Bøger udgivet af National Academies Press

"The National Academies Roundtable on Aligning Incentives for Open Science, established in 2019, has taken on an important role in addressing issues with open science. The roundtable convenes critical stakeholders to discuss the effectiveness of current incentives for adopting open science practices, current barriers of all types, and ways to move forward in order to align reward structures and institutional values. The Roundtable convened a virtual public workshop on fostering open science practices on November 5, 2020. The broad goal of the workshop was to identify paths to growing the nascent coalition of stakeholders committed to reenvisioning credit/reward systems (e.g., academic hiring, tenure and promotion, and grants)to fully incentivize open science practices. The workshop explored the information and resource needs of researchers, research institutions, government agencies, philanthropies, professional societies, and other stakeholders interested in further supporting and implementing open science practices. This publication summarizes the presentations and discussion of the workshop."--

During the past century, the Everglades, one of the world's treasured ecosystems, has been dramatically altered by drainage and water management infrastructure to improve flood management, urban water supply, and agricultural production. The remnants of the original Everglades now compete for water with urban and agricultural interests and are impaired by contaminated runoff from these two sectors. The Comprehensive Everglades Restoration Plan (CERP), a joint effort launched by the state and the federal government in 2000, seeks to reverse the decline of the ecosystem. The multibillion-dollar project was originally envisioned as a 30- to 40-year effort to achieve ecological restoration by reestablishing the natural hydrologic characteristics of the Everglades, where feasible, and to create a water system that serves the needs of both the natural and the human systems of South Florida. In establishing the CERP, Congress also requested that an independent scientific review be conducted on progress toward restoration with biennial reports. The National Academies' Committee on Independent Scientific Review of Everglades Restoration Progress has provided biennial reviews of restoration progress and advice on scientific and engineering issues that may impact progress since 2004. This eighth study of the series describes substantive accomplishments over the past 2 years and reviews developments in research, monitoring, and assessment that inform restoration decision making. Progress Toward Restoring the Everglades: The Eighth Biennial Review - 2020 also reviews the recently developed Combined Operational Plan, which is a prerequisite for CERP progress in the central Everglades, and examines issues facing the northern and southern estuaries, including priorities for science to support restoration decision making.

This is the twenty-third volume in the series of Memorial Tributes compiled by the National Academy of Engineering as a personal remembrance of the lives and outstanding achievements of its members and foreign associates. These volumes are intended to stand as an enduring record of the many contributions of engineers and engineering to the benefit of humankind. In most cases, the authors of the tributes are contemporaries or colleagues who had personal knowledge of the interests and the engineering accomplishments of the deceased.

The Defense Materials Manufacturing and Infrastructure standing and planning committee of the National Academies of Sciences, Engineering, and Medicine convened a workshop on May 19-20, 2016, to discuss the value of collaboration between the materials and civil engineering communities in addressing the following problem: People and equipment are continuously monitored through multiple organizations and instruments, but the physical infrastructure where they live, train, and deploy receives little attention until it fails or is shown to be inadequate. The workshop was organized into three sessions: (1) highway infrastructure, (2) waterways infrastructure, and (3) railways infrastructure. Within these three sessions, individual speakers gave presentations on technical, functional, and economic paradigms and answered questions from workshop participants. Following these sessions, a panel discussion was held to discuss existing gaps as well as ways to overcome challenges. This publication summarizes the presentations and discussion of the workshop.

