Policies to Combat the Impact of a Global Health Crisis on Cancer Science and Medicine

In this chapter, you will learn:

• How supplemental research funding for NIH would help restore momentum against cancer.
• How FDA’s efforts to encourage changes in the conduct of cancer clinical trials are making them more patient centered.
• How expanding telehealth increases access to cancer care for patients during COVID-19.
• How to minimize disruptions to cancer research and society during future pandemics by learning from COVID-19 and increasing the cancer community’s resilience.
• How building confidence in public health and combating misinformation protects patients with cancer by increasing vaccinations and promoting evidence-based cancer control and treatment options.

Steps That Helped Offset Pandemic Impact on Cancer Research

The COVID-19 pandemic challenged the medical research community in many ways, including through the loss of productivity because of the suspension of laboratory activities and delays in reporting results of ongoing basic and clinical research (see Impact on Research Funding and Workforce). These issues came at a substantial cost to the medical research community. The former NIH Director, Francis S. Collins, MD, PhD, estimated that NIH and its grantees lost approximately $16 billion in research costs (514)Bloomberg Law. Pandemic cost NIH $16 billion in delayed, lost medical research [updated 2021 Mar 19; cited 2021 Dec 17]..

NIH took many important steps to assist researchers during these challenging times, including extending deadlines for applications, allowing delayed submission of preliminary data after grant deadlines, authorizing grants to cover salaries and stipends of scientists during laboratory closures, and extending project timelines and requirements. In targeting assistance to early-career researchers, NIH also extended eligibility periods for early-stage investigators and trainees and permitted the carryover for institutional training grants if they had been previously approved (515)OncLive. NCI director talks response to COVID-19 crisis, focuses on overcoming disruptions in cancer care [updated 2020 Nov 6; cited 2021 Dec 17].(516)NIH Extramural Nexus. Reminder of COVID-19-related flexibilities for NIH grants [updated Sep 24, 2021, ;ited 2021 Dec 17]..

NIH and NCI also provided flexibility with timelines and funding, such as no-cost extensions, case-by-case administrative supplements for unanticipated costs, and funded extensions on some grants due to delays caused by COVID-19. Additionally, NIH fellowship (“F”) and career development (“K”) award recipients were allowed to request a funded extension if their training or career development had been “significantly hindered over and above lost research productivity that most individuals experienced because of COVID-19 related shutdowns” (517)NIH. NOT-OD-21-052: Reminder requesting extensions for early career scientists whose career trajectories have been significantly impacted by COVID-19 [updated 2021 Feb 2; cited 2021 Dec 17]..

As noted in The AACR Call to Action, significant funding is needed to defray these costs and solidify the medical research enterprise. The broader medical research community, including the AACR, continues to advocate for the NIH to receive emergency supplemental funding to offset the costs caused by the pandemic and support the medical research workforce (518)Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2019 to 2034 [updated 2021 Jun 1; cited 2021 Dec 17]..

Pandemic-Related Flexibilities for Cancer Clinical Trials

The COVID-19 pandemic greatly impacted the conduct of cancer clinical trials by exacerbating existing hurdles for trial participation. In response, FDA outlined voluntary flexibilities for clinical trials in March 2020 (see Improving Clinical Trial Design and Conduct) (519)U.S. Food and Drug Administration. Clinical trial conduct during the COVID-19 pandemic [updated 2020 Jun 1; cited 2021 Dec 17]., including:

• Using telemedicine to assess outcomes and wellness;
• Home delivery of trial medications;
• Remote consenting; and
• Collaborations with local clinics, imaging facilities, and laboratories.

FDA has recommended these modifications to cancer clinical trials in the past, but the COVID-19 pandemic greatly increased their acceptance among trial sponsors. If implemented permanently, these changes could decrease costs and make it easier for patients with cancer to participate in trials.

