>>DAVID, CAN YOU PLEASE INTRODUCE OUR FIRST SPEAKER, PLEASE. >> YES, HAPPY TO DO SO. TERRIFIC WE HAVE ONE OF OUR OWN DELEGATES WHO IS GOING TO TALK TO US NEXT. SO Mr. TYLER LAPLAUNT IS A CITIZEN OF THE CHIPPEWA INDIANS AND DESCENDANT OF THE EAGLE CHANT. HE BEGAN WORKING IN TRIBAL HEALTH AS A COMMUNITY HEALTHEDGEICATOR AND MOVED ON TO SERVE HIS REGION AS THE EXECUTIVE DIRECTOR OF THE GREAT LAKES AREA TRIBAL HEALTH BOARD. TYLER WORKS AS THE ASSISTANT EXECUTIVE DIRECTOR OF THE UPPER PENINSULA HEALTH CARE SOLUTIONS. HE TAKES HIS KNOWLEDGE AND HIS UNDERSTANDING OF TRIBES AND CULTURE TO SERVE ALL PEOPLE IN THE UPPER PENINSULA OF MICHIGAN. WITH THAT, I'LL TURN IT OVER TO YOU, TYLER. [ SPEAKING NATIVE LANGUAGE. MY SPIRIT NAME IS EAGLE FEATHER AND I'M FROM EAGLE CHANT. SO TODAY, I DON'T HAVE A CALL ON POINT FOR YOU. I WANTED TO HAVE MORE SO A DISCUSSION AND TALK ABOUT TOPICS WE HAVE BEEN DISCUSSING WITHIN THE NIH PACK FOR THE PAST COUPLE OF YEARS AND TRY TO BRING THEM TO THE FOREFRONT OF THE DISCUSSION TO SEE IF WE CAN MOVE ISSUES FORWARD ON BEHALF OF AWFUL TRIBAL NATIONS ACROSS THE UNITED STATES. -- BEHALF OF ALL TRIBAL NATIONS ACROSS THE UNITED STATES. THE FIRST THING I'D LIKE TO ADDRESS IS AN EXPANSION ON GARY GARY'S CLOSEOUT YESTERDAY ABOUT INFRASTRUCTURE AND TRIBAL RESEARCH. SO RIGHT NOW WE ARE SEEING SOME GOOD THINGS NONE OUR COMMUNITIES AND WE ARE SEEING GOOD PARTNERSHIPS. MOVING FORWARD WITH TRIBAL RESEARCH, HOWEVER, IT IS NOT THE INDIGENOUS-LED. I KNOW THERE IS A HUGE BARRIER THERE WITH EDUCATION AND TRYING TO GET OUR COMMUNITIES UP TO SPEED. WE ARE FURTHER BEHIND BUT WE ARE FINDING OUR VOICE NOW AS OUR NEW GENERATIONS ARE BECOMING MORE AND MORE EDUCATED. WE ARE ABLE TO INFLUENCE POLICY. WE ARE ABLE TO INFLUENCE OUR OWN GRANT DECISION-MAKING, OUR TRIBAL HEALTH CARE SYSTEMS AND HOPEFULLY, OUR OWN RESEARCH BECOMES MUCH MORE PREVALENT IN THE NOT TOO DISTANT FUTURE. SO WHAT WE ARE LOOKING FOR WITH THAT AND WHAT WE DISCUSSED COUNTLESS TIMES IN THE NIH TAC IS TO MAKE SURE WE ARE ENCOURAGING AWARDS OUT TO INDIGENOUS RESEARCHERS. NOT SO MUCH UNIVERSITY-LED. WE DO KNOW THAT A LOT OF THIS MONEY GOES TO MUCH LARGER UNIVERSITIES, DIVISION 1 SCHOOLS, SO ON AND SO FORTH, AND THEY ALL MEAN WELL. AND WE CAN'T DENY THAT PEOPLE MEAN WELL, BUT THINGS HAPPEN IN TRIBAL COMMUNITIES THAT ARE NOT SO NICE TO OUR PEOPLE. AND I WON'T GO INTO GREAT DETAIL ABOUT THAT. WE DON'T HAVE A LOT OF TIME AND I'M ALSO SPEAKING KIND OF FAST TO GET AS MUCH OF THIS OUT AS I CAN. WHAT WE WOULD LIKE TO SEE IS INDIGENOUS-LED RESEARCH IN TRIBAL COMMUNITIES OWNED BY THE TRIBAL COMMUNITY. SO WHAT THAT MEANS IS, WE ARE LOOKING FOR ALMOST LIKE A SELF-DETERMINATION. WHEN INDIAN HEALTH SERVICES WAS UNDERGOING A HUGE TRANSITION AFTER THE 70s WITH THE INDIAN HEALTH SELF DETERMINATION ACT, INDIAN HEALTH SERVICES STARTED GOING INTO THE HANDS OF TRIBAL COMMUNITIES. WE BELIEVE THAT RESEARCH ALSO NEEDS TO BE PUT BACK INTO THE HANDS OF TRIBAL COMMUNITIES AND THESE LARGER NIH-FUNDED GRANTS FOR RESEARCH NEED TO BE OWNED BY TRIBAL COMMUNITIES F THEY CHOOSE TO CONTRACT WITH THE UNIVERSITY DIVISION 1, DIVISION 2, DOESN'T MATTER F THEY CHOOSE TO DO THAT, THAT IS UP TO THEM. THERE ARE 574 RECOGNIZED TRIBES IN THE UNITED STATES RIGHT NOW, CURRENTLY, THAT IS 574 DIFFERENT RESEARCH COMMUNITIES WHO CANNOT DO A ONE-SIZE-FITS-ALL. SO YOU COME INTO THIS AREA WITH 34 TRIBES WITHIN OUR REGION, JUST BECAUSE YOU'RE RESEARCHING IN ONE DOESN'T MEAN ALL ARE GOING TO BE THE SAME. SO ALL OF THEM SHOULD HAVE THEIR OWN AUTONOMY OVER THEIR RESEARCH AND HOW THEY ENTER INTO THOSE HEALTH RESEARCH PARTNERSHIPS. WE DO KNOW THAT UP-AND-COMING NATIVE INDIGENOUS RESEARCHERS ARE STARTING TO GAIN MORE TRACTION BUT WE NEED SOME SUPPORT IN THAT AS WELL. WE NEED THE NIH TO STEP UP AND SUPPORT US AND OUR PEOPLE TO MAKE SURE THAT WHEN WE ARE PUTTING FORWARD APPLICATIONS THAT THEY ARE READ BY PEOPLE WHO UNDERSTAND OUR COMMUNITIES. BY THAT, LIKE IT CAN'T JUST BE A CHECK THE BOX. WE HAVE AN ANNUAL TRAINING FOR OUR GRANT REVIEWERS, SO ON AND SO FORTH. WE NEED AN ACTUAL ACTIVE HEALTH EQUITY APPROACHES TO THE GRANT REVIEW PROCESS BECAUSE I CAN WRITE SOMETHING AND SOMEBODY COULD REVIEW IT AND IT WILL BE LIKE, THIS DOESN'T MAKE SENSE. BECAUSE THE WESTERN WAY OF RESEARCH AS OPPOSED TO THE INDIGENOUS WAY OF RESEARCH IS THAT YOU TAKE THINGS OUT THAT ARE PART OF A SYSTEM, AND EVERYTHING IN OUR TRIBAL COMMUNITIES IS INTERCONNECTED, IT'S PART OF ONE SYSTEM. SO IF YOU TRY TO TAKE ONE THING OUT AND SAY, WE'RE GOING TO RESEARCH THIS, THAT WOULD BE THE WESTERN MODEL. BUT THE INDIGENOUS MODEL OF RESEARCH AND WHAT YOU'RE GOING TO SEE MORE PROMINENT IN THE NEXT COUPLE OF DECADES AS OUR YOUTH YOUTH ARE GETTING INTO THE FIELD AND BECOMING MORE EDUCATED, THEY WILL LOOK AT A MORE HOLISTIC APPROACH WHERE WE DON'T TAKE OUT PIECE BY PIECE. WHERE WE RESEARCH THE ENTIRE SYSTEM. SO WHAT I MEAN BY THAT IS THAT FOR MEDICINE FOR EXAMPLE. HERE IS A SIMPLE EXAMPLE. MEDICINE. FOR US, IT IS A CEREMONY, A PRACTICE, SONG GOES INTO IT. SOMETIMES THE COMMUNITY IS INVOLVED. SOMETIMES CERTAIN FOODS ARE INVOLVED. SOMETIMES FOODS ARE THE MEDICINE. BUT ALL OF THESE THINGS ARE PART OF THE TREATMENT. SO WHEN YOU'RE TAKING THIS IN THE WESTERN WORLD, WHEN YOU TAKE OUT LITTLE PIECES OF A PIECE OF A PLANT, THAT'S NOT THE RESEARCH THAT WE ARE LOOKING FOR IN OUR TRIBAL COMMUNITIES AND THAT'S NOT WHAT IS BEST FOR OUR PEOPLE. ADDITIONALLY, WHEN IT COMES TO CULTURE AND CEREMONY, IN OUTSIDE RESEARCHER MAY GAIN SOME GROUND OR TRACTION WITH PARTNERSHIPS IN TRIBAL COMMUNITIES, BUT THEY ARE NEVER GOING TO BE NULLY ACCEPTED. YOU HAVE TO GET TO A CERTAIN LEVEL WITHIN YOUR OWN COMMUNITY, EVEN, TO EVEN TAKE PART IN SOME OF THE CULTURAL ACTIVITIES AND CEREMONIES WE HAVE AVAILABLE TO US. THERE IS A LOT OF DISCONNECT THERE AND I THINK IT CAN BE SOLVED IMPROVING OUR INFRASTRUCTURE AND WORKING TOGETHER TO SUPPORT OUR UP-AND-COMING INDIGENOUS RESEARCHERS AND GETTING MORE SUPPORT FOR OUR TRIBAL COMMUNITIES AND OUR NATIONS TO BE THE HOLDERS OF THOSE GRANT FUNDS AND LET THEM BE AUTONOMOUS OVER WHO WE PARTNER WITH AND WHO WE MOVE FORWARD WITH WORKING WITH IN THE FUTURE. THAT YOU WILL BEING SAID, I'M GOING TO JUMP INTO THE NEXT PART REALLY QUICK. AS FAR AS AN EXAMPLE OF STUDYING CULTURE AND CEREMONIES AS A HEALTH INDICATOR, AND WHERE DOES THE NIH COME IN ON THIS? SO ONE OF MY THOUGHTS IS, WE HAVE BEEN VERY PROTECTIVE OVER OUR CULTURE AND CEREMONIES THROUGHOUT THE YEARS AND THERE IS A REASON FOR THAT. WE HAVE BEEN EXPLOITED AND TAKEN ADVANTAGE OF COUNTLESS TIMES. OUR MEDICINE STOLEN FROM US. THINGS TRADEMARKED AWAY FROM US. SO ON AND SO FORTH. WE DON'T WANT TO SEE ANY OF THIS COMMERCIALIZED OR PRIVATIZED IF IT COMES OUT THAT CERTAIN THINGS WORK. I MEAN LOOK AT WHAT HAPPENED HERE IN THE UPPER PENINSULA WITH COMINGA IT'S A VERY PROMINENT MEDICINE IN OUR FORREST BUT AS SOON AS NON NATIVES UNDERSTOOD IT AND GOT A HOLD OF IT, PEOPLE ARE TAKING MORE THAN THEIR FAIR SHARE OF SUSTAINABLE HARVESTING. WHAT DOES THAT MEAN? WHAT I'M LOOKING AT HERE IS ENCOURAGING THE NIH TO SUPPORT FUNDING FOR CULTURAL AND CEREMONIAL RESEARCH. SOMETHING THAT YOU ALL HAVE BEEN A COUPLE OF YEARS AGO WITH YOUR TRADITIONAL MEDICINE SUMMIT, THAT HAPPENED IN COLORADO. SO THAT WAS A HUGE STEP FORWARD FOR US. BUT WHAT IS THE NEXT STEP? SO WHAT I WOULD LOOK AT IS WORKING WITH INDIGENOUS RESEARCHERS TO STUDY THE HUMAN EFFECTS OF CULTURE AND CEREMONY. WE CAN KEEP THE CULTURE AND CEREMONY BLIND. YOU CAN CONTINUE TO PROTECT THAT AS PRESCRIBE NATIONS AND NOT ALL TRIBES WILL BUY INTO THIS BUT IT COULD BENEFIT US AS A WHOLE IF WE TAKE THE PERSON, TAKE PHYSIOLOGICAL, PSYCHOLOGICAL, BLOOD BIOMARKERS AND GET SOME BEFORE, AFTER AND FOLLOW-UP READINGS OF THE INDIVIDUAL WHO GO THROUGH CERTAIN PRACTICES. THAT IS A GREAT WAY TO START SOME OF OUR CULTURAL AND CEREMONIAL KNOWLEDGE AND RESEARCH AND THEN TRY TO PUSH FORWARD WITH THAT AS A INDICATOR OF HEALTH. AND THAT CAN REALLY HELP OUR COMMUNITIES IN THE FUTURE. BECAUSE ULTIMATELY LOOK AT, WE HAVE BECOME ONE OF THE MOST VULNERABLE AND SICKEST POPULATIONS IN THE COUNTRY. LOOK AT WHAT IS HAPPENING EVEN WITH COVID-19, A RECENT EXAMPLE. BUT ALSO WE ARE ONE OF THE FEW POPULATIONS AND I'LL SAY FEW BECAUSE IT'S ALSO HAPPENING TO AFRICAN-AMERICANS AND BLACKS WHO WERE FORCED OVER HERE. OUR CULTURE AND IDENTITY WAS STRIPPED FROM US. WE WERE PUT IN BOARDING SCHOOLS TO EDUCATE THE INDIAN OUT OF US. AND NONE OF THAT WAS EVER PUT BACK. AND THAT IS BEING PUT BACK INTO OUR CULTURES, INTO OUR COMMUNITIES, AND IN ORDER TO ENCOURAGE THAT AND WHERE THE NIH CAN REALLY STEP IN AND HELP US OUT HERE, IS ENCOURAGE RESEARCH, HEALTH RESEARCH, REVOLVING AROUND OUR CULTURE AND OUR LANGUAGE. HOW DOES THIS MAKE US BETTER AS A HUMAN BEING? HOW DOES THIS MAKE US HEALTHIER? YOU CAN TAKE PHYSIOLOGICAL AND PSYCHOLOGICAL READINGS SO YOU CAN BETTER GAUGE AND UNDERSTAND HOW THIS CULTURE IS IMPACTING OUR COMMUNITIES. AND THEN FINALLY, I KNOW I'M RUNNING OUT OF TIME BECAUSE THERE IS SUPPOSED TO BE A QUESTION AND ANSWER. SO I'M GOING TO SKIP OVER A COUPLE OF OTHER THINGS I WANTED TO SAY ABOUT THAT AND JUMP INTO OUR FOCUS ON REGIONAL. AS I SAID, EVERY TRIBE IS A UNIQUE TRIBE. EVERYBODY IS DIFFERENT ACROSS THE COUNTRY. I WORK FOR OUR AREA BUT I DON'T SPEAK FOR EVERYBODY. I SPEAK OF WHAT I HEAR ON THE ROAD ALL THE TIME. ENVIRONMENTAL CHANGE IS A HUGE ISSUE FOR US RIGHT NOW. AND IT'S IMPACTING EVERYBODY AGAIN. AND OBVIOUSLY HAS SOME ATTENTION BECAUSE IT'S AFFECTING MORE THAN JUST THE NATIVE-AMERICAN POPULATION. WHILE THAT IS SAD, IT IS ALSO GOOD FOR US. BUT BEFORE, PRIOR TO THE PANDEMIC, WE DID SEE AN IMPROVEMENT IN FOOD SOVEREIGNTY AND ACCESS, PEOPLE GAINING THEIR TRADITIONAL KNOWLEDGE TO IMPLEMENT THEIR OWN FOOD SYSTEMS WITHIN THEIR COMMUNITIES. AND THAT DID HELP US OUT THROUGHOUT THE PANDEMIC TO HELP SUSTAIN AND BRING PEOPLE INTO THE CULTURE. A GREAT OPPORTUNITY FOR US TO TEACH IN OUR COMMUNITIES. WE HAD MORE AND MORE PEOPLE ENTERING IN TO OUR CULTURE, OUR PRACTICES AND THINGS OF THAT NATURE THAT IS VERY INTERESTING HOW THIS USED TO NOT BE TALKED ABOUT PUBLICLY BUT NOW WE ARE GETTING A LOT OF TEACHING OVER FACEBOOK AND THE INTERNET. SO THAT'S REALLY INTERESTING. ANYWAY, FOCUSING ON REGIONAL FOOD SYSTEMS AS OPPOSED TO GLOBAL FOOD SYSTEMS AND IMPACT ON ENVIRONMENTAL CHANGE, EVEN CHRONIC ILLNESS SUCH AS COVID-19. LOOK WHAT HAPPENED TO THE SUPPLY CHAIN BECAUSE OF THAT. IF WE CAN REINVIGORATE OUR TRADITIONAL PLANS, OUR TRADITIONAL FOODS, THAT CAN HELP SUSTAIN OUR HEALTH AS WELL. AND THERE NEEDS TO BE RESEARCH AROUND THAT, NOT ONLY AROUND OUR TRADITIONAL FOOD SYSTEMS AND OUR REGIONAL FOOD SYSTEMS, BUT REALLY ABOUT HOW THE ENVIRONMENT IS IMPACTING THEM RIGHT NOW. BECAUSE THIS ENVIRONMENTAL IMPACT WILL EFFECT EVERYBODY. LOOK WHAT IS HAPPENING IN CALIFORNIA RIGHT NOW. EVEN HERE, MICHIGAN, WISCONSIN, MINNESOTA, NORTHERN PARTS OF THE STATE, SOME OF OUR WILD RICE BAGS ARE NOT ACCESSIBLE ANYMORE. THE DEER POPULATION ARE FACING INCREASING AMOUNTS OF WASTING DISEASE AND IT'S ONLY AN AMOUNT OF TIME THAT CRY ON FINDS A WAY INTO THE HUMAN BODY. SO THERE ARE THINGS WITH CLIMATE CHANGE AND CHANGES IN OUR ENVIRONMENT THAT COULD GREATLY IMPACT THE HEALTH OF NATIVE PEOPLE. SO THESE ARE JUST SOME HIGHLIGHTS, I WANTED TO ADDRESS AND HAVE AN OPPORTUNITY TO DISCUSS WITH YOU AND THAT'S PRETTY MUCH IT FOR ME. I KNOW THAT I HAD TO CUT IT SHORT HERE. >> THANK YOU, TYLER. ANY QUESTIONS OR ANY ADDITIONS OR THINGS THAT PEOPLE WOULD LIKE TO ADD TO THIS DISCUSSION? I'M LEAVING THAT DOOR OPEN RIGHT NOW. I CAN JUST TELL YOU THAT AS WE INCORPORATE MORE TRADITIONAL VALUES INTO OUR HEALTH SYSTEMS, I KNOW THAT IT IS IMPACTING US IN A POSITIVE WAY. AGAIN, IT'S LIKE I FEEL LIKE EVEN MYSELF, FEEL LIKE I'M COMING OUT OF BEING A HOMOGENIZED INDIAN AND HAVING TO GO BACK AND LEARN NEW WAYS BECAUSE I GREW UP IN A HOUSE WHERE THE LAST SPEAKER OF THE LANGUAGE THAT KNEW ALL FIVE DIALECTS, WHO HELPED PUT THE FOUNDATION INTO A TRANSITION OF US TO LEARN OUR LANGUAGE IN A WRITTEN FORMAT WITH THE LOCAL UNIVERSITY BECAUSE WE DIDN'T WRITE OUR LANGUAGE. BUT AS WE STARTED INCORPORATING THESE ACTIVITIES INTO OUR CULTURE AND INTO OUR HEALTH CARE TREATMENTS, IT'S BEEN HELPFUL. AND WE TALK ABOUT FOOD AND, I KNOW ONE OF THE ISSUES I TALKED ABOUT IS PLANT MEDICINE. OUR FREEDOM WE NEED AS INDIGENOUS PEOPLE IS THE RIGHT TO RESEARCH PLANT MEDICINE. AND IF IT HELPS OUR PEOPLE, WE SHOULD NOT BE RESTRICTED BY ANY SCHEDULING OR ANYTHING BECAUSE THE POLITICS AT THE VERY HIGH LEVEL OF OUR GOVERNMENT INFRINGE UPON OUR HUMAN RIGHT TO THESE FOODS AND PLANT MEDICINES AND THESE ACTIVITIES THAT ARE INDIGENOUS TO US SO WE NEED TO BE ABLE TO EXERCISE THAT SOVEREIGNTY AGAIN. SO THAT IS MY INPUT ON THAT. ANYBODY ELSE HAVE ANYTHING ELSE? >> LISA, WHAT I FORGOT TO MENTION IS THAT PRIOR TO COLONIZATION, WE HAD THE RIGHT TO MOVE NO MAT -- BE A NOMATIC POPULATION AND MOVE WHERE THE FOOD WAS. WHEREAS GEO POLITICAL BOUNDARIES DO NOT ALLOW THAT ANYMORE. AND PEOPLE SAYING THIS IS THE WAY THINGS HAVE ALWAYS BEEN DONE, IF YOU LOOK THROUGHOUT HISTORY, NOT EVEN IN THE INDIGENOUS POPULATION BUT ACROSS THE WORLD, CITIES HAVE MOVED CONSTANTLY AND WE ARE CONSTANTLY FIGHTING WITH NATURE NOW TO TRY TO KEEP CITIES WHERE THEY ARE AT. BUT I FEAR THAT NOT TOO FAR FROM NOW WE WILL SEE SOME OF OUR MAJOR CITIES HAVE TO MOVE OR BE DESERTED. AND THIS IS SOMETHING THAT AGAIN WILL NOT JUST AFFECT THE INDIGENOUS POPULATION BUT EVERYBODY. SO IT SEEMS LIKE PEOPLE WILL NOT LISTEN UNTIL IT'S TOO LATE AND SOME OF THESE THINGS NEED TO BE RESEARCHED AND ADDRESSED MUCH SOONER THAN THEY ARE BEING. >> THANK YOU. I THINK THE STRESS OF IT, WE LEARNED THAT NOT ONLY IS IT ACCESS TO THESE THINGS BUT THE IMPACT ON OUR ECONOMIES AND OUR ABILITY TO HAVE THE STABLE THINKS OF AN ECONOMY THAT COMES OUT OF THAT. AND I'M GLAD TO SEE THAT NIH IS ACTUALLY ADDED THAT ECONOMICS AND THE IMPACT OF HAVING A STABLE INCOME AND WAYS TO GET ACCESS TO RESOURCES IS PART OF HEALTH CARE. IT NEEDS TO BE IN OUR RESEARCH AS WELL. ANYONE ELSE? I WANT TO ADD THAT. ANYTHING ELSE YOU WANT TO ADD BEFORE WE GO ON TO OUR NEXT SPEAKER? OR ANYONE ELSE, I WANT TO OPEN THE DOOR. SO THANK YOU FOR BRINGING THESE IMPORTANT THINGS AND I BELIEVE THIS NEEDS TO BE DISCUSSED. I THINK IT'S A WHOLE DIFFERENT PERSPECTIVE THAT ISN'T CONSIDERED IN THE FORMAT AS WE WORK AS AN ADVISORY COMMITTEE TO THE NIH. SOMETIMES WE ARE NOT ABLE TO SPEAK AS FREELY ABOUT THESE ISSUES AND BREAK IT DOWN INTO SOMETHING THAT CAN BE A DIRECTIVE OR SOME KIND OF ADVICE TO THE COMMITTEE. SO THANK YOU. WE ARE GOING TO GO ON TO OUR NEXT SPEAKER AND DAVE, YOU'RE ON A FEW MINUTES EARLY SO YOU HAVE A COUPLE OF MINUTES EXTRA TODAY. PLEASE SHARE WITH US OUR ACCOMPLISHMENTS. >> THANK YOU, LISA. I HAVE A LOT HERE TO SHARE THAT I THINK IS VERY COMPLEMENTARY TO WHAT TYLER WAS TALKING ABOUT AND THIS IS ABSOLUTELY AIR APPLIES WHERE WE CAN AND -- A PLACE AND WE SEEK THE TAX THE TAC'S SUPPORT AND ADVISEMENT IN HOW TO INCORPORATE MORE CULTURE INTO THE RESEARCH PROCESS. SO FIRST AND FOREMOST -- CAN YOU SEE MY SCREEN, FIRST OF ALL? >> YES. >> PERFECT. IS THAT WE HAVE TO UNDERSTAND OUR MISSION AND WHERE WE ARE WORKING. AND SO NIH'S MISSION HERE AS YOU CAN SEE IS TO SEEK FUNDAMENTAL KNOWLEDGE ABOUT THE NATURE AND THE BEHAVIOR OF THE LIVING SYSTEMS AND THE APPLICATION OF THAT KNOWLEDGE TO ENHANCE HEALTH, LENGTHEN LIFE, REDUCE ILLNESS AND DISABILITY. AND SO I BRING THIS UP BECAUSE THERE IS SO MANY OPPORTUNITIES FOR US TO POTENTIALLY GET INTO OTHER HHS OPERATING DIVISION SWIM LANES. LIKE OUR CLOSE PARTNERS, CDC AND OUR PARTNERS AT IHS. SO IT'S IMPORTANT FOR US TO HAVE A CLEAR FOCUS ON WHAT ARE OUR BOUNDARIES AND WHAT CAN WE DO AND NOT DO. AND WHERE DO WE SEEK OUT SISTER OPERATING DIVISION PARTNERSHIPS TO HELP US ACHIEVE COMMON GOALS? SO WITH THAT IN MIND, LET'S LOOK AT SOMETHING ELSE THAT I WANTED TO BRING UP. SO TODAY I THOUGHT IT WOULD BE A MORE USEFUL PRESENTATION FOR US, FOR ME TO LOOK BACK. I HAVE BEEN DIRECTOR NOW FOR FIVE YEARS. AND I THINK IT IS REALLY IMPORTANT TO TAKE A STEP BACK AND REALLY LOOK AT SOME OF THE PROGRESS THAT HAS BEEN MADE, AND ALSO WHAT ARE SOME OF THE THINGS AS WE LOOK AHEAD THAT WE CAN BEGIN THINKING ABOUT. TYLER JUST BROUGHT UP A REALLY IMPORTANT TOPIC THAT I AM VERY INTERESTED IN, THINKING ABOUT HOW WE CAN STRENGTHEN THIS AREA OF OUR PORTFOLIO. SO HERE ON THIS SLIDE, YOU CAN SEE THE MATRIX ON THE LEFT AND THESE ARE ALL OF THE DIFFERENT ACTIVITIES. SO THE ORANGE DOTS ARE THERE TO INDICATE THE INSTITUTE'S CENTERS AND OFFICES AT THE NIH AND THEY HAVE A MIRED OF ACTIVITIES ALL THE TIME THAT ARE BEING CREATED, THAT ARE ONGOING, THAT ARE GOING AWAY AND NEW ONES BEING REPLACED BY NEW ONES. SO IT'S IMPORTANT FOR US TO THINK ABOUT HOW DOES THIS ALL FIT TOGETHER IN THE GRAND SCHEME OF OUR WORK TO SUPPORT TRIBAL COMMUNITIES? WHAT I'M GOING TO TALK ABOUT AND WHAT WE HAVE BEEN DOING WILL KIND OF SEEM LIKE THIS PUZZLE HERE WITH A LOT OF DIFFERENT PIECES THAT WEREN'T IN PLACE BUT I'M HOPING THAT BY THE END OF THIS, YOU'LL BE ABLE TO SEE HOW THIS ALL COMES TOGETHER AND HOW WE ARE REALLY MAKING SOME SIGNIFICANT PROGRESS IN OUR WORK TOGETHER. SO SOMETHING THAT WE HAVE TO SAY THAT IS I THINK, A CRITICAL ACTIVITY AND A DOCUMENT FOR OUR SUCCESS, IS THE NIH TRIBAL CONSULTATION POLICY. NOW THIS DOCUMENT IS SO IMPORTANT BECAUSE IT REALLY PROVIDES A STANDARDIZED PROCESS OF HOW THE ENTIRE AGENCY IS GOING TO ENGAGE TRIBAL COMMUNITIES. TYLER HAD BROUGHT UP THAT RESEARCH, UNETHICAL RESEARCH, AND WE ARE VERY MUCH AWARE OF THAT. THAT IS THE GOAL IS TO STANDARDIZE THE PROCESS AND ALSO EDUCATE THE NIH COMMUNITY AND THE SCIENTIFIC COMMUNITY AS A WHOLE ABOUT HOW IMPORTANT IT IS TO RECOGNIZE AND RESPECT TRIBAL SOVEREIGNTY. BUT NOT ONLY THIS, WE LEARNED, AND YOU'LL HEAR MORE ABOUT THIS FROM DR. LORSCH'S PRESENTATION LATER THIS AFTERNOON, THAT THE PROCESS OF CONSULTATION PROVIDES TREMENDOUS AMOUNT OF MEANINGFUL INPUT THAT MAKES THE PROGRAMS EVEN BETTER. AND SO HERE YOU CAN SEE THAT OUR POLICY HAS BEEN DESIGNED VERY MUCH TO MIRROR THE HHS POLICY BUT IT HAS VERY SPECIFIC ELEMENTS FOR THE NIH BECAUSE WE ARE PRIMARILY A RESEARCH-SUPPORTING AGENCY. AND WHERE ARE WE AT CURRENTLY IN THIS PROCESS? YOU CAN SEE HERE THIS IS THE TIMELINE OF WHERE WE ARE AT. SO WE INITIATED CONSULTATION WAY BACK IN MAY OF THIS YEAR. WE WENT TO 10 DIFFERENT REGIONS. DR.S TABAK, ANDERSON AND I HAD CONSULTATION WITH ALL THE DIFFERENT TRIBES THAT WERE PRESENT AT THESE MEETINGS AND WE RECEIVED A TREMENDOUS AMOUNT OF VERY CONSTRUCTIVE FEEDBACK. AND THAT FEEDBACK WAS INCORPORATED INTO WHAT WE ARE CALLING NOW AN ADJUSTED POLICY THAT IS NOW BEING REVIEWED BY OUR OFFICE OF SCIENCE POLICY. AND OUR OFFICE OF GENERAL COUNSEL. AND THIS POLICY, I THINK, THE WAY IT LOOKS NOW IS GOING TO REALLY RESPECT TRIBAL SOVEREIGNTY AND STRENGTHEN THAT RELATIONSHIP. SO CURRENTLY WHERE ARE WE AT RIGHT NOW IN THE PROCESS? YOU CAN SEE HERE THERE IS A NICE BIG CALL BUBBLE HERE THAT WE ARE BEGINNING TO START THE INTERNAL VETTING OF THIS POLICY. AFTER WE GET FULL APPROVAL FROM THE OFFICE OF SCIENCE POLICY AND OUR OFFICE OF GENERAL COUNSEL, THEN IT WILL BE TIME TO COMMUNICATE THIS ACROSS THE AGENCY ABOUT WHAT THIS POLICY LOOKS LIKE AND WHAT IT MEANS AND HOW WE CAN HELP SUPPORT PARTS OF THE AGENCY THAT WANT TO TAKE ON THE CONSULTATION PROCESS OR THAT SEE THE NEED TO DO SO. AND THEN AFTER OUR INTERNAL VETTING, THEN WE WILL SEND THIS POLICY DOWNTOWN FOR FINAL APPROVAL AND IMPLEMENTATION. WE ARE REALLY LOOKING FORWARD TO SOME TIME EARLY NEXT YEAR BEING ABLE TO FULLY IMPLEMENT THE NIH TRIBAL CONSULTATION POLICY. SO THIS IS SOMETHING THAT LAYS THE FRAMEWORK FOR EVERYTHING ELSE THAT IS GOING TO FOLLOW IN THE FUTURE. BUT NOW I WANT TO TALK ABOUT WHAT WE'RE DOING NOW TO ADDRESS THE STRATEGIC GOALS FOR THE NIH -- STRATEGIC PLAN FOR TRIBAL HEALTH. YOU CAN SEE THAT WE ARE GETTING CLOSE TO FULFILLING THIS PLAN. NEXT YEAR OUR INTENTIONS ARE TO TAKE A NEW PLAN, TO CONSULTATION, SO WE CAN RECEIVE MORE FORMAL INPUT FROM COMMUNITIES ACROSS THE COUNTRY THAT MAY ACTUALLY CHANGE WHAT OUR PRIORITIES ARE MOVING FORWARD. AND I THINK THAT WE HAVE HEARD THROUGH YESTERDAY'S PRESENTATIONS AND TODAY'S, THAT THERE ARE SOME ADJUSTMENTS THAT CAN BE MADE AND THAT SHOULD BE VOICED DURING THAT CONSULTATION PROCESS. BUT FOR THIS PARTICULAR PLAN, YOU SEE THERE ARE FOUR MAIN PILLARS OF OUR NIH STRATEGIC PLAN. ENHANCING COMMUNICATION AND COLLABORATION, BUILDING RESEARCH CAPACITY, EXPANDING RESEARCH AND ENHANCING CULTURAL COMPETENCY AND COMMUNITY ENGAGEMENT. NOW THIS IS ALSO HAS BEEN A VERY, VERY IMPACTFUL DOCUMENT BECAUSE IT GIVES THE AGENCY A ROADMAP ABOUT WHAT ARE SOME OF THE THINGS THAT WE SHOULD BE THINKING ABOUT WHEN WE DESIGN PROGRAMS OR WHEN WE THINK ABOUT INITIATIVES OR EFFORTS. HOW