U.S. Department of Veterans Affairs Uniquely Poised to contribute to COVID-19 Research
On May 29, 2020, Research!America hosted an alliance member meeting with two distinguished representatives of the U.S. Department of Veterans Affairs (VA). Dr. Carolyn Clancy, Deputy Under Secretary for Discovery, Education and Affiliate Networks, and Dr. Rachel Ramoni, Chief Research and Development Officer, in concert, discussed the breadth of funding and capabilities that the VA has across the nation, presenting unique opportunities for innovative research that tackles disease in general, and as of late, responses specific to COVID-19. This is a summary of that meeting.
The Veterans Health Administration has significant reach: 105 active research sites across the country, 7,372 funded projects that assisted in the publication of 11,279 research articles in 2019 alone. Coupled with an FY19 research budget of $1.96B and $729M in congressional appropriations for medical and prosthetic research, the Department is well-equipped to deploy clinical trials, broad-scope observational and interventional research studies, and medical supplies with both the efficiency of a single health system and the scope of the entire nation. No other health system in the country has the size or reach of this network, making it uniquely valuable to the biomedical research enterprise. Some say the VA is the “best-kept” secret in medical research.”
The VA has had three priorities in research and health care in recent years, including increasing veteran’s access to high-quality clinical trials, increasing the real-world impact of VA research, and mobilizing technology to ensure data is put to work for veterans and the nation. Recent progress has streamlined the collaboration of the VA with industry partners and other federal agencies, enabling quality clinical trials to be launched in record timing. This is in concert with operating a health system that employs over 300,000 individuals and has its own research enterprise embedded into the framework. The VA is in a distinctive position to have its researchers work hand in hand with its clinical partners to keep the learning-health cycle advancing, further generating a robust impact on the nation’s greater health care system.
The VA has been deeply involved in research and primary care efforts during the COVID-19 pandemic. Much of their special abilities result from the diffuse geographic diversity served. Analyses from vast clinical data sets examine existing drugs that may be repurposable candidates for COVID-19 treatment. This information serves a direct role in informing the FDA. There are also multiple efforts underway to get therapies into circulation, including a compassionate-use protocol addendum for convalescent plasma treatment at over 80 VA medical centers. Clinical trials are ongoing for repurposed COVID-19 treatments. In 2017, the VA completed enrollment of a 50,000 person clinical trial for colorectal cancer — the largest trial ever performed exclusively by the VA. This size provides an example of the diverse populations for recruiting and the data they can collect. Samples this large are better at encompassing comorbid, aging, and racially varied populations, all of whom are particularly vulnerable during COVID-19. Scale is a recurrent theme that the VA harnesses well; with over nine million veterans enrolled in their health care program, initiatives that would take years of collaborative partnerships and infrastructure can be executed swiftly and effectively. For example, the Million Veteran Program, set up in 2011 with the focus of learning how genes, lifestyle, and military exposure affect health and illness, has recruited over 800,000 veterans to date and is generating an immense data repository on the intersection of genes and environment in disease. Additionally, the VA is tapping this network in real-time to poll veterans on their experiences with COVID-19 in recent months. This is an unprecedented opportunity to acquire vital information from at-risk demographics during this time. Because the VA’s broad infrastructure is set up, they can respond to the ‘fierce urgency of now’ with rigor and are able to do high-quality trials, quickly.
It’s also important to note that one in five Americans live in rural areas today, but for the VA, that number is one in three. What does this mean in the context of COVID-19? It means that for the VA, reaching beneficiaries anywhere has already been of critical importance. Now, as technology-driven care has seen a sharp increase in use and acceptance, the VA has been fortunate to begin “way down the field” regarding the expansion and enhancement of telehealth platforms and consultations. The VA is now looking into the use of wearable devices that can monitor patients living in these remote areas, further advancing the capabilities of remote consultations. In fact, one of the silver linings that has stemmed from this public health crisis is being able to test and derive data on how to most effectively engage in telehealth protocols so that both patients and care providers see value in this new point of care setting.
As of May 29, 11,000 U.S. veterans had tested positive for COVID-19. This number has undoubtedly grown and will continue to grow as the nation grapples with the most effective ways to recuperate economic and social losses. But the U.S. Department of Veterans Affairs stands prepared for the enduring relationship that the nation and the world will have with COVID-19, as well as its inevitable successors. The extremely unique and encompassing stance that the VA has as a consortium of over 100 research sites, 1,200 health care facilities, 170 medical centers, and an additional 1,000 outpatient care settings, coupled with ahead-of-the-curve virtual care practices, makes them worthwhile to remember and to learn from to as health care investments and preparedness practices shift in response to the formative public health crisis that continues to affect us all.
Dr. Carolyn Clancy is Deputy Under Secretary for Discovery, Education and Affiliate Networks (10X), Veterans Health Administration; Dr. Rachel Ramoni is Chief Research and Development Officer (10P9), Veterans Health Administration.