In collaboration with NCI and other stakeholders, FDA is researching which flexibilities and adaptations are the most important to keep permanently (520)Flaherty KT, Doroshow JH, Galbraith S, Ribas A, Kluetz PG, Pazdur R, et al. Rethinking cancer clinical trial conduct induced by COVID-19: an academic center, industry, government, and regulatory agency perspective. Cancer Discov 2021;11:1881–5.. One key strategy will be to add lines of investigation to postapproval therapeutic trials to test differences in protocols and the types of data collected, such as patient-reported outcomes (521)NCI Clinical Trials and Translational Research Advisory Committee. Strategic Planning Working Group Report [updated 2020 Nov 4; cited 2021 Dec 17].. Additionally, the NCI Cancer Therapy Evaluation Program is currently conducting retrospective analyses of trials that were active before and during the COVID-19 pandemic to determine how changes impacted recruitment and data quality (521)NCI Clinical Trials and Translational Research Advisory Committee. Strategic Planning Working Group Report [updated 2020 Nov 4; cited 2021 Dec 17].. NCI has also issued administrative supplements for institutional P30 clinical research grants to assess the feasibility of integrating trial forms directly into electronic health records systems (522)NCI. NCI Announces funding for development of standardized electronic treatment plans for NCI-supported clinical trials applicable across clinical research sites [updated 2020 Sep 28; cited 2021 Dec 17].. It is important to note that regulatory decisions like these do not happen in a vacuum. FDA and NCI will seek input from all stakeholders, including patient advocates, informally and formally at events such as workshops and major scientific conferences.

Increasing the representation of racial and ethnic minorities and other medically underserved populations in cancer clinical trials has also been a key priority of FDA during the pandemic. In early 2020, the FDA Oncology Center of Excellence launched Project Equity to improve the evidence base for underrepresented populations in trials by issuing guidance to facilitate recruitment of diverse patients, stakeholder collaboration, and analysis of outcomes (523)U.S. Food and Drug Administration. 2020 Annual Report Oncology Center of Excellence [updated 2021 Jan 1; cited 2021 Dec 17].. Additionally, the FDA Center for Drug Evaluation and Research and the Center for Biologic Evaluation and Research issued voluntary guidelines in November 2020 that would increase representation of racial and ethnic minorities (524)U.S. Food and Drug Administration. Enhancing the diversity of clinical trial populations — eligibility criteria, enrollment practices, and trial designs guidance for industry [updated 2020 Nov 1; cited 2021 Dec 17]., including:

• Expanding eligibility criteria for large efficacy trials;
• Strategies to improve recruitment of participants that reflect the diversity of the patient population;
• Encouraging trial sponsors to definitively determine the safety and efficacy of investigational therapies in racial and ethnic minorities through sufficient recruitment or follow-up studies;
• Maintaining data quality and patient safety while partnering with local health facilities in decentralized trials; and
• Leveraging real-world evidence to fill gaps in evidence where the feasibility of randomized clinical trials may be limited.

As noted in The AACR Call to Action, Congress should support FDA’s initiatives to improve the drug development and review process by increasing the discretionary budget authority by at least $343 million in FY 2022. Additionally, Congress could support efforts to increase diversity in clinical trials by passing the Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials Act.

Lessons for Priority Vaccination of Patients with Compromised Immune Systems, Including Patients with Cancer

One of the most valuable lessons learned from COVID-19 was how to rapidly develop safe and effective vaccines. The novel mRNA vaccine technology, originally developed to treat cancer, enabled early-phase clinical trials to start within two months after the genomic sequence of SARS-CoV-2 was published (131)Wherry EJ, Jaffee EM, Warren N, D’Souza G, Ribas A, AACR COVID-19 and Cancer Task Force. How did we get a COVID-19 vaccine in less than 1 year? Clin Cancer Res 2021;27:2136–8..