DOE WE INCLUDE TRIBES AND ARE THEY GOING TO HELP US ACHIEVE OUR GOALS WITHIN OUR STRATEGIC PLAN? SO YOU'LL SEE THAT WE ARE GOING TO PROVIDE SOME HIGHLIGHTS OF EACH OF THESE DIFFERENT AREAS ON WHAT WE HAVE BEEN DOING AND I ALSO WANT TO MAKE SURE THAT WE ARE ALL AWARE THAT THIS IS AN ENTIRE AGENCY EFFORT. WE ARE REPRESENTING THIS ON BEHALF OF US BUT IT TAKES THE ENTIRE AGENCY. IT'S A TEAM EFFORT IN ORDER FOR US TO DO THIS WORK EFFECTIVELY AND TO MAKE SURE THAT THE DIFFERENT AREAS OF RESEARCH ARE IMPACTED WITH OUR STRATEGIC PLAN PLAN. SO FIRST I WANT TO TALK ABOUT COMMUNICATION. COMMUNICATION IS SLIGHTLY VITAL. AND IT'S THE ESSENTIAL WAY THAT WE ARE ABLE TO REACH AND ENGAGE TRIBAL COMMUNITIES. OVER THE LAST FIVE YEARS WE HAVE LEARNED A LOT ABOUT WHAT EFFECTIVE MESSAGING LOOKS LIKE AND OUR GOALS ARE TO BE ABLE TOL PROVIDE MESSAGING THAT IS READY FOR TRIBES TO BE ABLE TO SHARE DIRECTLY TO THEIR COMMUNITY MEMBERS. YOU CAN SEE HERE THE PANEL UP IN THE MIDDLE HERE, THIS WAS THE PANEL THAT WAS DESIGNED AS WE WERE A PART OF THE CORONA VIRUS PREVENTION NETWORK, BUT THIS IS VERY MUCH A NON-STANDARD NIH PRESENTATION. BUT IT'S VERY EFFECTIVE FOR OUR COMMUNITY MEMBERS WHO REALLY UNDERSTAND ABOUT THE MOLECULAR PIECE THAT IS GO INTO DEVELOPING THE mRNA VACCINES THAT WILL NOT CAUSE INFECTION IN AN INDIVIDUAL WHO IS VACCINATED. SO THIS MESSAGING WAS EXTREMELY EFFECTIVE FOR OUR COMMUNITIES AND OUR GOALS ARE TO INCORPORATE THIS KIND OF MESSAGING IN ALL DIFFERENT AREAS OF RESEARCH. SOMETHING ELSE THAT HAS BEEN TALKED ABOUT IS CULTURAL ADAPTATION OF NOT ONLY RESEARCH BUT PUBLIC HEALTH MESSAGING. YOU CAN SEE HERE WE WORKED CLOSELY WITH A LOT OF DIFFERENT PARTNERS, ONE OF THOSE PARTNERS HAS BEEN THE CENTER FOR AMERICAN INDIAN HEALTH AT THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH. THEY HAVE BEEN TERRIFIC PARTNERS WE HAVE BEEN WORKING VERY CLOSELY ON DEVELOPING A MESSAGE TO GET INTO THE COMMUNITIES AND IT WOULD BE EFFECTIVE NOT ONLY FOR TRIBAL LEADERSHIP BUT ALSO FOR COMMUNITY MEMBERS TO BE ABLE TO SHARE. AND ALSO ADDRESSING MISINFORMATION. YOU CAN SEE THE PANEL HERE ON THE FAR RIGHT. IT WAS REALLY IMPORTANT FOR US TO IMMEDIATELY BEGIN ADDRESSING MISINFORMATION AND MISINFORMATION IS NOT ONLY RESTRICTED TO THE COVID-19 PANDEMIC. THERE IS SO MUCH MISINFORMATION OUT ON THE STREETS ABOUT SCIENCE IN GENERAL. AND SO IT'S REALLY IMPORTANT FOR US TO CONTINUE TO EDUCATE OUR COMMUNITY MEMBERS ABOUT THE POTENTIAL BENEFITS OF BIOMEDICAL RESEARCH AND HOW IT COULD PLAY A BIG PART OF THEIR IMPROVING THEIR LIVES. I THINK THAT A LOT OF THAT WAS A VERY WELL-DEMONSTRATED IN OUR RESPONSE TO THE COVID-19 PANDEMIC. TRIBAL COMMUNITIES REALLY ASKED A TREMENDOUS AMOUNT OF QUESTIONS. BUT THE AGENCY WAS REALLY UP FOR THE TASK. WE REALLY MET THEM HALFWAY AND IN EVERY REQUEST THAT WE POSSIBLY COULD. SOME OF IT CAME IN THE FORM OF SOCIAL MEDIA ENGAGEMENTS. HERE THIS WAS THE INTERVIEW LIVE ON FACEBOOK CHAT WITH DR. FAUCI. THIS WAS SOMETHING THAT WAS EXTREMELY EFFECTIVE AND VERY WELL RECEIVED. WE HAD OVER 1800 LIKES, COMMENTS AND SHARES AROUND THIS PARTICULAR EVENT. SO THESE WERE THE KIND OF THINGS THAT WE ARE BEGINNING TO UTILIZE MORE AND MORE. AND IT WAS REALLY IMPORTANT BECAUSE AGAIN IT'S A TEAM EFFORT ON HOW WE COMMUNICATE WITH OUR TRIBES AROUND REALLY IMPORTANT RESEARCH THAT IS HAPPENING. SOMETHING ELSE THAT WE'RE ACTIVELY PURSUING AND THEN MANY OF YOU HAVE ALREADY SEEN THIS, IS OUR COMMUNICATION DIRECTOR DEVELOPED THESE SHORT INTERVIEWOS TOPICS OF INTEREST FOR TRIBES. AND THESE ARE REALLY GREAT BECAUSE THEY ALSO SERVE AS A PLATFORM FOR TRIBES TO BETTER UNDERSTAND THE WORK OF THE INSTITUTES ACROSS THE AGENCY AND IT ALSO HELPS US DIRECT OUR TRIBAL MEMBERS TO THE RESOURCES THAT ARE BEING PRODUCED BY EACH OF THESE INSTITUTES, CENTERS AND OFFICES. WE ARE CURRENTLY PLANNING ON A NEW ONE SOIBILITY THE NEXT ON THE LIST OR ROSTER WILL BE THE NATIONAL INSTITUTE OF DRUG ABUSE. SO WE ARE LOOKING FORWARD TO THAT CONVERSATION WHICH WILL HAPPEN IN THE NEXT COUPLE OF WEEKS. THIS IS IMPORTANT TO FIND OUT WHAT ARE THESE NATIONAL EXPERTS SEEING IN TERMS OF HEALTH-RELATED ISSUES THAT MAY IMPACT OR DEFINITELY IMPACT OUR TRIBAL COMMUNITIES. YOU HEARD DR. GORDON'S PRESENTATION YESTERDAY. IT WAS EXTREMELY IMPACTFUL AND THAT SATURDAY KIND OF INFORMATION THAT WE REALLY NEED TO FIND A WAY TO GET TO OUR COMMUNITY MEMBERS. WE WANT THEM TO UNDERSTAND WHAT ARE THE WARNING SIGNS OF BEING UNDER MENTAL STRESS? WHAT ARE SOME OF THOSE INDICATORS? IF YOU'RE NOT FAMILIAR, THE DATA SHOWS THAT MANY PEOPLE DON'T EVEN KNOW THAT THEY NEED TO SEEK PROFESSIONAL HELP TO OVERCOME THESE CHALLENGES. SO THIS IS ALL ABOUT BRINGING MORE OF THE RESEARCH INTO THE COMMUNITIES. SOMETHING ELSE I THOUGHT WAS REALLY EXCITING WAS DR. FAUCI'S WILLINGNESS TO PURSUE A LOT OF DIFFERENT VENUES FOR COMMUNICATION. WE PARTNERED WITH THE OFFICE OF COMMUNICATION AND PUBLIC LIASON ON A RADIO MEDIA TOUR AND THIS WAS COMPLICATED TO GET SET UP. OUR DIRECTOR OF COMMUNICATIONS DID A FANTASTIC JOB IN COORDINATING ALL OF THESE DIFFERENT SOUNDBITES AND ALL THE DIFFERENT ENGAGEMENTS WITH ALL THE DIFFERENT MEDIA. BUT IT WAS REALLY WELL RECEIVED. AND THIS IS A WAY THAT AS WE ALL KNOW THAT MANY OF OUR ELDERS, THAT'S HOW THEY RECEIVE A LOT OF DAILY NEWS OR THEIR INFORMATION THROUGH RADIO. IT'S A IMPORTANT MECHANISM WE WILL BE USING MORE AND MORE IN THE FUTURE. >> LET ME SPEAK DIRECTLY TO YOUR ELDERS -- >> THERE WE GO. SORRY ABOUT THAT. [ AUDIO SOUNDBITES ] >> LET'S FOCUS ON GOAL NUMBER 2 NOW. BUILDING CAPACITY, BUILDING RESEARCH CAPACITY. THIS IS WHAT TYLER TALKED ABOUT EARLY ON IN HIS CONVERSATION WITH US JUST A FEW MINUTES AGO. AND NOT ONLY WAS OUR STRATEGIC PLAN CRITICALLY IMPORTANT BUT SO ARE OUR ANALYSIS. THESE REPORTS AND DOCUMENTS GAVE US A MUCH CLEARER VIEW ON HOW RESEARCH WITH TRIBAL COMMUNITIES LOOKED AT A MORE GRANULAR LEVEL. SO THESE REPORTS ARE NOT ONLY USEFUL FOR OUR COMMUNITIES BUT THEY ARE ALSO USEFUL FOR THE AGENCY INTERNALLY. WE WERE ABLE TO LOOK AT THESE AND GET A QUICK UNDERSTANDING OF WHERE MIGHT THERE BE POTENTIAL GAPS AND OPPORTUNITIES FOR US TO EXPAND RESEARCH FOR TRIBAL COMMUNITIES. SO WE UNDERSTOOD WHAT OUR STARTING POINT AND WAS WHERE DO WE WANT TO GO WITH THE WORK OF THE AGENCY. IT CREATED PARTNERSHIPS FOR US AND ALSO EXPANDING RESEARCH. SO WE ALSO ARE THINKING ABOUT HOW TO INCREASE THE NUMBER OF AMERICAN INDIAN AND ALASKA NATIVE STUDENTS INTERESTED IN PURSUING CAREERS IN RESEARCH. ANOTHER FOUNDATIONAL DOCUMENT FOR US IN THE SHORT FIVE YEARS WE HAVE REALLY BEEN UP AND RUNNING. SO HERE IS A LIST OF OUR CONSULTATIONS AND WE THOUGHT THE YEAR 2020 WAS ACTUALLY GOING TO BE THE YEAR OF CONSULTATION. BUT IN 2021, WE MAY SURPASS THAT. WE HAVE ONE CONSULTATION THAT IS GETTING READY TO LAUNCH. THE NATIONAL COVID-19 -- >> DAVE, THIS IS BOBBY. EXCUSE ME, YOUR SLIDES ARE NOT ADVANCING. YOU'RE STILL ON THE RADIO MEDIA TOUR WITH DR. FAUCI. IF YOU WANT TO GO BACK -- CAN YOU GO BACK TO THE ONE AFTER THAT, PLEASE. SORRY TO INTERRUPT. >> THANK YOU FOR THAT. >> IF YOU CLOSE THE PRESENTATION AND RESTART, THAT SOMETIMES FIX THIS IS ZOOM GLITCH. >> OKAY. I DIDN'T KNOW TONY WAS GOING TO THROW US SUCH A CURVEBALL HERE. LET ME DO SOMETHING HERE REAL QUICK. I HAD NO IDEA TONY WAS DOMINATING THE CONVERSATION HERE. I. TO QUICKLY GO BACK OVER THESE TWO DOCUMENTS. OUR PORTFOLIO ANALYSIS REPORTS WERE SO IMPORTANT AND CRITICAL FOR US TO GET A BETTER UNDERSTANDING OF OUR INVESTMENT IN TERMS OF TRIBAL HEALTH RESEARCH. WE THOUGHT 2020 WAS GOING TO BE THE YEAR OF CONSULTATION BUT WE ARE GOING ON THE VERGE OF SURPASSING THAT WITH FOUR CONSULTATIONS AND THESE ARE REALLY IMPORTANT. I THINK THAT WE ALL RECOGNIZE THE CONSULTATION SERVE AS AN EXCELLENT FORUM FOR COMMUNICATION BETWEEN TRIBAL LEADERS AND I THINK WHAT IS AN ADDED FEATURE OF CONSULTATION IS WE OFTEN HEAR CONCERNS THAT ARE NOT RELATED TO THE TOPIC AT CONSULTATION SO IT'S IMPORTANT WE HEAR THESE AND WE ARE ABLE TO FOLLOW-UP WITH THE TRIBAL LEADERS ON ADDRESSING SOME OF THESE CONCERNS. MORE TRIBES ARE BEING INCLUDED IN MANY DIFFERENT EFFORTS ACROSS THE AGENCY. SOME OF THESE WE'LL TALK ABOUT -- DR. LEARCH WILL TALK ABOUT THE PROGRAM. WE BRIEFLY COVERED THE CONSULTATION POLICY AND YESTERDAY WE TALKED ABOUT THE RED XTR PROGRAM AND SOON, HOPEFULLY WE WILL BE HAVING CONVERSATIONS ABOUT THE N3C PROGRAM. SO SOME OF THE OTHER THINGS THAT WE COULD DEFINITELY SEEK YOUR ADVISEMENT ON IN TERMS OF IMPROVEMENT AND THIS WAS SOMETHING THAT TYLER BROUGHT UP, WE ARE ENGAGING OTHER PARTNERS ACROSS THE AGENCY TO PROVIDE TECHNICAL ASSIST THINKS IN TERMS OF GRANT WRITING WORKSHOPS TO TRIBAL COLLEGES AND UNIVERSITIES. THIS IS SOMETHING THAT WE KNOW IS NOT -- IT MAY NOT BE THE MOST AFFECTIVE BUT I THINK THAT WITH A LOT OF YOUR ADVISEMENT AND HELPING US RESHAPE HOW THIS ENGAGEMENT LOOKS, THAT IT CAN BE MORE EFFECTIVE. ONE OF THE THINGS I THINK THAT THIS REALLY IS IMPORTANT FOR IS THAT THIS IS A BUILDING BLOCK OR A STEPPING STONE INTO MORE COMMUNITIES BEING ABLE TO APPLY FOR AND SECURE NARCH FUNDING. AS YOU RECALL THE NARCH PROGRAM, THE FUNDING FROM THE PROGRAM GOES DIRECTLY TO TRIBAL COMMUNITIES WHERE THEN THEY ARE ABLE TO DETERMINE WHO ARE THEIR RESEARCH PARTNERS TO HELP THEM ANSWER SOME OF THE RESEARCH QUESTIONS RELATED TO THEIR COMMUNITIES. SO OCTOBER 22, WE HAD OUR FALSERS LAUNCH AND WE ARE REALLY HAPPY TO SAY -- FALSERS LAUNCH. SEVERAL -- FALL SERIES LAUNCH -- SEVERAL FACULTY SIGNED UP TO PARTICIPATE IN THIS PARTICULAR TRAINING AND NOT FROM THE SAME INSTITUTE, BUT FROM ACROSS THE COUNTRY. WE ARE HOPING TO BUILD UPON THIS AS IT GAINS MORE TRACTION TO BRING IN MORE TRIBAL COLLEGE FACULTY AND NOT ONLY THAT, WE ALSO ARE ENCOURAGING POSTDOCS AND GRAND STUDENTS TO BEGIN THINKING ABOUT HOW TO EFFECTIVELY APPLICATIONS TO SECURE NIH FUNDING. SO SOMETHING ELSE THAT WE ARE VERY MUCH A PART OF OUR INNOVATIVE IDEAS ON TRAINING OPPORTUNITIES FOR AMERICAN INDIAN AND ALASKA NATIVES. SO THIS HERE IS A COLLABORATIVE EFFORT BETWEEN THE OFFICE OF DATA SCIENCE STRATEGY AND THE NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES. THIS IS ALSO IN PARTNERSHIP WITH THE AMERICAN INDIAN HIGHER EDUCATION CONSORTIUM AND NORTH DAKOTA UNIVERSITY. AND WHAT WE ARE DOING HERE IS SUPPORTING THE NORTH DAKOTA UNIVERSITY TO DEVELOP A DATA SCIENCE TRAINING PROGRAM FOR AMERICAN INDIAN AND ALASKA NATIVE STUDENTS THAT WILL THEN BE IMPLEMENTED IN TRIBAL COLLEGES ACROSS THE COUNTRY WHERE WE ARE NOW LAUNCHING THIS IN THREE TRIBAL COLLEGES WITH THE ANTICIPATION THAT THEY ARE EXPANDING THIS TO ALL TRIBAL COLLEGES ACROSS THE COUNTRY WITH THE ASSISTANCE AND THE HELP OF THE AMERICAN INKEDDIAN HIGHER EDUCATION CONSORTIUM. -- AMERICAN INDIAN -- AS MANY ARE AWARE, SCIENCE IS DEFINITELY MOVING IN THIS DIRECTION. AND THIS IS AN AREA WHERE WE CAN REALLY HAVE A TREMENDOUS IMPACT IF WE ARE ABLE TO TRAIN OUR OWN TO BE ABLE TO HAVE ACCESS TO LARGE DATA PLATFORMS, TO BE ABLE TO ANALYZE AND GENERATE REALTIME REPORTS THAT WOULD HELP OUR COMMUNITIES BETTER UNDERSTAND WHAT ARE SOME OF THE SITUATIONS OR CONDITIONS THEY ARE GOING THROUGH. THIS IS REALLY, I THINK AN IMPORTANT FEATURE OF THIS, AN ADDED FEATURE. A LOT OF THE DATA THAT IS BEING HOUSED AND STORED IS IN THE CLOUD SO IT DOESN'T TAKE A WHOLE LOT OF INFRASTRUCTURE. WE HAD THAT CONVERSATION ABOUT INFRASTRUCTURE TO GET UP AND GOING IN TERMS OF DATA ANALYSIS. SO THAT I THINK IS AN IMPORTANT FEATURE THAT WHILE WE PROVIDE SUPPORT IN OTHER AREAS TO BUILDUP THE INFRASTRUCTURE AND CAPACITY, WE CAN IMMEDIATELY BEGIN TO TRAIN STUDENTS SO THEY CAN BEGIN TO THINK ABOUT SOME OF THESE TOUGH QUESTIONS RELATED TO THE TRIBAL COMMUNITIES. SO EVEN THOUGH OUR SUMMER INTERNSHIPS WERE VIRTUAL THIS YEAR, WE REALLY TRIED TO MAKE THE MOST OF IT AND WE ARE REALLY ANTICIPATING A MORE ROBUST ENGAGEMENT WITH STUDENTS IN THE NEAR FUTURE AS HOPEFULLY WE GET TOWARDS THE EARNED OF THE PANDEMIC. ONE OF THE THINGS I CAN SAY IS THAT WE HAVE BEEN WORKING VERY CLOSELY WITH NINDS TO HELP DEVELOP THEIR OR OUR PARTNERSHIP AND ALSO THE CURRICULUM THAT AIN STUDENTS EXPERIENCE WHEN THEY COME TO THE CAMPUS OR WHEN THEY PARTICIPATE IN THE NIH VIRTUAL TRAINING INTERNSHIP. SO THIS YEAR DR. HOLD, WAS A MENTOR, SERVED AS A MENTOR FOR ONE OF THE STUDENTS IN THE PROGRAM, AND TOGETHER ALONG WITH DR. BLOOM, THEY WORKED TOGETHER AND PUBLISHED A COMMENTARY IN THE JOURNAL OF BIOETHICS. AND I'LL SHOW THAT A LITTLE BIT LATER. BUT THESE ARE SOME OF THE WAYS THAT WE ARE HOPING TO TRAIN MORE AIN STUDENTS TO BETTER UNDERSTAND WHAT HAPPENS AT THE NIH AND WHY IT'S SO CRITICAL TO UNDERSTAND ALL THE DIFFERENT COMPONENTS. SO IT'S TERRIFIC TO HAVE THESE STUDENTS WE CONTINUE TO HOPE TO HAVE MORE STUDENTS IN OUR OFFICE TO SUPPORT IN THE FUTURE. SOME OF THE THINGS THAT WE ARE LOOKING FORWARD TO GETTING BACK IN THE COMMUNITIES, ARE THE ESTABLISHMENT OF AMERICAN INDIAN AND ALASKA NATIVE REGIONAL TRAINING HUBS. THIS IS A PART THAT SPEAKS ABOUT ROWING YOUR OWN AND DEVELOPING SCIENTISTS WHO ARE ABLE TO GO BACK TO THEIR COMMUNITIES AND BUILD CAPACITY INFRASTRUCTURE WITHIN THEIR COMMUNITIES AROUND RESEARCH. SO THIS IS A COLLABORATION THAT WE, THE PICTURES HERE ARE FROM THE PACIFIC NORTHWEST. AND THIS IS A TERRIFIC PROGRAM WHERE WE NOT ONLY GET COMMUNITY SUPPORT. SO TRIBAL ELDERS COME TO THE EVENT AND WELCOME THE INTERNS OR STUDENTS, AND THEY CHARGE THEM WITH WHAT ARE THEIR RESPONSIBILITIES IN RESPECTING THEIR COMMUNITIES. AND THEY ACTUALLY MAKE THEM SIGN A CONTRACT, WHICH IS REALLY EXCITING AND REALLY NEAT. IT HOLDS THE STUDENTS ACCOUNTABLE THAT THEY ARE THERE TO REALLY LEARN AND REPRESENT THEIR TRIBE IN THIS EFFORT. AND WHAT OUR GOALS ARE IS THAT WE HAVE CURRENTLY THREE-FUNDED SITES THAT ARE IN THE PACIFIC NORTHWEST IN NORTHERN ARIZONA AND THE GREAT PLAINS, BUT AS MORE INFORMATION HAS COME OUT ABOUT THESE TERRIFICALLY IMPACTFUL PROGRAMS, THAT THERE IS A GROWING INTEREST IN SUPPORTING THESE IN DIFFERENT AREAS OF THE COUNTRY. SO WE ARE NOW LOOKING AND HOPING OUR GOAL IS TO LAUNCH UP TO FIVE MORE SITES IN THE NEAR FUTURE. AND OUR GOALS ARE ALSO TO INCLUDE MORE OF THE INSTITUTES SO WE CAN PROVIDE A DIVERSITY OF TRAINING OPPORTUNITIES, A DIVERSITY OF RESEARCH DISCIPLINES TO THESE STUDENTS. NOW IT'S REALLY FOCUSED ON NEUROLOGICAL DISORDERS, NEUROLOGY AND WE REALLY WANT TO THINK ABOUT HOW CANCER CAN BE INCORPORATED, CANCER RESEARCH, HOW HEART, LUNG AND BLOOD RESEARCH COULD BE INCORPORATED INCORPORATE D INTO THESE ALL IMPORTANT AREAS THAT WOULD ULTIMATELY ONE OF THESE IS GOING TO HOPEFULLY CATCH THE INTEREST OF OUR STUDENTS AND PUT THEM ON A CAREER PATH TO BECOME BIOMEDICAL RESEARCHER FOR THEIR COMMUNITIES. SO NOW WE ARE TOUCHING ON GOAL NUMBER 4, WHICH IS EXPANDING RESEARCH. AND SOME OF THE WAY THAT IS WE ARE DOING THIS IS WORKING WITH OUR SISTER OFFICES IN THE OFFICE OF THE DIRECTOR. ONE OF THEM IS THE NIH COMMON FUND PROGRAM. AND THIS ONE IS VERY UNIQUE. I THINK IT'S THE FIRST TIME THAT THIS PROGRAM, A REALLY FAST-MOVING, HIGH-IMPACT PROGRAM, SO THAT COMMON FUND FUNDS PROGRAMS THAT ARE DESIGNED TO ACHIEVE HIGH IMPACT GOALS AND THEY MUST BE CROSSCUTTING. THEY ARE UNIQUE BECAUSE THESE FUNDING OPPORTUNITIES OR PROGRAMS USUALLY ARE NOT TYPICALLY SUPPORTED BY THE IC ICs. ONE IS THE TRANSFORMATIVE RESEARCH TO ADDRESS HEALTH DISPARITIES AND ADVANCE HEALTH EQUITY. SOMETHING REALLY INTERESTING AND GREAT ABOUT THIS PROGRAM IS THAT WE ARE CURRENTLY GOING TO BE SEEKING TRIBAL INPUT, COMMUNITY INPUT ABOUT WHAT ARE SOME OF THE DEEP-ROOTED BARRIERS FOR COMMUNITIES TO BE ABLE TO PARTICIPATE IN BIOMEDICAL RESEARCH? AND AS YOU CAN SEE HERE ON THE RIGHT HAND PANEL, NOVEMBER 4, FROM 2-3:30 P.M., WE WILL BE HAVING THIS COMMUNITY LISTENING SESSION. IF YOU HAVEN'T SIGNED UP ALREADY, PLEASE DO SO IN THE NEAR FUTURE SO WE CAN HEAR YOUR INPUT AS THIS PROGRAM CONTINUES TO TAKE SHAPE. SO SOMETHING WE ALSO TALKED ABOUT, AND I THINK THIS REALLY SPEAKS TO ALL OF OUR INSTITUTE AND CENTER PARTNERS ACROSS THE AGENCY, IS THAT THERE ARE SO MANY -- REALLY IMPORTANT PROGRAMS THAT ARE BEING LAUNCHED TO NOT ONLY ADDRESS COVID -- RIGHT NOW MOST ARE FOCUSED ON COVID AND WE UNDERSTAND THAT MANY TRIBES ARE NOT GOING TO PARTICIPATE OR ARE NOT GOING TO WANT TO PARTICIPATE IN DIFFERENT PROGRAMS FOR DIFFERENT REASONS. BUT WE THINK IT IS EXTREMELY IMPORTANT FOR US TO OFFER THESE OPPORTUNITIES TO THE TRIBES. BUT NOT ONLY THAT, IS THAT WE ARE INCLUDING TRIBES EARLY ON IN THE DEVELOPMENT OF THESE PROGRAMS SO THAT THE PROGRAMS CAN BE SHAPED AND CREATED TO MAXIMIZE TRIBAL PARTICIPATION AS THESE PROGRAMS MOVE FORWARD. I THINK WHAT IS REALLY IMPORTANT IS AS THESE PROGRAMS, MORE AND MORE PROGRAMS BEGIN TO SOLICIT TRIBAL FEEDBACK, NOT ONLY ARE WE LEARNING MORE AND MORE ABOUT THE EXPECTATIONS FROM TRIBES, BUT THE PROGRAMS ARE BECOMING MORE AND MORE AWARE OF TRIBAL SOVEREIGNTY AND THE CONCERNS RELATED TO DATA SOVEREIGNTY AND INTELLECTUAL PROPERTY. SO THESE ARE ALL REALLY IMPORTANT BENEFITS AND WE CAN THINK ABOUT SEEING MORE OF THESE OPPORTUNITIES IN THE FUTURE AS WE MOVE FORWARD. NOW WE ARE GOING TO TOUCH ON GOAL NUMBER 4 AND THIS IS EXTREMELY IMPORTANT. THIS SPEAKS DIRECTLY TO WHAT TYLER AND DR. FERGUSON HAVE BROUGHT UP IN OUR PREVIOUS CONVERSATIONS. HOW DO WE INCLUDE MORE OF TRADITION AND CULTURE INTO THE RESEARCH ARENA OR AREA? AND IN LATE 2019 AS MANY OF YOU ARE AWARE, WE HELD THE FIRST NIH TRADITIONAL MEDICINE SUMMIT. AND IT WAS AN ABSOLUTELY FANTASTIC ENGAGEMENT. THIS WAS SUCH AN IMPORTANT EVENT WHERE NOT ONLY WERE WE ABLE TO EDUCATE THE SCIENTIFIC COMMUNITY ABOUT HOW IMPORTANT TRADITIONAL PRACTICES ARE AND HOW EFFECTIVE TRADITIONAL HEALING IS FOR OUR COMMUNITIES, BUT IT WAS ALSO IMPORTANT FOR THE TRADITIONAL HEALERS TO GET A BETTER UNDERSTANDING OF WHAT KIND OF SCIENCE GETS SUPPORTED AT THE NIH. THE DIRECTOR OF THE NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH, GAVE A WONDERFUL PRESENTATION ON HOW NON-CONVENTIONAL METHODS OF HEALING WERE SO IMPORTANT TO MANY DIFFERENT COMMUNITIES AND THIS TRANSLATES DIRECTLY TO TRIBAL COMMUNITIES AS WELL. SO THIS WAS -- AND I WANT YOU ALL TO KNOW THAT WE ARE ON THE VERGE -- YOU CAN SEE ON THE VERY RIGHT-HAND CORNER, IS THE REPORT THAT HAS COME FROM THIS PARTICULAR EVENT THAT WE ARE GETTING READY TO RELEASE DURING NATIONAL NATIVE-AMERICAN HERITAGE MONTH, WE ARE JUST A FEW SHORT DAYS AWAY FROM. SO YOU'LL BE THE FIRST TO GET THE PDF COPY OF THIS REPORT. AND WE ARE HOPING THO BUILD UPON THIS. THIS IS A VERY FIRST ENGAGEMENT AND IT WAS A GREAT OPPORTUNITY FOR US TO BEGIN THE CONVERSATION. WE ARE VERY MUCH LOOKING FORWARD TO CONTINUING THAT CONVERSATION AND WE KNOW THAT THERE IS A TREMENDOUS AMOUNT OF ENTHUSIASM ACROSS THE COMMUNITY ABOUT A SECOND EVENT OR A SECOND SUMMIT. SO SOMETHING TALES IS REALLY IMPORTANT THAT WE REALLY PAID A LOT OF ATTENTION TO, IS HOW DO WE MOST EFFECTIVELY CREATE AWARENESS AROUND CONDUCTING RESEARCH FOR TRIBAL COMMUNITIES THAT REINFORCES THE UNDERSTANDING OF TRIBAL INTEREST? AND WE SEE THIS AS PUBLICATIONS BEING A REALLY IMPORTANT MECHANISM FOR THIS. SO THIS YEAR, WE HAVE TWO PUBLICATIONS THAT HAVE RECENTLY BEEN PUBLISHED. ONE OF THEM YOU CAN SEE HERE ON THE LEFT, YOU'LL SEE A MORE CLEAR PICTURE. AND THESE HAVE BEEN INSERTED INTO YOUR NIH PLATFORM FOR YOU TO ACCESS AND READ AT YOUR LEISURE. IT'S THINKING ABOUT SOLIDARITY AS AN ASPIRATIONAL BASIS FOR PARTNERSHIP WITH TRIBAL COMMUNITIES. AND THEN ONE RECENTLY PUBLISHED WAS ABOUT OUR EFFORTS WITH THE CORONA VIRUS PREVENTION NETWORK AND HOW IT WAS CRITICALLY IMPORTANT TO ENGAGE COMMUNITIES EARLY ON AND CREATING CONFIDENCE AND OUR ENGAGEMENT TRIBAL COMMUNITIES REALLY LED TO OUR COMMUNITIES FULLY TAKING ON AND IMPLEMENTING PUBLIC HEALTH SAFETY MEASURES. BUT NOT ONLY THAT, I THINK THAT WITH OUR EFFORTS, WITHIN THE CORONA VIRUS PREVENTION NETWORK, THE TRIBAL COMMUNITIES REALLY GOT THE INFORMATION THAT THEY NEEDED TO FEEL COMFORTABLE WITH RECEIVING THE COVID-19 VACCINES AS THEY RECEIVED. UA AUTHORIZATION AND THEY WERE AVAILABLE TO THE PUBLIC. SO WE ALSO, IN THIS PAPER, TALK ABOUT THE IMPORTANCE OF FUNDING IMPLEMENTATION STRATEGIES AS WE PREPARE FOR THE POTENTIAL NEXT PUBLIC HEALTH EMERGENCY. IT WAS A LOT OF FOCUS ON THE DESIGN AND THE DEVELOPMENT OF THE COVID-19 VACCINES BUT THEN ONCE THOSE WERE DEVELOPED, THERE WAS A PRETTY SIGNIFICANT GAP ABOUT HOW WE WERE GOING TO GET THOSE VACCINES INTO ALL OF OUR COMMUNITIES AND WHAT THAT WOULD LOOK LIKE. SO THERE IS A LOT OF -- AND YOU CAN SEE WE HAD OTHER REPORTS THAT HAVE COME OUT THROUGH THE YEARS. I THINK THIS IS A REALLY IMPORTANT MECHANISM FOR US TO BE ABLE TO SHARE WHAT WE ARE LEARNING TO THE SCIENTIFIC COMMUNITY. SO ANOTHER WAY THAT WE HAVE BEEN ENGAGING COMMUNITIES, AND I APOLOGIZE FOR ALL THE TEXT. THERE IS A LOT OF TEXT. BUT IT IS REALLY IMPORTANT. I THINK ONE OF THE WAYS WE ARE HAVING THE MOST IMPACTFUL ENGAGEMENT