focus remains on its early performance in the ISM market; the recommendation for Blueprint Medicines' stock continues to be "Buy."

Read the full article on Seeking Alpha

The Minister of State, Minister of Higher Education, Jacques Fame Ndongo, represented the Prime Minister, Head of Government at the ceremony yesterday June 1, 2023.

On the sidelines of the 76^th World Health Assembly, Harvard University's Professor of Global Health Systems, Rifat Atun, the Copenhagen Institute for Future Studies (CIFS), Microsoft, Roche, and Siemens Healthineers came together to announce the formation of the Movement Health Foundation. While many countries around the world are facing enormous pressures on their healthcare systems, populations keep growing, people are living longer, chronic diseases are on the rise, and infectious diseases remain a threat, the Foundation aims to foster collaboration across sectors to ultimately provide access to quality health care for all people, now and in the future.

Working on the ground with governments, entrepreneurs, healthcare providers and patients, the Movement Health Foundation will harness the expertise, skills and resources of its founding partners to equip healthcare systems for the demands of the future and help them adopt the digital innovation needed to create the change that best serves the world's healthcare needs. Through a five-step approach of challenge identification, local networking, focused policy change work, incubation of solutions and pilots, and scaling, the Foundation aims to create long-term impact while fostering collaboration, best practice sharing, and entrepreneurship.

On their end, CIFS will leverage the power of data to locate innovation challenges and bottlenecks, along with opportunities for cross-border collaboration that will help countries overcome their most pressing health issues; Siemens Healthineers will explore ways to apply innovative patient-centric solutions in areas such as AI-driven diagnostics, and Roche will leverage its deep understanding of medical biology and long-term approach to maximising innovation to help make universal access to quality healthcare a reality; all of them guided by strategic advice from the Chair of the Foundation, Professor Atun, who is committed to accelerating universal health coverage to develop resilient health systems.

“Critical for the sustainability of health systems will be their ability to harness the power of digital and AI technology to accelerate a more equitable global delivery of healthcare across patients, practitioners and systems. We are proud to be one of the founding partners of Movement Health and see the Foundation as a catalyst for this transformation to bring value for patients and society,” said Tom McGuinness, Corporate Vice President, Global Healthcare and Life Sciences at Microsoft, the company that will harness the potency of technology to identify and drive breakthrough solutions to address the needs identified by the Foundation. 

“The challenge of tackling the world’s greatest health issues cannot be solved by one organisation or company alone, but by harnessing the insights and capabilities of leading institutions and cross-industry partners,” said Professor Atun, who chairs the Foundation's Board of Trustees, about the origin of this community. "Through an inclusive partnership approach, Movement Health Foundation can make a real difference on a global scale," he concluded. Professor Atun has been part of the foundation since it was first launched in Latin America as a learning initiative in 2019, with the goal of building more responsive, resilient, and equitable health systems in this region by combining digital innovation and policy shifts to help achieve the bold target set by the United Nations to reduce premature mortality from major illnesses by one-third by 2030.

Movement Health has seen notable successes in countries such as Chile, where a 30% reduction in time to effective treatment for lung cancer patients has been achieved and Peru, where a dramatic improvement in key performance indicators, particularly for early childhood development and health workforce productivity were achieved without the need for increased budget spending. It has recently expanded to become a global program reaching Africa, Europe, and the Middle East, and now, as an official foundation comprising leading companies and individuals from various sectors, it will accelerate its work by partnering to effectively help transform health systems around the world.

Rolf Hönger, Vice President of the Foundation's Board, Area Head of LatAm at Roche Pharma, and has been part of Movement Health since its inception, said: "When we launched Movement Health in Latin America, we did not foresee that a pandemic would put our healthcare systems under even greater pressure, but we did know one thing: we needed to strengthen them for the future of humanity. The events of the past three years have not only reaffirmed our commitment to a future of accessible, high-quality healthcare for all, but they have also made Movement Health Foundation stronger.”

As leaders in the healthcare industry and co-founding partners of the Movement Health Foundation, we are all driven by the opportunity to make focused impact on underserved populations by combining the power of our unique capabilities and our commitment to building more sustainable healthcare systems around the world. We share the belief that health is a fundamental human right and that everyone should have the opportunity to benefit from the innovations in healthcare, for example improved diagnostics to catch diseases early.”

