CONCORD – A federal plan to incentivize research to combat Lyme Disease, and make telehealth more accessible in rural areas were discussed by top brass from the Trump Administration who came to New Hampshire Tuesday to talk with the Gov. Chris Sununu.

They also talked about the hoped-for plan to distribute a COVID-19 vaccine by the end of this year.

Sununu met at Bridges House, the governor’s official residence in East Concord, to privately discuss those issues with the U.S. Health and Human Services Department Deputy Secretary Eric. D. Hargan and HHS Assistant Secretary Admiral Brett Giroir along with the nation’s leading expert on tick-borne illnesses, Dr. Kristen Honey.

They then held a press conference outside the brick mansion. The meeting to talk about issues critical to New Hampshire’s health came exactly two weeks before election day for both the Republican Trump and Sununu administrations.

New Hampshire, the governor noted, is disproportionately impacted by Lyme Disease and the problem is growing northward and extending into other areas of the Northeast.

He recalled growing up in the state when there was no Lyme Disease, but now it is an issue in every house in every county where people bitten by ticks, become very ill in some cases, and have life-long impacts in some extreme instances.

New Hampshire seems to be most susceptible because we spend so much time outdoors and the climate and life cycle of the ticks, the doctors said.

For years, there has not that much focus on the illness to keep up with the growth of the problem, Honey conceded, but a new initiative called LymeX is being rolled out for the coming year, similar to KidneyX, which aims to engage everyone with finding a vaccine, cure or an advancement at diagnosis.

The effort will look particularly at those who have suffered from tick-borne illness, those in research medicine, scientists in labs, academia, and primary care doctors to get them to collaborate and find on a break-through in combating Lyme.

The organizational winners of the challenge, with results all submitted to HHS, will be financially rewarded as a grand prize of multi-millions of dollars through America Competes, though a specific amount has not yet been set, Honey said.

According to a 2019 New Hampshire Medical Society, not only does the Granite State have a problem with Lyme Disease but other tick-borne illnesses such as Anaplasma and Babesia with a handful of cases since 2013 of Borrelia miyamotoi and Powassan, a neurological illness.

There may be many more cases than reported as it is hard to diagnose. Hargan and Giroir sat down with Sununu on a range of health issues, which touched on the pandemic, but what the governor said he was most excited about was fast-tracking progress and strategies to bring down infection levels of Lyme.

According to the CDC, each year more than 30,000 people in the country are diagnosed with Lyme Disease.
It began in Lyme, Conn. in the 1980s when the tick of deer was found to jump to dogs and then to humans and it spread northward. It first presented as a form of arthritis which could be treated with antibiotics but many people were misdiagnosed or undiagnosed.

New Hampshire’s Health and Human Services Department developed a plan https://www.dhhs.nh.gov/dphs/cdcs/lyme/index.htm and media campaign to get the “tick out.”

But largely, science has not advanced as fast in terms of reducing incidence. Honey, considered a leading expert in Lyme Disease, said there may be breakthroughs someone comes up with in their basement.

“There’s more research needed,” she said noting that funding has not kept up “compared to the magnitude of the problem.” She said shorter winters due to climate change may be a factor in the increase of the problem of Lyme which is expanding and extending now into Canada.

There is just more exposure, she said. There has also been changes in human use of lands and more urbanization leads more to tick problems.

“It’s more temperate and they can go further north,” Honey said of the ticks.

She also said the loss of top predators can also influence the ecology. “We have to do a lot more to turn the tide and go in another direction,” she said.

Hargan, who served in Republican administrations since 2003, was first tapped for the same role he now plays by President George W. Bush. A Chicago mergers and acquisitions attorney, educated at Harvard and Columbia Law, Hargan has been in this returned role to the government since 2017 after helping with the Trump Administration’s transition team.

Alex Azar, the secretary of the U.S. Health and Human Services Department, and currently chair of the White House Coronavirus Task Force, held the deputy role prior to Hargan being taped for the second spot.

Along with Dr. Honey, Hargan was also in the state with HHS Assistant Secretary Giroir, a pediatrician and former professor of pediatrics at Texas A&M and author of over 100 publications, before being tapped by the federal government. He has been involved in innovative approaches to the HIV crisis.https://www.hhs.gov/about/leadership/brett-giroir/index.html

About $25 million in federal grants will come to the states in 2021 mainly to the college systems to develop treatments for Lyme, and the hope is that there will be new collaborative energy to find advances. Competitive awards will be to develop nationwide data.

Rural healthcare grant money was also discussed including expanding broadband to allow for telehealth, Sununu said. The discussion was also about connecting rural hospitals with larger institutions. Grants for more than $8 million to develop telehealth, $2 million for grants to develop rural cancer control, and $2 for interventions that can reduce homelessness were also discussed, which would be available through federal Health and Human Services. The latter would be over four years for homelessness.