FOR TRIBAL COMMUNITIES IS REALLY THINKING ABOUT THE POLICIES THAT SUPPORT AND SHAPE BIOMEDICAL RESEARCH AT THE NIH. AND SO WE HAVE BEEN INVITED TO PROVIDE GUIDANCE ON A VARIETY OF DIFFERENT POLICIES AS THEY RELATE TO BIOMEDICAL RESEARCH. AND IT'S REALLY IMPORTANT FOR US TO SHARE WHAT OUR TRIBAL INTERESTS AND CONCERNS TO EXISTING POLICIES SO THEY MAY BE ADAPTED OR THEY MAY BE EXEMPTIONS INCLUDED INTO THESE POLICIES TO FURTHER FACILITATE THE INCLUSION OF TRIBAL COMMUNITIES AS RESEARCH CONTINUES TO MOVE FORWARD. BUT NOT ONLY THAT, WE ARE -- DR. HALL AND I, UPPER RIGHT-HAND CORNER, WE ARE HAVING CONVERSATIONS WITH A LOT OF DIFFERENT OFFICES ACROSS THE AGENCY, CONTINUING TO SHARE WHAT WE HAVE LEARNED AND TO TALK ABOUT HOW WE MOVE FORWARD WITH TRIBAL COMMUNITIES IN RESEARCH. OTHER AREAS OF ENGAGEMENT WE PARTICIPATED IN ARE IN PODCASTS AND ALSO ENGAGING WITH NATIVE MEDIA OUTLETS. INDIAN COUNTRY TODAY, WE PROVIDED SEVERAL INTERVIEWS WITH THEM. THEY HAVE BEEN A TERRIFIC PARTNER AND WE KNOW IT'S A REALLY EFFECTIVE WAY TO GET SOME OF THE MESSAGES AND CREATE MORE AWARENESS ABOUT THE NIH INTO TRIBAL COMMUNITIES ACROSS THE COUNTRY. SO I KNOW I'M GETTING CLOSE. I WANT TO HAVE SOME TIME FOR DISCUSSION BUT I WANTED TO BRIEFLY TOUCH UPON WHY THIS SLIDE IS SO IMPORTANT. WE HAVE REALLY PUT AN EMP SIGNIFICANCE BEHIND SUPPORTING -- EMPHASIS -- SUPPORTING TRIBES TO BE ABLE TO TAKE ON CLINICAL TRIALS IN THEIR OWN COMMUNITIES. AND AS YOU ALL KNOW THAT WE HAVE BEEN VERY SUCCESSFUL IN A COUPLE OF THESE DIFFERENT REGIONS. SHEAR A PICTURE OF THE AMERICAN INDIAN CENTER -- AMERICAN INDIAN CLINICAL TRIALS RESEARCH NETWORKS IN THE GREAT PLAINS. THIS IS A DOCUMENT THAT CAME OUT OF ANOTHER COMMUNITY AS IT RELATES TO COVID-19 AT PHASE III CLINICAL TRIALS. AS YOU CAN SEE, THIS IS AN IMAGE, A TIMELINE OF WHAT THE CLINICAL TRIAL PROCESS LOOKS LIKE. IT'S A CHART THAT COMES FROM THE NATIONAL ACADEMIES AND IT'S A DOCUMENT OR A PAPER THAT TALKS ABOUT CLINICAL TRIAL DATA MAXIMIZING THE BENEFITS AND MINIMIZING THE RISKS. BUT AS YOU CAN SEE HERE, WE HAVE BARELY TOUCHED ON JUST A COUPLE OF DIFFERENT POINTS ALONG THIS CONTINUUM OF WHERE THERE MIGHT BE OPPORTUNITIES TO CHANGE THE CLINICAL TRIAL PROCESS TO BETTER INCLUDE TRIBAL COMMUNITIES. ONE OF THE THINGS THAT WE HAVE BEEN ASKING AND DR. HULL HAS BEEN REALLY INSTRUMENTAL IN THIS AND SHE HAS A KEEN EYE FOR THIS S REVIEWING CONSENT FORMS AND ASKING, ARE THESE ALL QUESTIONS REALLY NECESSARY TO ACHIEVE THE GOALS OF THIS PARTICULAR STUDY? ALSO, WHAT HAS BEEN YOUR EXPERIENCE IN CONDUCTING CLINICAL TRIALS? A TRIBAL COMMUNITY CONDUCTING CLINICAL TRIALS FOR THE FIRST TIME CAN BE AN OVERWHELMING EXPERIENCE SO HOW CAN WE SUPPORT COMMUNITIES THAT WANT TO DO THIS WITHOUT PUSHING THEM AWAY WITH THE TREMENDOUS AMOUNT OF DIFFERENT REGULATIONS OR REQUIREMENTS THAT ARE NECESSARY? THEY ARE NECESSARY BUT HOW CAN WE SUPPORT THE TRIBES TO ADDRESS THEM AND TO FULFILL THEM? SO I TALKED ABOUT ALL OF THE DIFFERENT PARTS OF THE STRATEGIC PLAN AND WHAT THEY MEAN. AND NOW I WANTED TO SHOW YOU EXACTLY HOW WE SEE THIS AS PANNING OUT OR WHAT IS THE BENEFIT OF THIS. SO HERE YOU CAN SEE IN THIS CHART, AND THIS IS A GRAPH FROM THE NIH REPORTER THAT SHOWS THAT IN 2015, ABOUT 180 MILLION DOLLARS WERE INVESTED IN TRIBAL HEALTH RESEARCH. BUT AS WE PROGRESSED THROUGH THE YEARS IN 2019, THAT NUMBER HAS GONE UP. IN 2020, THE DOLLAR AMOUNT WAS 308 MILLION. IN 2021 -- AND THESE BARS ARE SHADED A LITTLE DIFFERENTLY BECAUSE THEY ARE ESTIMATES. BUT THE 2021 ESTIMATE IS 340 MILLION DOLLARS AND IN 2022, THE ESTIMATE IS AT 355 MILLION DOLLARS. SO YOU CAN SEE AS A COLLECTIVE AGENCY, THERE HAS BEEN A GROWING INVESTMENT IN TRIBAL HEALTH RESEARCH. AND THAT IS BECAUSE OF ALL OF OUR COMBINED EFFORTS TOGETHER. AND SO I THINK THAT LOOKING BACK AT THE LAST FIVE YEARS THAT WE ARE ON A TERRIFIC PATH TO SEE GREATER GAINS, GREATER ENGAGEMENT FROM THE TRIBAL COMMUNITIES, BUT THAT IS GOING TO REQUIRE ALL OF US TO MAKE SURE THAT TRIBES ARE INCLUDED AND TRIBES NEED THE NECESSARY INFORMATION AND EVERYTHING ELSE TO FEEL LIKE THEY ARE A PART OF THE RESEARCH PROCESS. SO WHAT ARE SOME OF THE THINGS WE ARE LOOKING FORWARD TO IN THE IMMEDIATE FUTURE? ONE OF THE THINGS THAT REALLY PLAGUED US FOR A LONG TIME AND REALLY HAS BEEN A CHALLENGING QUESTION IS HOW DO WE ETHICALLY INCLUDE URBAN INDIAN POPULATIONS OR URBAN INDIAN COMMUNITY MEMBERS IN BIOMEDICAL RESEARCH? AND THIS IS SOMETHING THAT DR. HULL IS ACTIVELY LEADING WITH A SUBCOMMITTEE OF THE NIH TAC AND OTHER ACADEMICS ACROSS THE COUNTRY. SO THIS EFFORT IS MOVING FORWARD AND WE ARE REALLY, REALLY EXCITED ABOUT WHAT ARE THE RESULTS THAT WILL COME OUT OF THIS. AND SOME OF THE OTHER THINGS WE CAN SEE IN THE NEAR FUTURE IS THAT OTHER LONGSTANDING PROGRAMS -- THERE IS SO MUCH OPPORTUNITY FOR US TO ENGAGE ACROSS THE AGENCY FOR TRIBES, THINKING ABOUT HOW AGING PLAYS A ROLE IN TRIBAL COMMUNITIES. WE HAVEN'T EVEN ENGAGED THE NATIONAL INSTITUTE ON AGING. THERE IS STILL A NUMBER OF GREAT OPPORTUNITIES THAT ARE OUT THERE. SOMETHING ELSE WE ARE IMMEDIATELY PURSUING IS HOW CAN WE INVOLVE MORE TRIBAL COMMUNITIES IN THE SMALL BUSINESS AND INNOVATION RESEARCH PROGRAM OR THE SBIR PROGRAM. ALSO IN ADDITION TO THIS, OUR OFFICE IS VERY MUCH ENGAGED AT LISTENING TO SPECIFIC COMMUNITY REQUESTS ON ENGAGING OR PARTICIPATING IN DIFFERENT PROGRAMS. SO HERE YOU CAN SEE THE NIH SERVICE AREA MAP 09 LOWER RIGHT-HAND CORNER. WE ARE GETTING A LOT OF SPECIFIC REQUESTS AND I'M HOPING THAT CONTINUES AND ACTUALLY INCREASES SO THAT WE CAN HEAR ABOUT THE SPECIFIC NEEDS OF INDIVIDUAL TRIBES LIKE TYLER MENTIONED BEFORE. ONE SIZE DOES NOT FIT ALL. IT'S REALLY IMPORTANT FOR US TO HEAR THOSE CONCERNS AND THOSE CHALLENGES FROM THE COMMUNITIES SO WE CAN ADDRESS THEM AS AN AGENCY. WITH THAT, I WANT TO THANK YOU VERY MUCH. I APOLOGIZE FOR THE TECHNICAL GLITCH. I'M GLAD THAT IT HAPPENED TO ME AND NOT ANY OF OUR INVITED SPEAKERS. BUT WITH THAT, I WILL TURN IT BACK OVER TO LISA. >> THANK YOU, DAVE. THAT WAS A GREAT RECAP. FANTASTIC WORK IS BEING DONE ON SEEING THE INCREASE OF DOLLARS -- [ NO AUDIO ] >> YOU HAVE BEEN DOING A EXCELLENT JOB IN THE PAST COUPLE OF YEARS. AS OUR JOB WITH THE TAC CONTINUES TO RELAY THE MESSAGES WE ARE HEARING FROM EACH OF OUR REGIONS AND MAKE SURE THE FOCUS BOILS DOWN TO WHAT IS NEEDED IN OUR COMMUNITIES. I WANTED TO MAKE THAT CLEAR. I THINK WE HAVE AN EXCELLENT RELATIONSHIP. I LOVE SEEING IT BUILDUP AND I LOVE TO SEE IT BUILDUP EVEN MORE. ONE THING I WOULD LIKE TO MENTION THOUGH RELATED TO NATIVE-AMERICAN INDIANS IN THIS RESEARCH, IN GENERAL, IS THE IMPORTANCE OF HAVING OUR OWN RESEARCHERS IN OUR COMMUNITIES TRAINED. SO FOR INSTANCE, AND AGAIN, I KIND OF HINTED AT THIS EARLIER, ONE OF THE ISSUES WE HAVE IS THAT THINGS DON'T GET RESEARCHED OR ADDRESSED UNTIL IT FACTS EVERYBODY. IF YOU LOOK -- AFFECTS -- HISTORICALLY, LOOK AT WHAT CAME OUT OF THE STRONG HEART STUDY. IT WAS ORIGINALLY STARTED BECAUSE THEY THOUGHT WE HAD SOME KIND OF BIOINDICATOR OR SOMETHING IN OUR BODIES THAT PREVENTED HEART DISEASE BUT THEY FOUND THE OPTION WITH THAT STRONG HEART STUDY. IT'S BEEN A STUDY FOR 30 PLUS YEARS. THE INDIAN STUDY WITH THE DIABETES AND LOOKING AT THE TRIM LINE OF DIABETES IN THE COUNTRY IS NOW OVER WEIGHING THAT OF THE ORIGINAL PEOPLA INDIAN STUDY. THAT IS CONCERNING. SO IF YOU LOOKED WHAT THE OUR COMMUNITIES AND THE HOW WE LIVE IN THE MOST REMOTE AREAS, MAJORITY OF US IN OUR TRIBAL COMMUNITIES, RURAL AREAS, NOT A WHOLE LOT OF ACCESS TO THINGS. AND I SAID THIS BEFORE. IF YOU DO THE RESEARCH IN OUR COMMUNITIES AND YOU DO IT APPROPRIATELY, YOU CAN ACTUALLY PROBABLY GET SOME OF THE TREND LINES FOR THE REST OF THE COUNTRY 10-20 YEARS IN ADVANCE BEFORE IT AFFECTS EVERYBODY. SO YOU CAN WORK AND RESEARCH ISSUES IN OUR TRIBAL COMMUNITIES AND ACTUALLY WORK TO TRY TO ADDRESS THEM OVER THE COURSE OF 10-20 YEARS BEFORE IT AFFECTS EVERYBODY. SO LOOK AT THE OPIOID EPIDEMIC, FOR INSTANCE. LIKE WE KNOWN ABOUT THIS FOR YEARS. WE HAVE BEEN DEALING WITH THIS IN OUR COMMUNITIES FOR YEARS. AND IT DIDN'T GET ATTENTION OR MONEY UNTIL IT AFFECTED -- AND I HATE TO SAY IT THIS WAY BUT -- WHITE PEOPLE. THAT'S WHEN THE MONEY CAME. THAT'S WHEN THE POLICY CHANGE CAME. WE HAVE BEEN IN THE CRUX OF IT FOR GENERATIONS NOW. SO I JUST WANTED TO HIGHLIGHT THAT AND LIKE THAT IS WHY IT'S IMPORTANT TO WORK WITH NATIVE AND INDIGENOUS RESEARCHERS WHO ARE IN OUR COMMUNITIES AND GROW UP EITHER BEING A STATISTIC OR SEEING THE STATISTICS IN THE FAMILY PICTURE. LIKE THOSE ARE -- IT'S HEARTBREAKING BUT IT'S ALSO THE TRUTH. AND MISSING AND MURDERED INDIGENOUS WOMEN AS WELL IS ANOTHER EXAMPLE. THANK YOU. >> YES, THANK YOU, TYLER. SO WE ARE REALLY HOPING THAT THE REGIONAL TRAINING HUBS WOULD PROVIDE ONE OF THOSE IMMEDIATE MECHANISMS TO BE ABLE TO ATTRACT NATIVE YOUTH. THE PROGRAM IS SPECIFICALLY GEARED FOR JUNIORS AND SENIORS IN HIGH SCHOOL. AND WE ALL KNOW THAT MAYBE THAT IS NOT EVEN EARLY ENOUGH AS WELL. BUT IT'S REALLY IMPORTANT FOR US TO BEGIN THINKING ABOUT THAT THERE. AND ENGAGING AS MANY STUDENTS AND GETTING THEIR INTERESTS IN RESEARCH AND SCIENCE AS EARLY ON AS POSSIBLE SO THAT THEY CAN HAVE THAT OPPORTUNITY AND THINK ABOUT A CAREER IN BIOMEDICAL RESEARCH. THANK YOU FOR THE QUESTION. >> GREAT. WE HAVE IVET. >> THANK YOU FOR THE UPDATE. APPRECIATE THE HARD WORK OF EVERYBODY WORKING IN THE OFFICE. I KNOW THAT NIH IS A BIG AGENCY WITH NOT A LOT OF PEOPLE WHO UNDERSTAND TRIBAL ISSUES SO WE APPRECIATE THE HARD WORK TO TRY TO GET THAT INFORMATION ACROSS AND TRYING TO IMPLEMENT PRIORITIES THAT YOU'RE HEARING EVERY TIME WE MEET WITH THE TAC. I HAVE THREE QUESTIONS SO I'LL RATTLE THEM ALL OUT. THE FIRST ONE IS THE DOCUMENT THAT WAS DEVELOPED FOR REVIEWERS, UNDERSTANDING AMERICAN INDIANS AND ALASKA NATIVES. IT SEEMS LIKE IT'S BEING HANDED TOUT REVIEWERS BUT THERE IS NO -- I DON'T KNOW WHAT OTHER ACTIVITIES ARE BEING DONE TO MAKE SURE THAT NOT ONLY THEY READ IT BUT IMPLEMENT THE RECOMMENDATIONS AND ANY WAY FOR HOLDING ACCOUNTABLE REVIEWERS OR GROUPS THAT DON'T FOLLOW THE RECOMMENDATION? THAT'S THE FIRST QUESTION. BECAUSE I REALLY FEEL LIKE JUST HANDING OUT A DOCUMENT IS THE FIRST STEP BUT THERE IS OTHER STEPS THAT NEED TO BE TAKEN TO GET ACTION AND CHANGE. BECAUSE CHANGE IS REALLY HARD AND THE REVIEWERS STILL DON'T GET IT. THE SECOND THING IS -- >> HOLD ON. I JUST WANT TO ACKNOWLEDGE THAT IT'S NOW OUR BREAK TIME. THAT WE HAVE A BREAK AND I WANT TO MAKE SURE THAT -- WE HAVE TWO HANDS UP AND TWO OTHER COMMENTS TO MAKE SO DAVE, WHAT WOULD YOU RECOMMEND TO DO BECAUSE PEOPLE CAN EITHER STAY ON DURING THIS TIME IF THEY WANT BUT IF PEOPLE NEED TO TAKE BREAKS, WE ONLY HAVE 10 MINUTES BEFORE WE GO BACK ON LIVE AGAIN. SO I THINK MAYBE IF IT'S UP TO ANYBODY ELSE IF THEY WANT TO STAY FOR THE Q&A OR TAKE A BREAK. IS THAT HOW YOU WANT TO DO THAT OR DO WE JUST NEED A BREAK? JUST CHECKING. >> I'M HAPPY TO STAY AND ANSWER QUESTIONS. THESE ARE REALLY IMPORTANT AND AGAIN I APOLOGIZE FOR THE TECHNICAL GLITCH THAT WE HAD. >> OKAY, GREAT. GO AHEAD. IF ANYBODY NEEDS TO TAKE A BREAK, NOW IS YOUR TIME. SO LETTING YOU KNOW. THANK YOU. IS. >> THAT IS SOMETHING I'M GOING TO DEFER TO HIM TO SHARE THAT INFORMATION. BUT WE ARE ACTIVELY PURSUING THIS AS A FORMAL OPPORTUNITY TO TRAIN TRIBAL OR SORRY, REVIEWERS THAT REVIEW TRIBAL APPLICATIONS. THANK YOU. >> LISA, ARE YOU BACK? >> I WASN'T SURE IF YOU GOT MY MESSAGE, YES. GO AHEAD AND I HAD TO TAKE CARE OF MY MOM. >> IF YOU DON'T MIND, WE HAVE ONE MORE QUESTION. MICHELLE? >> THANK YOU SO MUCH. THANK YOU FOR YOUR PRESENTATION AND I HOPE THAT WE CAN GET COPIES OF YOUR SLIDE. I THOUGHT THERE WAS A LOT OF INFORMATION THAT YOU COVERED. MY QUESTION IS SORT OF PIGGYBACKING ON WAS MENTIONED ABOUT ACCOUNTABILITY. I WAS CURIOUS ABOUT WHAT IS THRO'S ROLE IN ENSURING RESEARCHERS OR INSTITUTIONS THAT ARE FUNDED BY NIH OR CONDUCTING RESEARCH THAT IS ETHICAL AND RESPECTFUL? BECAUSE I THINK IT'S GREAT THAT THERE ARE PUBLICATIONS BEING MADE, GUIDANCE BEING DEVELOPED BUT WHEN IT COMES TO ACTUAL IMPLEMENTATION, HOW ARE RESEARCHERS AND INSTITUTIONS HELD ACCOUNTABLE? AND IF THERE IS AN ISSUE, WHAT HAPPENS? >> I THINK THAT THIS IS A REALLY IMPORTANT QUESTION AND IT'S ONE THAT WE HAVE REALLY BEEN THINKING ABOUT CAREFULLY. IT'S IMPORTANT FOR US TO RECOGNIZE THAT THE NIH IS A GRANTING INSTITUTION OR AGENCY. SO THE FUNDING WOULD GO TO A PARTICULAR ACADEMIC INSTITUTION. RESEARCHERS THAT ARE EMPLOYED BY THAT INSTITUTION ACTUALLY HAVE THE FINAL SAY ON THEIR CONDUCT. WE DO HAVE MECHANISMS TO ADDRESS EGREGIOUS, UNETHICAL ACTS IN TERMS OF RESEARCH, BUT WE REALLY RELY HEAVILY ON THE INSTITUTIONS THAT WE FUND TO MAKE SURE THEY ARE MONITORING FACULTY MEMBERS AND CONDUCTING RESEARCH IN THE MOST ETHICAL WAY. I WOULD OFFICE INVITE DR. ANDERSON WHO WAS ABLE TO JOIN US THIS MORNING, TO ADD ANY ADDITIONAL COMMENTS TO THAT STATEMENT. WE DO HAVE MEASURES TO ADDRESS THAT BUT WE THINK THAT EDUCATION IS THE MOST IMPORTANT WAY TO DO THIS ON A BROAD SCALE THROUGH EDUCATION AND SHARE OF INFORMATION. THANK YOU, MICHELLE. >> THANK YOU. >> I DON'T SEE ANY OTHER HANDS UP. SO LET'S FINISH OUT OUR BREAK. 4 OR 5 MORE MINUTES. AND THEN AT 3:00, IF YOU'LL INTRODUCE DR. COMPTON -- WILL THAT BE OKAY? >> ABSOLUTELY. HAPPY TO. >> THANK YOU. AND THANK YOU FOR YOUR PRESENTATION. >> WE HAVE A NEW SPEAKER AND IF YOU COULD INTRODUCE THEM FOR US, PLEASE. >> I WILL DO SO. SO I'M VERY HAPPY TO INTRODUCE DR. WILSON COMPTON WHO SERVES AS THE DEPUTY DIRECTOR AT THE NATIONAL INSTITUTE ON DRUG ABUSE. MANY OF US KNOW IT AS NIDA AT THE NATIONAL INSTITUTE OF HEALTH. SO NIDA SUPPORTS MOST OF THE WORLD'S RESEARCH ON HEALTH ASPECTS OF DRUG ABUSE AND ADDICTION AND PREVENTING DRUG ABUSE AND TREATING ADDICTION AND ADDRESSING SERIOUS HEALTH CONSEQUENCES RELATED TO DRUG ABUSE, INCLUDING RELATED HIV/AIDS AND OTHER HEALTH CONDITIONS. IN HIS CURRENT ROLE HIS RESPONSIBILITIES INCLUDE WORKING WITH THE DIRECTOR TO PROVIDE TERRIFIC SCIENTIFIC LEADERSHIP IN THE DEVELOPMENT AND IMPLEMENTATION AND MANAGEMENT OF NIDA'S RESEARCH PORTFOLIO. THIS IS ALL DONE TO PREVENT OR IMPROVE THE PREVENTION AND TREATMENT OF DRUG ABUSE AND ADDICTION ACROSS THE COUNTRY AND ACROSS THE WORLD TOO. SO WITH THAT, I WANT TO WELCOME YOU, DR. COMPTON. IT'S BEEN A WHILE SINCE WE HAVE SEEN EACH OTHER. I LOOK FORWARD TO THE TIME WE ARE ABLE TO GATHER AGAIN AND HAVE A CONVERSATION. >> THANK YOU VERY MUCH. IT IS CERTAINLY A PLEASURE TO BE WITH THE TRIBAL ADVISORY COMMITTEE THIS AFTERNOON. AND TO BE ABLE TO SPEAK ON BEHALF OF THE NATIONAL INSTITUTE ON DRUG ABUSE. I WANT TO START OUT JUST BY LETTING YOU KNOW THAT DR. NOR HOL COUGH EXPECTED AND HOPED TO BE HERE BUT DUE TO AN UNEXPECTED AND UNAVOIDABLE SCHEDULING CONFLICT, WASN'T ABLE TO BE HERE. SO SHE ASKED ME TO PRESENT TO YOU ALL. BUT I WANT YOU ALL TO REALIZE THAT I AM KIND OF A LAST-MINUTE SUBSTITUTE BECAUSE OUR DIRECTOR TAKES THESE ISSUES SO SERIOUSLY OF WORKING TO MAKE SURE WE ADDRESS THE DRUG ADDICTION AND DRUG USE ISSUES THAT CONFRONT TRIBES AND AMERICAN INDIANS, ALASKA NATIVES THROUGHOUT OUR COUNTRY. AND WE ARE PROUD OF THE WORK WE HAVE DONE TO INCREASE OUR PORTFOLIO IN THIS AREA AND ADDRESS SOME OF THE SERIOUS HEALTH DISPARITIES WITH SOME PROMISING APPROACHES WHILE WE CAN CERTAINLY DEFINE AND EXPLAIN BODY AND THE HEALTH DISPARITIES, WE HAVE CLUES ABOUT SOME OF THE UNDERLYING CAUSES MUCH MORE THAN JUST SIMPLE SIMPLE RACIAL OR ETHNIC IDENTITY. AND SO AS WE ADDRESS SOME OF THE UNDERLYING RISK FACTORS AND BEHAVIORS THAT ARE ASSOCIATED WITH SUBSTANCE USE AND SUBSTANCE USE PROBLEMS IN THE TRIBES THAT YOU ALL REPRESENT, WE HAVE SOME HOPE FOR THE FUTURE. I JUST HAVE A BRIEF PRESENTATION FOR YOU SO I'M NOT GOING TO TALK ABOUT ALL THE ISSUES RELATED TO DRUG USE. AND WE COULD TALK ABOUT PRETTY MUCH EVERYTHING FOR THE MOST BASIC SCIENCE ALL THE WAY THROUGH HEALTH SERVICES. BUT I THOUGHT I'D HIGHLIGHT FOR YOU WHAT HAS BEEN GARNERING THE MOST ATTENTION IN OUR COUNTRY OF LATE, WHICH OF COURSE IS THE OVERDOSE CRISIS ACROSS THE UNITED STATES. AND I'LL START OUT BY HIGHLIGHTING SOME OF THE GENERAL TRENDS AND THEN WE'LL FOCUS IN ON ISSUES SPECIFIC TO AMERICAN INDIANS AND ALASKA NATIVES. WHEN WE THINK ABOUT THE OVERDOSE CRISIS IN OUR COUNTRY, IT STARTED OUT IN THE 2000S OR FIRST RECOGNIZED IN THE EARLY 2000S AS PREDOMINANTLY RELATED RELATED -- DRIVEN BY CHANGES IN THE MARKETING OF HEROIN. THERE IS EVIDENCE TO SUPPORT THAT THE MARKET THAT WAS DEVELOPED BY ALL OF THESE MILLIONS OF PEOPLE WHO WERE EXPOSED TO PRESCRIPTION OPIOIDS, CREATED A READY ENVIRONMENT FOR THOSE THAT SELL HEROIN TO PROVIDE THESE ILLICIT SUBSTANCES TO MANY WHO HAD LEARNED ABOUT WHAT OPIOIDS DID TO THEIR BRAIN AND BEHAVIOR. SO THEY SHIFTED TO HEROIN AND WE SAW THIS IN INCREASING USE OF HEROIN AND PARTICULARLY THE INCREASING HEROIN OVERDOSE DEATHS IN THE SECOND DECADE OF THE 21ST CENTURY. THE THIRD PART OF THIS STORY RELATES TO FENTANYL OR SYNTHETIC OPIOIDS OTHER THAN METHADONE. THIS CATEGORY INCLUDES ALMOST ENTIRELY ILLICITLY-PRODUCED FENTANYL AND BECAUSE OF THE IN EXPENSIVE NATURE AND AS WELL AS ITS POTENCY, WE SEE THAT IT IS REALLY TAKING OVER THE MARKETPLACE FOR ILLICIT OPIOIDS AND THE NUMBER OF DEATHS HAVE SKYROCKETED IN THE LAST FEW YEARS RELATED TO THIS ILLICITLY-PRODUCED AND SOLD VERY POTENT OPIOID COMPOUND. AS IT THAT WEREN'T ENOUGH PROBLEMS, WE NOTED IN THE LAST DECADE A MARKET INCREASE IN DEATHS ASSOCIATED AND RELATED TO STIMULANTS, BOTH COCAINE AND PARTICULARLY METHAMPHETAMINE. WE'LL TOUCH ON THAT IN A LITTLE MORE DETAIL. THE LAST YEAR FOR WHICH WE HAVE THE FULL DATA FROM THE NATIONAL CENTER OF HEALTH STATISTICS IS 2019. THAT INCLUDED OVER 70,000 DEATHS THAT THE TIME. BUT I WILL SHARE WITH YOU SOME INFORMATION FROM THE PANDEMIC YEAR DURING THE COVID PANDEMIC TO SUGGEST THAT THESE OVERDOSE DEATHS HAVE JUST SKYROCKETED IN THE LAST YEAR OR YEAR AND A HALF. WHEN WE LOOK AT HEALTH DESIGNATE TERMS OF RACIAL IDENTITY, WE DO SEE THAT AMERICAN INDIAN ALASKA NATIVE POPULATIONS HAVE HAD HIGHER RATES OF DRUG OVERDOSE THROUGHOUT MOST OF THIS TIME PERIOD AND THE INCREASES ARE EXTRAORDINARY AND DEVASTATING FOR AMERICAN INDIANS. I WILL POINT OUT THAT THESE NUMBERS ARE BASED ON THE CLASSIFICATION IN DEATH CERTIFICATES BUT WE HAVE LEARNED FROM RESEARCH DONE IN WASHINGTON STATE IN PARTICULAR, THAT THESE MAY BE A MARKED UNDER REPRESENTATION OF THE NUMBER OF AMERICAN INDIAN PERSONS WHO HAVE DIED OF OVERDOSES. SO I THINK YOU CAN CONSIDER THESE TO BE THE LOWER ESTIMATE OF THE ACTUAL OVERDOSE DEATH RATES SUGGESTING VERY STRONG HEALTH DISPARITIES. WHEN WE LOOK AT METHAMPHETAMINE IN PARTICULAR, WE SEE THAT AMERICAN INDIANA AND ALASKA NATIVE POPULATIONS ARE DISPROPORTIONATELY AFFECTED. TRUE FOR BOTH MEN AND WOMEN AND WHILE THEY MAY BE BROAD ISSUES, I THINK SOME IS EXPLAINED BY THE GEOGRAPHY OF METHAMPHETAMINE. WHERE IT'S BEEN PREDOMINANTLY BEEN AVAILABLE AND PRODUCING SERIOUS CONSEQUENCES IN THE WESTERN PART OF OUR COUNTRY WHERE THERE ARE HIGHER OR LARGER POPULATIONS OF AMERICAN INDIANS. MANY OF THE TRIBAL GROUPS THAT YOU ALL REPRESENT ARE LOCATED. AS IF THE OVERDOSE CRISIS BEFORE THE PANDEMIC WEREN'T ENOUGH, THERE IS WHAT APPEARS TO BE A MARKED ENTER ACTION OF THE COVID PANDEMIC WITH OVERDOSE DEATHS AND YOU SEE THAT JUST HIGHLIGHTED IN SOME OF THESE HEADLINES FROM THE LAST YEAR AND A HALF. THIS ISSUE HASN'T GOTTEN ANYWHERE NEAR THE AMOUNT OF ATTENTION, OF COURSE, AS THE COVID CRISIS HAS, BUT THE INTERACTIONS OF COVID WITH MANY OTHERS IS IMPORTANT TO CONSIDER. HERE IS THE PRELIMINARY OVERDOSE DEATH DATA FROM THE NATIONAL CENTER OF HEALTH STATISTICS. IT REMINDS US THAT ALL OVERDOSE DEATHS MAY HAVE INCREASED BY 30% DURING THE PERIOD OF THE PANDEMIC. ALL THE WAY FROM 74,000 AS A YEARLY RATE IN FEBRUARY OF 2020, TO SOMETHING LIKE 97,000 BY FEBRUARY OF 2021. INCREASE OF 30%. WHEN WE LOOK AT THE SYNTHETIC OPIOIDS, THE INCREASES ARE OVER 50% AND WHEN WE LOOK AT PSYCHOSTIMULANTS, THAT MEANS PREDOMINANTLY METH AM FAT MEN, THE INCREASES WERE 50 NURSE THAT ONE-YEAR PERIOD OF TIME. I THINK IT'S SAFE TO SAY, AND UNFORTUNATE WE SEEN THAT THE COVID PERIOD HAS LEAD TO A SKYROCKETING IN OVERDOSE DEATHS FROM A VARIETY OF SUBSTANCES. WHY MIGHT THAT BE? ALL OF US HAVE EXPERIENCED EXTREME STRESS DURING THE LAST YEAR AND A HALF DUE TO THESE MAJOR SOCIAL CHANGES AND ISSUES THAT WE ALL FACED. STRESS IS NO FORUOUS FACTOR IN DRUG RELAPSE AND MAY BE PART OF WHAT HAS BEEN RESPONSIBLE FOR INCREASES. THERE ALSO MAY BE SOME VERY PRACTICAL ISSUES INVOLVED IN THAT SOCIAL DISTANCING THAT WE ALL HAVE BEEN ENCOURAGED TO DO HAS AT LEAST A COUPLE OF EFFECTS. IT BRINGS PEOPLE APART AND SO THAT MAY BE STRESSFUL IN AND OF ITSELF AND CAUSE RELAPSES IN USE OF SUBSTANCES AND A MAJOR RISK FACTOR FOR A FATAL OVERDOSE DEATH IS WHEN PEOPLE USE DRUGS BY THEMSELVES. AND SO THE SOCIAL DISTANCING AND SOCIAL