Alliance Discussion with Rashi Romanoff and Liz Stout, NAVREF: Innovative Research at VA is Impacting Veterans and Civilians Alike
Veterans Affairs (VA) research does not demand the spotlight, but richly deserves it: from conducting the first trials of effective treatments of tuberculosis to pioneering the treatment of hypertension, the VA has been at the forefront of research advances that benefit veterans and us all. Rashi Romanoff and Liz Stout from the National Association of Veterans’ Research and Education Foundations (NAVREF) recently joined us for a stimulating alliance discussion. NAVREF is one of several unique and extraordinarily effective organizations at the center of VA research collaboration and innovation. Here are some of their thoughts on:
The VA infrastructure and unique public-private partnerships:
“The VA is the nation’s largest integrated health care system. It has over 1,200 sites of care, including hospitals, nursing homes, community-based outpatient clinics, and specialty care centers, in all 50 states and territories. One of the things that not a lot of people know, is the unique public-private partnership model that VA has sustained over time, specifically, with the academic medical centers. If you’re a physician, chances are when you were in medical school or your residency, you did some portion of your clinical training at an affiliated VA Medical Center. The VA trains 70% of the nation’s doctors and a lot of times this goes beyond training. When you look at research, oftentimes the PIs and the research staff that are leading these initiatives are duly appointed personnel. It’s an interesting dynamic, which has led to so many great examples of innovation and partnership across the health ecosystem for veterans.”
The Innovative VA Research Program:
“Many healthcare innovations had their origins at the VA itself – the nicotine patch, pacemaker, CT scanner – all were invented at the VA. More recently, innovations related to the electronic medical record, psychedelic treatments for PTSD – the VA has really been a testbed for a lot of these different kinds of innovations and a force multiplier for medical innovation across the United States. Over 115 VA medical centers have active research programs. So, a large footprint across the United States thinking about opportunities to engage in research.”
How the VA is funded through intramural and extramural sources:
“Because of very complicated appropriations law, NIH, Johnson & Johnson, Pfizer, Robert Wood Johnson or Alzheimer’s Association, they can’t just cut a check over to the VA and say, ‘Okay, now go do this research.’ They came together to set up a nonprofit infrastructure, which would serve as this flexible funding mechanism, and the whole purpose would be to work with extramural research sponsors to facilitate and execute research efforts across the VA. These nonprofits would be responsible for budgeting the administration of all these extramural grants. […] These nonprofits facilitated upwards of $310 million in extramural research across the VA. Putting that in context, […] what Congress has appropriated for VA to focus on research initiatives is around $890 million.”
Priorities for VA Research:
“One of the things I’m really excited about is the Million Veteran Program. It’s a program that’s all about advancing precision health care, by learning how someone’s genetic background, their military experience, and their exposures have impacts on their health and wellness in the long term. The Million Veteran Program met their initial goal and enrolled one million veterans last November. So, it’s now one of the world’s largest genetic databases. It’s also the largest genetic database of individuals of African descent. So, when we think about the diversity that the VA has and the power of precision medicine, it feels like the next frontier of medicine. The VA could really be at the forefront, whether it’s Parkinson’s, cholesterol, COVID-19, or diabetes, [there are] so many applications around genetic medicine.”
Advocacy priorities around increased VA research funding:
“NAVREF now proudly chairs the Friends of VA Medical Care and Health Research (FOVA) Coalition. It’s made up of more than 80 national academic, medical, and scientific societies, health, and patient advocacy groups, and of course, veteran focus associations. FOVA mainly advocates for appropriations funding for the VA Medical and Prosthetic Research Program, along with infrastructure needs, such as major and minor construction.”
“Funding is a huge priority. It’s important for VA and for the Office of Research and Development to have the resources they need. As much as we are excited about extramural research, it doesn’t make the whole machine run. We need things like IT, infrastructure, space and facilities, and the budget story is critical. Research is not in that essentials bucket, so, one thing I would note is that anytime one of these continuing resolution issues come up, PIs across the country are having to think about what’s going to happen to their research. […] So, saying we’re going to invest in this in a real way and not this dance that I think we do in government. There are real implications around strategic planning, and I think the needs of veterans and their families are too important for this to end up being a political football.”