Sununu said it was an honor to have these key decision-makers in New Hampshire and to sit down and talk a little bit about what is happening with COVID-19 worldwide, nationally and locally.

“Overall, I think we continue to do a fantastic job,” Sununu said. “Our COVID is low, our economy is strong. Lots of flexibility. We talked a lot about the vaccine, what that might look like, timing, availability, and then we talked about some of the key issues that we were focusing on today, the new opportunities if you will…rural access to broadband and importantly, telehealth medicine.”

He said telehealth is the “21st century way” for people, particularly in rural areas, to get access to excellent health care without having to drive huge distances to see their health care providers.

It should be, he said, one of the best care is not “just centralized in the cities.”

Lyme Disease, he said, falls under the radar yet it affects so many New Hampshire families. We have 14-blood borne illnesses in the state, Sununu said, and some have more impact than others. Some are more neurological than others.

He said the LymeX is a $24 million initiative that will spur innovation on a very serious health issue that disproportionately impacts New Hampshire.

“Spurring that innovation is what we love to see,” Sununu said.
Hargan, a fellow Republican, said he appreciated the cooperative work on health care with the Sununu Administration, particularly on COVID-19.

He said Health and Human Service under the Trump Administration has focused on “tackling impactable, emerging and neglected health changes. Frankly, Lyme Disease is all three of those.”

“We think it represents a real chance to move the needle on a long-neglected disease.”

He said the way to do that likely is to “shake up the status quo,” with creativity and innovative action.

The Steven and Alexandra Cohen Foundation https://www.steveandalex.org/ will be part of the new public-private partnership, the largest in history, to develop Lyme and other tick-borne solutions through LymeX, Hargan said.

There are three prongs to LymeX:
– Allow patients themselves to make suggestions on care and ideas on research and how they would like to be cared for.
– A prevention and awareness campaign, which will look at crowdsourcing prevention and awareness rather than the typical nurse’s pamphlets, or billboard approach to public health awareness, he said.

“Third, we are going to foster breakthroughs in next-generation diagnostics. This is going to be a Lyme diagnostics flu shot, a multimillion-dollar grand-prize challenge that we are going to aim to revolutionize the field of testing for Lyme Disease.
“It is a disease which looks a lot like many other diseases, and that has been a real block for there to be real progress to know the contours of who is being affected by the disease. So announcing a next-generation diagnostic, providing millions of dollars in prize challenge, we think, could be way to spur innovation,” Hargan said.

Rural Health Action

A rural action plan launched by a Trump executive order this summer, looks to transport rural health to the level  equalizing the care provided regardless of where one lives.
Hargan grew up in a rural town of 8,000 in Illinois and his family has been involved in rural health for generations before him, he said, and he felt it important that the Trump administration was addressing issues.

They will look forward to a roll-out of more complete information on what that might look like in 2021, he said.
That would be provided the Trump Administration gets a new term or the idea is adopted by the successors.

Silver Lining for COVID-19

COVID-19 has helped shine a light on disparities in rural health care.

“We’ve been reminded by the close partnerships,” with state partners, he said, in ensuring access to the underserved.
He said as the nation faces rising cases both nationally and here in New Hampshire, he remains committed to getting the states what they need to fight back against the virus and urged people to remember the following:
-Wash your heads
-Wear a mask
-Watch your distance from others.
Admiral Giroir echoed those three practices to keep the spread of COVID-19 down but he added a fourth which is COVID-19 testing.

Giroir noted that there are lessons being learned from COVID-19, just as the Vietnam War helped revolutionize emergency medical response and prosthetics, noting that New Hampshire’s Dean Kamen played a role.

He said the “silver lining” of COVID-19 is still being learned. A revolution in diagnostics, he said, is underway.
Billions of dollars are being spent now and this makes it the perfect time to leverage that for Lyme Disease research, he said.

“I really look forward to working with everyone up here who has been affected by this disease,” and come up with some scientific answers.

COVID-19 Vaccine

Giroir said we are on the pathway to a COVID-19 vaccine but there is a bit of testing fatigue related to the pandemic.
He urged people to get tested, even if they don’t feel sick and that testing is available and can help prevent the spread.

“God willing, and with the science and the investment, we will have vaccines by the end of the year to start help protecting our very vulnerable. But remember, if you feel sick stay home and get tested. If you have been in close contact with someone of 15 minutes, you need to be tested and local public health will want to screen individuals, particularly young people.”

He said in many outbreak areas of the country it is the young people age 18 to 30 that need to get tested.