ISOLATION MAY BE RELATED DIRECTLY TO INCREASING RISK OF A FATAL OVERDOSE BECAUSE THERE IS NO ONE THERE TO PROVIDE RESCUING OR ADMINISTER MEDICATION THAT IS MIGHT SAVE A LIFE. WE HAVE NOTED THAT THE SERVICES DURING THE TIME OF THE PANDEMIC, HAVE SHIFTED MARKEDLY. ALL EXPERIENCED THE USE OF INTERNET-BASED COMMUNICATION JUST LIKE WE ARE DOING TODAY WITH THIS ZOOM-BASED MEETING. THESE TELEMEDICINE OR ZOOM-BASED APPROACHES ARE BEING USED MORE AND MORE FOR HEALTH CARE DELIVERY. I WILL POINT OUT THAT WE USE THE TERM TELEMEDICINE BECAUSE IT'S NOT JUST INTERNET SUPPORTED BUT IT CAN ALSO BE REGULAR VOICE OR TRADITIONAL PHONE CALLS THAT CAN BE USED FOR HEALTH CARE DURING THESE TIMES AND A LIFELINE AND A LIFESAVER IN SO MANY SITUATIONS. WE WERE INTERESTED IN LEARNING MORE ABOUT THE IMPACT OF THE COVID PANDEMIC ON THE OPIOID AND SUBSTANCE USE ISSUES FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES AND THE WE CONVENED A MEETING LAST JUNE, JUNE OF 2020. IN THIS LISTENING SESSION, WE HEARD A GREAT DEAL ABOUT THE DEVASTATING CONSEQUENCES IN COMMUNITIES ACROSS THE COUNTRY RELATED TO OVERDOSE, RELAPSES, DRUG SUBSTITUTION, MENTAL HEALTH PROBLEMS, SUICIDALLY AND VIOLENCE. ALL RELATED TO THE UNDER SECRETARYING PROBLEMS OF COVID AND -- INTERSECTING PROBLEMS OF COVID AND ADDICTION ISSUES. IN ADDITION TO THE PROBLEMS, WE ALSO HEARD SOME POTENTIAL STRENGTHS IN TERMS OF COHESION AND COMMUNITIES COMING TOGETHER TO ADDRESS THESE INTERSECTING CRISIS AND ISSUES. AND I THINK SOME OF THAT IS REFLECTED IN THE VERY HIGH VACCINATION RATES THAT WE SEE IN MANY TRIBES ACROSS THE COUNTRY AS THEY CAME TOGETHER TO RESPOND TO THIS PUBLIC HEALTH CRISIS. SO WHAT ARE WE DOING ABOUT THE OVERDOSE CRISIS? ONE OF THE KEY TOOLS TO ADDRESS THE MORTALITY ASSOCIATED WITH OPIOIDS HAS BEEN TO MAKE SURE THAT MEDICATIONS THAT CAN SAVE LIVES ARE AVAILABLE ALL ACROSS THE COUNTRY WHERE PEOPLE NEED THEM. WHILE THERE IS SOME MORE LIMITED DATA ON THE IMPACT OF MEDICATIONS IN ADDRESSING FENTANYL-OPIOID USE DISORDER, PRELIMINARY INFORMATION AND SEVERAL STUDIES SUPPORT METHADONE AND BU NOR 15 AS LIFE-SAVING -- CLINICIANS TO BE ALLOWED -- WITHOUT PREVIOUSLY REQUIRED TRAINING FOR PHYSICIANS ABOUT 8 HOURS OF TRAINING FOR NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. IT'S 24 HOURS OF TRAINING. SO NOW THE REGISTRATION CAN BE DONE FOR SMALL NUMBERS OF PATIENTS WITHOUT THAT TRAINING REQUIREMENT. WE ARE JUST BEGINNING TO GET INFORMATION ABOUT HOW MUCH THIS LED TO INCREASED AVAILABILITY OR INCREASED ACCESS TO CARE AND I REALLY DON'T KNOW ANYTHING ABOUT ACCESS TO CARE IN THE TRIBES THAT YOU ALL REPRESENT SO I AM CURIOUS WHETHER YOU HAVE ANY INFORMATION ABOUT THAT AND CERTAINLY THAT IS A TOPIC THAT ALL OF US ARE INTERESTED IN LEARNING ABOUT. DOES THIS MAJOR POLICY CHANGE HAVE AN IMPACT ON TRIBES AND AMERICAN INDIAN POPULATIONS OUTSIDE OF TRIBAL AREAS? IN ADDITION TO FOCUSING ON THE OPIOID USE DISORDER, WE HAVE BEEN ARE FOCUSED ON METHAMPHETAMINE USE DISORDER AND METHAMPHETAMINE OVERDOSES. AND MEDICATIONS APPROVED BY THE FD TOO. TREAT METHAMPHETAMINE USE DISORDER OR OVERDOSE. WE DO HAVE BEHAVIOR THERAPIES LIKE CONTINGENCY MANAGEMENT AND PARTICULARLY CONTINGENCY MANAGEMENT COMBINED WITH COMMUNITY REINFORCEMENT APPROACHES THAT HAVE BEEN SHOWN IN MULTIPLE STUDIES TO BE HELPFUL FOR METHAMPHETAMINE USE DISORDER. I'M LEADS IN THIS LAST YEAR, WE SAW A COMBINATION OF NALTREXONE AND BUPRENORPHINE LOOKS PROMISING TO IMPROVE OUTCOMES FOR PERSONS WITH THIS DISORDER. WHERE WE SEE A MARKED INCREASE IN POSITIVE RESPONSE TO TREATMENT WITH MEDICATIONS COMPARED TO THOSE WITH THE PLACEBO GROUP OR COMPARISON GROUP. NOW I WANT TO END BY FOCUSING ON SOCIAL ISSUES AND HOW THESE RELATE TO DRUG USE. THERE IS A BASIC SCIENCE STUDY THAT WAS PUBLISHED A COUPLE OF YEARS AGO BY OUR COLLEAGUES IN THE INTRAMURAL RESEARCH PROGRAM AT NIDA THAT DOCUMENTED THAT RODENTS, AND THAT'S THE TYPICAL MODEL USED TO STUDY THE BASIC SCIENCE, THE BRAIN EFFECTS AND THE BASIC EFFECTS OF SUBSTANCES, THAT RODENTS WILL CHOOSE SOCIAL INTERACTIONS OVER HEROIN MANY POKE CREATURES, INCLUDING HUMANS AS WELL AS ANIMAL MODELS TO SELECT THE DRUG OVER OTHER REWARDING BEHAVIOR. BUT IT TURNS OUT RODENTS JUST LIKE HUMANS, HAVE VERY ACTIVE SOCIAL INTERACTIONS AND GIVEN A CHOICE BETWEEN PLAYING WITH ANOTHER CREATURE OR USING DRUGS, THEY'LL CHOOSE THE PLAYING OR SOCIAL INTERACTIONS. THEY DID FIND THAT BY PUNISHING THIS AWARD THEY WILL SHIFT TO DRUG USE. SO I THINK THIS REMINDS US OF THE COMPLEXITIES OF SOCIAL INTERACTIONS BUT ALSO THE IMPORTANCE OF SOCIAL FACTORS IN PREVENTING DRUG USE AND THEN POTENTIALLY IN SUPPORTING THE TREATMENT AND BROAD RECOVERY OUTCOMES. THIS IS AN INTRODUCTION TO THE OVERALL CONCEPT OF SOCIAL DETERMINANTS OF HEALTH AND WHILE I HIGHLIGHTED FOR YOU EARLY ON SOME OF THE HEALTH DISPARITIES RELATED TO AMERICAN INDIAN ALASKA NATIVE POPULATIONS, WE NEED TO LOOK BEYOND RACIAL IDENTITY FOR CLUES AS TO WHAT MIGHT EXPLAIN THE DISPARITIES AND OUR MOST LIKELY AREA OF INVESTIGATION WOULD BE THE SOCIAL DETERMINANTS OF HEALTH. DIFFERENCES IN HOUSING, CHILDHOOD EXPERIENCES, INERGENERATIONAL TRAUMA. THESE KIND OF DIFFERENCES CAN MAKE A VERY LARGE DIFFERENCE IN HEALTH CARE OUTCOMES AND MAYBE SOME OF THE REASONS FOR THE HEALTH DISPARITIES THAT WE SEE. ONE WAY I WANT TO INTRODUCE THIS IS BY REMINDING US OF HOW IMPORTANT IT IS TO MEASURE A BROAD RANGE OF ISSUES. FOR INSTANCE HERE IS A PRETTY TYPICAL STUDY COMPARING THE RATES OF DEPRESSIVE SYMPTOMS IN TWO AMERICAN INDIAN POPULATIONS COMPARED TO GENERAL U.S. POPULATIONS. WHAT WE SEE IS THAT THERE A HEALTH DISPARITY. THE AMERICAN INDIAN GROUPS IN THESE STUDIES SHOWN HIGHER RATES OF DEPRESSION. IF WE DIDN'T FOCUS ON OTHER ISSUES, WE MIGHT MISS IMPORTANT CLUES ABOUT WHERE WE COULD SUCCESSFULLY ADDRESS THESE PROBLEMS. WHEN WE LOOK AT POSITIVE MENTAL HEALTH MEASURES IN THESE SAME POPULATIONS, WHAT WE SEE IS THAT IN THE TWO AMERICAN INDIAN GROUPS, WE SEE HIGH OR EQUALLY HIGH RATES OF POSITIVE MENTAL HEALTH MEASURES, SUGGESTING THAT THERE ARE MANY AREAS OF STRENGTH TO BUILD UPON OR TO USE TO ADDRESS SOME OF THE UNDERLYING HEALTH DISPARITY ISSUES. THIS BUILDS ON AND COMPLIMENTS OBSERVATIONAL DATA THAT REMINDS US THAT CULTURAL FACTORS ARE LINKED TO MANY POSITIVE OUTCOMES WHETHER THAT IS ACADEMIC SUCCESS, DECREASED SUICIDALLY, AMONG YOUTH, OR FLOURISHING MENTAL HEALTH, LESS APATHY AND LESS SUBSTANCE USE AMONG ADULTS. OVERALL, SUGGESTING THAT CULTURAL FACTORS ARE LINKEDIN IMPORTANT WAYS TO BUFFERRINGS THE EFFECTS OF ADVERSE CHILDHOOD EXPERIENCES AND OTHER ISSUES RELATED TO INTERGENERATIONAL TRAUMA, AS WELL AS PHYSICAL AND MENTAL HEALTH PROBLEMS. I THINK THIS IS VERY IMPORTANT AS A PLATFORM ON WHICH TO THINK ABOUT INTERVENTIONS. I'M GOING TO END BY HIGHLIGHTING A TERRIFIC STUDY, THE FAMILY SPIRIT STUDY WAS A EXTRAORDINARILY WELL-DESIGNED PROJECT THAT LOOKS AT EARLY CHILDHOOD HOME VISESITATION AND INTERVENTION FOR AT-RISK TEEN MOTHERS. THE GOAL WAS TO HELP TEEN MOTHERS BE SUCCESSFUL AS PARENTS AND THROUGH THAT TO IMPROVE THE EMOTIONAL, BEHAVIORAL AND DEVELOPMENT OF CHILDREN IN PARTICULAR. IT MAY HAVE BEEN ON THE MOTHERS AS WELL AND OF COURSE WHEN WE ARE TALKING ABOUT FAMILY DECISIONS WE NEED TO BE THINKING ABOUT FAMILY AND THE COMMUNITY AS A WHOLE. THIS INTERVENTION WAS DEVELOPED IN PARTNERSHIP WITH THE AMERICAN INDIAN COMMUNITIES AND IT PROVIDED TRAINED PARAPROFESSIONALS TO TEACH A CURRICULUM TO AT RISK YOUNG MOTHERS. WHAT DO WE MEAN BY THAT? THEY WERE PREGNANT OR JUST AROUND THE TIME OF DELIVERY. THESE INTERVENTIONS TO GO PLAC IN THEIR HOMES T INVOLVES THEM AND THEIR FAMILIES. THE PARTICIPANTS WERE MOSTLY ALMOST ENTIRELY UNMARRIED. VERY HIGH RATES OF SUBSTANCE USE AND DEPRESSION SCORES. SO THAT'S WHAT WE MEANT SAYING THESE WERE AT-RISK TEEN MOTHERS. THE OUTCOMES HAVE SO FAR BEEN EXTRAORDINARY. THOSE WHO RECEIVED THE FAMILY SPIRIT INTERVENTION IN ADDITION TO RECEIVING UPGRADED PEDIATRIC CARE, SHOWED IMPROVED PARENTING SKILLS, BOTH IN TERMS OF KNOWLEDGE AND BEHAVIOR AND FEELING LESS STRESSED AND ALSO HAD ENHANCED SELF-EFFICACY, THEY FELT GOOD ABOUT THEMSELVES AND FELT EMPOWERED TO ENGAGE IN THEIR PARENTING MORE SUCCESSFULLY. THE MOTHERS REPORTED LESS DEPRESSION, LESS SUBSTANCE USE AND LESS OTHER FORMS OF RISKY BEHAVIORS. AND OUR TARGET FOR THIS INTERVENTION WAS THE CHILDREN AND WE HAVE SHOWN IMPROVED DEVELOPMENTAL OUTCOMES FOR THE FIRST. >>> FEW YEARS OF LIFE. THIS INTERVENTION HAS BEEN SO SUCCESSFUL IT IS NOW A MODEL IN 87 COMMUNITIES AROUND THE COUNTRY AND EVEN TWO NON-AMERICAN INDIAN COMMUNITIES. ONE IN CHICAGO AND ONE IN ST. LOUIS. THIS IS THE KIND OF INTERVENTION THAT I WANTED TO END WITH TO REMIND US THAT THERE ARE SOME WAYS TO ADDRESS THE CONCERNS AND WE WANT OUR RESEARCH TO LEAD TO SUCCESSFUL INTERVENTIONS FOR TRIBES AND AMERICAN INDIAN POPULATIONS WHERE EVER THEY MAY LIVE MOVING FORWARD. THAT'S WHAT I HAVE FOR A FORMAL OR RAPID FIRE PRESENTATION. AND I HAVE LEFT SOME TIME FOR QUESTIONS AND I LOOK FORWARD TO DISCUSSION. >> THANK YOU, WILSON. APPRECIATE YOUR PRESENTATION AND I WANT TO OPEN THE FLOOR TO ANY OF OUR TECHNICAL ADVISORS OR TAC MEMBERS TO HAVE QUESTIONS. GOING -- GOING -- >> LISA? I WANTED TO SAY THAT WAS REALLY POWERFUL PRESENTATION. A LOT OF GOOD DATA AND HOPEFULLY THAT PRESENTATION WILL APPEAR IN THE BOX SO WE CAN GET COPIES OF IT. AND MAYBE SOME MORE INFORMATION ON HOW SURVEILLANCE FOR SUBSTANCE ABUSE IS BEING DONE IN OUR COMMUNITIES AND BECAUSE I THINK THIS IS ONE OF THE ISSUES THAT NEEDS TO BE RESPONDED TO IN A QUICK FASHION. SO ALL OF THE PRIOR AND PREVENTIVE EFFORTS BUT ALSO QUICK RESPONSE IS NOT WAITING UNTIL THE -- AS TYLER SAID EARLIER, THE OPIOID EPIDEMIC WAS PREVALENT IN OTHER COMMUNITIES. SO THANK YOU DR. COMPTON. >> THANK YOU FOR THOSE COMMENTS. I WANT TO POINT OUT THAT JUST LIKE I SUGGESTED TO YOU, THAT SOME OF THE OVERDOSE DEATHS MAY BE UNDERCOUNTING AMERICAN INDIAN DEATHS BECAUSE OF THE RELIANCE ON DEATH CERTIFICATE INFORMATION NOTORIOUSLY INACCURATE. I'M PLEASED THAT DR. CATHY WHO I BELIEVE IS ON THE -- ON LINE WHERE US SOMEWHERE IN THIS TWO DIMENSIONAL SPACE, HAS LED OUR EFFORT AT NIDA TO ENGAGE THE TRIBAL EPICENTERS AND INQUIRY ABOUT WHAT SOME OF THE BARRIERS AND SOLUTIONS OF THE BARRIERS ARE TO COLLECTING BETTER INFORMATION FROM TRIBES ACROSS THE COUNTRY. AND AMERICAN INDIANS NOT LIVING IN TRIBAL AREAS. IT IS MADE DIFFICULT BY MOST OF THE NATIONAL DATA, REALLY DON'T PROVIDE CLUES OR A GOOD VISION INTO THE MULTIPLE TRIBES AND THE VARIATION ACROSS THE DIFFERENT TRIBES IN OUR COUNTRY. AND WE'LL GET A HANDLE ON DIFFERENCES IN THE POPULATIONS IN THE NORTH CENTRAL AREA COMPARED TO NAVAJO OR COMPARED TO OTHER OTHERS OVER THE MANY, MANY DIFFERENT POPULATIONS REPRESENTED BY THE GROUPS ON THIS TRIBAL ADVISORY COUNCIL LET ALONE ALL THE OTHER TRIBES IN THE COUNTRY. WHEN WE HAVE THAT REPORT FROM THE GROUP WORKING WITH THE TRIBAL EPICENTER, WE'LL SHARE IT WITH YOU. I HAVE NOT SUBMITTED MY SLIDES QUITE YET BUT I WILL GET THEM TO THE LEADERS OF THIS GROUP SO THEY CAN MAKE SURE THEY ARE SHARED WITH ALL OF YOU. I'M HAPPY TO DO THAT. >> HELLO. HI, MY NAME IS ED MEANIA AND I'M WITH THE TUCSON AREA OFFICE AND THANK YOU SO MUCH FOR YOUR PRESENTATION. I WANTED TO SHARE WITH YOU THAT JUST LAST NIGHT WE HAD A TOWN HALL IN MY COMMUNITY AND IT WAS ON -- WE HAVE A ANTIDRUG INITIATIVE AND SPECIFICALLY IT WAS TO TALK ABOUT FENTANYL. AND TO TALK ABOUT THE ISSUE WITH FENTANYL IN OUR COMMUNITY. AND ONE OF THE THINGS THAT WE SHARED THERE WAS THAT RIGHT NOW JUST IN OUR COUNTY, FENTANYL HAS BEEN THE NUMBER 1 CAUSE OF DEATH FOR PEOPLE UNDER THE AGE OF 19. AND THAT INFORMATION THAT WAS SHARED WITH SUSBECAUSE WE ARE SEEING IT IN OUR COMMUNITY WITH JUST THE KIDS EVEN IN OUR FOSTER CARE SYSTEM, WHEN SOMEBODY GETS -- WITH CPS OR -- WE KNOW IT'S AN ISSUE. SO THE INFORMATION THAT YOU SHARED WAS VERY IMPORTANT BECAUSE WE HAVE BEEN SO WRAPPED UP WITH THE PANDEMIC AND COVID THAT ONE OF THE THINGS IN OUR COMMUNITY, WE HAVE TO PAY ATTENTION TO THE IMPACT THAT THIS HAD AND WHAT IS ALREADY HAPPENING AND HOW PEOPLE ARE SELF MEDICATING OR HOW SOME PEOPLE -- WE SHARED THAT PEOPLE CAN'T GET THEIR -- THAT THE PEOPLE THAT ARE ALREADY IN PAIN, EITHER THEY ARE SELF MEDICATING BECAUSE OF THE TRAUMA, OR THEY CAN'T GET THEIR MEDICATIONS. THEY DON'T HAVE ACCESS TO THEIR MEDICATIONS SO THEY THINK THAT THEY DON'T REALIZE HOW POTENT FENTANYL IS AND THE DANGER OF IT BEING LACED THAT THEY JUST TAKE ONE AND ITS TOXIC T BECOMES LETHAL. SO JUST HAVING THAT COMMUNICATION WITH OUR COMMUNITY TO SHARE WITH THEM AND EDUCATE THEM AND HAVING THOSE PEOPLE WITHIN OUR COMMUNITY TO HAVE THAT CONVERSATION WAS REALLY IMPORTANT. SO THIS IS REALLY IMPORTANT. EVERYTHING YOU BROUGHT UP IS REALLY IMPORTANT BECAUSE IT IS SOMETHING THAT IS AT THE PULSE OF COMMUNITY THAT IS SOMETHING THAT WE NEED TO CONTINUE TO BE SHARING AT THE GRASSROOTS LEVEL WITH OUR IS IT THESHIP SO THEY ARE ALL AWARE WITH OUR -- CITIZENSHIP -- IN CONSTANT EDUCATION BECAUSE IT IS HAPPENING RIGHT NOW. >> I THINK YOU BROUGHT UP SOME OF THE DEVASTATION WE ARE SEEING IN SO MANY PARTS OF THE COUNTRY. UNFORTUNATELY, THE WEST WAS SOMEWHAT SPARED FROM FENTANYL UNTIL JUST THE LAST FEW YEARS AND WE HAVE SEEN IN THE LAST YEAR AND A HALF OR TWO YEARS REALLY DEVASTATING INCREASES IN FENTANYL IN AREAS OF THE COUNTRY THAT DIDN'T REALLY HAVE AS MUCH OF A PROBLEM WITH IT AS PREVIOUSLY. SO, WHAT YOU DESCRIBE IN YOUR COMMUNITY, MIGHT BE RELATED TO COUNTERFEIT PRESCRIPTION PILLS, FOR INSTANCE. THERE ARE A LOT OF PEOPLE NOW, YOU BUY A PILL PRESS. BUY FENTANYL AND YOU PRESS IT INTO SOMETHING THAT LOOKS AND MIMICS A PAIN KILLER. SO IT LOOKS TO MOST OF OUR EYES, IF YOU LOOK CAREFULLY, YOU CAN MAYBE TELL THERE IS A DIFFERENCE. BUT MOST PEOPLE THINK, THAT LOOKS LIKE THE CAN EXBAR THAT I NORMALLY WOULD TAKE FOR ANXIETY -- XANAX. OR SOMEBODY MIGHT HAVE OFFERED ME IN THE ILLICIT MARKETS PREVIOUSLY. UNFORTUNATELY WE ARE NOW SEEING THOSE THAT WHAT LOOK LIKE MEDICATIONS TO BE COUNTER FITS THAT HAVE SYNTHETIC OPIOIDS LIKE FENTANYL IN THEM. WE HAVE STARTED TO SEE FENTANYL SOMETIMES EVENLY IN STIMULANTS, METHAMPHETAMINE AND COCAINE SUPPLY. THAT ONE DOESN'T MAKE AS MUCH SENSE TO ME WHY A DRUG DEALER WOULD DO THAT. SOME OF IT MAY BE ACCIDENTAL. BUT IT LOOKS LIKE SOME OF IT IS INTENTIONAL AS WELL. SO THERE IS REALLY A LOT OF CONCERNS TO SHARE WITH COMMUNITIES AS YOU WERE DESCRIBING. I'M SO SORRY TO HEAR ABOUT THE PROBLEMS. I HOPE THAT THE INFORMATION WE PROVIDE WILL HELP SAVE LIVES. >> THANK YOU. >> TYLER? >> I JUST WANT TO POINTED OUT SOME INFORMATION AS A TRIBAL ADVISER. WORKING WITH EPICENTERS I THINK IS PROACTIVE. I THINK IT'S GREAT YOU REACHED OUT TO THEM ON SOME OF THESE THINGS BUT I DO WANT YOU TO BE COGNIZANT OF THE FACT THAT A MAERT JOY OF OUR EPICENTERS ARE NOT RUN BY TRIBAL PEOPLE. THEY ARE ACTUALLY VERY FEW EPICENTERS THAT ARE RUN BY NATIVE-AMERICANS AND THIS GOES BACK TO THE INFRASTRUCTURE ISSUE THAT WE HAVE WITH TRIBAL RESEARCHERS AND HEALTH PROFESSIONALS. AND EVEN MORE SO VERY, VERY FEW OF OUR TRIBAL EPIDEMIOLOGY CENTERS HAVE OVER 50% TRIBAL EMPLOYEES. SO THERE IS A COUPLE OF CASES WHERE THERE IS ONLY ONE NATIVE EMPLOYEE OUT OF 16-20 PEOPLE. SO I THINK THAT YOU NEED TO BE MINDFUL OF THAT WHEN LOOKING FOR REPRESENTATIVE INFORMATION BECAUSE WHILE THEY MAY HAVE DATA COLLECTED FROM PEOPLE THAT ARE PARTNERS, THEY DON'T NECESSARILY HAVE THE VOICE OF THE COMMUNITY BEHIND THEM. SO, THE OTHER THING WE TALKED ABOUT A LITTLE BIT IN OUR CAUCUS, ALSO ABOUT THE INFRASTRUCTURE ISSUE, IS THAT WE HAVE A LOT OF NON-NATIVE PEOPLE COMING THROUGH OUR EPIDEMIOLOGY CENTERS AND USING IT AS A STEPPING STONE IN THEIR CAREER AND WHAT WE WOULD LIKE TO SEE MORE SO AND IT REALLY ISN'T RELATED TO YOU, I'M JUST ADDRESSING THIS OUT IN THE OPEN, IS THAT WE WOULD LIKE TO SEE OR ENCOURAGEMENT OF NATIVE PROFESSIONALS BEING PUT IN POSITIONS. IF ANYBODY IS GOING TO USE IT AS A STEPPING STONE, IT SHOULD BE NATIVE-AMERICAN PEOPLE HELPING THEIR OWN PEOPLE. SO THOSE ARE THINGS I'D LIKE YOU TO BE COGNIZANT ABOUT WHEN YOU'RE GETTING THIS INFORMATION AND UNDERSTAND THAT GOING TO OUR TRIBAL LEADERS DIRECTLY MIGHT BE A BETTER -- GETTING THIS DATA AND INFORMATION AND THEN GOING TO OUR TRIBAL LEADERS AND DOING REAL CONSULTATION BODY ANDING WHAT THE TRIBAL LEADERS ARE SEEING IN THEIR COMMUNITIES AND THE WHAT THEY WANT WOULD BE MORE BENEFICIAL TO ANY KIND OF PROGRAMMING AND MOVING FORWARD WITH THAT. SO I JUST WANTED TO PUT THAT OUT THERE. I THINK EPICENTERS DO GREAT WORK BUT AGAIN IT IS IMPORTANT TO THE TRIBE THAT THEY ARE HEARD OVER THE VOICE OF PEOPLE WHO ARE TRYING TO HELP US. BECAUSE THEY ARE TWO TOTALLY DIFFERENT THINGS. SO THANK YOU VERY MUCH FOR BEING PATIENT. >> THANK YOU VERY MUCH FOR THOSE COMMENTS. I CERTAINLY TAKE THAT ADVICE VERY SERIOUSLY AND I APPRECIATE YOU BRINGING IT OUT INTO THE OPEN. WE NEED TO MAKE SURE THAT WE COMPLIMENT EVEN SOME OF THESE TYPICAL SOURCES OF INFORMATION WITH OTHER MORE DETAILED INFORMATION FROM THE PEOPLE WHO ARE ACTUALLY IMPACTED. I ALSO THINK THE OTHER ISSUE YOU BROUGHT UP IN TERMS OF WHAT I THINK OF HELICOPTER RESEARCH OR -- I DON'T WANT TO USE SOMETHING MORE DISPARAGING BUT OUTSIDE PEOPLE COMING IN BECAUSE SOMETHING ISN'T IMPORTANT OR A POPULAR TOPIC BUT NOT REALLY REPRESENTING INTEGRATED FULL CHANGE FOR A COMMUNITY IS SOMETHING WE WOULD LIKE TO AVOID AVOID. WE ARE VERY MOVING TOWARDS RESEARCHERS, AMERICAN INDYARN ALASKA NATIVE RESEARCHERS THEMSELVES STUDYING EPIDEMIOLOGY AND EPICENTERS ARE IMPORTANT TO THEIR OWN POPULATION. WE ARE HAPPY IF THEY ALSO BECOME BASIC SCIENTISTS, NEUROSCIENTISTS, OR PHYSICIANS WHO WANT TO STUDY HEART DISEASE. THAT WOULD BE FINE TOO. PLEASE BRING YOUR BEST CANDIDATES TO US AND WE WILL WORK WITH THEM AS BEST WE CAN TO SUPPORT THEIR CAREERS. >> LISA. I'M NORTHERN CALIFORNIA AND I WANTED TO BRING TO YOUR ATTENTION SINCE WE ARE ON THIS SUBJECT AND YOU SIT WHERE YOU SIT AND YOUR POSITION. A LOT OF TREATMENTS, SELF TREATMENTS, ARE DIRECTLY RELATED TO TRAUMA, WHATEVER THEY ARE. AND INDIGENOUS COMMUNITY, BECAUSE I LOVE IN AN AREA WHERE THERE IS A LOT OF CAN BUS AND MUSHROOMS NATURALLY HERE IN THIS SPACE, BUT I BELIEVE THAT IT'S TIME WE START LOOKING AT FUNDING NATURAL MEDICINE. THERE IS SAY MOVEMENT OF DECRIMINALIZING NATURE SO WE CAN GO BACK AND RESEARCH THE IMPACT ON -- IN RESPONSE TO OPIOIDS, WE NEED IT IN DOSAGES. WE NEED A SAFE PLACE TO STUDY THIS AND I THINK IT WOULD BE A GOOD TIME TO STARTED FUNDING AN ACTIVE PLANT MEDICINE RESEARCH WITH NATIVE RESEARCHERS DONE IN CEREMONY AND HOW THAT HELPS WITH RELIEVING TRAUMA. BECAUSE YOU KNOW THERE HAS BEEN STUDIES THAT TALK ABOUT MICRODOSING AND THINGS LIKE THAT IN A SAFE ENVIRONMENT PROPERLY TREATED. BECAUSE OPIOIDS ARE A TREATMENT BUT IT'S ABUSED, RIGHT? SO WE WANT TO TAKE ACTIVE PLANT MEDICINE, DO IT IN CEREMONY TO HELP PEOPLE TREAT PTSD, FOR INSTANCE. OR BECAUSE THAT IS ALL TRAUMA-BASED THINGS. WE NEED FUNDING FOR THAT AND IT'S ALL SYNTHETIC FUNDING. IT'S NOT NATURAL PLANT MEDICINE, ACTIVE PLANT MEDICINE FUNDING. SO WE NEED THAT TYPE OF DOOR OPENED AND PARTNERSHIP SO THAT THE TRIBAL RESEARCHERS AND PEOPLE THAT DO THESE THINGS DONE IN CEREMONY, CAN ACTIVELY LOOK AT THAT SO WE HAVE A PROCESS WE CAN INCORPORATE INTO OUR NATURAL PROCESSES. BECAUSE IT'S KIND OF BEING HODGE BODGED NOW BUT WE NEED REAL RESEARCH. WE NEED THE DATA BEHIND IT. WE NEED TO BE ALLOWED TO DO THAT AS SOVEREIGN ENTITIES AND PLANT MEDICINE IN OUR BACKYARD. >> ADDRESSING THE FULL COMPLEXITIES OF THESE ISSUES WILL GO BEYOND THE NEXT FEW MINUTES. I AGREE WE NEED RESEARCH TO ADDRESS PROMISING AREAS OF HEALTH AND SCIENCE. FIGURING OUT HOW TO BUILD ON INDIVIDUAL PERSON'S EXPERIENCE AND UNDERSTAND WHAT HELP ONE PERSON CAN BE A CLUE ABOUT WHAT MIGHT HELP SOMEBODY ELSE. AT THE SAME TIME, I'M A RIGOROUS RESEARCH DESIGN KIND OF PERSON. AND SO I WANT TO MAKE SURE THAT IT'S STUDIED IN A WAY THE INFORMATION THAT COMES OUT AT THE END WILL BE ACTIONABLE L PROVIDE ANSWERS THAT WE CAN RELY ON AND THEN CAN GENERALIZE TO OTHER PEOPLE. AND THAT HASN'T BEEN SO EASY TO DO. SO THIS IS A COMPLICATED AREA AND TOUCHES ON A LEGAL ISSUE IN TERMS OF WHAT SUBSTANCES ARE LEGAL AND FEDERAL VERSUS STATE VERSUS TRIBAL AREA AS WELL AS SCIENTIFIC OPPORTUNITIES. BUT I CERTAINLY AGREE WE NEED TO MAKE SURE THAT WE UNDERSTAND HOW, WHAT YOU DESCRIBED AS -- I WOULD CALL BOTANICAL SUBSTANCES BUT SOMETHING IN PLANT-BASED MEDICINE CAN BE HOPEFUL FOR MANY SERIOUS CONDITIONS. WE JUST FUNDED A GROUP TO LOOK AT HOW SILL I CYB IN MAY BE USEFUL IN THE TREATMENT OF TOBACCO USE DISORDER AS ONE POTENTIAL EARLY WAY TO APPROACH THIS FIELD. BUT THERE MAY BE MANY OTHER OPPORTUNITIES. WHEN IT COMES PTSD AND DEPRESSION, I CERTAINLY SEE THESE AS PROMISING AREAS OF INVESTIGATION AND I WILL ENCOURAGE SOMEWHAT MY OWN GROUP BUT PARTICULARLY MY COLLEAGUES AT