Emerging techniques in data analytics, including machine learning and artificial intelligence, offer exciting opportunities for advancing scientific discovery and innovation in materials science. Vast repositories of experimental data and sophisticated simulations are being utilized to predict material properties, design and test new compositions, and accelerate nearly every facet of traditional materials science. How can the materials science community take advantage of these opportunities while avoiding potential pitfalls? What roadblocks may impede progress in the coming years, and how might they be addressed? To explore these issues, the Workshop on Data Analytics and What It Means to the Materials Community was organized as part of a workshop series on Defense Materials, Manufacturing, and Its Infrastructure. Hosted by the National Academies of Sciences, Engineering, and Medicine, the 2-day workshop was organized around three main topics: materials design, data curation, and emerging applications. Speakers identified promising data analytics tools and their achievements to date, as well as key challenges related to dealing with sparse data and filling data gaps; decisions around data storage, retention, and sharing; and the need to access, combine, and use data from disparate sources. Participants discussed the complementary roles of simulation and experimentation and explored the many opportunities for data informatics to increase the efficiency of materials discovery, design, and testing by reducing the amount of experimentation required. With an eye toward the ultimate goal of enabling applications, attendees considered how to ensure that the benefits of data analytics tools carry through the entire materials development process, from exploration to validation, manufacturing, and use. This publication summarizes the presentations and discussion of the workshop.

The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a workshop at Hunter College in New York City, New York on February 6, 2020, to explore the value of co-creating and keeping inclusive healthy spaces. The workshop was designed to understand and highlight the economics of inclusive placemaking and to explore its value in improving health, equity, and well-being. Placemaking (the work of creating livable, vibrant, or quality places, especially public places) draws on various traditions of community development, arts and culture, regional planning, and civic engagement, combining different disciplinary perspectives into a creative way of shaping public spaces, land use, commerce, transportation, housing, and social fabric. The workshop (1) examined the economics of this work, (2) described how inclusive placemakers gather resources to do their work, and (3) explored the social and economic value they are able to generate when places are designed with health, equity, and well-being in mind. This publication is a summary of the presentations and discussions that occurred during the workshop.

The Dietary Reference Intakes (DRIs) are a set of evidence-based nutrient reference values for intakes that include the full range of age, gender, and life stage groups in the US and Canada. At the request of the U.S. Department of Agriculture, Agricultural Research Service and the U.S. Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Applied Nutrition, the National Academies of Science, Engineering, and Medicine convened an ad hoc committee to carry out a literature search and evidence scan of the peer-reviewed published literature on indicators of nutritional requirements, toxicity, and chronic disease risk reduction for riboflavin. Scanning for New Evidence on Riboflavin to Support a Dietary Reference Intake Review builds on the methodology for evidence scanning nutrients (which have existing DRIs) to determine whether there is new and relevant knowledge available that may merit a formal reexamination of DRIs for riboflavin. This report offers comments on the methodological approach to the evidence scan and discusses its findings and interpretation of the process to provide the study sponsors with a greater context to support their interpretation and application of the reported results.

As the largest generation in U.S. history - the population born in the two decades immediately following World War II - enters the age of risk for cognitive impairment, growing numbers of people will experience dementia (including Alzheimer's disease and related dementias). By one estimate, nearly 14 million people in the United States will be living with dementia by 2060. Like other hardships, the experience of living with dementia can bring unexpected moments of intimacy, growth, and compassion, but these diseases also affect people's capacity to work and carry out other activities and alter their relationships with loved ones, friends, and coworkers. Those who live with and care for individuals experiencing these diseases face challenges that include physical and emotional stress, difficult changes and losses in their relationships with life partners, loss of income, and interrupted connections to other activities and friends. From a societal perspective, these diseases place substantial demands on communities and on the institutions and government entities that support people living with dementia and their families, including the health care system, the providers of direct care, and others. Nevertheless, research in the social and behavioral sciences points to possibilities for preventing or slowing the development of dementia and for substantially reducing its social and economic impacts. At the request of the National Institute on Aging of the U.S. Department of Health and Human Services, Reducing the Impact of Dementia in America assesses the contributions of research in the social and behavioral sciences and identifies a research agenda for the coming decade. This report offers a blueprint for the next decade of behavioral and social science research to reduce the negative impact of dementia for America's diverse population. Reducing the Impact of Dementia in America calls for research that addresses the causes and solutions for disparities in both developing dementia and receiving adequate treatment and support. It calls for research that sets goals meaningful not just for scientists but for people living with dementia and those who support them as well. By 2030, an estimated 8.5 million Americans will have Alzheimer's disease and many more will have other forms of dementia. Through identifying priorities social and behavioral science research and recommending ways in which they can be pursued in a coordinated fashion, Reducing the Impact of Dementia in America will help produce research that improves the lives of all those affected by dementia.

