The National Institutes of Health (NIH) recently invited me to represent SGIM at a listening session about President Biden’s plans for establishing the Advanced Research Projects Agency for Health (ARPA-H). ARPA-H will be structured as a new entity within the NIH with a radically different culture and organization intended to accelerate transformational breakthroughs in the prevention, detection, and treatment of diseases.1 This listening session focused on how ARPA-H could help to improve minority health by addressing disparities in health and health care. This column summarizes how I answered questions that were posed to the invited speakers. For additional information about the ARPA-H listening sessions, see the summary released by the White House Office of Science and Technology Policy.2 I want to give special thanks to SGIM member Dr. Lisa Cooper, SGIM’s Health Policy Committee Chair, Dr. Elizabeth Jacobs, and SGIM’s President, Dr. Monica Lypson, for offering great advice on what to emphasize.
Which scientific opportunities could be catalyzed by a different approach to funding?
The innovative approach to funding ARPA-H projects should help to catalyze implementation of research into practice with a focus on engaging communities at highest risk. It should increase investment in the science of community engagement and organizational behavior with the goal of determining the most effective ways to foster adoption and use of breakthroughs in our complex health system. ARPA-H also should create new opportunities to incorporate social and behavioral research with the goal of addressing the complex ways in which human behavior and social factors influence adoption and use of breakthroughs. Furthermore, ARPA-H should catalyze transdisciplinary approaches across basic, translational, and social sciences to address multiple chronic conditions with shared risk factors at the individual and community level, as well as inter-sectoral approaches with regulatory relief to address social determinants of health that can impede adoption and use of breakthroughs.
What systemic gaps in the research and development enterprise are impeding progress?
One of the most important gaps relates to how policy makers influence the translation of evidence into practice and the adoption of breakthroughs. This gap calls for more attention to studying the role of policy makers in translating innovations into practice.
What are the challenges in advancing research through to commercialization, implementation, and dissemination?
To translate research advances into practice, three major challenges must be addressed. First, it will take time and appropriate incentives to effectively engage stakeholders across multiple groups within each area of innovation. Second, attention must be given to how implementation of innovation is hampered by regulatory bureaucracy at multiple levels. Third, it will be necessary to identify and address barriers beyond the reach of NIH, such as liability issues.
What partnership or collaboration strategies should be incorporated into the ARPA-H design?
ARPA-H should build upon the success and lessons learned from the Community Engagement Alliance Against COVID-19 Disparities (CEAL) which incorporated community-based participatory research methods and collaboration with the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities (NIMHHD).
ARPA-H leadership should also consider lessons learned from the Centers for Population Health and Health Disparities (established by NIH in 2005), and the Centers of Excellence on Minority Health and Health Disparities (established by NIMHHD in 2000) which could have benefitted from greater investment in the infrastructure needed to sustain such networks.
What other suggestions should be considered?
The NIH should listen to the voices of communities when setting priorities for ARPA-H and should promote diversity and inclusion in selecting ARPA-H program managers and project leaders. The NIH should also weave equity considerations throughout the mission of ARPA-H and should explore ways to ensure that breakthroughs do not worsen disparities in health and health care.
- Collins FS, Schwetz TA, Tabak LA, et al. ARPA-H: Accelerating biomedical breakthroughs. Science. 2021;373:165-7.
- White House Office of Science and Technology Policy & National Institutes of Health Listening Sessions for ARPA-H: Summary Report. https://www.whitehouse.gov/wp-content/uploads/2021/09/093021-ARPA-H-Listening-Session-Summary_Final.pdf. Published September 2021. Accessed November 15, 2021.