THE NATIONAL INSTITUTE OF MENTAL HEALTH TO REALLY LOOK INTO THIS IN DETAIL. >> AND I THINK IT'S JUST THAT THE WHEN I SAY THAT, IT'S A RESPONSE TO DRUG ABUSE AS SOMETHING THAT CAN BE SAFELY TRANSITIONED INTO SOMETHING ELSE INSTEAD OF ANOTHER ADDICTIVE -- SOMETHING THAT IS SYNTHETIC. BUT THANK YOU SO MUCH FOR YOUR TIME. I KNOW I THREW A CURVEBALL AT YOU PROBABLY. IT HAD TO BE SAID. >> YOU'RE THE ADVISORY COMMITTEE. THAT'S THE POINT IS TO HEAR YOUR ADVICE AND I APPRECIATE IT. >> THANK YOU VERY MUCH. AND WE ARE ON TOO OUR NEXT SPEAKER BUT I WANT TO THANK YOU FOR YOUR TIME. EXCELLENT PRESENTATIONING AND WE LOOK FORWARD TO SEEING YOUR SLIDES AND EVERYTHING AND LEAVE THOSE WITH OUR FOLKS AND THEY'LL BE IN OUR DROPBOX. >> IF THERE ARE ANY OTHER QUESTIONS, JUST REACH TOUT ME PERSONALLY, I'M HAPPY TO RESPOND. >> FANTASTIC. THANK YOU. DAVE, CAN YOU INTRODUCE OUR NEXT GUEST, PLEASE? >> SURE. IT'S MY PLEASURE TO WELCOME BACK DR. JON LORSCH WHO IS THE DIRECTOR OF THE NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES AND NIGMS IS THE INSTITUTES SUPPORTS BASIC RESEARCH THAT INCREASES OUR UNDERSTANDING OF BIOLOGICAL PROCESSES AND LAYS THE FOUNDATION FOR ADVANCES IN DISEASE DIAGNOSTICS, TREATMENT, PREVENTION. NIGMS -- I DIDN'T KNOW THIS -- SUPPORTS MORE THAN 5,500 INVESTIGATORS AND 5000 RESEARCH GRANTS WHICH ADDS UP TO AROUND 11% OF TOTAL NUMBER OF GRANTS FUNDED BY THE NIH AS A WHOLE. SO I DIDN'T KNOW. THAT'S REALLY INTERESTING. NIGMS IS THE HOME OF THE MORPH PROGRAM AND WILL HE IS HERE WITH US TO TALK ABOUT THE CONSULTATION PROCESS AND THE OUTCOMES OF THE NARCH PROGRAM. SO I'D LIKE TO TURN IT OVER TO YOU. >> THANK YOU. CAN YOU HEAR ME? >> PERFECT. >> GREAT. LET ME SHARE. THANK YOU FOR HAVING ME BACK TO TELL YOU ABOUT THE RESULTS OF THE FAR EVALUATION AND TRIBAL CONSULTATION PROCESS AND FOCUSING ON THE NEXT STEPS BASED ON WHAT WE HEARD DURING THAT PROCESS. JUST TO REMIND YOU OF HOW THE PROCESS WORKS IN 2020 WE PERFORMED A COMPREHENSIVE ANALYSIS OF THE MATCHPROGRAM INCLUDING OUTCOMES, MEASURES, DATA ANALYSIS, QUANTITATIVE AND QUALITATIVE. WE THEN IN FEBRUARY WITH THE HELP OF THRO IN DAVE'S OFFICE, SENT A DEAR TRIBAL LEADER LEADER TO ALL FEDERALLY RECOGNIZED TRIBES INFORMING THEM WE ARE DOING THIS EVALUATION AND ASKING FOR A FORMAL TRIBAL CONSULTATION. IN MARCH, WE HAD AN ORIENTATION MEETING FOR A WORKING GROUP, AN EVALUATION WORKING GROUP THAT WAS WORKING GROUP OF THE NIGMS COUNCIL WE PUT TOGETHER TO ORIENT THEM TO THIS EVALUATION PROCESS THAT WE WERE GOING TO ASK THEM FOR FEEDBACK INTO. IN APRIL, WE HAD A FULL-DAY MEETING OF THAT GROUP. THEY SEEN THE DATA IN ADVANCE. THEY DISCUSSED THE DATA AND THEY DEVELOPED SOME DRAFT SUGGESTIONS AND OBSERVATIONS ABOUT THE PROGRAM. IN MAY, HOPEFULLY YOU RECALL, WE PRESENTED THOSE DELIBERATIONS AND SUGGESTIONS TO YOU AND THEN IN JUNE, WE HAD THE FORMAL TRIBAL CONSULTATION REGARDING WHAT WE HEARD BOTH FROM THE EVALUATION GROUP AND FROM THE TAC. WRITTEN FEEDBACK WAS GIVEN TOWARDS THE EARNED OF AUGUST FROM THE TRIBAL LEADERS AND THEN IN SEPTEMBER, WE PRESENTED WHAT WE HEARD FROM THE TRIBAL LEADERTS AND FORMAL TRIBAL CONSULTATION AND THE REST OF THE PROCESS TO OUR ADVISORY COUNCIL AND THEN WE IN THE END OF SEPTEMBER, POSTED THE WRITTEN RESPONSE TO THE TRIBAL LEADERS ON THE NIH WEBSITE AND THE NIGMS WEBSITE AND LET THE TRIBAL LEADERS KNOW THAT WAS THERE. SO WE ARE COMING NOW BACK TO YOU AT YOUR REQUEST TO TELL YOU HOW THIS PROCESS WENT AND WHAT WE ARE PLANNING AND WORKING ON IN TERMS OF CHANGES TO THE PROGRAM AND IMPLEMENTING THE IDEAS THAT WE HEARD. SO LET ME JUST SUMMARIZE FIRST WHAT WE HEARD FROM THE TRIBAL CONSULTATION SINCE THAT OCCURRED AFTER WE SPOKE TO YOU. THE FIRST THING WE HEARD FROM THE TAC AS WELL IS THAT WE SHOULD ENSURE THAT BOTH RESEARCH PROJECTS, INFRASTRUCTURE AND CAPACITY-BUILDING PROJECTS SUPPORTED BY NARCH ARE CONDUCTED AND CONCEIVE THE TRIBAL NATIONS AND COMMUNITIES RATHER THAN BY ACADEMIC PARTNER INSTITUTIONS. IT WAS SUGGESTED BY THE TRIBAL LEADERS THAT WE REMOVE BARRIERS TO APPLICATION BY REDUCING THE COMPLEXITY OF THE MISSION REQUIREMENTS, COMPLEXITY FOA FOR EXAMPLE, AND THAT WOULD PARTICULARLY HELP TRIBAL NATIONS AND ORGANIZATIONS THAT DON'T ALREADY HOLD NIH GRANTS, WHICH OBVIOUSLY PART OF THAT CAPACITY BUILDING GOAL. THEY SUGGESTED AS YOU HAD, THAT WE ENSURE THAT REVIEWERS UNDERSTAND THE IMPORTANCE OF CULTURE AND LANGUAGE AS RESEARCH ELEMENTS FOR EXAMINING HEALTH DISPARITIES, RESILIENCE AND IN DEALING WITH TRAUMA IN THE INDIAN COUNTRY AND THEY PARTICULARLY POINTED US AGAIN AS THE TAC DID, TO UTILIZING THE AMERICAN INDIAN AND ALASKA NATIVE RESEARCH AND HEALTH SCIENCES CONSIDERATIONS THAT WERE DEVELOPED A COUPLE OF YEARS AGO THROUGH THE THRO OFFICE. WE ALSO HEARD THE CALL WE -- A LOT OF SUPPORT FOR AMERICAN INDIAN AND ALASKA NATIVE TRAINEES EARLIER IN THE PATHWAY, FOR INSTANCE STARTING IN HIGH SCHOOL RATHER THAN JUST AS UNDERGRADUATES AND PROVIDING GREATER SUPPORT TO AMERICAN INDIAN AND ALASKA NATIVE INSTITUTIONS OF HIGHER LEARNING, SUCH AS TRIBAL COLLEGES AND UNIVERSITIES. THEY WANT TO PROVIDE STABLE ADMINISTRATIVE CORE FUNDING AND INCREASE OVERALL PROGRAM FUNDING TO SUPPORT NEW GRANTEES ALONGSIDE THE EXISTING ONES. MAKE FUNDING ANNOUNCEMENTS CONTINUOUS UNDER THE CURRENT SKIPPED CYCLE. CURRENTLY THERE IS A TWO YEAR SKIP BETWEEN THE TWO CONSECUTIVE YEARS OF THE FUNDING ANNOUNCEMENTS. THEY SUGGESTED WE CREATE OPPORTUNITIES FOR NEW APPLICANTS TO LEARN FROM EXISTING GRANTEES THROUGH MENTORSHIP OR COLLABORATION ON PROPOSALS. AND FINALLY THEY WANTED US TO CONTINUE THE TRIBAL CONSULTATION PROCESS BY CONDUCTING A REGULAR CONSULTATION INCLUDING CONSULTATIONS RELATED TO PROGRAMMATIC CHANGES AND ANY FUTURE PROGRAM EVALUATIONS. SO THOSE WERE THE MAIN THINGS THAT WE HEARD FROM THE TRIBAL CONSULTATION PROCESS. I SHOULD SAY THAT I THINK THIS PROCESS WAS EXTREMELY HELPFUL TO US. IT REALLY EXCEEDED OUR EXPECTATIONS IN TERMS OF WHAT WE LEARNED AND THE INFORMATION AND IDEAS THAT THE COMMUNITY GAVE TO US. SO WE REALLY THANKED TRIBAL LEADERS FOR THAT INFORMATION. WE ALSO THANKED THE TAC AND THE EVALUATION GROUP THAT PROVIDED INFORMATION AS WELL. SO LET ME TELL YOU AN OVERVIEW OF SOME OF WHAT WE ARE PLANNING HERE. THE AND TO GET YOUR FEEDBACK ON AS WELL. SO A NUMBER OF CHANGES ARE PLANNED IN THE NARCH PROGRAM ITSELF IN ORDER TO ADDRESS WHAT WE HEARD DURING THIS PROCESS. THE FIRST, AS YOU HEARD, A SUGGESTION WE GO TO ONE RECEIPT DATE A YEAR. THAT IS OUR PLAN. WE WILL MOVE IN THE FUTURE TO HAVING ONE RECEIPT DATE FOR NARCH A YEAR RATHER THAN THE SKIPPED TWO-YEAR CYCLES. WE PLAN TO ALLOW FOR RENEWALS TO INCREASE THE STABILITY OF FUNDING. SO A TRIBE OR TRIBAL ORGANIZATION THAT HAS A NARCH COULD APPLY TO RENEW IT RATHER THAN APPLY FOR A COMPLETELY NEW NARCH EACH TIME. AND THAT WOULD, GIVE CONTINUITY IN THE ABILITY TO BUILD IN TERMS OF THINGS LIKE CAPACITY BUILDING AND INCREASE THAT CAPACITY OVER TIME. WE ARE GOING TO WORK VERY HARD TO SIMPLIFY THE APPLICATION AND AWARD ADMINISTRATION. I THINK WE ALREADY HAVE A NUMBER OF IDEAS LOOKING AT THE FOA AND COMPLEXITY AND LENGTH IN TERMS OF THE APPLICATION PROCESS. ONE OF MY SENIOR LEADERS WAS LOOKING AT IT AND SAID THAT IT WAS ESSENTIALLY LIKE WRITING 10 RO1s AND BUNDLING THEM TOGETHER IT'S A LOT TO ASK ORGANIZATIONS TO DO. I THINK THERE ARE WAYS WE CAN SIMPLIFY THAT AND STILL GET THE SAME OR BETTER QUALITY IN TERMS OF THE APPLICATION AND IN TERMS OF REVIEWING IT. WE WANT TO INCREASE THE EMPHASIS ON CAPACITY-BUILDING PROJECTS. YOU MAY RECALL THOSE WERE ALLOWED A FEW YEARS AGO IN THE PROGRAM. I THINK PERHAPS THERE IS NOT BEEN ENOUGH EMPHASIS ON THE IMPORTANCE OF CAPACITY-BUILDING PROJECTS AND THEN PERHAPS REVIEWERS HAVE NOT FULLY APPRECIATED THE EMPHASIS WE WANT TO PLACE ON THOSE RELATIVE TO JUST HAVING RESEARCH PROJECTS. SO THAT IS SOMETHING WE WILL BE DOING AS WE WORK THE FOA AND THE PROGRAM AND THE REVIEW CONSIDERATIONS. WE WANT TO INCREASE THE EMPHASIS TRIBES CONDUCTING RESEARCH THEMSELVES. THAT'S SOMETHING WE HEARD LOUD AND CLEAR FROM YOU AND ALSO IN THE TRIBAL CONSULTATION PROCESS. AND THAT INCLUDES ENSURING THAT TRIBALLY-BASED RESEARCHERS RECEIVE APPROPRIATE CREDIT AND RECOGNITION. IN ONE OF THE LAST COMMENTS TO WILSON'S TALK, THIS CAME UP, THIS EXACT ISSUE CAME UP. AND I THINK ONE OF THE CLEAR GOALS OF THE NARCH PROGRAM IS TO BUILD THE CAPACITY OF THE TRIBES THEMSELVES TO DO RESEARCH AND OF THE RESEARCHERS WITHIN THOSE TRIBAL COMMUNITIES AND PART OF THAT BUILDING INCLUDES THINGS LIKEN SURING THAT THEY ARE CONCEIVING THE RESEARCH, CONDUCTING THE RESEARCH AND GETTING CREDIT IN TERMS OF CAREERS FOR DOING THAT RESEARCH. WE PLAN TO EXPAND THE CAREER DEVELOPMENT PROJECTS TO ALLOW PRE-K-12 PROJECTS. THE INITIAL SUGGESTION WAS HIGH SCHOOL BUT WE THINK THERE COULD BE VERY IMPORTANT PROJECTS EVEN IN MIDDLE OR ELEMENTARY SCHOOL AND SO HOPEFULLY WE WILL BE ABLE TO OPEN IT UP TO A BROADER RANGE IN TERMS OF CAREER STAGE, EDUCATION STAGE. WE PLAN TO ALLOW ALTERATION AND RENOVATION, ALSO CALLED ANR PROJECTS TO ALLOW YOU TO RENOVATE SPACES AND MAKE ALTERATIONS. THIS IS ESPECIALLY TARGETED AT THE CALL FOR HELPING TRIBAL COLLEGES AND UNIVERSITIES EXPAND THEIR CAPACITY SO FOR INSTANCE A YOU MAY WANT TO RENOVATE THEIR TEACHING LAB SPACES, FOR EXAMPLE. OR OTHER LEARNING STUDIO SPACES TO PROVIDE RESOURCES TO DO THAT. WE WANT TO ENHANCE REVIEWER TRAINING. USE THE PRINCIPLES THAT ARE IN THAT IMPORTANT DOCUMENT THAT WAS PUT OUT. WE ARE GOING TO HAVE TO FIGURE OUT EXACTLY HOW TO DO THAT IN A WAY THAT IS EFFICIENT AND IMPACTFUL. I THINK ONE OF THE PROBLEMS WE HEARD IS WE HAVE BEGUN EXPLORING THIS, THE DOCUMENTS OR THE TEXT FOR THE DOCUMENTS, 40 PAGES LONG. IT'S VERY THOROUGH AND WELL-CONCEIVED DOCUMENT BUT IT'S DIFFICULT FOR REVIEWERS TO READ IT AND PROCESS IT IN THE TIME THEY HAVE PRIOR TO REVIEWING APPLICATIONS. SO, IDEAS WE HAVE ARE TAKING THE KEY PRINCIPLES OF THAT DOCUMENT AND MAKING FOR INSTANCE A POWERPOINT PRESENTATION THAT CAN BE USED IF YOU WERE TRAINING OR PERHAPS EVEN MAKING A VIDEO PRESENTATION THAT COULD BE USED IN REVIEWER TRAINING. SO THOUGHTS ON THAT WOULD BE USEFUL. WE WANT TO REVIEW THE CRITERIA WITH ALL THESE GOALS INCLUDING RECOGNIZING CULTURALLY-APPROPRIATE RESEARCH QUESTIONS AND METHODS AND RESEARCHERS AND OUTCOMES MEASURES. SO FOR EXAMPLE, NOT NECESSARILY THOSE THAT COME FROM TRADITIONAL ACADEMIA. THAT IS SOMETHING WE HEARD FROM THE TAC AND FROM TRIBAL LEADERS AND SO I THINK MAKING SURE THAT THE REVIEW CRITERIA REALLY REINFORCE ALL THE GOALS OF THIS PROGRAM AND THAT THEY DON'T INADVERTENTLY DRIVE IT IN DIRECTION THAT IS WE DON'T INTEND IT TO GO AND DON'T INADVERTENTLY INCENTIVIZE THE WRONG THINGS ARE GOING TO BE VERY IMPORTANT AS WE RE-WORK THIS PROGRAM. SO THAT'S THE NARCH PROGRAM ITSELF. WHAT CAME UP IN THESE DISCUSSIONS WAS THAT IN ADDITION TO NARCH, WHICH WE HAVE A CONTINUED COMMITMENT FOR, AND WE WANT TO FUND AT OR ABOVE CURRENT LEVELS AS WAS INDICATED BY TRIBAL LEADERS, THERE IS A POTENTIAL THAT OTHER PROGRAMS THAT WOULD SUPPORT THE GOALS OF NARCH WOULD ALSO BE QUITE USEFUL TO THE COMMUNITY. AND SO, WE DISCUSSED THESE WITH TRIBAL LEADERS DURING THE CONSULTATION AND THERE SEEMS TO BE ENTHUSIASM FOR THEM. LET ME RUN THEM PAST YOU AS WELL. SO, FIRST POSSIBLE NEW PROGRAM WHICH WILL BE IN ADDITION TO THE NARCH PROGRAM AND THE POTENTIAL CHANGES TO THAT I JUST DETAILED FOR YOU. THE FIRST WOULD BE A NEEDS ASSESSMENT AND PLANNING GRANT PROGRAM FOR TRIBE THAT IS DON'T HAVE NARCH AWARDS. SO THIS WILL BE A SMALLER, SHORTER GRANT PROGRAM, MAYBE 1-2 YEARS, ALLOW TRIBES THAT DON'T HAVE NARCHS TO PROVIDE THEM TIME AND RESOURCES TO ASSESS THEIR RESEARCH NEEDS, CAPACITY-BUILDING NEEDS, TRAINING NEEDS AND THEN DEVELOP PLANS TO ADDRESS THEM. SO TIME AND SUPPORT FOR THE TRIBES TO DEFINE RESEARCH QUESTIONS AND PLAN HOW TO ANSWER THEM SO RATHER THAN HAVING EXTERNAL ORGANIZATIONS FROM ACADEMIA, FOR INSTANCE, COME TO TRIBES AND SAY, WE HAVE AN IDEA FOR A GOOD NARCH PROGRAM. DO YOU WANT TO WRITE IT WITH US? THE TRIBES THEMSELVES WOULD HAVE TIME TO THINK ABOUT IT AND PLAN WHAT IT IS THEY PRIORITIZE AS THE IMPORTANT QUESTIONS AND HOW THEY WANTED TO ANSWER THOSE QUESTIONS. TIME AND SUPPORT FOR TRIBES TO ASSESS CAPACITY BUILDING AND TRAINING NEEDS. TIME TOL BUILD THE ADMINISTRATIVE CAPACITY TO SUPPORT THE APPLICATION PROCESS AND GRANTS MANAGEMENT. TIME TO IDENTIFY ANY NEEDED CONSULTANTS, CONTRACTORS OR COLLABORATORS. THESE COULD BE ACTIVE NARCH AWARDEES WHO MIGHT WANT TO HELP THIS TRIBAL ORGANIZATION THAT DOESN'T HAVE THE MATCHGRANT THINK ABOUT HOW TO MOVE FORWARD AND MAYBE DEVELOP A COLLABORATION WITH THEM. SUPPORT THINGS LIKE MEETINGS, TRAVEL, STAFF TIME, CONSULTATION, AND THE GOAL WOULD BE TO INCREASE THE NUMBER OF COMPETITIVE NARCH AND OTHER GRANT APPLICATIONS THAT WERE ACTUALLY DRIVEN BY TRIBAL, LEADERS IN THE TRIBAL COMMUNITY. NEXT IDEA RELATED TO CAPACITY BUILDING IN THE TRIBES IS A TRIBAL TECHNICAL ASSISTANCE RESOURCE CENTER. THIS WOULD PROVIDE SUPPORT FOR TRIBES IN APPLYING FOR AND ADMINISTERING NIH GRANTS. THEY COULD PROVIDE TRAINING AND CONSULTING TO HELP TRIBES ESTABLISH THEIR OWN SPONSORED PROGRAMS OFFICES OR INCREASE THE CAPACITY OR SKILLS THESE PROGRAM OFFICES. THEY COULD ALLOW THEM TO GET TRAINING AND CONSULTING HELP. SO ALSO DEVELOP CAPACITY FOR FINANCIAL ADMINISTRATION OF NIH OR OTHER GRANTS AND THIS IS SIMILAR TO A CONCEPT THAT WE JUST LAUNCHED FOR OUR SURE PROGRAM WHICH IS CALLED THE SURE RESOURCE CENTER, WHICH HAS THE SAME GOALS AS THIS BUT MORE BROADLY FOR MINORITY SURVEYING UNDER RESOURCED INSTITUTIONS. GOING ALONG WITH THIS, A SECOND PROGRAM WOULD BE WE HOPE COMPLEMENTARY, WHICH WOULD BE GRANTS DIRECTLY TO TRIBES TO HELP THEM BUILD OR ENHANCE THEIR OWN SPONSORED PROGRAMS OFFICES. SO THEY COULD PAY FOR THE TRIBE TO DEVELOP CAPACITY TO APPLY FOR AND ADMINISTER GRANTS SUPPORTING STAFF TRAINING, SYSTEMS PURCHASES OR UPGRADES AND THE SYSTEM REQUIRED TO ADMINISTER FINANCIAL MANAGEMENT SYSTEMS AND CONSULTING SERVICES. WE VALUES A PROGRAM LIKE THIS AS WELL ONGOING, IT'S CALLED SPAD. IT IS PART OF THE DIVERSITY OF THE PROGRAM CONSORTIUM. SO THIS IS THE SPIN OFF OF THE SPAD PROGRAM DEDICATED TO TRIBES AND TRIBAL ORGANIZATIONS. ANOTHER IDEA WE HAD IS GRANTS TO SUPPORT THE ESTABLISHMENT OR ENHANCEMENT OF TRIBAL INSTITUTIONAL REVIEW BOARDS. SO THESE GRANTS MIGHT SUPPORT STAFF TIME, CONSULTATION, TRAINING, SYSTEMS PROCUREMENT OR DEVELOPMENT THAT WOULD BE REQUIRED TO DEVELOP A NEW IRB IN TRIBAL REEG ORGANIZATION OR ENHANCE AN EXISTING ONE. THE QUESTION WE HAVE IS, NARCH CURRENTLY ALLOWS IRB DEVELOPMENT OR ENHANCEMENT PROJECTS AND I THINK WE FUNDED A COUPLE AT THIS POINT. BUT IS THAT SUFFICIENT? THERE IS A INTERNAL DEBATE WE ARE HAVING ABOUT WHETHER THAT IS SUFFICIENT OR NOT. ONE ISSUE WOULD BE IF YOU'RE NOT READY YET TO GET A NARCH, YOU WOULD THEREFORE NOT BE ABLE TO GET A GRANT TO SUPPORT YOUR IRB, WHICH MAY BE REQUIRED TO GET A NARCH. SO THERE MAY BE A CHICKEN-AND-EGG PROBLEM THERE. WE WOULD APPRECIATE FEEDBACK ON WHETHER THIS PROGRAM, IN ADDITION TO WHAT IS ALLOWED THROUGH MATCH, WOULD BE HELPFUL. -- MATCH. AND THEN FINALLY, AN IDEA AND THIS CAME UP FROM THE TAC PROVIDE TUITION AND ADMISSION AND STIPENDS FOR STUDIES TOWARDS A BACHELOR'S DEGREE INCLUDING AT TWO-YEAR COLLEGES AND TCUs, USUALLY THEY WOULD PROVIDE RESEARCH EXPERIENCES AND MENTORING AS WELL AND THEN THERE COULD BE A GRADUATE VERSION OF THAT. A T32 FOR TUITION OR MISSION AND STIPENDS FOR STUDIES TOWARDS PH.D. AND ALSO PROVIDE RESEARCH EXPERIENCE MENTORING AND CAREER DEVELOPMENT. THE GOAL IS TO DEVELOP FUTURE RESEARCHERS. THIS COMES FROM THE OBSERVATION THAT OVER THE PAST 20 PLUS YEARS THE NUMBER OF INDIVIDUALS FROM AFRICAN-AMERICAN AND HISPANIC BACKGROUNDS GETTING PH.D.s IN THE BIOMEDICAL SCIENCES HAS INCREASED SUBSTANTIALLY. STILL NOT AS HIGH AS THE POPULATION AVERAGES BUT IT HAS INCREASED SUBSTANTIALLY WHEREAS THE NUMBER OF NATIVE-AMERICANS ALASKA NATIVE GETTING PH.D.s IN THE BIOMEDICAL SCIENCES HAS REMAINED FLAT AROUND 12-14 INDIVIDUALS A YEAR OVER THAT SAME PERIOD OF TIME. SO THAT SEEMED TO BE AN AREA THAT COULD CERTAINLY USE SOME HELP IN GROWING. THE AREA HERE THAT WE NEED TO THINK ABOUT AS WE CAN'T GIVE 574 DIFFERENT TRAINING GRANTS, ONE TO EACH TRIBE. SO WE WOULD HAVE TO FIND A WAY THAT WE COULD GIVE IT TO SAY A TRIBAL ORGANIZATION, WHICH WOULD THEN SUPPORT STUDENTS FROM MULTIPLE TRIBES AT THEIR DIFFERENT COLLEGES OR UNIVERSITIES, DEPENDING ON WHAT STAGE AND WHERE THEY WERE. SO THAT IS SOMETHING WE ARE STILL THINKING ABOUT. >> JOHN, WE HAVE ABOUT 5 MINUTES LEFT. >> I'M DONE HERE. SO PERFECT TIMING. SORRY ABOUT THAT. >> PERFECT. I JUST WANT TO LET YOU KNOW WE HAVE 5 MINUTES AND THEN A FEW PEOPLE I KNOW THAT HAVE SOME QUESTIONS OR COMMENTS. AND I'D LIKE TO CALL THEM. YVETTE AND JEFFREY HENDERSON. >> CAN YOU HEAR ME NOW? OKAY. SO THANK YOU DR. LORSCH FOR LISTENING TO THE TRIBAL CONSULTATION AND WORKING TO TRY TO HELP CREATE A PROGRAM THAT IS MORE RESPONSIVE TO WHAT TRIBAL NATIONS NEED. THE FIRST COMMENT IS I HOPE WHEN YOU TRAIN REVIEWERS IF YOU FIGURE OUT WAYS TO MEASURE THE SUCCESS OF THAT TRAINING AND HOW THOSE WILL BE HELD ACCOUNTABLE FOR ODD AND STRANGE COMMENTS F THAT MAKES SENSE. THE SECOND AREA IS, I APPRECIATE THE IDEA ABOUT RELATIVELY POSSIBLE PROGRAMS BUT THE ORIGINAL PURPOSE OF NARCH WAS ALL THOSE THINGS SO I STILL DON'T UNDERSTAND WHY IT CAN'T BE A PART OF THE NARCH PROGRAM TO HAVE THOSE AS OPTIONS IN THE PROGRAM. I WOULD JUST RECOMMEND THAT. ANYWAY, THAT IS ALL I HAVE TO SAY. >> THANK YOU VERY MUCH, IVET. YES, I AGREE IF THERE WERE WAYS WE COULD MEASURE THE EFFECT OF THE TRAINING, THAT WOULD BE VERY USEFUL. AND THERE ARE THINGS THAT CAN BE DONE IN REVIEW THAT CAN GIVE THEM SURVEYS AND THINGS LIKE THAT. THERE ARE OTHER THINGS THAT ONE COULD DO TO LOOK AT. THE PHRASEOLOGY OF REVIEWS, FOR EXAMPLE, SO THOSE ARE THINGS WE COULD CONSIDER AS STUDIES TO SEE IF WE COULD MEASURE AN EFFECT. I CERTAINLY TAKE YOUR POINT IN TERMS OF THE NARCH PROGRAM WAS SUPPOSED TO DO A NUMBER OF THESE THINGS. THERE ARE SOME THINGS THE PROGRAM CANNOT DO, FOR INSTANCE IT CANNOT PROVIDE STIPEINS AND TUITION REMISSION FOR STUDENTS -- STIPPENCE -- THAT'S JUST A LEGAL ISSUE FROM THE NRSA. THAT'S WHY WE THINK THAT MECHANISM COULD BE VERY USEFUL. IT IS SOMETHING THAT WAS SUGGESTED LAST TIME ON THE TAC BUT SUPPORTING STUDENTS BOTH THROUGH GIVING THEM TUITION REMISSION AND THEN GIVING THEM STIPENDS TO LIVE ON CAN BE VERY, VERY IMPACTFUL IN TERMS OF THEIR ABILITY TO CONTINUE THEIR EDUCATION. SO THAT IS OUR IDEA THERE. SOME OF THE OTHER ONES I THINK, IF YOU DON'T HAVE THE NARCH OR THE CAPACITY TO APPLY FOR ONE IS HOW WE WERE THINKING ABOUT THIS, IN TERMS OF YOU DON'T HAVE A SPONSORED PROGRAMS RESEARCH OFFICE, DON'T HAVE THE SYSTEMS TO MANAGE THE GRANTS. THAT COULD MAKE IT HARD TO GET THE NARCH GRANT IN THE FIRST PLACE. SO SOME OF THESE THINGS WERE DESIGNED TO TRY TO BUILD THAT CAPACITY SO THAT TRIBES AND TRIBAL ORGANIZATIONS COULD APPLY FOR THE NARCH GRANTS SUCCESSFULLY. >> TRYING TO GET SOME OF OTHER OTHER PEOPLE ON. JEFFREY AND THEN BOBBY I SEE. SO WE ONLY HAVE LIKE THREE MINUTES, TWO MINUTES. >> THANK YOU, DR. LORSCH. I DIDN'T REALLY HAVE A QUESTION. I MADE MY COMMENT IN THE CHAT. BUT AS A COMMUNITY-BASED RESEARCHER FOR OVER 20 YEARS, THE TOPIC OF STABLE FUNDING HAS BEEN OF CONSIDERABLE INTEREST TO ME. AND I ALSO SAT ON THE NATIONAL ADVISORY COMMITTEE FOR NIMHD A DECADE OR SO AGO AND WAS VERY IMPRESSED WITH THEIR ENDOWMENT PROGRAM. BUT, UNFORTUNATELY, NEARLY NO NARCH AWARDEES HAVE EVER BEEN ELIGIBLE TO COMPETE FOR THOSE PRECIOUS ENDOWMENT FUNDS ONLY TO THE FACT THEY ARE NOT DEGREE-GRANTING INSTITUTIONS AND THAT HAS ALWAYS BOTHERED ME A GREAT DEAL THAT NOT THAT WE OUGHT TO BE ELIGIBLE TO COMPETE WITH HBCU WAS AND OTHER AREA 51 INSTITUTIONS, BUT THAT WE SHOULD ALSO HAVE SUCH A POTENTIAL STABLE SOURCE OF FUNDING TO SUPPORT OUR EFFORTS IN COMMUNITY-BASED TRIBAL SETTINGS. THANK YOU. >> THANK YOU. WE HAVE SPECIAL AUTHORITY TO GIVE THOSE GRANTS BUT WE HAVE BEEN LOOKING AT WAYS TO EXPAND THAT PROGRAM. SO THANK YOU FOR THAT COMMENT. >> AND ONE MORE -- IT IS THE TOP OF THE HOUR. BOBBY IS IT REALLY QUICK? >> YES. IT WILL BE. JUST THANK YOU DR. LORSCH FOR THAT. NICE TO HEAR THERE IS MOVEMENT FROM THE CONATION AND FROM THE TAC COMMENTS THAT WE HAD SEVERAL MONTHS AGO. WE TALKED EARLIER TODAY IN OUR CAUCUS ABOUT ACCOUNTABILITY TO SOME OF THE THINGS WE DISCUSSED SO IT WAS REALLY GOOD TO SEE SOME CONCRETE STEPS TOWARDS THAT. MY QUESTION F I RECALL CORRECTLY, THIS REVIEW YOU CONDUCTED, THAT WAS THE FIRST REVIEW THAT WAS DONE IN MANY, MANY YEARS F I'M NOT MISTAKEN. >> CORRECT. >> SO GOING ALONG DOWN THE PATH OF ACCOUNTABILITY, WILL YOU DO MORE FREQUENT REVIEW TO MAKE SURE THAT THESE NEW STEPS ARE BEING ACCOMPLISHED AND I ALSO -- I DON'T KNOW IF I CAN DO THIS OR