As detailed in prior sections (see Varied Responses to COVID-19 Vaccines in Patients with Cancer), unvaccinated patients with cancer are twice as likely to die from COVID-19 compared to unvaccinated patients without cancer (204)Ribas A, Sengupta R, Locke T, Zaidi SK, Campbell KM, Carethers JM, et al. Priority COVID-19 vaccination for patients with cancer while vaccine supply is limited. Cancer Discov 2021;11:233–6.. Because of the increased risk, AACR and 140 other cancer-focused organizations advocated for patients with cancer, survivors of cancer, and their caregivers to be prioritized for vaccinations (525)American Association for Cancer Research. Prioritize COVID vaccines for cancer patients.Letter to Biden Adminstration [updated 2021 Feb 17; cited 2021 Dec 17].. Indeed, many states and countries prioritized patients with cancer and others with elevated risk of severe COVID-19 disease for vaccination, although prioritization orders varied greatly (526)The Kaiser Family Foundation. State COVID-19 vaccine priority populations [updated 2021 Apr 5; cited 2021 Dec 17].(527)Canadian Agency for Drugs and Technologies in Health. COVID-19 mRNA vaccines for people with cancer [updated 2020 Dec 22; cited 2021 Dec 17].. However, many of these patients prioritized for vaccination were excluded, or were not adequately represented, or their data were not stratified in large vaccine efficacy trials (528)U.S. Food and Drug Administration. Pfizer-Biontech COVID-19 vaccine (BNT162, PF-07302048) [updated 2020 Dec 10; cited 2021 Dec 17].(529)U.S. Food and Drug Administration. Vaccines and Related Biological Products Advisory Committee Meeting Presentation [updated 2020 Dec 17; cited 2021 Dec 17]..

Of the three vaccines authorized in the United States, only the Johnson & Johnson vaccine phase III trial specified the number of patients with cancer or survivors of cancer included in their trial (530)U.S. Food and Drug Administration. Janssen Ad26.COV2.S vaccine for the prevention of COVID-19 [updated 2021 Feb 26; cited 2021 Dec 17].. It is critical that vaccine trials in a future pandemic include adequate numbers of patients with cancer to inform their clinical use in this key patient population. Furthermore, additional studies have found that patients with cancer may also receive more benefit than the general population from a third vaccine dose (285)Naranbhai V, Pernat CA, Gavralidis A, St Denis KJ, Lam EC, Spring LM, et al. Immunogenicity and reactogenicity of SARS-CoV-2 vaccines in patients with cancer: the CANVAX cohort study. J Clin Oncol 2022;40:12–23.(291)Ribas A, Dhodapkar MV, Campbell KM, Davies FE, Gore SD, Levy R, et al. How to provide the needed protection from COVID-19 to patients with hematologic malignancies. Blood Cancer Discov 2021;2:562–7.. Therefore, AACR also advocated for the Biden administration to recommend three doses for patients with cancer and survivors of cancer and booster doses for caregivers and household members of patients with cancer (282)American Association for Cancer Research. AACR sends letter to CDC director urging boosters for caregivers and household members to protect patients with cancer [updated 2021 Oct 18; cited 2021 Dec 15]..

Telehealth Policies During COVID-19 and the Impact on the Cancer Care Continuum

The federally declared public health emergency in response to the COVID-19 pandemic resulted in unprecedented, rapid shifts to support flexible telehealth use for both health care providers and the patients they serve (see Implementing Telemedicine). For patients with cancer and survivors of cancer, the temporary changes to telehealth coverage provided by Congress or implemented by CMS address overlapping areas across the cancer care continuum.