Tisha Boatman, Senior Vice President Global Access to Care Siemens Healthineers and Movement Health Board Member.

Health is the most important pillar for equality, equity, for reducing poverty and for developing sustainable societies. Systemic change of healthcare is a main component of the Foundation’s purpose. We want to build future proofed and intergrated health systems globally. By collaborating across countries and continents, we aim to solve the largest challenges of health: improving equal access to quality health care and reducing the avoidable disease burden,”

Bogi Eliasen, CIFS Health Director and Member of the Board of the Foundation.

Movement Health Foundation is committed to being a catalyst for change and a leader of action on a mission to prepare and transform health systems, with the rights, expectations, and hopes of future generations front of mind.

The Hill 2/5/2023 Scott A. Rivkees, opinion contributor

© Provided by The Hill

As the COVID-19 public health emergency winds down, there has been an increased focus on the federal response to the pandemic. 

There is finger-pointing at public health officials, the Centers for Disease Control and Prevention and departments of health for problematic and confusing communication. There is a backlash against COVID-19 public health control efforts and vaccines. In some circumstances, this backlash has triggered investigations and reactive legislation. 

But we need to recognize that what we are experiencing is not merely a reaction against public health and medical experts, but rather an expansion of denialism — the rejection of facts — with potentially very harmful consequences. 

Denialism represents a shift in the common practice of disputing notions that we may not agree with to the outright rejection of facts in an antagonistic way. Notable examples of denialism include the idea that climate change is a hoax, that human immunodeficiency virus (HIV) is not the cause of acquired immune deficiency syndrome (AIDS), smoking does not cause cancer, that guns are not a leading cause of death for children, and that the 2020 election was rigged. This escalating rejection of truth poses special challenges to public health and healthcare. 

Denialism related to the pandemic is now taking hold with a belief that some states fought COVID-19 by having a laissez-faire approach — a fact that is wrong. Even in states in which schools and businesses reopened before others and there were less strict COVID-control measures, billions of dollars were spent to control COVID-19 spread and impact. Mitigation measures took place across the country during the pandemic that included stay at home or safer at home orders, mask distribution, testing and contact tracing programs, vulnerable population protection strategies, efforts to protect students and large-scale vaccination efforts. More than $4 trillion was allocated to the pandemic response by the federal government. Irrespective of whether they had more or less stringent COVID control strategies, we cannot deny that billions of dollars went to each and every state to support pandemic response efforts. 

Denialism has similarly ignored and discredited the impact of public health in combating COVID-19. Ample evidence shows the effectiveness of face masks, improved ventilation and testing and contact tracing in controlling COVID-19. The importance of infection control measures to protect individuals who are medically vulnerable or are older is clear as well. 

Nevertheless, ignoring mainstream expert opinion, legislation has been enacted in many states to curb public health activities. In more than 20 states, laws have been recently passed that now limit the activities of state and local health departments.   

Denialism has trampled over the established belief that businesses and communities best know their employee or resident characteristics, social networks and health care availability in implementing infection control measures. Businesses and communities may have people who are especially vulnerable medically — either by age or underlying medical conditions. Yet, in many states, businesses and communities are now prohibited from implementing CDC or medical expert recommendations. More than 15 states have passed laws banning the implementation of recognized mitigation measures including mask use, COVID screening, or COVID vaccination requirements — even in high-risk settings. 

There is no denying that vaccines and vaccination prevent illness and save lives. In the U.S., the importance of vaccines goes back to the 1700s when there was mandatory vaccination of the Continental Army against smallpox. Most states in the country provide exemptions from vaccination based on religious or personal preference. But we are now seeing an increasing objection to vaccines based upon false claims that vaccines are not effective or cause illnesses when they indeed have excellent efficacy and safety profiles. Unfortunately, these claims are supported by non-mainstream physicians that misrepresent scientifically accepted facts.   