NOT, BUT I WOULD INVITE YOU TO REPORT REGULARLY TO THE TAC. SINCE THIS IS REALLY A VERY, VERY CRITICAL PROGRAM TO TRIBES ACROSS THE NATION. SO REGULAR REPORTS TO THE TAC UPDATING US ON PROGRESS ON THOSE I THINK WOULD BE VERY, VERY HELPFUL TO ALL OF US. AND THANK YOU AGAIN FOR YOUR PRESENTATION. >> THANK YOU. YES TO BOTH OF YOUR QUESTIONS. WE WILL DEFINITELY DO THIS MORE FREQUENTLY AND WE WOULD LIKE TO MEET WITH YOU ON A REGULAR BASIS. >> THANK YOU. THANK YOU, JOHN. WE APPRECIATE YOUR VISIT BUT WE ARE OUT OF SCHEDULE NOW AND I'D LIKE TO INVITE DAVID TO INTRODUCE OUR NEXT GUEST. THANK YOU. >> THANK YOU, LISA. WELL, THIS IS THE MOMENT EVERYBODY HEADS BEEN WAITING FOR. -- WE ARE SCHEDULED FOR THE CONVERSATION WITH OUR PRINCIPLE DEPUTY DIRECTOR, LAWRENCE TABAK, AND ALSO THE DIVISION DIRECTOR DR. JIM ANDERSON. WITH THAT, I WILL TURN IT OVER TO DR. TABAK AND DR. ANDERSON TO INITIATE THE CONVERSATION. >> WELL, THANK YOU VERY MUCH, DAVE. AND THANKS TO ALL OF YOU FOR PARTICIPATING IN THIS IMPORTANT GROUP. I GUESS I'LL JUST START WITH ONE BRIEF COMMENT. I'LL STATE THE OBVIOUS AND TURN IT OVER TO JIM FOR ANY COMMENTS HE MIGHT HAVE TO START. AND THEN WE'LL OPEN IT UP. I THINK THE OBVIOUS THING TO SAY IS, AS YOU NOW ALL KNOW, DR. COLLINS HAS ANNOUNCED HIS DECISION TO STEP DOWN HIS NIH DIRECTOR. HE HAS BROKEN ALL THE RECORDS IN TERMS OF NIH DIRECTORS, SERVING THREE DIFFERENT PRESIDENTS OVER THE COURSE OF 12 YEARS. I THINK YOU KNOW THE HISTORY OF THE TRIBAL HEALTH RESEARCH OFFICE AND OBVIOUSLY IT WAS ESTABLISHED DURING FRANCIS'S TENURE. AND BOTH HE AND DR. ANDERSON AND I, ALL SUPPORT VERY STRONGLY THESE EFFORTS. AND AS I HAVE TOLD PEOPLE IN A VARIETY OF FORUM ABOUT, SO WHAT DOES THIS MEAN FOR THE IMMEDIATE FUTURE? FOR THE IMMEDIATE FUTURE IT MEANS YOU DON'T LOSE ANY MOMENTUM AND IN FACT, YOU WORK EVEN HARDER TO KEEP MOMENTUM GOING. SO THAT WHENEVER A PERMANENT DIRECTOR IS APPOINTED BY OR NOMINATED BY THE PRESIDENT AND SUPPORTED BY THE SENATE, HE OR SHE WILL LOOK AT THESE EFFORTS AND INDICATE HOW AMAZING THEY ARE AND HOW THEY HAVE TO GET BETTER AND GO FASTER AND BE GREATER. SO WE DON'T WANT TO LOSE ANY MOMENTUM. I THINK THAT IS VERY, VERY IMPORTANT. AND I HAVE SAID THIS NOW AND I'M SAYING IT FOR THIS. SO JUST TO REASSURE YOU THIS REMAINS A VERY HIGH PRIORITY FOR US. AND I THINK -- LET ME TURN IT TO JIM TO SEE IF THERE ARE ANY COMMENTS I'D LIKE TO MAKE ABOUT THIS OR OTHER THINGS RELATED. >> THANK YOU, LARRY. I JUST WANT TO SAY IT'S GREAT TO ACTUALLY TURN ON THE MONITOR AND FEEL LIKE I'M THERE WITH YOU. EVERYBODY IS AT A NAME ON A BLACK BOX AND I'M LOOKING FORWARD TO US BEING TOGETHER FOR A REAL MEETING AT SOME POINT. I ALWAYS ENJOYED THE CONVERSATIONS IN THE 458 WAY ASKING QUESTIONS AS WE GOT CUPS OF COFFEE AND THAT'S NOT HAPPENING. WE NEED TO BRING THAT BACK. I ALSO HAVE TO SAY WHEN DAVE WAS GIVING HIS PRESENTATION, UPDATE ON PROGRESS NOTES, I HAD TO SMILE. AND BEFORE I SAY ANYTHING MORE, I'M GOING TO SAY NOBODY IS PATTING US ON THE BACK BECAUSE WE HAVE A LONG WAY TO GO. BUT OVER THE 5 OR 6 YEARS SINCE WE STARTED THIS THRO OFFICE, I THINK WE LEARNED HOW TO BEGIN TO LISTEN TO TRIBES, HOW TO COMMUNICATE. THE FORMAL TRIBAL CONSULTATION POLICY AGREEMENT ON HOW WE DO THAT SHOULD BE FINISHED FAIRLY SOON. WE HAVE DONE QUITE A FEW CONSULTATIONS. AND THEY HAVE BEEN EFFECTIVE. IF YOU KNOW THE IN NAUGHT JON LORSCH AND NIGMS RECEIVED IS ADDRESSING CONCERNS. I'M GRATIFIED WE HAVE BEGUN TO LEARN,WORK WITH TRIBES AND RESPECT THIS SPECIAL APPROACH AND THE GOVERNMENT TO GOVERNMENT RELATIONSHIP. AND ALSO REALLY TO EDUCATE OUR OWN STAFF, OR BEGINNING TO, IN WHAT THOSE SPECIAL APPROACHES NEED TO BE. SO I THINK WE HAVE STARTED. AND THERE IS A GREAT OPPORTUNITY HERE AS WE ARE ABOUT TO THINK ABOUT STARTING THE NEXT STRATEGIC PLAN. THIS IS A FORMAL STATEMENT OF WHAT WE WANT TO BE HELD ACCOUNTABLE FOR. WHAT OUR GOALS ARE. AND IT'S GOING TO REQUIRE SIGNIFICANT INPUT FROM YOU. AND SO ONE OF THE THINGS, I HOPE WHY CAN DO IN THE NEXT HOUR, TO GET AN IDEA WHAT DO YOU THINK THRO IS DOING RIGHT? WHAT DO YOU WANT TO BUILD ON? AND THEN HOW CAN WE BECOME MORE SPECIFIC WITH THE NEXT STRATEGIC PLAN TO TRANSLATE THE COMMUNICATION TO BETTER PROCESS INTO HAVING IMPACT? HAVING MORE INVESTIGATORS BEING TRAINED. HAVING MORE INFRASTRUCTURE SUPPORT. HAVING MORE APPROPRIATE RESEARCH DONE AND HAVING HEALTH IMPROVED. SO -- >> COMMITTEE MEMBERS MAY ASK QUESTIONS. GO AHEAD. >> OPENING THE DOOR FOR EVERYBODY ELSE FIRST. I DON'T WANT TO SPEAK WITHOUT TAC MEMBERS GOING FIRST. >> DENISE HAS HER HAND UP. >> HI. IT'S REALLY GOOD TO SEE BOTH OF YOU AND I AGREE. IT WILL BE NICE WHEN WE CAN SEE EACH OTHER IN PERSON. ZOOM FATIGUE IS REAL. I WANTED TO AGREE SINCE THE THRO OFFICE HAS BEEN DEVELOPED, THERE HAS BEEN A LOT OF ACTIVITY AND A LOT OF FANTASTIC STARTS TO DIFFERENT THINGS AND REAL PROGRESS. I'M THINKING ABOUT WHAT MAY BE THE FOCUS OF THE NEXT STRATEGIC PLAN. WONDERING IF IT'S SOMETHING AROUND IMPACTING ALL OF THE INSTITUTES AND CENTERS WITHIN THE ORGANIZATION? AND PART OF THIS IS MY EXPERIENCE AND MY PERSPECTIVE. I DON'T KNOW IT FOR A FACT. BUT IT'S ALL DIFFERENT IN APPROACH TO WORKING WITH TRIBES. I'LL GIVE YOU AN EXAMPLE. I THINK YOU KNOW I'M A LEADER AND RESEARCHER AND A DIRECTOR. AND ONE OF THE THINGS THAT WE ARE EXPERIENCING UP IN ALASKA, NOT FROM ALL INSTITUTES BUT FROM A COUPLE OF PROGRAM OFFICERS, IS PRESSURE TO GET OUR RECRUITMENT NUMBERS UP. SO I'M ACTUALLY WORKING WITH OUR PRESIDENT AND CE. TO WRITE A LETTER EXPLAINING WHERE WE ARE WITH THE COVID PANDEMIC AND LIKE RIGHT NOW, I, AS A COMMUNITY MEMBER, I'M NOT GOING TO PUSH RESEARCH ON COMMUNITY MEMBERS WHEN PEOPLE, OR ALASKA HAS ONE OF THE HIGHEST COVID RATES IN THE NATION. ONCE AGAIN THIS IS NOT ALL PROGRAM OFFICERS. BUT TYLER, ONE OF THE THINGS THAT HE SAID, WHICH I REALLY APPRECIATED WAS, IT'S NOT JUST THE RESEARCH PROJECT. BECAUSE YOU CAN LOOK AT A PROJECT AND THINK, WHY CAN'T THEY MAKE PROGRESS ON THAT? BUT THAT RESEARCH PROJECT FITS THE COMMUNITY AND I THERE IS THE WHOLE COMMUNITY WHO HAVE THEIR EXPERIENCE AND LIKE THE WORK THAT WE DO AT OUR FOUNDATION WITHIN A TRIBAL HEALTH SYSTEM. OUR HEALTH SYSTEM IS OVERLOADED. SO WHEN I GO TO OUR PROVIDERS OR LEADERSHIP AND TALK ABOUT WANTING TO DO OUR RESEARCH PROJECT, THEY JUST KIND OF LOOK AT ME LIKE I'M INSANE. HONESTLY. BECAUSE THEY ARE VERY MUCH IN CRISIS MODE. BUT TO ME, IT'S LIKE AN EXAMPLE. ONCE AGAIN I FEEL MOST PROGRAM OFFICERS WITH VARIOUS UNDERSTANDINGS BUT THEN WITH OTHERS, EACH OF THE INSTITUTES REALLY SEEMS TO HAVE A DIFFERENT FEEL TO THEM. AND THAT CAN BE CONFUSING IF YOU'RE ON THE RESEARCHER END. BUT ALSO JUST CALLS TO MIND FOR ME, LIKE ARE WE -- IS THE THRO IMPACTING OTHER OR ALL OF THE ICs? AND THEIR A WAY THAT MAYBE WE COULD ADDRESS THAT? >> SO I THINK HETEROGENEITY REMAINS AMONG THE INSTITUTES AND CENTERS. FRANKLY THE SITUATION YOU'RE DESCRIBING, I THINK A GOOD GRAIN OF COMMON SENSE WOULD WORK WONDERINGS HERE WHICH APPARENTLY IS NOT BEING TAKEN ADVANTAGE OF ON THE PART OF THE PROGRAM OFFICER. BUT I KNOW GOING FORWARD THE GOAL IS TO BETTER HARMONIZE HOW WE DO THINGS ACROSS ALL OF THE INSTITUTES AND CENTERS. JIM, ANY THOUGHTS IN THIS DIRECTION? >> SO, NO VICTORY LAPS HERE. WE ARE STILL IN THE RACE. BUT WE HAD TO START SOME PLACE. AND I THINK WE STARTED WITH THRO AND DAVE AND THE OFFICE HELPED INDIVIDUAL INSTITUTES WITH ISSUES THEY ARE DEALING WITH AND WE ARE STRIVING TOWARDS MORE CONSISTENCY. I THINK THE TRIBAL CONSULTATION POLICY HAVING THAT AS A UNIFORM GUIDE FOR ALL THE INSTITUTES IS GOING TO BE A MAJOR STEP. A MAJOR STEP IN ENSURING THAT THEY REALIZE THEY ARE RESPONSIBLE. THAT THE THINGS THAT THEY HAVE TO DO AND THEY HAVE TO DO THEM CONSISTENTLY OR ALL THE SAME WAY. AND SO, THE COMMUNITY UNDERSTANDS WHAT NIH IS DOING NOW WITH 27 DIFFERENT GROUPS. SO I'M STILL SMILING BUT I'M STILL RUNNING. >> I TOTALLY AGREE. THANK YOU FOR YOUR ATTENTION WITH THIS AND I CAN ONLY IMAGINE WHAT IT IS LIKE TO TRY TO GET 27 DISTINCT CENTERS TO TRY TO AGREE ON ANYTHING. >> YOU'RE UNDERSTANDING. >> THAT'S THE FIRST LINE IN BOTH OF OUR JOB DESCRIPTIONS. [ LAUGHS ] >> WELL, I KNOW THAT CRITICAL CONSIDERATIONS DOCUMENT THAT DR. LORSCH MENTIONED, THERE IS SAY REASON WHY IT'S LIKE 40 PAGES LONG BECAUSE IT WAS A GROUP EFFORT. SO EVERYBODY HAD TO HAVE THEIR SAY AND ONCE AGAIN IT TOOK A LONG TIME AND ANYWAY. THANK YOU BOTH. >> YVETTE. >> THANK YOU AND HELLO DR. TABAK. IT'S GOOD SEE YOU AGAIN. APPRECIATE YOUR COMMITMENT TO SUPPORTING THE TRIBAL RESEARCH AND TRIBAL NATIONS OVER THE YEARS. REALLY APPRECIATE THAT. SO GIVE MY REGARDS TO DR. COLLINS AND FROM ME, THANK HIM FOR ALL OF HIS SUPPORT OVER THE YEARS, ESPECIALLY OF TRIBAL ISSUES. I WANTED TAMINGS TWO THINGS TODAY. I APPRECIATE YOU'RE HERE -- I WANTED TO MENTION TWO THINGS TODAY. THE FIRST RELATED TO THE LAST COMMENT ABOUT THE CRITICAL CONSIDERATIONS DOCUMENT AND TRAINING OF STAFF AND HOW TO APPROPRIATELY UNDERSTAND TRIBAL RESEARCH AND ALL THE CHALLENGES AND THE WILLINGNESS OF TRIBAL NATION TO BE INVOLVED IN RESEARCH AND ALL THE BARRIERS THAT OCCUR, SOMETIMES FROM NIH STAFF. IS THERE A WAY THAT YOU COULD EXPAND THE TRAINING EMPHASIS OF THE CRITICAL CONSIDERATION DOCUMENT TO MORE PROGRAM STAFF, SROs AND PROGRAM OFFICERS AND ESPECIALLY THE CSR? AND ALSO LIKE CAN YOU IN SENT VISE AND REWARD NIH STAFF TO DO RIGHT BY TRIBAL NATIONS TO MAKE THAT SOMETHING THAT IS OF SPECIAL EXPERTISE THAT PEOPLE AT NIH GET REWARDED FOR AND ARE PROUD OF RATHER THAN IT BEING A BOTHER AS IT SEEMS TO US EXTERNALLY? AND FINALLY, I HOPE THAT THERE IS SOME SIGNIFICANT FOCUS ON THE CENTER FOR SCIENTIFIC REVIEW. I JUST HAD A VERY NEGATIVE EXPERIENCE WITH THEM. THEY CLEARLY DIDN'T, AFTER TWO OR THREE TRIES, THEY STILL DIDN'T ACKNOWLEDGE HOW THE TRIBAL ORGANIZATION COULD V. ANY KIND OF DIFFERENT CHALLENGES IN THE AN ACADEMIC CENTER OR OUR CONCERNS, EVEN THOUGH WE READ THE GUIDANCE AND QUOTED IT THAT SAID IT SHOULD HAVE BEEN IN OUR FAVOR. SO CSR IS JUST SO INFLUENTIAL AROUND HOW THINGS ARE DONE AND THE REVIEW PROCESS AND THE TRIBAL RESEARCH. SO I HOPE THAT MOVING FORWARD THERE CAN BE AN EMPHASIS THAT RESPONDING TO TRIBAL NATIONS IS A POSITIVE THING, AND SPECIAL EXPERTISE THAT SHOULD BE REWARDED AND SHOULD BE SOMETHING THAT IS EMPHASIZED AT NIH NOT JUST SOMETHING TO CHECK THE BOX. >> THANK YOU. AND 1st THANK YOU FOR THE GOOD WISHES TO FRANCIS, WHICH OF COURSE I'LL SEND HIS WAY ON YOUR BEHALF. SO I LIKE THAT IDEA VERY MUCH THAT YOU HAVE RAISED OF USING THIS AS AN OPPORTUNITY TO ENHANCE TRAINING OF SROS AND PROGRAM OFFICERS AND 2349 CONTEXAND IN THECONTEXT OF SOMETHING TO AS PIRE TO AS OPPOSED TO ANOTHER SET OF THINGS THEY HAVE TO WORRY ABOUT. I LIKE THAT IDEA VERY MUCH. AND I WILL CERTAINLY EXPLORE THIS WITH THE DIRECTOR OF CSR AS A STARTING POINT. AND USUALLY AS CSR GOES, THE REST OF THE REVIEW TEAMS AT NIH GO. YOU KNOW, AS YOU WELL KNOW. AS TO THIS NEGATIVE ENCOUNTER, I'M VERY SORRY TO HEAR ABOUT THAT. AND IF IT'S SOMETHING THAT YOU WOULD LIKE ME TO RAISE WITH THE DIRECTOR OF CSR, OFF LINE, IF YOU JUST PROVIDE ME A LITTLE MORE INFORMATION, I'LL WILLING TO DO THAT. BECAUSE AGAIN AS YOU WELL KNOW, OUR SCIENTIFIC REVIEW OFFICE IS THERE TO SERVE, NOT TO DO ELSE WISE. AND IF THERE IS A DIFFERENCE OF OPINION, THERE ARE WAYS OF GETTING THINGS ADJUDICATED AND IT DOESN'T SOUND LIKE THAT NECESSARILY HAPPENED HERE. SO AGAIN, NOT THAT YOU NEED AN INVITATION. YOU CAN ALWAYS REACH OUT BUT IF YOU THINK THAT WOULD BE OF HELP, PLEASE DO AND LET ME TAKE IT UP WITH THE CSR. >> THANK YOU. >> THANK YOU. BOBBY? >> THANK YOU FOR BEING HERE WITH US THIS AFTERNOON. EARLIER TODAY WE WERE TALKING ABOUT ACCOUNTABILITY FOR UNETHICAL RESEARCH. AND HOW THAT IS HANDLED WITH NIH AND WE TALKED ABOUT SOME OF THE INSTITUTES HAVING THEIR OWN BIOETHICS PROGRAMS AND IT REMINDED ME THAT LASTED WEEK I WAS ATTENDING THE AMERICAN SOCIETY OF BIOETHICS AND HUMANITIES, THEIR ANNUAL MEETING, TWO DAYS, AGAIN. ZOOM FATIGUE. YOU'RE RIGHT. THERE WAS A FACULTY MEMBER FROM THE NATIONAL CANCER INSTITUTE -- I CAN'T REMEMBER WHO WAS PRESENTING. BUT WAS TALKING ABOUT BIOETHICS AND THEIR DEPARTMENT. AND ONE OF THE QUESTIONS THAT CAME UP WAS WHETHER THERE IS AN NIH AGENCY-WIDE BIOETHICS LC-TYPE INITIATIVE THAT GOES TRANSCENDS ALL OF NIH, BECAUSE APPARENTLY NOT EVERY INSTITUTE HAS THIS TYPE OF INITIATIVE IN PLACE. SO, I TOLD THEM I DIDN'T KNOW BUT I KNEW FOLKS THAT WOULD PROBABLY HAVE AN ANSWER. AND I'M AFRAID I DROPPED A FEW NAMES. DR. HALL I MENTIONED YOU AS A POSSIBLE CONTACT AND DR. ANDERSON AS WELL. AND WE JUST HAD OUR MEETING WITH DR. LAUER AS WELL NOT TOO LONG BEFORE WITH THE OFFICE OF EXTERNAL RESEARCH. SO I THOUGHT THAT MAYBE A PLACE TO START AS WELL. BUT I JUST THOUGHT I WOULD BRING THAT QUESTION UP AS WE ARE TALKING ABOUT TRANS-NIH-TYPE PROGRAMS AND INITIATIVES. SO CAN YOU COMMENT ABOUT THAT OR IF THERE WAS ANY -- OR PERHAPS THAT THEY HAVE THEIR OWN BIOETHICS PROGRAMS WITHIN EACH INSTITUTE. AGAIN, I THINK THAT'S AN OPPORTUNITY FOR COMMUNICATION ACROSS ALL INSTITUTES TO ENSURE WE ARE DOING THE RESEARCH CORRECTLY IN INDIAN COUNTRY. >> THANK YOU. SO I KNOW A NUMBER OF INSTITUTES HAVE SUCH PROGRAMS BUT DON'T THINK THEY ALL DO. JIM? DO YOU HAVE ANY INSIGHT? >> I DON'T KNOW WHAT THEY ALL DO. WE DO HAVE SARAH HALL ON IT. SHE IS ONE OF OUR BIOETHICIST. SHE MIGHT HAVE A VIEW OF WHAT THE DIFFERENCES ARE AND WHAT WE ALL DO THE SAME AND WHAT WE CAN DO BETTER. >> I'M HAPPY TO RESPOND. I WAS RECENTLY APPROACHED BY A COLLEAGUE WHO MADE ME AWARE OF A TRANS-NIH BIOETHICS COORDINATING COMMITTEE THAT IS RUN BY THE OFFICE OF SCIENCE POLICY. SHE ACTUALLY WANTED TO SEE IF THERE WOULD BE VALUE IN COORDINATING BETWEEN THRO AND THIS GROUP AND COMPARING NOTES ON WHAT THE ICs RESEARCH PORTFOLIO INVESTMENT IN BIOETHICS RESEARCH INVOLVING TRIBAL COMMUNITIES OR TRIBAL RESEARCHERS. AND I KNOW SPEAKING FROM MY PRIMARY APPOINTMENT IN THE GENOME INSTITUTE. AND I KNOW WE DO HAVE A SUBSTANTIAL INVESTMENT IN BIOETHICS RESEARCH WITH A NUMBER OF NATIVE COLLEAGUES WHO ARE THE PIs OF THOSE PROGRAMS. BUT WE HAVE A LOT TO LEARN AND I THINK THIS IS JUST A GREAT CATALYST, A GREAT DIVISION FOR US TO CONTINUE WITH THOSE CONVERSATIONS AND TO COMPARE NOTES AND TO MAKE SURE WE ARE COORDINATING TOGETHER. >> THANKS FOR BRINGING THIS UP. WE WILL FOLLOW-UP. I'M NOT SURE SARAH WAS INTRODUCED BEFORE BUT SHE IS IN THE BIOETHICS PROGRAM IN GENOME, COME OF COURSE DATA SHARING IS A HUGE ISSUE THERE. AND SHE'S ON DETAIL TO THRO. SO SHE HAS BEEN WORKING WITH US ON SOME SPECIFIC PROJECTS WHERE SHE CAN BRING HER EXPERTISE TO WHAT WE NEED IN THRO. THANK YOU, SARAH. >> THANK YOU FOR RAISING THIS. THIS IS A VERY GOOD POINT AND WE'LL TAKE ADVANTAGE OF SARAH'S PRESENCE WITHIN THE THRO OFFICE TO MOVE FORWARD AND SEE WHAT CAN BE DONE. SO THANK YOU. >> THANK YOU. HER MANIA? >> THANK YOU. I'M GOING TO REFER MY QUESTION TO AT OR ABOUT SULLIVAN. THANK YOU. >> THANK YOU COUNCILWOMAN. THIS IS DR. TESHA SULLIVAN. SO FIRST OF ALL, I WANT TO THANK DR. TABAK. I KNOW THE LAST TIME WE TALKED TO YOU WE GIVE YOU SEVERAL THINGS WE THOUGHT WOULD BE HELPFUL AND BEGINNING TO SEE SOME OF THOSE THINGS COME TO LIGHT PROPOSALS FOR STRUCTURAL RACISM, INCREASED PROPOSAL FOR JUNIOR RESEARCHERS. AND WE WANT TO ENCOURAGE YOU TO INCREASE THAT TO KEEP THAT GOING AND MOVING THAT FORWARD. ALSO, I LIKED SEEING THE INCREASE IN THE DOLLARS FROM THE AMERICAN INDIAN AND ALASKA NATIVE PORTFOLIO. THINKING THAT COULD GROW MORE SIGNIFICANTLY BY THE USE OF THE COMPETITION MECHANISM. SO NOT SEEING MUCH OF THOSE OUT THERE. THAT THE INFORMATION IS SPECIFIC TO OUR COMMUNITIES. ANOTHER THING I THINK THAT COVID ELIMINATED WAS THE INTENSE DISPARITIES THAT OUR COMMUNITIES EXPERIENCE AND THE GREAT NEED WE HAVE SPECIFICALLY AROUND CAPACITY BUILDING, RESEARCH FOR TRIBES AND AMERICAN INDIAN COMMUNITIES AND DR. LORSCH'S PRESENTATION REALLY HELPED US LOOK THAT THE THROUGH THE NARCH MECHANISM BUT OTHER KINDS OF FUNDING THAT IS MORE BROAD RANGE OPPORTUNITIES THAT MIGHT BE INCLUDED SUCH AS TRAINING FOR NON-ACADEMIC TRIBAL STAFF FOR RESEARCH. SO THINKING ABOUT TRAINING FOLKS THAT WORK IN THE TRIBAL COMMUNITIES AS EPIDEMIOLOGISTS AS STATISTICIANS AND WE DON'T EXPECT THEM TO COME TIER 1, WHICH IS INSTITUTION ACADEMICS IN THOSE FIELDS BUT RATHER GIVING TIMELY INFORMATION TO THEIR COMMUNITIES. ALSO, BUILDING INFRASTRUCTURE THAT ALLOWS THE PRACTICE OF SOVEREIGNTY OVER DATA AND BIOSPECIMENS, WHATEVER THAT MIGHT LOOK LIKE. SO WHETHER THAT IS THE APPROPRIATE KINDS OF FREEZERS OR IF IT'S THE APPROPRIATE KIND OF OFFICES THAT NEED TO ADMINISTER THAT WORK, THAT THERE IS FUNDING SPECIFIC TO THOSE INITIATIVES. ALSO ADDRESSING INTELLECTUAL PROPERTY RIGHTS TO SACRED INFORMATION AND ALSO POTENTIALLY STIGMATIZING INFORMATION. WE DON'T WANT TO LIMIT TRIBES AND NATIVE COMMUNITIES TO PARTICIPATE IN RESEARCH BECAUSE THEY HAVE FEAR THAT THEY HAVE TO SHARE THROUGH PUBLICATION OR OTHER FORMS INFORMATION THAT THEY CONSIDER SACRED OR POTENTIALLY STIGMATIZING. AND ALSO THEN ON THE FLIP SIDE OF THAT IS THE DISSEMINATION OF INFORMATION AND RESEARCH NEEDS IN OUR COMMUNITIES. WE KNOW THAT WITH COVID, COVID WAS SUCH A GOOD TEACHER. WE KNOW THAT ONE OF THE THINGS IS MAKING SURE THAT THE INFORMATION THAT GETS TO THEM IS ACCURATE AND CAN BE TRUSTED AND YOU KNOW FOR NATIVE COMMUNITIES, TRUST AND RELATIONSHIP BUILDING IS CRITICAL. SO, INFORMATION NEEDS TO COME BACK TO OUR COMMUNITIES IN WAYS THAT OUR FAMILIES CAN UNDERSTAND IT BUT ALSO ACCESS IT. AND THAT IS NOT THE SCIENTIFIC JOURNAL. WE KNOW WE ARE JUDGED ON HOW MANY PUBLICATIONS WE WRITE IN THE SCIENCE JOURNALS AND HOW MANY PEOPLE SITE OUR PUBLICATIONS. IN THE LEGAL WORLD, PEOPLE NEED TO UNDERSTAND WHERE THIS RESEARCH IS IN A WAY THEY CAN INTERPRET IT. SO RESEARCH INTO THE BEST PATHWAYS AND READINESS TO CONDUCT RESEARCH IS CRITICAL AS WELL. I THINK DR. LORSCH MENTIONED THAT AS WELL. SO THANK YOU FOR THAT. THANK YOU. >> THANK YOU FOR THOSE COMMENTS. YOU TOUCHED UPON MANY VERY, VERY IMPORTANT ISSUES, OBVIOUSLY. AND YOU'RE LAST SET OF COMMENTS UNDERSCORE WHY IT'S SO IMPORTANT TO GET MORE NATIVE RESEARCHERS TRAINED SO THAT THEY CAN ALSO HELP US WITH THE DISSEMINATION OF PLAIN LANGUAGE INFORMATION AND SO THANK YOU FOR ALL OF THOSE COMMENTS. >> DR. TABAK, I KNOW YOU MAY NOT BE ABLE TO ANSWER THIS QUESTION, BUT CAN YOU SHARE ANYTHING AROUND THE PROCESS AND TIMELINES FOR NEW NIH DIRECTOR AND ACTING DIRECTOR OF DR. COLLINS LEAVE. I UNDERSTAND YOU MAY NOT BE ABLE TO SHARE MUCH BUT CAN YOU GIVE THE NIH TAC AN IDEA OF WHAT YOU MIGHT BE ABLE TO SHARE. >> I'M HAPPY TO ADDRESS IT TO THE EXTENT THAT I KNOW. SO AS YOU KNOW FROM YOUR PRIOR SERVICE IN GOVERNMENT, I AM ONE OF THE FIRST ASSISTANT, WHICH IS AN ODD-SOUNDING TERM BUT WHAT IT MEANS IS THAT TYPICALLY I WOULD ASSUME THE ROLE OF ACTING DIRECTOR ONCE THE PERMANENT DIRECTOR STEPS DOWN. THAT REQUIRES THE FINAL CONFIRMATION BY THE WHITE HOUSE AND WHILE I KNOW THAT THEY ARE WORKING THROUGH THIS, WE HAVE NOT YET RECEIVED THAT. SO AT THE MOMENT, I DON'T KNOW WITH 100% CERTAINTY THAT I WILL BE ASSUMING THAT ACTING ROLE. IN TERMS OF THE PERMANENT DIRECTOR, WHICH HISTORICALLY IS NEVER THE PERSON WHO IS ACTING. IT'S ALWAYS A DIFFERENT PERSON. THAT IS AGAIN, AS YOU KNOW, AND I'M SURE SOME OF YOUR COLLEAGUES DO AS WELL, THAT IS A PRESIDENTIAL APPOINTMENT WHICH NEEDS CONFIRMATION FROM THE SENATE AND SO, THE PRESIDENT AND PRESUMABLY HIS SCIENCE ADVISORS AS WELL AS OTHER INDIVIDUALS WILL PROVIDE THE PRESIDENT WITH INPUT AND THEN HE WOULD BE NOMINATING SOMEBODY FOR THIS ROLE. THAT REQUIRES THEN A VERY EXTENSIVE FINANCIAL/CONFLICT OF INTEREST PROCESS. AND THEN ENGAGEMENT WITH KEY MEMBERS OF THE SENATE, ULTIMATELY MANY MEMBERS OF THE SENATE. AND THEN ULTIMATELY WE HOPE A FAVORABLE VOTE ON THE APPOINTMENT. NOW AS TO THE TIMING, IT DEPENDS ON WHETHER YOU CATCH ME IN AN OPTIMISTIC OR A PESSIMISTIC MOOD. OPTIMISTICALLY, THAT COULD ALL HAPPEN BY -- EARLY SPRING. MY PESSIMISTIC SIDE SAYS IT MIGHT TAKE A LITTLE LONGER THAN THAT. BUT AS EVERYBODY KNOWS, THE R. THE MOMENT THE CONVERSATION IS ALLOWED, THIS WILL BE ONE MORE OF THOSE ISSUES ONCE DR. COLLINS ACTUALLY DOES DEPART. AND HE HAS INDICATED HE WILL DEPART BY THE END OF THE CALENDAR YEAR. SO, I THINK YOU CAN KIND OF GUESS WHAT MIGHT MAKE SENSE THERE. SO THAT IS HOW IT STANDS AT THE MOMENT. THE FIRST ASSISTANT IS WAITING FOR FINAL CONFIRMATION. AND THEN PRESUMABLY, AND I AM IN THE MORE IMPORTANT PROCESS OF NOMINATING THE PERMANENT DIRECTOR AND PRESUMABLY THAT HAS ALREADY BEGUN IN TERMS OF DISCUSSIONS WITH THE PRESIDENT, HIS IMMEDIATE STAFF, THE SCIENCE ADVISER AND SO FORTH. SO, STAY TUNED, EVERYBODY. SO MANY PEOPLE AT NIH HAVE NEVER HAD ANYBODY BUT FRANCEIS AS THE DIRECTOR OF NIH. NOW AS YOU CAN TELL BY ALL OF THE GRAY HAIR, I HAVE BEEN AROUND A LONG TIME. SO I HAVE ACTUALLY BEEN