Among the most significant changes for health care delivery were CMS’s provision of an expanded use of telehealth for more than 80 additional services for seniors covered by Medicare and CMS’s approval of telehealth for state-run Medicaid and CHIP health insurance programs (531)Centers for Medicare and Medicaid Services. Trump Administration releases COVID-19 telehealth toolkit to accelerate state use of telehealth in Medicaid and CHIP [updated 2022 Jan 12; cited 2021 Dec 17].. In April 2020, CMS created a toolkit for states to accelerate adaptation of telehealth coverage policies for Medicaid and CHIP (532)Centers for Medicare and Medicaid Services. State Medicaid & CHIP Telehealth Toolkit policy considerations for states expanding use of telehealth COVID-19 version [updated 2020 Apr 23; cited 2021 Dec 17].. By providing reimbursement for many telehealth services, CMS opened the door for patients to consult with their physicians without having to risk their health by entering a medical facility.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted in March 2020, provided $2.2 trillion in economic stimulus, emergency support for hospitals and health care providers, investments in COVID-19 testing, vaccines, and therapeutics, as well as provisions to expand coverage for telehealth. Specifically, the temporary expansion of the Medicare and Medicaid telehealth services benefit under the 1135 waiver authority in the CARES Act removes previous geographic constraints associated with telehealth use and reimbursement (533)US Department of Health and Human Services. HIPAA flexibility for telehealth technology [updated 2021 Jan 28; cited 2021 Dec 17].. Providers are allowed to: expand telehealth delivery to patients in every part of the country; permit health care providers to practice across state lines if permissible by the state; serve new and established patients; and supervise patients using either audio or video communication. The four main types of virtual services covered under Medicare include telehealth visits, virtual check-ins, e-visits, and audio only. Although these flexibilities have been implemented and some are slated to continue through 2023 (534)Centers for Medicare and Medicaid Services. Calendar year (CY) 2022 Medicare physician fee schedule final rule [updated 2021 Nov 2; cited 2021 Dec 17]., adverse differences in technology access, digital literacy, and infrastructure to support these efforts disproportionately impact chronically disadvantaged groups (535)Division of Broadband and Digital Equity. Who is affected by the digital divide? [updated 2022 Jan 4; cited 2021 Dec 17].(536)Lai J, Widmar NO. Revisiting the digital divide in the COVID-19 era. Appl Econ Perspect Policy 2020 Oct 12 [Epub ahead of print]..

Health care delivery and improved patient outcomes are additionally supported by the use of electronic health record (EHR) systems. The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part of the American Recovery and Reinvestment Act of 2009. Health care providers were encouraged to securely use electronic health records and improve security protections for health data sharing (537)US Department of Health and Human Services. HITECH Act Enforcement Interim Final Rule [updated 2009 Oct 28; cited 2021 Dec 17].. A temporary, COVID-19 related amendment to the HITECH Act in January 2021 focused on regulatory requirements and Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation enforcement; however, requiring the effective use of EHR systems to capture appropriate health-related data, safeguard health information sharing, and mandating public health reporting could support patients with cancer in this and future pandemics (538)US Department of Health and Human Services. Covered entities and business associates [updated 2015 Nov 23; cited 2021 Dec 17].(539)Health Affairs Blog. How President Biden can improve health data sharing for COVID-19 and beyond [updated 2021 Mar 1; cited 2021 Dec 17].. Amended provisions in HIPAA also allowed covered health care providers to deliver telehealth through popular, non-public-facing video chat and text-based applications without the risk of penalty (533)US Department of Health and Human Services. HIPAA flexibility for telehealth technology [updated 2021 Jan 28; cited 2021 Dec 17].. Secure and timely health data sharing between providers has the potential to improve outcomes for patients with cancer during and after the COVID-19 pandemic.

Policies to Address Disparities Exacerbated by the Pandemic

The social determinants of health (SDOH) are defined as the conditions in which people are born, live, learn, work, play, worship, and age that affect their health and quality of life (540)US Department of Health and Human Services. Social determinants of health [updated 2022 Jan 12; cited 2021 Dec 17].. The five domains of SDOH include economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social community context. Policies described previously (see Telehealth Policies During COVID-19 and the Impact on the Cancer Care Continuum) have the potential to improve one of the SDOH domains: health care access and quality. The CARES Act helped offset unexpected clinical costs associated with the response to COVID-19 for providers, and the HITECH amendments encouraged the safe and efficient use of health data between health care providers. For patients with cancer, it is imperative to consider the entire SDOH framework in the context of the cancer care continuum as policies are designed and implemented to combat the ravages of the COVID-19 pandemic (See The AACR Call to Action).

