PResident's Column

Read archives from AAN Past President Orly Avitzur, MD, MBA, FAAN, who served from May 2021 to April 2023.

October 2021

Your Voice Matters

When faced with difficult challenges—and since the onset of COVID-19 there have been many—I often turn to you, members of the American Academy of Neurology. The interviews I conduct for stories in Neurology Today^® and, more recently, this AANnews column, help me assess the scope of problems, become aware of evolving trends, and inform my actions as your president. Since March of 2020, I have spoken to hundreds of you this way to hear what you are experiencing and how you are coping. I’ve also had many more conversations with some of you during one-on-one calls and virtual committee meetings.

I have heard you say that practicing neurology in these tentative times is immeasurably taxing, as we are a profession that normally derives joy from making a discernible difference in outcomes for our patients, not all of whom are following the science. As I write this column in late August, we are facing continued uncertainty about a novel virus as well as confronting resistance to the solutions that will destroy it. Over time, I have become aware of the invisible wounds of the pandemic: burnout, exhaustion, anxiety, depression, fear, doubt, and powerlessness. The roller coaster of hopes and disappointments has been brutal and left many re-evaluating how we conduct our lives and whether our work situations should change.

This is compounded by a sense of lagging leadership, one which has created a deterioration of trust in governance: the US Food and Drug Administration, which ignored an advisory panel vote to reject approval of aducanumab; other agencies that have been accused of inconsistent decisions regarding COVID-19 and poor communication; state governments that have banned mask orders in schools; and more.

As an organization, we have found ourselves needing to make decisions in an absence of definitive guidance and reliable data. We have had to resort to environmental scans including valuable anecdotal information from you, our members across the world. This boots-on-the-ground reporting made us aware that waning vaccine immunity was a reality, that our vaccinated members were contracting breakthrough COVID, and that quarantine was placing a burden on some academic departments as well as on practices. It also led to our recognition that members were becoming increasingly worried about their immunocompromised patients. It has spurred us to action, holding an emergency board meeting on August 5 and voting on several actions including one to send a letter the following day to FDA Acting Commissioner Janet Woodcock, MD, to request that she authorize boosters to restore immunity levels for all individuals and health care providers who continue to be at risk for COVID breakthrough infections.

Advocating for our members in this COVID era means redefining what it means to be indispensable to you. This August, the Quality Committee, chaired by Lyell K. Jones, Jr., MD, FAAN, asked for the AAN to sign on to a joint statement calling for all health care employers to mandate employees be vaccinated against the SARSCoV-2 virus. Also this summer, when we heard from Academy members, especially child neurologists, about their concerns for this vulnerable segment of our patients, this committee endorsed an expansion of the AAN COVID-19 position statement advocating for continued efforts to expedite regulatory approvals and deployment of COVID-19 vaccinations for children under the age of 12 once clinical trial data support their use.

The Advocacy Committee, led by Bruce H. Cohen, MD, FAAN, has supported a call to action for a federal commission to develop a comprehensive national plan to defeat the long COVID, or post-acute sequelae SARSCoV-2 (PASC), crisis, and submitted a detailed letter to the Centers for Medicare & Medicaid Services advocating for revisions to the 2022 Physician Fee Schedule to continue support for telehealth services for the duration of the public health emergency. This committee also monitors and coordinates state actions such as changed laws or policies during the pandemic to require more robust insurance coverage for telehealth and supports the Interstate Medical Licensure Compact, which streamlines the licensing process for physicians who want to practice in multiple states.

Advocating for our members also means caring for our pipeline, so in late July, in consultation with other groups, the AAN Education Committee, led by Joseph I. Sirven, MD, FAAN, adopted a consensus statement regarding virtual interviews to maximize safety for applicants and programs and maintain an equitable interview process for all candidates. Prioritization of safety has likewise led to the cancellation of in-person meetings through the end of 2021, and reversion of meetings like our Fall Conference to a virtual platform.

These are but a small sampling of dozens of letters sent to regulators, legislators, and other key actions taken by our organization as committees and staff continue to diligently work on their normal daily efforts to bring members up-to-date educational and scientific initiatives and conferences.

It is rewarding when our advocacy is taken to heart. The August 23 approval of the Pfizer-BioNTech COVID-19 vaccine puts us one step closer to mandates that will ensure the safety of our patients in the workforce. And although it is rare to hear back, we received a direct response from Dr. Woodcock after only a few hours thanking the AAN for our letter advocating for boosters. We were also delighted when the agency authorized an additional vaccine dose for certain immunocompromised individuals six days later, and a joint statement from the HHS announced on August 18 that the CDC was prepared to offer Pfizer and Moderna mRNA booster shots for all Americans beginning the week of September 20 and starting eight months after an individual’s second dose. It also is anticipated booster shots will likely be needed for people who received the Johnson & Johnson vaccine.

I want to thank all of you who continue to keep me and this organization informed, our hard-working staff, and our dedicated volunteers. As we move forward during this time of crisis, please know that your voice matters and is indispensable to us.

Orly Avitzur, MD, MBA, FAAN
President, AAN
@OrlyA on Twitter