THROUGH THIS -- SEVERAL NIH DIRECTORS. AND I WAS APPOINTED BY DR. RUTH KIRB TEE WHEN SHE WAS ACTING DIRECTOR, THEN DR. ZERHOUNI, RAYNARD KINGTON, ACTING DIRECTOR AND I SKIPPED ELLIOT. SO ELLIOT ZERHOUNI, THEN REYNARD AND THEN FRANCIS. AND SO YES, IT CAN BE A LITTLE SETTLING TO THOSE WHO HAVE NEVER GONE THROUGH THIS BEFORE. BUT HERE WE ARE. SO FRANCIS SPOILED US ALL BY BEING HERE SO VERY LONG. >> GREAT. THANK YOU FOR THAT. IS THIS ANY OTHER QUESTIONS RIGHT AT THE MOMENT OR DO WE NEED TO STIMULATE SOME CONVERSATION HERE? >> I HAVE ANOTHER ONE. >> GO AHEAD. >> DR. TABAK. WHEN WILL NIH MIGHT BE GOING BACK TO WORKING IN THE OFFICE? >> SO OUR LOCAL CIRCUMSTANCE IN MONTGOMERY COUNTY NEAR BETHESDA, MARYLAND MONTGOMERY COUNTY, IS LOOKING QUITE GOOD IN TERMS OF NUMBERS. SO MUCH SO THAT THE COUNTY GOVERNMENT IS CONTEMPLATING LIFTING SOME OF THE INDOOR MASK MANDATES, ACCORDING TO SOME OF THE CDC NUMBERS. WE OF COURSE AS A FEDERAL FACILITY HAVE TO FOLLOW THE FEDERAL REGULATIONS AND SO I THINK WE ARE PROBABLY LOOKING AT SOMETHING NOT SOONER THAN THE BEGINNING OF THE NEW CALENDAR YEAR. I THINK THERE IS A CONCERN, WHICH SING SHARED BY MANY PEOPLE, THAT OVER THE HOLIDAY SEASON, WITH PEOPLE TRAVELING TO BE WITH FAMILY MEMBERS AND SO FORTH, THAT WE MIGHT UNFORTUNATELY SEE AN UPTICK AGAIN, EVEN THOUGH OUR LOCAL AREA, THE NUMBERS ARE QUITE FAVORABLE. AND THEN AS -- AS A FEW MOMENTS AGO, IN OUR PARTS OF THE COUNTRY, WHERE THE EPISODIC NATURE IS STILL VERY MUCH ON THE HIGH POINT. AND SO, I DON'T THINK ANYTHING WILL HAPPEN HERE BEFORE THE BEGINNING OF THE NEW CALENDAR YEAR. AND THE HOPE IS, OF COURSE, WE ALL VERY MUCH WOULD LIKE TO GET BACK TO A MORE NORMAL, IF WE CAN CALL IT THAT, STATUS. BUT NOT PROBABLY UNTIL AFTER THE HOLIDAY SEASON. AND THEN WE'LL HAVE TO REASSESS. I'M SURE -- YOU ARE ALL DOING FOR YOUR TRIBAL NATIONS IN TERMS OF HOW THEY ARE FUNCTIONING AND SO FORTH. BUT WE -- ABOUT 55% OF OUR WORKFORCE IS AT WORK. SO THE PEOPLE IN THE HOSPITAL HAVE NEVER STOPPED WORKING. THEY HAVE ALWAYS BEEN HERE. AND THEN MOST PEOPLE IN THE RESEARCH LABORATORIES ARE PRETTY MUCH BACK TO WORK. SOCIAL DISTANCING, MASKING, SOON WE'LL HAVE IN PLACE THE MANDATES FOR VACCINATION. WE ARE COMING VERY CLOSE EVERYBODY NEEDS TO BE VACCINATED TO BE EMPLOYED. MOST OF OUR ADMINISTRATIVE STAFF CONTINUES TO TELEWORK. AND HAVE DONE SO EFFECTIVELY BUT AS JIM POINTED OUT EARLIER, THE HALLWAY CONVERSATION IS SO CATALYTIC SO OFTEN. WE ARE REALLY LOOKING FORWARD TO EVERYBODY BEING WORK. WE ARE BAT 55% OF OUR NORMAL WORKFORCE. >> YOU'RE PROBABLY RIGHT. MY BACKGROUND IS PART OF THE NIH CAMPUS AND I'M WALKING TO THE ENTRANCE TO THE CLINICAL CENTER AND I USE THIS IN HOPES THAT WE WILL BE BACK. I HOPE IT WILL BE SOON. >> ONE OF THE THINGS -- >> PLEASE GO AHEAD. >> TRIBAL NATIONS ARE MAKING DECISIONS EVERY DAY AND THE UNFORTUNATE THING IS THAT SO SCIENCE METRICS FOR WHETHER YOU SHOULD OPEN AND THEN THERE IS POLITICAL THINGS OR CONSIDERATIONS THAT ARE KIND OF -- IS IT MORE A CDC THING OR CAN NIH TALK TO THEM ABOUT THEIR RECOMMENDATIONS ON WHAT KINDS OF DATA OR TRENDS MAKE SENSE FOR TRIBAL NATIONS AND OTHERS TO CONSIDER RELATED -- >> IT'S REALLY A CDC THING. AS YOU CAN APPRECIATE. BUT AGAIN, WE ARE LOOKING -- AT NIH WE ARE LOOKING AT OUR POSITIVITY RATE. WE MONITOR THIS WEEKLY. WE LOOK AT THE SURROUNDING COUNTY BECAUSE PEOPLE EITHER LIVE OR TRAVEL THROUGH THE SURROUNDING COUNTY TO GET TO THE PHYSICAL WORKSPACE. AND WE ALSO LOOK AT THE SURROUNDING HOSPITALS AND THEIR UTILIZATION OF ICU BEDS FOR COVID CASES. THOSE ARE SOME OF THE KEY INDICATORS THAT WE LOOK AT. AND THEY ALL NEED TO BE TRENDING DOWN FOR A NUMBER OF DAYS BEFORE WE EVEN WOULD CONSIDER BRINGING EVERYBODY BACK. AND SO AGAIN, OUR SURROUNDING COUNTY IS TRENDING IN THE RIGHT DIRECTION AND LOOKING BETTER AND BETTER. AND OUR PERCENT POSITIVITY AMONG OUR OWN STAFF IS LOOKING PRETTY GOOD ALSO. BUT I WOULD IMAGINE THAT THE CDC AND CONCERT WITH HHS AND PARTS OF THE GOVERNMENT WILL WANT TO HAVE MORE OF A UNIFORM GUIDANCE THAN QUITE AS LOCAL CIRCUMSTANCE AS WE HAVE WE DID ASK FOR VARIANCE IN SOME OF THE PROCEDURES BECAUSE WE HAVE OUR OWN TESTING NERVOUS PLACE WE MONITOR OUR STAFF VERY CLOSELY, AND IT'S VOLUNTARY OF COURSE BUT OUR STAFF AVAIL THEMSELVES OF IT. I THINK WE HAVE BEEN ABLE TO GET MANY OF OURS BACK. BUT ADMINISTRATIVE STAFF WHO CAN DO THEIR JOBS REMOTELY, ALBEIT PERHAPS LESS EFFICIENCY, THROUGH DIRECT TELEWORK. >> ARE THERE ANY OTHER QUESTIONS FROM ANYONE? >> I THINK SOMEBODY -- >> TESHA? >> THANK YOU, AGAIN. SO I WAS JUST THINKING THROUGH THE ISSUE THAT MANY TALKED ABOUT. DR. TABAK, IF YOU WERE ON OR DR. ANDERSON, BUT MANY BROUGHT UP THE FENTANYL ISSUE THAT IS A SERIOUS CRISIS FOR OUR POPULATIONS RIGHT NOW. AND PARTICULARLY BECAUSE OF GEOGRAPHY. IT HAS A BIG PIECE OF THAT AS WELL WITH SOME OF THE INDUSTRY IN MEXICO. I THINK THIS IS AN ISSUE THAT IS AN EXAMPLE OF ONE OF THOSE THINGS THAT REQUIRES CROSS COMMUNICATION AROUND AGENCIES AND BECAUSE I DON'T THINK 27 AGENCIES AND STRATEGICALLY WORKING WITH THEM ENOUGH OF A CHALLENGE FOR YOU, I'M GOING TO ASK THAT YOU TAKE THE MODEL THAT COVID HAS PRESENTED AND HAS BEEN SO USEFUL IN ADDRESSING COVID WITH CROSS AGENCY COLLABORATION AND COOPERATION, AND THAT WE TRY AND STRATEGIZE WHAT HAPPENS USING THAT SAME -- ACTUALLY A BETTER MODEL THAN COVID IMPLEMENTED. WHAT IT INTENDED. HOW ABOUT WE GO WITH THAT? AND USE THAT TO ADDRESS THE ISSUES. BECAUSE IT ISN'T ABOUT JUST THE RESEARCH OR JUST THE PUBLIC HEALTH PIECE OF IT IT'S THE JUSTICE SYSTEM. IT'S FROM OUR PERSPECTIVE THE COMMUNITY. THE COMMUNITY IS NOT WELL. THE INDIVIDUALS ARE NOT WELL. IF THE INDIVIDUALS ARE NOT WELL, THE COMMUNITY IS NOT WEL. WE BELIEVE IN CULTURE AND IT'S ONE OF THE BIGGEST SOLUTIONS TO MAKING COMMUNITIES WELL AND TO MAKING PEOPLE WELL. BUT IT REQUIRES A WHOLE EMBRACE OF ALL THE SOCIOECOLOGICAL FRAMEWORK GIVES US AND ANY WAYS AND THOUGHTS AND BRING THAT ENERGY OUT THERE TO THINK ABOUT HOW CAN WE STRATEGIZE ACROSS THESE GOVERNMENT AGENCIES TO WORK TOGETHER TOWARDS ONE GOAL. AND THE -- THE MISSING WOMEN'S INITIATIVE IS ONE OF THOSE THINGS I HAVE SEEN HAPPEN WITH JUSTICE AND CDC, WE JUST DID AN ARTICLE WITH THEM. BUT BEGINNING TO LOOK FROM A HOLISTIC PERSPECTIVE, RIGHT IN LINE WITH INDIGENOUS PEOPLES. SO THANK YOU. >> SO, IT'S INTERESTING. WE HAVE HAD A TRANSGOVERNMENT WAY CONVERSATIONS AS YOU JUST SO BEAUTIFULLY SUMMARIZED IN THE CONTEXT OF PLANNING FOR A NEW PRESIDENTIAL INITIATIVE KNOWN AS -- AND ONE OF THE GOALS OF DARPAH, A NEW ENTITY AS, POSED TOW NIH, WILL BE ABLE TO ATTACK THESE MUCH LARGER KINDS OF ISSUES. YOUR EXAMPLE OF THE JUSTICE DEPARTMENT NEEDED TO WORK WITH THE CDZ A GOOD ONE. AT NIH, I THINK SOME OF YOU KNOW, IN THE CONTEXT OF THE HEAL INITIATIVE B OPIOID USE DISORDER, WE WORKED TOGETHER WITH THE DEPARTMENTS AND COMMUNITIES. WE DO NEED TO DO MORE OF THIS MORE EFFECTIVELY. AND I CO-CHAIR A SO-CALLED FAST TRACK COMMITTEE WITH MULTIPLE DIFFERENT GOVERNMENT DEPARTMENTS AND AGENCIES TO FIGURE OUT HOW WE CAN BEST HARMONIZE HOW WE DO THINGS AND HOW WE COULD BEST COLLABORATE. AND AT LEAST WITHIN THE CONTEXT OF THIS NEW ENTITY THAT WE ARE HOPING TO STAND UP AND ONCE WE HAVE A BUDGET AND AUTHORIZATION, THERE HAVE BEEN SOME GOOD APPROACHES TO THIS. AND BECAUSE I THINK EVERYBODY AT THESE DIFFERENT DEPARTMENTS AND AGENCIES HAVE THE SAME UNDERSTANDING OF THE PROCESS. SO THANK YOU FOR RAISING THAT AND I HOPE -- MY HOPE IS THAT WE WILL BE ABLE TO MAKE THINGS BETTER. IF WE ARE ABLE TO STAND UP DARPH TO USE THOSE AS LESSONS LEARN TO DISSEMINATE THAT ACROSS THE AGENCY. >> COULD SPELL THE AGENCY YOU'RE TALKING ABOUT? >> IT'S ADVANCED RESEARCH PROGRAM AGENCY, I THINK IS THE ACRONYM WHAT IT STANDS FOR. IT'S BASED UPON DARPA. IT'S A DARPA-LIKE ENTITY FOR HEALTH. THIS IS SOMETHING THE PRESIDENT PUT IN HIS BUDGET. HIGH PROPOSED 6 1/2 BILLION DOLLARS. THE HOUSE SAID, INTERESTING. THEY PUT TO 3 BILLION. THE SENATE IN THEIR -- IT WASN'T A FORMAL MARK UP ON WHAT THEY DISTRIBUTED, PROPOSED 2.4 BILLION. SO I THINK AGAIN, WE HOPE IN THE FIRST YEAR ONCE WE GET A BUDGET, THAT WE'LL HAVE THIS NEW ORGANIZATION AT NIH ARPAH, AND IT WILL HAVE A BUDGET SOMEWHERE BETWEEN 2.4 AND 3 BILLION DOLLARS. USUALLY THEY SPLIT THE DIFFERENCE ON THESE THINGS BUT WE'LL SEE. THIS ORGANIZATION WILL HAVE UNIQUE AUTHORITIES MORE LIKE DARPA AND LESS LIKE NIH. ONE OF THE HALLMARKS OF WHAT THEY WILL DO IS THEY WILL NOT DO VERY MUCH IN THE WAY OF TRADITIONAL GRANT MAKING BUT MORE IN THE WAY OF CONTRACTS AND OTHER TRANSACTION AUTHORITIES, WHICH MEANS THAT THEY WILL BE ABLE TO REACH OUT AND MIX-AND-MATCH TEAMS THAT ARE RESPONSIVE TO ANY REQUEST FOR FUNDING ANNOUNCEMENTS AND SO FORTH. AND WHAT THAT DOES, IT GIVES A TREMENDOUS AMOUNT OF LATITUDE TO PICK TEAMS IN A NON THAT DITIONAL WAY. -- NON TRADITIONAL WAY. WE HAD SOME EXPERIENCE WITH THIS APPROACH WITH OTHER TRANSACTION AUTHORITIES AT THE AGENCY. MOST RECENTLY WITH THE AIM AHEAD EFFORT, WHICH SEEKS TO SEEK OUT BIASES IN THE USE OF A I AND NL IN THE USE OF ELECTRONIC HEALTH RECORDS AND WE WERE ABLE TO CRAFT A VERY INTERESTING TEAM THAT PROBABLY WOULD NOT NORMALLY -- PROBABLY WOULDN'T HAVE ARRIVED WITH THE GROUP WE WOUND UP WITH USING THE MORE TRADITIONAL PROCESS. WE THINK MIGHT BE A VERY POWERFUL ADJUNCT TO THINGS THAT NIH IS ALREADY DOING. >> THANK YOU. >> YOU'RE MUTED, LISA. >> THANK YOU, BOBBY. HELLO, DR. TABAK AND DR. ANDERSON. AND PLEASE SEND MY PERSONAL CONGRATULATIONS AND HOPEFULLY DR. COLLINS WILL BE ABLE TO ENJOY THE NEXT PHASE OF HIS LIFE. I'D LIKE TO SEE HOW WELL HE IS ABLE TO STAY OUT OF THE GAME. THAT WILL BE HARD. BUT ENJOY THE REST OF HIS TIME. BUT I WANTED TO -- WE HAVE A COUPLE OF OTHER PEOPLE WHO MIGHT HAVE THEIR HANDS UP AND IF YOU DO, I WILL GET TO YOU HERE. BUT I BROUGHT UP EARLIER THE NEED, AND I'M GLAD YOU'RE TALKING ABOUT THESE SILOS COMING TOGETHER BECAUSE ONE OF THE CHALLENGES THAT I'VE HAD IN MY OWN MIND SINCE I HAVE BEEN HERE TRYING TO UNDERSTAND HOW BIG AND VAST NIH IS AND THEN SITTING ON A BOARD OF DIRECTORS FOR A CLINIC AND SEEING HOW RESEARCH IMPACTS WHAT TREATMENTS WE ACTUALLY GET AT THE SERVICE LEVEL WHERE WE ARE ONE-TO-ONE, BOOTS ON THE GROUND SERVICING OUR COMMUNITY MEMBERS. AND ONE OF MY PASSIONS IS PTSD AND TRAUMA-BASED TREATMENTS. AND ONE OF THE -- SOME OF THE RESEARCH THAT HAS BEEN DONE INDEPENDENT BECAUSE OF THE SCHEDULING OF PLANT MEDICINE, WHICH WOULD BE SILL I CYB INS AND THINGS OF THAT NATURE, ONLY SYNTHETIC ONES ARE ALLOWED TO BE RESEARCHED RIGHT NEWS AND TRIBES ARE PLANT MEDICINE PEOPLE. SO SOMETIMES THESE THINGS USE THE TREATMENTS FOR IN CEREMONY AND AT THE END OF COMING BACK FROM WAR. FOR THOSE TYPES OF THINGS. WE HAD TREATMENT FOR THAT WE TRAD TRADITIONALLY BEFORE WESTERN INVASION. AND SO I'D LIKE TO SEE TRIBALLY-BASED RESEARCH PROJECTS AND THE FREEDOM PRACTICE AS SOVEREIGN NATIONS, ACTIVE PLANT MEDICINE AND HAVING SPECIFIC THINGS. BECAUSE I THINK THAT THAT COULD BE SOMETHING AS AN ALTERNATIVE TO THE STUFF WOE SEE GOING ON WEAPONNOIDS. THAT'S OBVIOUSLY AN ABUSE OF SOMETHING THAT IS DESIGNED TO TREAT PAIN -- OPIOIDS. WE NEED THE DATA. WE NEED THE AUTHORIZATION TO BE ABLE TO RESEARCH AND SO BEING ABLE TO HAVE THAT OPPORTUNITY TO DO THAT IS SOMETHING THAT THESE AGENCIES WHICH COULD COME TOGETHER AND HELP US FACILITATE THAT KIND OF THINGS. >> IT'S A CHALLENGE. THEY HAVE TO USE SYNTHETIC MATERIAL WHICH MAY NOT BE EQUIVALENT TO THE NATIVE PLANTS. AND THE WAY THE NATIVE PLANT IS EXTRACTED AND TREATED AND SO FORTH. THAT IS A VERY GOOD POINT. AND IT'S ONE WE CONTINUE TO WORK ON FOR JUST THE KINDS OF REASONS YOU'RE REFERRING TO. NOT ONLY BECAUSE OF THE NATIVE USE OF THESE TYPES OF COMPOUNDS, BUT FOR OTHER REASONS THAT ARE SOMEWHAT RELATED. BUT THANKS FOR RAISING IT BECAUSE IT GIVES US AN OPPORTUNITY I TO RAISE THIS TO HHS AND SAY, THIS IS ONE OF THE THINGS THAT CAME UP DURING OUR TRIBAL ADVISORY COMMITTEE. THEY ARE CONCERNED ABOUT THIS FOR THE FOLLOWING REASONS. SO THAT IS VERY HELPFUL THAT YOU RAISED THAT. THANK YOU. >> THANK YOU. AND ALSO I WANT TO LET YOU KNOW WE ARE WORKING ON A WAY, HOPEFULLY, THAT WE'LL BE ABLE TO, OUR ADVISORY COMMITTEE IS GOING TO BE SUBMITTING SOME PRIORITIES AND THEN HOPEFULLY ONGOING BASIS BEING ABLE TO, AS THINGS OCCUR, BEING REALTIME WITH YOU GUYS AND SHARING SOME OF THE FINDINGS WE HAVE AND HOPEFULLY HAVE A REALLY GOOD PARTNERSHIP GOING FORWARD IN DEVELOPING AND PROGRESSING AS WE GO ALONG AS WE HIT THE NEW TRAJECTORY. THE OTHER THING I WANTED TO BRING OUT AND THEN I WANT TO PASS THE BATON OVER TO ERAN, IS THE FACT THAT IT'S A LANGUAGING OF -- AND MY CONCERN OF THE POLICIES THAT GET CREATED AS A RESULT OF THE VACCINE OR NOT VACCINE. WE ALL KNOW EVERYONE IS POLARIZED BY IT FROM EVERY LEVEL. I WAS TALKING TO MY SON, AND FORMER CHAIRMAN OF OUR TRIBE. WE WENT THROUGH THE WHOLE OR DEAL WITH THE CHALLENGE OF OPIOIDS AS WELL. AND THE CHALLENGES WE SEE AND THE MANDATES OF WHAT IT IS DOING TO THE HEALTH CARE SYSTEM AND HAVING ACCESS TO THOSE TYPES OF SERVICES. SO I JUST WANT -- BECAUSE IN OUR EARLIER DISCUSSION YESTERDAY, WITH THE PERSON WHO IS THE HEAD OF THE INFECTIOUS DISEASE OR WHATEVER, COVID IS HERE TO STAY T PROBABLY WILL NEVER GO AWAY. AND HOW DO WE DEAL WITH THAT? AND THEN THE MESSAGING ABOUT THAT. BECAUSE ALL THE LEADERSHIP IN EVERY DEPARTMENT FROM THE PRESIDENT ON DOWN TO PEOPLE WHO RUN ORGANIZATIONS, ARE HAVING TO MAKE POLICIES AROUND IT AND IT'S DIFFERENT EVERYWHERE. IT'S JUST ALL OVER THE PLACE. SO TO EMBRACE THE FACT THAT IT'S HERE AND THEN HOW DO WE MOVE FORWARD AS A COUNTRY. BECAUSE WE ARE DEALING WITH IT AT OUR LEVEL TOO. THANK YOU VERY MUCH FOR YOUR TIME. ERAN, I KNOW YOU WANTED THIS OPPORTUNITY TO GIVE YOUR COMMENTS TO DR. COLLINS. >> YES. SO FIRST, I APOLOGIZE FOR BEING INTERMITTENT THE LAST TWO DAYS. YESTERDAY WE HAD A CRISIS WITH THE THREAT TO EXIT OUT OF THE APPROPRIATIONS AND BUDGET RECONCILIATIONS AND PROVISIONS WE FOUGHT SO HARD FOR. AND THEN TODAY THE WHITE HOUSE COUNCIL HAD A HEALTH SUBCOMMITTEE SESSION WITH SECRETARYBA ZARA AND HOLLAND AND A COUPLE OF OTHER SECRETARIES AND PRESIDENT HAS FACILITATED A CONVERSATION WITH INDIAN COUNTRIES. SO I HAD TO LEAVE TO GO OVER THERE AND I HAD TO TYPE MY COMMENTS IN BECAUSE THEN I HAD TO LEAVE TO TESTIFY IN THE SENATE COMMITTEE ON VOTING RIGHTS. AND SO I'M SHARING THAT WITH YOU REAL QUICK BECAUSE AS COMMITTED AS I AM TO OUR PURPOSE UPON AND OUR MISSION HERE, THERE IS TIMES WHEN TRIBAL LEADERS GET PULLED AWAY AND I DO APOLOGIZE FOR THAT. WHAT I WANTED TO SAY TO MARK THE OCCASION AT DR. COLLINS RETIREMENT. I WANTED TO SAY JUST A COUPLE OF WORDS AND I'M HOPING, DR. TABAK AND DR. ANDERSON IF YOU COULD SHARE THAT BACK WITH HIM IS, WHEN I FIRST MET HIM -- I KNEW ABOUT HIM A LONG TIME BEFORE BECAUSE I ALWAYS HAVE BEEN A SCIENCE GEEK AND I'M NOT ASHAMED OF THAT TERM. AND I HAVE ALWAYS TRACKED HIS CAREER AND THE WORK THAT HE HAD DONE WITH THE HUMAN GENOME AND REALLY THE SOLUTION TO A LOT OF OUR HEALTH PROBLEMS THAT WE HAVE AS AMERICANS, AS CITIZENS AND HUMAN BEINGS. IS GOING TO BE ABLE TO HELP US IN PACK ALL OF THAT AND UNDERSTAND THAT AT LEVELS WE DON'T UNDERSTAND TODAY. AND IT WILL BE ABLE TO GIVE US WHAT WE NEED FOR PRECISION MEDICINE TO PRESCRIBE EXACTLY THE LIFESTYLE THAT WE SHOULD LIVE. AND I JOKE TO YOU MANY TIMES. I'M A RUNNER. I RUN MY BUTT OFF. I RUN SOMETHING LIKE 50 OR 60 MILES A WEEK AND I STILL HAVE MY FRY BRED CENTER RIGHT HERE. THERE IS NOTHING I CAN DO TO GET RID OF IT. BUT I WANT TO FIND OUT WHAT I CAN DO TO GET RID OF IT. AND I KNOW WORKING SMARTER IS BETTER THAN WORKING HARDER AND I WANT TO KNOW THAT THROUGH THE RESULTS OF THE ALL OF US RESEARCH. SO I'M GIVING A LITTLE BIT OF AN ENDORSEMENT FOR THAT TOO. WHEN I FIRST MET DR. COLLINS IT WAS AT A HHS SECRETARY TRAVEL ADVISORY MEETING ABOUT SEVEN YEARS AGO AND HE WAS THERE VERY PROUDLY EXPLAINING THIS AND THEN I ASKED THE QUESTION, AN ETHICS QUESTION ABOUT, WHAT PROTECTIONS DO WE HAVE SO THAT NON-NATIVE PEOPLE DON'T MISUSE THAT INFORMATION TO PAINTED A PICTURE THAT WE'RE INTELLECTUALLY INFERIOR OR GENETICALLY INFERIOR OR WHATEVER? HE LOOKED AT ME IN SUCH AN INNOCENT SORT OF SCIENCE WAY AND SAID, THAT WOULD BE WRONG. AND SO I REALLY ENJOY HIS INTELLECT AND I ENJOY HIS COMMITMENT AND ALSO TO OUR EFFORT HERE. SO IF YOU KNOW RECENTLY I GOT APPOINTED TO DIRECTOR'S ADVISORY. I WENT TO MY FIRST SESSION. THAT'S WHERE I GET TO FIND OUT THAT I'M NOT THE MOST NERDY PERSON THAT I KNOW. HIS CAT WAS A FEATURE ON THAT SESSION BUT WITH ALL OF HIS TALLENTS AND ABILITIES, I JUST WANT TO SHARE BACK THAT I APPRECIATE HIS COMMITMENT AND ATTENTION AND ELEVATING NATIVE-AMERICANS TO SERVE ON THAT ADVISORY. I JUST SIGNED MY PAPERWORK TODAY EVEN THOUGH HE IS RETIRING. I'M STILL GOING TO BE ON THE ADVISORY AND I'LL DO MY BEST TO BRING AND GIVE VOICE TO OUR EFFORT HERE UP THERE SOY EVERYBODY CAN UNDERSTAND WHAT IT IS WE ARE DOING HERE. AND SO I JUST WANTED TO SHARE ALL THAT AND IF YOU COULD GIVE MY REGARDS AND OUR REGARDS TO DR. COLLINS THAT WE APPRECIATE THE GROUNDBREAKING WORK THAT HE HAS DONE IN HIS CAREER. WHEN WE LOOK BACK, WHEN OUR DESCENDANTS LOOK BACK AND LOOK BACK TO SOME OF THE SMARTEST PEOPLE THAT EXISTED IN THIS ERA, HIS NAME WILL BE ON THAT LIST. AND SO I JUST WANTED TO SHARE OUT OF RESPECT FOR DR. COLLINS. THANK YOU. >> THANK YOU VERY MUCH. WE ARE DELIGHTED THAT YOU'RE ABLE TO SERVE ON THE ADVISORY COMMITTEE TO THE NIH DIRECTOR. AND I THINK THAT AS YOU WILL SEE, THIS IS A PRETTY IMPORTANT GROUP, A LOT OF IMPORTANT DECISIONS ARE MADE AND WE ARE LOOKING FORWARD TO YOUR PERSPECTIVE. NO ONE ON THAT COMMITTEE IS BASHFUL AS I'M SURE YOU HAVE DISCERNED AND THAT IS A GOOD THING, QUITE FRANKLY. WE ARE LOOKING FORWARD TO YOUR CONTINUED PARTICIPATION. BY THE WAY, HE IS NOT RETIRING. HE IS GAG BACK TO HIS LABORATORY FULL-TIME. HE IS STEPPING DOWN FROM THE DIRECTORSHIP -- ALL OF THIS TIME HE STILL RAN A LABORATORY. NOW HE IS ONLY GOING TO DO THE FUN STUFF GOING FORWARD. SO JUST TO CLARIFY THAT POINT. >> AWESOME. >> THANK YOU. WE HAVE A MINUTE LEFT HERE AND I JUST WANT TO GIVE YOU GENTLEMAN A BIT OF TIME FOR ANY CLOSING COMMENTS OR REMARKS YOU'D LIKE TO MAKE TO THE TAC? >> WELL, LOOK. FROM MY PERSPECTIVE AND THIS IS ONLY SPEAKING TO BOTH FRANCIS AND JIM ANDERSON ABOUT QUITE A BIT. THIS IS KNOW WHO OF THE MOST IMPACTFUL COMMITTEES WE HAVE AT NIH. WE ARE -- WE GOT A LOT TO DO. WE ARE NOT THERE YET. BUT AS A RESULT OF YOUR GUIDANCE AND YOUR WILLINGNESS TO WORK WITH US, I THINK WE ARE MAKING PROGRESS. AND TOO OFTEN GOVERNMENT COMMITTEES CAN'T SAY THAT ABOUT -- THIS IS ONE OF THE COMMITTEES WHERE YOU CAN SAY THAT AND WHAT I HOPE YOU NOW SEE GOING FORWARD IS AN ACCELERATION OF PROGRESS. BECAUSE I THINK, AND AGAIN, A LOT OF CREDIT TO DAVE WILSON AND HIS COLLEAGUES. I THINK WE GOT A GOOD FOUNDATION AND I WANT TO BUILD ON THAT TO REALLY BEGIN TO ACCELERATE THE PROGRESS YOU MAKE. JIM IN THE FINAL MOMENTS. >> YES, I THINK THIS IS THE SPIRIT OF WHAT I TRIED TO SAY BEFORE IS THAT WE BUILT A FOUNDATION AND BEING OUTSIDE NIH YOU WOULDN'T SEE THIS ON A DAY-TO-DAY BASIS. YOU WOULDN'T SEE IT ON HOW THE DIRECTORS ARE RESPONDING AND HOW THE STAFF ARE RECOGNIZING WHAT WE ARE TRYING TO DO. BUT A LOT HAS HAPPENED WITHIN NIH THAT IS NOW TRANSLATED OUTSIDE. BUT IT'S HAPPENING. SO, AGAIN, NO VICTORY LAPS BUT I'M SMILING. >> WE APPRECIATE YOUR SUPPORT VERY, VERY MUCH. WE KNOW THAT WITHOUT THAT, WE WOULDN'T BE ABLE TO BE MAKING THIS KIND OF PROGRESS THAT WE ARE. SO THANK YOU FOR YOUR TIME. WE APPRECIATE YOU BEING HERE AND SPENDING THIS TIME WITH US AND ANSWERING OUR QUESTIONS. AND DAVID, ALSO I WANT TO ACKNOWLEDGE YOU TOO IN THE WORK THAT THE THRO DOES. I KNOW THAT WE DON'T SEE A LOT OF THIS WORK. AND AS ADVISORS, EVERYBODY IS BUSY DOING A MILLION DIFFERENT THINGS AND WE DON'T SEE WHAT HAPPENS IN THE BUILDING. BUT WE KNOW YOU'RE WORKING HARD BECAUSE I KNOW THAT EVERYONE IS TRYING TO GET AHOLD OF ME AND I'M ALWAYS BUSY OFF DOING 1000 THINGS. WE KNOW YOU'RE DOING YOUR BEST TO MAKE THINGS WORK FOR INDIAN COUNTRY. AND I WANT TO ACKNOWLEDGE ALL OF THE TAC MEMBERS TOO THAT SHOW UP TO THESE MEETINGS AND BRING YOUR VOICES FORWARD SO WE CAN ALL WORK TOGETHER AND THAT IS REALLY WHAT WE WANT TO DO GOING FORWARD IS PROBABLY HAVE A REALLY GOOD PARTNERSHIP WITH YOU ALL AND TRANSLATE THAT AS DR. ANDERSON SAID, AND I DO LOOK FORWARD TO HAVING COFFEE WITH YOU SOON! IN THE HALLWAY. I DO MISS THAT TOO HERE WITH US NOT BEING IN PERSON. SO I LOOK FORWARD TO THAT MOMENT TOO. SO GET US THERE, PLEASE! >> THANK YOU. >> SO, IF THERE ISN'T ANYTHING ELSE, WE WILL MOVE ON TO OUR NEXT THINGS THAT WE HAVE TO DO. WE HAVE SOME BUSINESS TO HANDLE HERE WITH THE TAC. SO THANK YOU VERY MUCH, AGAIN. AND DAVID, IF THERE IS ANY OTHER THINGS YOU WANT TO, CLOSING REMARKS YOU WANT TO MAKE, I'LL GIVE YOU THAT TIME. >> NO, NO. I THINK EVERYTHING