Lessons for Increasing Health Care Access and Insurance Coverage

One of the most important factors associated with quality cancer care and survival is insurance coverage (65)Sengupta R, Honey K. AACR Cancer Disparities Progress Report 2020: achieving the bold vision of health equity for racial and ethnic minorities and other underserved populations. Cancer Epidemiol Biomarkers Prev 2020;29:1843.(541)Buntin MB. Cancer, coverage, and COVID-19. JAMA Health Forum 2020;1:e200796.. The COVID-19 pandemic contributed to fluctuations in employer-sponsored health insurance and Medicaid enrollment (542)Bundorf MK, Gupta S, Kim C. Trends in US health insurance coverage during the COVID-19 pandemic. JAMA Health Forum 2021;2:e212487., thus disrupting health care access and quality. This is alarming as disruptions in insurance have the potential to increase the risk for adverse outcomes for patients with cancer. Reported disparities in cancer screening, stage at diagnosis, and mortality rates for those who are uninsured are described in greater detail in the AACR Cancer Disparities Progress Report 2020 (65)Sengupta R, Honey K. AACR Cancer Disparities Progress Report 2020: achieving the bold vision of health equity for racial and ethnic minorities and other underserved populations. Cancer Epidemiol Biomarkers Prev 2020;29:1843..

Building Resilience for Future Pandemics

To minimize interruptions to cancer science and medicine during future pandemics, it will be extremely important to address an emerging pathogen before it spreads widely in the community. Sustained and predictable public health funding is vital to build the infrastructure, reporting systems, and workforce before a pandemic or other health crisis starts. Unfortunately, public health and pandemic preparedness programs have suffered from slow funding growth or funding cuts between emergencies, and supplemental funding is then needed when an emerging threat becomes a crisis (543)Maani N, Galea S. COVID-19 and underinvestment in the public health infrastructure of the United States. Milbank Q 2020;98:250–9.(544)Trust for America’s Health. The impact of chronic underfunding on America’s public health system: trends, risks, and recommendations, 2021 [updated 2021 May 1; cited 2021 Dec 17].(545)Kaiser Health News. Hollowed-out public health system faces more cuts amid virus. [updated 2020 Jul 1, cited 2021 Dec 17].(546)New York Times. ‘Small town, no hospital’: Covid-19 is overwhelming rural west Texas [updated 2020 Dec 9; cited 2021 Dec 17].. For example, the U.S. Department of Health and Human Services’ (HHS) Hospital Preparedness Program, designed to prepare health care facilities for a wide variety of health crises, decreased from $515 million in FY 2004 to $276 million in FY 2020 (544)Trust for America’s Health. The impact of chronic underfunding on America’s public health system: trends, risks, and recommendations, 2021 [updated 2021 May 1; cited 2021 Dec 17].. In total, the federal COVID-19 relief packages provided approximately $400 billion in emergency funding to directly help federal agencies, states, cities, tribes, and health facilities fight the pandemic (547)Congressional Research Service. Overview of COVID-19 LHHS supplemental appropriations: FY2020 and FY2021 [updated 2021 Apr 23; cited 2021 Dec 17].. While beneficial for addressing this crisis, had the public health infrastructure and surveillance been stronger before 2020, there could have been a more swift and secure response that avoided disruptions to cancer research, health care, and the broader society. Robust and sustainable investments in public health will be needed to rebuild the public health infrastructure and workforce and have them emerge stronger before the future public health emergency (544)Trust for America’s Health. The impact of chronic underfunding on America’s public health system: trends, risks, and recommendations, 2021 [updated 2021 May 1; cited 2021 Dec 17]..