There is now a catchphrase that public health and vaccine choice is about personal freedom. But this call for personal freedom denies the ability of all individuals to venture into public safety, as a high proportion of the population needs to be vaccinated leading to herd immunity to prevent disease outbreaks. The accurate outbreak of measles in children in Ohio which had a 40 percent hospitalization rate, is an example of the consequences of under vaccination. The legislative impact of the anti-vaccine movement is expanding at a level of great concern to the medical community. Anti-vaccine legislation is being proposed in many states across the U.S. 

Throughout the pandemic, and now, you have heard experts say, “talk to your health care provider if you have questions about COVID-19 or vaccines.” But denialism has also undermined long-standing confidence in health care providers, leading to COVID-19 control recommendations being ignored. In some states, legislation has been introduced that will also allow practitioners protection against making public statements about infection control, even if their statements are viewed as incorrect by the mainstream medical community.    

To keep people healthy those in public health and healthcare must now wrestle with communication issues that transcend addressing misinformation. Experts have identified five major characteristics of denialism: claims of conspiracies, the use of fake experts, the selective use of medical literature, the creation of impossible expectations of what experts can deliver and the presentation of logical fallacies. Understanding these components provides the framework for addressing denialism.  

Studies have also examined how to best address denialism with effective approaches focusing on the continued delivery of facts and reinforcement of who are legitimate experts in the field. It is also imperative that we identify receptive minds in the legislative process to prevent false facts from undermining health care and public health.   

Medicine and public health are based on a foundation of science and accepted facts. But when consensus medical expert opinion is replaced with legislative actions not based on accepted scientific facts, there is no denying that the consequences will be real and unfortunate for all of us.   

Scott A. Rivkees, M.D. is a professor of practice at the Brown School of Public Health. He is the former state surgeon general and secretary of health of Florida. 

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BOSTON, MA – The Boston Bruins Foundation and forward Shawn Thornton have teamed up with Hallmark Health System and Olympic gold medalist Mike Eruzione to host the fifth annual Dr. Bob Harney Stride for Health Walk, Run or Roll on Saturday, August 18 at Revere Beach in Revere, MA. The event is set to start at 9:00 a.m., with registration beginning at 7:30 a.m. behind the State Police Barracks (220 Revere Beach Blvd, Revere, MA 02151). The day will also include a post-event barbecue on Revere Beach.

The Dr. Bob Harney Stride for Health Walk, Run or Roll is a collaborative effort to raise awareness and funds for the Cardiology, Orthopedic and Sports Medicine programs at Hallmark Health System. Proceeds from the Stride for Health will benefit the Boston Bruins Foundation, provide CPR training and choke-saving skills to 10th and 11th grade students in communities north of Boston, and will also be used to purchase lifesaving Automated External Defibrillators (AED) for area youth hockey teams and athletic facilities.

To register for the fifth annual Stride for Health Walk, Run or Roll for only $20 or make a pledge online, fans can visit www.firstgiving.com/BostonBruinsFoundation/stride4health. Those wishing to volunteer for the event may do so by calling (781) 979-6100.

About Hallmark Health System
Hallmark Health System is the premier charitable provider of vital health services to Boston's northern communities and is the official healthcare partner of the Boston Bruins. The system includes Lawrence Memorial Hospital of Medford; Melrose Wakefield Hospital, Melrose; Hallmark Health Cancer Center, Stoneham; The CHEM Center for MRI, Stoneham; The CHEM Center for Radiation Oncology, Stoneham; Hallmark Health Medical Center, Reading; Hallmark Health VNA and Hospice; Lawrence Memorial/Regis College Nursing and Radiography Programs, Medford and Hallmark Health Medical Associates, Inc. Hallmark Health is affiliated with Massachusetts General Hospital for cardiology and Tufts Medical Center for neonatology. The mission of Hallmark Health System is to provide, in a community-based setting, the highest quality health care to Boston's northern suburbs.

About the Boston Bruins Foundation
The Boston Bruins Foundation is a 501(c)(3) non-profit foundation whose mission is to assist charitable organizations that demonstrate a strong commitment to enhancing the quality of life for children throughout New England. Since its inception in July 2003 by the Jacobs Family, it has raised more than $12 million dollars through a series of fundraising events. The Foundation, which provides grants to organizations that meet the standards of its mission, concentrates on athletics, academics, health, and community outreach programs that assist in helping enrich the lives of children throughout New England.