HAS BEEN SAID. APPRECIATE YOU ALL. >> THANK YOU, GENTLEMAN. APPRECIATE IT VERY MUCH. THAT WAS GREAT AND IT WAS GREAT HAVE THEM HERE. WE ARE NOW ON TO THE PART OF OUR AGENDA, WE HAVE AN ELECTION AND BEFORE THE ELECTION, WE HAVE A DISCUSSION ON THE CHARTER THAT WE ARE ABLE TO ADDRESS AT THE -- IN OUR CAUCUS. AND IT'S RELATED TO THE LANGUAGE AND THE CHARTER OF THAT WHICH WAS DISCOVERED WHERE THE CHAIR AND THE CO-CHAIR NEED HAVE A LANGUAGE CHANGE IF WE WERE GOING TO CONTINUE TO BE ELIGIBLE TO EVEN RUN FOR THIS OR HOLD THIS SPOT. AND SO, THERE SI S. A PROPOSED CHANGE OF LANGUAGE. WE DISCUSSED EARLIER THE FACT THAT IT IS AN OPEN DISCUSSION STILL, I THINK. BUT I'M HOPING THAT WE KIND OF CONCLUDED THAT THE WORK HERE, WHETHER IT BE DONE BY TAC MEMBERS WHO ARE ELIGIBLE TO SERVE THE TAC IN GENERAL OR THEY HAVE TO BE ELECTED OFFICIALS IS REALLY WHAT THE DISCUSSION IS IN ORDER TO SERVE IN THIS CAPACITY BECAUSE MYSELF AND BOBBY ARE CURRENTLY THE CHAIR AND CO-CHAIR. SO THE CHARTER, IF WE WERE TO CONTINUE OR ANYBODY ELSE WHO WANTED TO SERVE IN THIS CAPACITY WHO ARE NOT IN TRIBAL LEADERSHIP, WOULD WANT TO -- SERVE IN THIS CAPACITY, WE WOULD NEED TO CHANGE THE CHARTER LANGUAGE. AND THE PROPOSED LANGUAGE THAT IS BEING PROPOSED, IF YOU LOOK AT THE VERY BOTTOM OF THE AGENDA, IT SAYS, PROPOSAL TO CHANGE THEEL JITTABILITY LANGUAGE FOR THE TAC CHAIR AND CO-CHAIR. THE CARE WILL BE APPOINTED TRIBAL LEADER PROPOSED CHANGE, THE TAC CHAIR WILL BE A FULLY-APPROVED TAC DELEGATE. CURRENTLY THE CO-CHAIR WILL BE AN ELECTED APPOINTED TRIBAL LEADER -- NO. YES, WE ALREADY SAID THAT. SO THE PROPOSED CHANGE IS THE TAC CHAIR WILL BE -- THE CHAIR OR CO-CHAIR, SHOULD BE IN THIS CAPACITY, WILL BE A FULLY-APPROVED TAC DELEGATE. SO I GUESS THAT WOULD BE THE LANGUAGE THAT WOULD BE PROPOSED. SO IF WE WOULD HAVE A MOTION OR NOT. ERAN? >> I HAVE A QUESTION FOR DAVE. IF WE WERE TO MAKE THE AMENDMENT TODAY AND SINCE WE HAVE ELECTIONS TODAY, WOULD THOSE ELECTIONS TAKE EFFECT OR SHOULD WE DO AN EXTENSION OF THE -- BECAUSE I KNOW ONCE WE MAKE THE BYLAW CHANGE IT DOESN'T MEAN IT CHANGED. IT MEANS THAT THE ADMINISTRATION HAS TO REVIEW IT AND IT HAS TO GO THROUGH LEGAL AND RUBBER STAMPED, RIGHT? SO MY QUESTION IS, IF THAT IS THE CASE AND IT DOESN'T TAKE EFFECT TODAY, CAN WE DELAY THE ELECTION OF OFFICERS UNTIL AFTER THE BYLAW CHANGE IS ACCEPTED? >> THAT IS A GREAT QUESTION. AND ACCORDING TO WHAT I READ IN THE BEGINNING OF OUR MEETING, WHICH IS THE EXEMPTION MEETING RULES, IS THAT THE CHANGES BEING PROPOSED ARE DEFINITELY WITHIN WHAT IS BEING OR WHAT IS STATED WITHIN THE FACA RULES. SO IT WOULD NOT BE SOMETHING OUT OF THE ORDINARY OR GO AGAINST WHAT IS STATED HERE. SO THE SPECIFIC LANGUAGE IS, FEDERAL OFFICIALS AND ELECTED OFFICERS FROM STATE AND LOCAL OR TRIBAL GOVERNMENTS OR THEIR DESIGNATED REPRESENTATIVES. AND SO THAT WOULD NOT HAVE ANY BEARING ON OR HAVE ANY KIND OF LEGAL CHALLENGE WITH IT. >> SO I WILL BE READY TO MAKE A MOTION AFTER YOU GET CONVERSATION. I DON'T WANT TO CUT ANYBODY OFF. >> I HAD TO SWITCH OVER TO MY iPAD AND IMINO JUST USING MY iPAD ON ZOOM. SO SORRY ABOUT THAT. I DID WANT TO COMMENT ON -- I DO THINK THAT IT'S IMPORTANT TO HAVE THE ELECTED OFFICIALS AS CHAIR AND CO-CHAIR. I KNOW THAT SOME OF THE OTHER TACs -- I RESPECT SOME OF THE INFORMATION WE SHARED EARLIER AND OPINIONS THAT IT'S NOT THAT WAY IN SOME OF THE OTHER TACs BUT I THINK IF YOU HAVE ENOUGH TRIBAL ELECTED OFFICIALS, THAT ARE INTERESTED, THAT WE SHOULD CONSIDER THAT IN 24 CASE. THAIN THIS CASE. IF WE DO HAVE ENOUGH THAT ARE INTERESTED, THAT WE SHOULD LEAVE IT IN THAT CASE. BECAUSE BEING A TRIBAL LEADER, I THINK THAT SOMETIMES -- EVEN THOUGH THIS IS NOT CONSULTATION AND IT DOESN'T TAKE PLACE AT CONSULTATION, IT'S REALLY IMPORTANT THAT WHEN THERE ARE THESE CONVERSATIONS THAT THEY ARE THERE. THAT ELECTED OFFICIALS ARE THERE. OR THEY ARE APPOINTEDDED PEOPLE. BUT IT'S JUST -- I THINK IT'S REALLY IMPORTANT THAT ONCE THOSE -- I FINISH FOR CHAIRS, IT'S A LITTLE BIT MORE DIFFICULT BECAUSE THE TIME IS -- YOU'RE STRETCHED ALL OVER THE PLACE. I HAVE BEEN THERE. BUT IF PEOPLE HAVE THE TIME AND THEY CAN MAKE THE COMMITMENT, I THINK THAT IS GOOD. AND I DID JUST SO YOU KNOW, I SENT OUT A NOTE TO YOU AND ALSO TO BOBBY, THAT I WOULD BE INTERESTED IN BEING CHAIR. I PUT THAT OUT THERE, AND I'M WILLING TO MAKE THE TIME AND COMMITMENT TO TO IT. EVEN THOUGH I HAVE ONLY BEEN ON IT FOR A YEAR. BUT I THINK IT'S REALLY IMPORTANT. AND I THINK THAT -- I CAN LEARN. I'M SURE I WOULD GET SUPPORT. IF THE COMMITTEE CHOOSES OTHERWISE, I THINK THAT IS FINE TOO. BUT I WOULD STILL STICK WITH THE POSITION THAT ANOTHER ELECTED OFFICIAL SHOULD CONSIDER VOLUNTEERING BECAUSE AGAIN I THINK IT'S IMPORTANT. BUT IF WE DON'T HAVE ENOUGH ELECTED OFFICIALS, THEN WE COULD DEFAULT TO NON-ELECTED OFFICIAL. >> THANK YOU. TYLER? >> YELLS, I WANTED TO BRIEFLY MENTION -- YES. SO I WAS ADVISER FOR OUR REGION PREVIOUSLY AS WELL. WE HAVE BEEN THROUGH THIS CONVERSATION I THINK TWO OR THREE TIMES NOW IN OUR MEETINGS. AND WHY HAD NEVER MADE THE CHANGE PREVIOUSLY BECAUSE WE ALL READ IT THE SAME WAY AS BASICALLY IF YOU'RE A DELEGATE, YOU'RE ALREADY APPROVED AND AUTHORIZED BY A TRIBE TO REPRESENT THE TRIBE OR THE REGION. SO THAT'S WHY I IT NEVER HAD BEEN CHANGED IN THE PAST. THAT'S WHAT HAPPENED IN OUR LAST THREE DISCUSSIONS IN CAUCUS. WE JUST SAID WE DON'T NEED TO CHANGE THAT. BUT I CAN UNDERSTAND THE NEED FOR THE CHANGE. SO IT'S CLEAR FOR EVERYBODY AND EVERYBODY FEELS COMFORTABLE. BUT I WOULD BE IN AGREEMENT THAT TRIBAL LEADERS OBVIOUSLY SHOULD TAKE PRIORITY WITH DELEGATES BEING SECONDARY FOR THE LEADERSHIP ROLES. SO I WOULD BE IN AGREEMENT WITH THAT AS WELL. AND I THINK WE DID DISCUSS THAT IN OUR DISCUSSIONS TOO. IS THAT WE WOULD ALWAYS SIT BACK FOR A TRIBAL LEADER FOR THAT POSITION. >> RIGHT. SO, OKAY. GREAT. >> WAIT A MINUTE. >> ERAN? >> I HAVE A COMPROMISE. WHAT ABOUT THIS LANGUAGE -- AMEND TO TAT TAC CHAIR AND CO-CHAIR INCLUDE A REPRESENTATIVE OF A ELECTED LEADER AND A FULLY-APPROVED TAC DELEGATE. THAT WAY FOR THE TWO CO-CHAIRS, WE HAVE ONE OF EACH. >> OR THAT IT GET OFFERED TO A TRIBAL CHAIR IF THEY WANT TO SERVE IN THAT CAPACITY. BUT THAT IT IS OPEN -- WHAT IF SOMEBODY CAN'T DO IT OR DOESN'T -- ISN'T ABLE TO FULFILL THAT CAPACITY? THAT WOULD BE THE ONLY CONCERN I WOULD HAVE. >> YES. >> SO AND I'M IN AGREEMENT TO -- FOR LEADERSHIP TO BE THERE AS WELL. I DON'T HAVE A PROBLEM WITH THAT. IT'S JUST A MATTER OF WHOMEVER CAN SERVE IT'S A MATTER OF BEING WILLING TO SERVE, I THINK AND BEING ABLE TO SHOW UP. SO I GUESS WHOMEVER -- >> SO I HAVE SOME LANGUAGE THEN. >> OKAY. >> MAYBE DAVE GET READY TO WRITE IT. TYPE IT UP. SO LET'S TRY THIS. THE MOTION IS -- PREFERENCE FOR APPOINTMENT TO THE TAC CHAIR SHALL BE AFFORDED TO A TRIBAL LEADER. IN THE ABSENCE OF A TRIBAL LEADER, A FULLY-APPROVED TAC DELEGATE IS ELIGIBLE TO SERVE AS CHAIR. DID YOU TYPE IT? I HAVE THESE MOMENTS OF BRILLIANCE THAT FADE AWAY. >> I'M HANDWRITING IT. DON'T LOSE THAT SECOND SENTENCE. >> WHAT WAS THE LAST PART, ERAN? >> I DON'T REMEMBER. IT WAS PREFERENCE TO AN ELECTED TRIBAL LEADER AND THEN -- SO THAT'S IN THE NOMINATION. SO IF YOU HAVE AN ELECTED TRIBAL LEADER THAN THAT IS WHAT WE GO WITH BUT THAT WE PROVIDE FOR ELIGIBILITY FOR A FULLY-APPROVED TAC DELEGATE. THAT'S THE WAY THE LANGUAGE THAT THEY HAD ON THE AGENDA. SO THAT MEANS ANYBODY THAT IS A - AUTO SEATED ONE IS THE ALTERNATE. >> IVET PUT IT IN THE CHAT. >> THAT WILL BE MY MOTION. THANK YOU. >> GREAT. SO DO I HAVE A SECOND FOR THAT? SO IF I DON'T HAVE A SECOND FOR THE LANGUAGE CHANGES. IS THERE A DIFFERENT LANGUAGE CHANGE? YOUR HAND IS UP. >> ARE WE GOING WITH THE ONE THAT CHAIRMAN PING MAN HAS IN THE TEXT OR THE ONE THAT YVETTE HAS IN THE TEXT? >> WAIT. I THOUGHT THAT -- >> DR. RUBE DUE TYPED IS CONSISTENT WITH WHAT I SAID. >> IT'S JUST WORDED A LITTLE DIFFERENT BUT IN THE END IT'S THE SAME. >> YES. SO MINI, YOUR HAND IS UP. >> I'LL SECOND. I'M TRYING TO FIGURE OUT MY ZOOM ON MY iPAD. [ LAUGHS ] I'LL SECOND. >> ANY DISCUSSION? >> LET'S LOOK AT IT. >> SO THE ONE THING IT ONLY ADDRESSES THE CHAIR POSITION IN THIS LANGUAGE. >> RIGHT. >> OKAY. >> SO REPHRASE IT. >> DOE WE HAVE A REFRACT OR WANT TO REPHRASE IT? WHAT ABOUT THE ALTERNATE -- NOT THE ALTERNATE. THE CO-CHAIR. >> IT WAS MY INTENT THAT -- SO DR. RUBE DUE IF YOU COULD CUT AND PASTE BECAUSE YOU DID THAT SO QUICK. IT WILL BE A MOTION PREFERENCE FOR APPOINTMENT OF TAC CO-CHAIRS AFFORDED TO A TRIBAL LEADER IN THE ABSENCE OF A TRIBAL LEADER, A FULLY-APPROVED TAC DELEGATE IS ELIGIBLE TO SERVE AS CO-CHAIR. SO JUST CHANGING THE TERM CHAIR, TO CO-CHAIRS IN BOTH REFERENCES. LOOK AT HOW FAST THAT IS! THAT'S AMAZING! >> CAN'T WE JUST PUT IT ALL IN ONE MOTION? >> YES, I THINK SO. THE ONE YOU JUST POSTED, I THINK DOES IT. SO LISA WOULD SAY THE RULES WOULD SAY WITHOUT OBJECTION THIS IS PULLED FROM THE FLOOR. THE ORIGINAL MOTION IS PULLED FROM THE FLOOR. AND IF NOBODY OBJECTS THEN IT'S PULLED. THEN YOU GO TO THE -- AND THEN I'LL BE READY TO MAKE THE NEW MOTION. >> OKAY. SO THE ORIGINAL MOTION IS BEING PULLED FROM THE FLOOR. ARE THERE ANY OBJECTIONS? >> RAMONEA HAS HER HAND UP. >> RAMONEA? >> THANK YOU. I RESPECTFULLY WOULD LIKE TO MAKE A SUGGESTION. IT SOUNDS LIKED ON THE FLOOR THE ORIGINAL IS BEING PULLED. I WOULD LIKE TO MOVE TO THE SECOND ONE WHICH WOULD BE THE TAC CHAIR OFFERED TO TRIBAL LEADER, PRESENT THESE LEADERS, AND THEN IN THE ABSENCE OF A TRIBAL LEADER, PRESENT THESE LEADERS, WITH APOSTROFEE S. BECAUSE I THINK THAT WOULD OPEN THE DOOR TO WHERE BOTH THE CHAIR AND CO-CHAIR, THE TWO SEATS WILL BE OFFERED TO TRIBAL LEADERS FIRST AND THEN SECONDLY TO IN THE ABSENCE OF A TRIBAL LEADER, LEADERS, THE THEN THE SECOND WOULD BECOME AVAILABLE WITH FULLY APPROVED TAC DELEGATE. THAT'S MY SUGGESTION. >> YOU HAVE TO CLOSE OUT THE OBJECTION TO THE FIRST CONSIDERATION, WHICH I DON'T THINK WE ARE CONSIDERING THE FIRST ONE ANYMORE. SO WE NEED TO CLOSE THAT ONE OUT IF THERE IS ANY OBJECTION BEFORE WE CAN MOVE TO A SECOND MOTION AND I AGREE. YOU CAN MAKE A MOTION OR I'LL MAKE IT. >> FIRST OF ALL, I'M GOING TO CLOSEOUT THE -- SO DO I NEED -- IF I'M GOING TO CLOSEOUT THAT LAST ONE, TAKE IT OFF THE FLOOR, DO I NEED TO ASK FOR A MOTION FOR THAT? >> NO. NO YOU CAN ASK WITHOUT OBJECTION BECAUSE IT'S THE SAME THING. >> OKAY. SO I THOUGHT I DID ALREADY. >> BUT THEN SOMEBODY JUMPED IN ON DISCUSSION BEFORE WE WERE DONE. >> OKAY. ARE THERE ANY OBJECTIONS IN PULLING THE ORIGINAL MOTION FROM THE FLOOR? >> NO. >> -- A FULLY APPROVED TAC GEL GAT IS ELIGIBLE TO SERVE AS CHAIR OR CO-CHAIR. -- DELEGATE. >> RAMONEA WOULD YOU LIKE TO MAKE THE MOTION? OR I'M WILLING. >> I WOULD LIKE TO DEFER TO A TRIBAL LEADER. THANK YOU. MY REPRESENTATION HAS STEPPED AWAY. THANK YOU. >> I'LL MAKE THAT MOTION. >> SO I HAVE A MOTION. >> SECOND. >> OKAY. WE HAVE A MOTION AND A SECOND. ALL THOSE IN FAVOR SAY AYE OR WITH A HAND. WAIT. DAVID, DO WE NEED AN E-MAIL ON THIS ONE OR HOW DO YOU WANT TO TAKE THIS VOTE? >> IT CAN EITHER BE -- [ MULTIPLE SPEAKERS ] >> PARDON? >> WHERE WE PUT IT IN THE CHAT TWO DAYS AND HE CAN ADD UP -- TO DAVE -- >> DO YOU WANT TO DO IT IN THE CHAT OR BY E-MAIL, DAVID? >> CHAT IS FINE. >> OKAY. SO IN CHAT, EVERYBODY VOTE. >> SO JUST TO MAKE SURE WE ARE SENDING DAVID A CHAT DIRECTLY TO DAVID? IS THAT WHAT WE ARE DOING? >> DIRECTLY TO DAVID. >> WE JUST WENT THROUGH THIS WITH NCAI WE HAD TO GET CREDENTIALED AND YOU HAD TO GO UP HERE AND CHANGE YOUR NAME AND PUT YOUR CREDENTIALS AS EITHER FOR YOUR NATION OR AS AN INDIVIDUAL. IT WAS FUN. WE DID T WE GOT THROUGH IT. >> THIS IS A VALID VOTE AND THE VOTES ARE UNANIMOUS TO AMEND THE CHARTER TO INCLUDE THE PROPOSED LANGUAGE: >> GREAT. THANK YOU. AND SO, WITH THAT, CAN I TAKE NOMINATIONS FOR CHAIR? >> I HAVE A FEELING MINIS TRYING TO FREE UP HER iPAD. >> I CAN NOMINATE -- BECAUSE SHE EXPRESSED INTEREST. >> I DON'T KNOW HOW IT WORKS. SO I WAS TRYING TO -- IT KEEPS SCROLLING BACK UP ON MY iPAD. THE SCREEN GOES UP. SO THAT'S WHY I LOSE IT. DON'T TAKE THAT AS INCOMPETENCY ON MY PART WITH MY iPAD. IT'S A BRAND NEW iPAD AND I DON'T USE THIS ONE. I USUALLY JUST USE MY LAPTOP. >> LISA, YOU CAN, IF THE ALTERNATE CAN VOTE AND MAKE A NOMINATION. FACILITY PRINCIPAL DELEGATE IS NOT PRESENT BUT THE TECHNICAL ADVISORS CAN'T. >> SO DO WE HAVE A NOMINATION? >> SHE WAS ASKING THE QUESTION? >> RIGHT. >> AND YOU CAN ALSO SELF NOMINATE. >> OKAY. SO I'LL SELF NOMINATE FOR -- I'M INTERESTED IN BEING CHAIR FOR THE TAC COMMITTEE. >> OKAY. GREAT. >> FOR THE ADVISORY COMMITTEE. >> SO WE HAVE A SELF NOMINATION. DO WE NEED A SECOND ON THAT? I GUESS WE WOULD NEED A SECOND. >> AYE. >> DO WE HAVE A SECOND? >> YES. >> I WAS CLARIFYING YOU DO NEED A SECOND. >> SO I NEED A SECOND. >> I CAN SECOND. >> OKAY, WE HAVE A NOMINATION, SELF NOMINATION AND A SECOND BY CHAIRMAN LEE GATE WOOD. ALL THOSE THAT CAN APPROVE OR CAN VOTE IN THE CHAT BOX AND SEND TO DAVE. >> CAN WE VOTE? CAN THE NOMINEE VOTE? >> YES. >> OKAY. >> I'M I'M A TRAINED PARLIAMENTARIAN SO IF I JUMP OUT, I'M SORRY. EVEN IF YOU'RE NOT ANSWERING ME, I'M GOING TO ANSWER. ROBERTS RULES. WHO IS THIS ROBERT? >> I KNOW, RIGHT? >> WE HAVE PARLIAMENTIARY MEETING RULES AND WE GET TRAINED EVERY COUPLE OF YEARS BY THE DCI AND YOU WOULD THINK THAT WE NEVER GOT TRAINED, SOMETIMES. I WILL SAY TYLER, I SEE YOU SMILING. I WON'T SAY ANYMORE THAN THAT. >> I DIDN'T SAY IT. >> I KNOW MY STUFF, THOUGH. I GO BACK AND READ ALL THE RULES. I KNOW IT. >> THAT'S AWESOME. >> SO THE VOTING IS IN AND WE HAVE, UNANIMOUS VOTING FOR COUNCILWOMAN MINITO ASSUME THE ROLE OF THE NIH TAC CHAIR FOR THE UPCOMING -- FROM HERE WE ARE MOVING FORWARD. >> CONGRATULATIONS! ALL RIGHT. AND THEN WE HAVE ALSO A CO-CHAIR. AND SO THE FLOOR IS OPEN FOR NOMINATIONS FOR CO-CHAIR. >> I'D LIKE TO ASK IF THERE ARE ANY TRIBAL LEADERS. IF NOT, I'D LIKE TO MAKE A NOMINATION FOR ONE OF OUR FULLY-APPROVED TAC DELEGATES. WE ASK THREE TIMES AND IF NOBODY ANSWERS, THAT'S IT. >> OKAY. SHOULD I ASK AGAIN, THEN? ARE THERE ANY TRIBAL LEADERS THAT WOULD LIKE TO SERVE AS CO-CHAIR? ONE MORE TIME. ARE THERE ANY TRIBAL LEADERS WHO WOULD LIKE TO SERVE AS CO-CHAIR. SO THAT WOULD BE THE RULE BOOK, THEN? >> IT IS. >> THAT'S GOOD TO KNOW. >> NOW YOU SAY NOMINATIONS ARE CLOSED. WITHOUT OBJECTION NOMINATIONS ARE CLOSED. >> WITHOUT OBJECTION NOMINATIONS ARE CLOSED AND NOW OPEN TO THE -- I GUESS IT WOULD BE TO THE FULLY -- WHAT DO YOU CALL THEM? >> FULLY-APPROVED TAC DELEGATE. >> SO THE NOMINATIONS ARE OPEN FOR THE FULLY-APPROVED TAC DELEGATES. >> I'D LIKE TO MAKE A MOTION TO APPOINTED LISA SUN BERG AS OUR CO-CHAIR FULLY-APPROVED TAC DELEGATE. >> AND I ACCEPT. WE NEED A SECOND, THOUGH. >> I SECOND. >> THANK YOU, CHAIRMAN GATE WOOD. APPRECIATE THAT. ARE THERE ANY OTHER NOMINATIONS FOR ANY OF THE OTHER FILLY-APPROVED TAC DELEGATES? ARE THERE ANY OTHER NOMINATIONS FOR APPROVED TAC DELEGATES. ARE THERE ANY OTHER NOMINATIONS FOR APPROVED TAC DELEGATES? WITH THAT, THE NOMINATIONS ARE CLOSED. AND I DON'T THINK WE NEED TO VOTE. DO WE, DAVE? I DON'T THINK WE NEED TO VOTE. >> YES. >> YOU [ TECHNICAL DIFFICULTIES ] >> OKAY SO THE VOTES ARE IN AND YOU HAVE BEEN UNANIMOUSLY APPROVED TO SERVE AS CO-CHAIR FOR THE NIH TRIBAL ADVISORY COMMITTEE. >> THANK YOU. >> CONGRATULATIONS TO BOTH OF OUR NEW CHAIR AND CO-CHAIR FOR ACCEPTING THIS. WE VERY MUCH LOOK FORWARD TO WORKING WITH YOU. THERE IS IT A LOT MORE WORK TO BE DONE AND WE ARE EXCITED THAT YOU'RE GOING TO BE ALONGSIDE US IN THIS ADVENTURE. >> THANK YOU. AND I'D LIKE TO ALSO -- FIRST OF ALL, THANK YOU, EVERYBODY FOR ALLOWING ME TO SERVE AS CHAIR THIS LAST YEAR. AND IT'S BEEN A LEARNING EXPERIENCE TO GO THROUGH ALL OF THIS AND I LOOK FORWARD TO CONTINUED WORK AND I WANT TO ALSO ACKNOWLEDGE BOBBY AND THE WORK HE HAS DONE OVER THE LAST YEAR. APPRECIATE YOUR PARTNERSHIP, BOBBY, AND OBVIOUSLY WE ALL HAVE AN OPEN DOOR WITH EACH OTHER SO BUT I WANTED TO ACKNOWLEDGE YOUR WORK AND APPRECIATE YOUR PARTNERSHIP OVER THE LAST TERM. >> THANK YOU, LISA. IT'S BEEN GREAT WORKING WITH YOU AS WELL. >> AND MINI, CONGRATULATIONS. I LOOK FORWARD TO WORKING WITH YOU. >> THANK YOU. AND I DO WANT TO THANK EVERYONE FOR YOUR VOTES AND FOR YOUR CONFIDENCE IN ME. I KNOW THIS IS KIND OF MAYBE IT SEEMS LIKE, WHO IS SHE? BUT I DO WANT TO LET YOU KNOW THAT THAT I'M VERY INTERESTED AND I WILL MAKE THE TIME TO INVEST IN HELPING EVERYONE AND THAT I HAVE BEEN IN TRIBAL LEADERSHIP FOR A VERY LONG TIME AND I HAVE SERVED MY COMMUNITY FOR OVER 20 YEARS AND I HAVE A BACKGROUND IN SCIENCE. I HAVE A BACHELOR'S DEGREE IN BIOCHEMISTRY AND A MASTERS DEGREES IN PUBLIC HEALTH. AND I HAVE ALWAYS BEEN SERVING. SO MY COMMITMENT IN MY HEART HAS ALWAYS BEEN IN INDCRAN COUNTRY. SO WHEN I HEAR ALL OF YOU TALK ABOUT WHAT YOU'RE DOING AND RESEARCH AND ALL OF THIS GRATED WORK HAPPENING IN INDIAN COUNTRY, I ALWAYS LIKE TO SIT BACK AND HOW CAN WE CONNECT IT IN OUR TRIBAL COMMUNITIES. SO IT MAY NOT SEEM LIKE I'M SAYING A LOT BUT I'M LISTENING AND INTERPRETING AND I'M SHARING HOW DO WE GET THIS BACK TO THE GRASSROOTS. SO I REALLY DO PLAN ON BEING INVOLVED. EVEN THOUGH I'M QUIET, I'M NOT REALLY QUIET. YOU'LL SEE MORE A LOT MORE ACTIVELY. THANK YOU. I APPRECIATE IT. >> I THINK THIS IS A GOOD THING. I DO. AND I'M GLAD TO HAVE TRIBAL LEADERSHIP HERE AND I ALSO AM GRATEFUL TO BE ABLE TO CONTINUE TO WORK THAT WE HAVE GOING ON. SO THANK YOU FOR THAT. SO WITH THAT, DAVID, IS THERE ANY OTHER CLOSING REMARKS YOU HAVE RIGHT NOW SINCE THIS PIECE IS DONE? >> WHAT WE HAVE LEFT ON THE AGENDA ARE THE APPROVAL OF THE TACK PRIORITIES. >> SO WE HAVE SUBMITTED -- WE HAVE A LIST OF TAC PRIORITIES THAT WE WENT OVER AND I GUESS THE QUESTION WOULD BE WITH TAC, DO YOU FEEL CONFIDENT TO APPROVE WHAT WAS PUT TOGETHER AND I KNOW WE TALKED ABOUT IT OVER THE LAST COUPLE OF DAYS. THERE IS A HANDFUL OF THEM AND I THINK DAVID, THE WAY WE REVAMPED THEM A LITTLE BIT AND LEFT THEM OPEN-ENDED SO WE CAN -- I THINK HAVE A BETTER PARTNERSHIP WITH THE THRO IN KIND OF LAYING OUT WHAT WE WOULD LIKE TO SEE HAPPEN BUT ALSO GETTING FEEDBACK FROM YOU ON HOW WE CAN CARRY THAT OUT TOGETHER AND THEN TRACK IT. SO IT WOULD BE LIKE USING A TRACKING SYSTEM. WE HAVE OUR CAUCUS BEFORE. THE TIME THAT WE HAVE BEFORE, AND THEN COMING UP WITH WAYS ON HOW WE ARE GOING TO BE ABLE TO CARRY THOSE THINGS OUT. >> SO HOW ABOUT THIS. HOW ABOUT IF YOU CAN SEND US A THRO, THE PROPOSED TAC PRIORITIES AND THEN WE WILL HAVE THE OPPORTUNITY TO LOOK AT THEM AND RESPOND AND THEN WE SHOULD PROBABLY TABLE THIS UNTIL OUR NEXT MEETING IN NOVEMBER. AND THEN WE CAN MOVE FULL FORCE, FULL SPEED AHEAD AT THAT TIME. DOES THAT SOUND LIKE A PLAN? >> THAT WOULD BE FANTASTIC AND I'D LIKE TO PUT IT IN THE DROPBOX SO IF ANYBODY WANTS TO WORK ON IT, AND I'M ALSO ASKING EVERYBODY TO LEARN THE BOX BECAUSE ALL OF THE CHANGES ARE DONE IN REALTIME AND SO WE CAN ALL SEE THAT. AND THEN HAVE A MEETING ABOUT IT. SO IT WILL BE IN THERE. I'LL SHARE SURE IT'S DROPPED IN THERE AND I'LL SEND IT TO SELENA AND GET THAT IN THERE AND DAVID, THEN YOU'LL HAVE ACCESS TO IT TOO, CORRECT? >> YES, ABSOLUTELY. >> OKAY. SO SUPER. AND ERAN I SAW YOUR HAND UP? >> I THINK THE WAY WE ARE DOING IT IS THE THING YOU IS CAN'T -- YOU GOT ME IN MY PARLIAMENTARIAN GEEKY ROLE. YOU CAN'T TABLE SOMETHING IF IT'S NOT ON THE FLOOR. BUT YOU MEAN JUST WEIS WILL HOLD OFF ON DOING IT UNTIL OUR NEXT MEETING. >> YES. >> RECESS. >> OKAY. >> OKAY. >> EXCELLENT. I KNOW THAT EVERYBODY IS SUPER BUSY. I JUST WANTED TO SAY WE ACCOMPLISHED A TREMENDOUS AMOUNT. THERE WAS SO MUCH GREAT INFORMATION THAT WAS SHARED OVER THE TWO DAYS. WE VERY MUCH LOOK FORWARD TO WHEN WE CAN COME BACK ALL TOGETHER AND MEET ON THE NIH CAMPUS AND WE WILL WELCOME EVERYBODY WITH OPEN ARMS. AND COFFEE AND DOUGHNUTS AND IF YOU REMEMBER HOW THAT ALL WAS BEFORE THE PANDEMIC. I WANTED TO SAY THANK YOU VERY MUCH FOR ALL OF YOUR ADVISEMENT. YOUR PARTICIPATION, AND AS YOU CAN SEE THINGS ARE REALLY BEGINNING TO MAKE THAT CHANGE. WE ARE CHANGING THE CULTURE OF AN AGENCY, WHICH I THINK IS, IT TAKES TIME AND I REALLY APPRECIATE EVERYBODY UNDERSTANDING THE TIME AND CONTINUED EFFORT TO DO THIS. IT'S A TEAM EFFORT. SO WE ARE ALL DOING THIS TOGETHER. ALL THE STAFF AT THE NIH, ALL THE ADVISORY COMMITTEE MEMBERS, AND WE ARE GOING TO CONTINUE TO MOVE THIS FORWARD LIKE DR. TABAK HAD SAID. WE BUILT THE FOUNDATION. NOW WE NEED TO CATALYZE THIS AND MOVE THINGS -- AND HOPEFULLY THINGS WILL BEGIN TO MOVE FASTER IN THE SAME DIRECTION IT'S GOING. SO WE ARE OFF TO A GREAT START. LIKE I MENTIONED, I'M AT MY FIVE YEARS FOR SERVING AS THRO DIRECTOR AND I'M REALLY EXCITED TO SEE WHAT HAPPENS IN THE FUTURE AND THE NEXT FIVE. SO WITH THAT, I WANT TO SAY THANK YOU, EVERYBODY AND ISLAND TURP IT OVER TO CHAIRWOMAN -- I WILL TURNT OVER TO CHAIRWOMAN GATE WOOD TO CLOSING US OUT WITH A BLESSING