Collecting High-Quality Public Health Data

Effective pandemic responses and cancer control efforts rely on timely and high-quality data. However, public health reporting systems in the United States and the types of data collected vary greatly and lack coordination (548)Politico. Holes in reporting of breakthrough Covid cases hamper CDC response [updated 2021 Aug 25; cited 2021 Dec 17].(549)Politico. Bad state data hides coronavirus threat as Trump pushes reopening [updated 2020 May 27; cited 2021 Dec 17].(550)New York Times. The C.D.C. waited ‘its entire existence for this moment.’ What went wrong? [updated 2020 Jun 3; cited 2021 Dec 17].(551)MedPage Today. Nursing homes shocked at ‘insanely wrong’ CMS data on COVID-19 [updated 2020 Jun 9; cited 2021 Nov 12].. Many states still rely on fax machines and spreadsheets that are manually re-entered into federal computer systems and that increase the risk of human error (552)New York Times. Bottleneck for U.S. coronavirus response: the fax machine [updated 2020 Jul 13; cited 2021 Dec 17].. For these reasons, the AACR urged President Donald J. Trump and Congress in the spring of 2020 to establish a de-identified nationwide public health reporting system (553)American Association for Cancer Research. AACR Letter to Trump Administration [updated 2020 Apr 1; cited 2021 Dec 17].(554)American Association for Cancer Research. AACR Letter to Congress [updated 2020 Mar 1; cited 2021 Dec 17].. In FY 2020 and FY 2021, Congress appropriated $50 million for CDC Data Modernization activities (555)Centers for Disease Control and Prevention. Surveillance and data strategy – notable milestones [updated 2021 Dec 8; cited 2021 Dec 17]., and an additional $1 billion was included in the CARES Act and the American Rescue Plan. These funds are a down payment on a modern public health reporting system that could greatly increase the speed and quality of data for future pandemics as well as chronic disease initiatives.

Testing and Tracing Infections Effectively

Stopping a pandemic pathogen before it has a chance to establish itself within a community requires an effective testing, tracing, and isolation program, which has been the cornerstone of pandemic responses for decades (556)Muller J, Kretzschmar M. Contact tracing – old models and new challenges. Infect Dis Model 2021;6:222–31.(557)Centers for Disease Control and Prevention. History of quarantine [updated 2020 Jul 20; cited 2021 Nov 27].(558)Centers for Disease Control and Prevention. The road to zero: CDC’s response to the West African Ebola epidemic [updated 2015 Jul 9; cited 2021 Dec 17].. Unfortunately, asymptomatic transmission, reliance on a single flawed test, and political interference with the CDC response caught the United States off guard early in the COVID-19 pandemic (550)New York Times. The C.D.C. waited ‘its entire existence for this moment.’ What went wrong? [updated 2020 Jun 3; cited 2021 Dec 17].(559)ProPublica. Inside the fall of the CDC [updated 2020 Oct 15; cited 2021 Dec 17].(560)Politico. Emails reveal new details of Trump White House interference in CDC Covid planning [updated 2021 Nov 12; cited 2021 Dec 17].(561)New York Times. How the virus won [updated 2020 Jun 27; cited 2021 Dec 17].. Fortunately, by the summer of 2020, NIH’s RADx initiative along with state, academic, and private laboratories facilitated a spectacular ramp-up of testing, demonstrating the power of public-private partnerships in emergency responses (562)Tromberg BJ, Schwetz TA, Perez-Stable EJ, Hodes RJ, Woychik RP, Bright RA, et al. Rapid scaling up of Covid-19 diagnostic testing in the United States – the NIH RADx initiative. N Engl J Med 2020;383:1071–7.(563)WBUR. Academic labs pivot to fill coronavirus testing gap [updated 2020 Apr 21; cited 2021 Dec 17].(564)Coronavirus testing: how academic medical labs are stepping up to fill a void [updated 2020 Mar 12; cited 2021 Dec 17].. A robust public health workforce and earlier activation of this efficient test development model in future pandemics could greatly improve early testing and tracing efforts.