During the COVID-19 pandemic, health professionals adapted, innovated, and accelerated in order to meet the needs of students, patients, and the community. To examine and learn from these experiences, the National Academies of Sciences, Engineering, and Medicine's Global Forum on Innovation in Health Professional Education convened a series of workshops, the first of which was a one-day virtual workshop on December 3, 2020. The first workshop explored lessons learned in the grand challenges facing health professions education (HPE) stemming from the COVID-19 pandemic and how those positive and negative experiences might inform development of sustainable improvements in the value, effectiveness, and impact of HPE. Educators, students, administrators, and health professionals shared ideas, stories, and data in an effort to discuss the future of HPE by learning from past experiences. Topics included: evaluation of online education; innovations in interprofessional education and learning opportunities within the social determinants of health and mental health; effects on preclinical and clinical education; regulatory and accreditation changes affecting HPE; and stress and workload on students and faculty. This publication summarizes the presentations and panel discussions from the workshop.

"Scientific thinking and understanding are essential for all people navigating the world, not just for scientists and other science, technology, engineering and mathematics (STEM) professionals. Knowledge of science and the practice of scientific thinking are essential components of a fully functioning democracy. Science is also crucial for the future STEM workforce and the pursuit of living wage jobs. Yet, science education is not the national priority it needs to be, and states and local communities are not yet delivering high quality, rigorous learning experiences in equal measure to all students from elementary school through higher education. Call to Action for Science Education: Building Opportunity for the Future articulates a vision for high quality science education, describes the gaps in opportunity that currently exist for many students, and outlines key priorities that need to be addressed in order to advance better, more equitable science education across grades K-16. This report makes recommendations for state and federal policy makers on ways to support equitable, productive pathways for all students to thrive and have opportunities to pursue careers that build on scientific skills and concepts. Call to Action for Science Education challenges the policy-making community at state and federal levels to acknowledge the importance of science, make science education a core national priority, and empower and give local communities the resources they must have to deliver a better, more equitable science education." --

The year 2020 presented extraordinary challenges to organizations working to improve population health - from public health agencies at all levels of government to health systems to community-based non-profit organizations responding to health-related social needs. To improve understanding of how different domains in the population health field are responding to and being changed by two major crises (racial injustice and the COVID-19 pandemic), the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine held a workshop from September 21-24, 2020, titled Population Health in Challenging Times: Insights from Key Domains. The workshop had sessions organized by themes: academic public health and population health; the social sector; health care, governmental public health; philanthropy; and cross-sector work. Each panel discussion highlighted difficulties and opportunities, both internal to the respective institutions and sectors, and at the interface with peers and partners, especially communities. This publication summarizes the presentations and panel discussions from the workshop.

"Significant efforts are ongoing within the U.S. Air Force (USAF) to improve national security and competitiveness by harnessing the growing power of information technologies, such as artificial intelligence (AI) and robotics. Product and process technologies are being researched, experimented with, and integrated into future warfighting concepts and plans. A significant part of this effort is focused on integrating operations, from the strategic to the tactical and across all lines of effort. A question that must be asked in considering these future warfighting concepts is: how will the devices that enable the knowledge-based future be powered? The abundant energy supplies that characterize peacetime operating environments may not be readily available at the far reaches of the force projections - the tactical edge - during conflict. Understanding the energy challenges associated with continued data collection, processing, storage, analysis, and communications at the tactical edge is an important part of developing the plans for meeting the future competition on the battlefield.This report identifies challenges and issues associated with energy needs at the tactical edge as well as any potential for solutions to be considered in the future to help address these challenges. The recommendations of Energizing Data-Driven Operations at the Tactical Edge address understanding these requirement needs and the cascading effects of not meeting those needs, integrating energy needs for data processing into mission and unit readiness assessments, and research into product and process technologies to address energy-efficient computation, resilience, interoperability, and alternative solutions to energy management at the tactical edge." --