Supporting a Robust Health Care Workforce

The pandemic has also exacerbated critical shortages of health care providers, including those who care for patients with cancer. Prior to the pandemic, there was an estimated shortage of more than 150,000 nurses and 30,000 physicians in the United States, which contributed to delays in cancer care and provider burnout, and decreased the quality of care (518)Association of American Medical Colleges. The complexities of physician supply and demand: projections from 2019 to 2034 [updated 2021 Jun 1; cited 2021 Dec 17].(565)Poteat TC, Adams MA, Malone J, Geffen S, Greene N, Nodzenski M, et al. Delays in breast cancer care by race and sexual orientation: results from a national survey with diverse women in the United States. Cancer 2021;127:3514–22.(566)Zhang X, Tai D, Pforsich H, Lin VW. United States registered nurse workforce report card and shortage forecast: a revisit. Am J Med Qual 2018;33:229–36.. Since the onset of the pandemic through September 2021, 30 percent of health care workers have either quit their jobs or were laid off, including 534,000 who quit in August 2021 alone (567)Politico. Walkouts and strikes hit hospitals in pandemic hot spots [updated 2021 Oct 20; cited 2021 Dec 17].(568)Morning Consult. Nearly 1 in 5 health care workers have quit their jobs during the pandemic [updated 2021 Oct 4; cited 2021 Dec 17].. Furthermore, the scarcity of personal protective equipment led to the deaths of more than 3,600 U.S. health care workers from COVID-19 in 2020 (569)National Nurses United. National Nurse Survey reveals devastating impact of reopening too soon [updated 2020 Jul 27; cited 2021 Dec 17].(570)The Guardian. Lost on the frontline: US healthcare workers who died fighting Covid-19 [updated 2020 Aug 11; cited 2021 Dec 17].. These staffing shortages, especially during local surges of COVID-19, contributed to suspension of cancer-related surgeries and other delays in cancer care (571)World Health Organization. Second round of the National Pulse Survey on continuity of essential health services during the COVID-19 pandemic [updated 2021 Apr 23; cited 2021 Dec 17].. Addressing crucial bottlenecks in the training of nurses and physicians could help alleviate long-term shortages of health care workers to care for a growing number of cancer survivors and prepare for future pandemics (572)American Association of Colleges of Nursing. Nursing shortage [updated 2020 Sep 20; cited 2021 Dec 17].(573)Association of American Medical Colleges. Medical school enrollments grow, but residency slots haven’t kept pace. [updated 2020 Mar 12; cited 2021 Dec 17]..

Combating Misinformation and Building Confidence in Public Health

The foundation of modern medicine is the approval of therapeutics and preventive interventions based on the evidence of treating a disease with acceptable side effects. However, mistrust in the medical establishment, regulatory bodies, and private industry, as well as advances in digital communication and foreign disinformation campaigns, continues to fuel the spread of medical misinformation (see sidebar on COVID-19 Vaccine Misinformation and How to Address It. Patients with cancer are especially inundated with harmful misinformation from advertisements and contacts on social media after posting about their diagnosis (574)NCI. The challenges of cancer misinformation on social media [updated 2021 Sep 9; cited 2021 Dec 17].. Addressing misinformation and building confidence in COVID-19 vaccines also help protect patients with cancer with compromised immune systems by increasing the likelihood that their families and the people they meet are vaccinated.

Additionally, lessons learned from COVID-19 vaccination campaigns could inform efforts to build confidence in HPV vaccines and promote cancer screenings. To build trust in public health, it is paramount that government agencies follow the most credible science, transparently communicate how decisions are made, and remain independent from political pressure (559)ProPublica. Inside the fall of the CDC [updated 2020 Oct 15; cited 2021 Dec 17].(560)Politico. Emails reveal new details of Trump White House interference in CDC Covid planning [updated 2021 Nov 12; cited 2021 Dec 17].(575)National Academies of Sciences, Engineering and Medicine. NAS and NAM presidents alarmed by political interference in science amid pandemic [updated 2020 Sep 24; cited 2021 Dec 17].(576)Politico. Trump officials interfered with CDC reports on Covid-19 [updated 2020 Sep 11; cited 2021 Dec 17].(577)New York Times. Trump pressed for plasma therapy. Officials worry, is an unvetted vaccine next? [updated 2020 Dec 9; cited 2021 Dec 17].. It is also important for scientists and medical providers to establish long-term, two-way relationships with trusted community leaders and the general population (578)National Academies of Sciences, Engineering, and Medicine. Strategies for building confidence in the COVID-19 vaccines [updated 2021 Mar 2; cited 2021 Dec 17].. In addition to building confidence in public health, these relationships can help research institutions direct their efforts toward the issues most important to the communities they serve.

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