As a living substrate, soil is critical to the function of Earth's geophysical and chemical properties. Soil also plays a major role in several human activities, including farming, forestry, and environmental remediation. Optimizing those activities requires a clear understanding of different soils, their function, their composition and structure, and how they change over time and from place to place. Although the importance of soil to Earth's biogeochemical cycles and to human activities is recognized, the current systems in place for monitoring soil properties - including physical, chemical, and, biological characteristics - along with measures of soil loss through erosion, do not provide an accurate picture of changes in the soil resource over time. Such an understanding can only be developed by collecting comprehensive data about soils and the various factors that influence them in a way that can be updated regularly and made available to researchers and others who wish to understand soils and make decisions based on those data. The National Academies of Sciences, Engineering, and Medicine convened key stakeholders in a workshop on March 2-4, 2021, to discuss the development of a dynamic soil information system. Workshop discussions explored possiblities to dynamically and accurately monitor soil resources nationally with the mutually supporting goals of (1) achieving a better understanding of causal influences on observed changes in soil and interactions of soil cycling of nutrients and gases with earth processes, and (2) providing accessible, useful, and actionable information to land managers and others. This publication summarizes the presentation and discussion of the workshop.

"Astronauts face unique health-related risks during crewed space missions, and longer-duration missions that extend to greater distances in our solar system (including to the Moon and Mars) will likely increase those risks. Cancer risks due to ionizing radiation exposure are one of these health-related risks. Assessing, managing, and communicating radiation-induced cancer risks associated with spaceflight are challenging because of incomplete knowledge of the radiation environment in space, limited data on radiation-induced cellular damage mechanisms, lack of direct observations from epidemiological studies, and the complexities of understanding radiation risk. At the request of the National Aeronautics and Space Administration (NASA), an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine convened to provide advice on NASA's proposed updates to their space radiation health standard, which sets the allowable limit of space radiation exposure throughout the course of an astronaut's career. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks provides the committee's recommendations and conclusions regarding the updated space radiation health standard, NASA's radiation risk communication strategies, and a process for developing an ethics-informed waiver protocol for long-duration spaceflight missions." --

The Federal Aviation Administration (FAA) has overseen significant upgrades to the technology used to manage aviation operations to increase the safety and efficiency of the National Airspace System (NAS). Though necessary to regular operations, these modern computing and communications systems provide a greater attack surface for criminals, terrorists, or nation-states to exploit and thereby increase the potential for cybersecurity threats to the NAS and its constituents. The future safety and security of air travel will rely in part on the ability of the FAA to build a workforce capable of addressing the evolving cybersecurity threat landscape. Securing the computers, networks, and data that underpin modern aviation depends in part on the FAA having enough cybersecurity professionals (capacity) with the right knowledge, skills, and abilities (capability)). It also depends on the FAA's workforce having sufficient diversity of backgrounds and experience. Such diversity is critical in analyzing cybersecurity problems and widely understood to be a "functional imperative" for effective cybersecurity programs. At the request of Congress, the publication examines the FAA's cybersecurity workforce challenges, reviews the current strategy for meeting those challenges, and recommends ways to strengthen the FAA's cybersecurity workforce.

"Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. Health and Medicine Division. Policy and Global Affairs, The National Academis of Sciences, Engineering, Medicine."

"The COVID-19 pandemic is transforming the global economy and significantly shifting workforce demand, requiring quick, adaptive responses. The pandemic has revealed the vulnerabilities of many organizations and regional economies, and it has accelerated trends that could lead to significant improvements in productivity, performance, and resilience, which will enable organizations and regions to thrive in the "next normal." To explore how communities around the United States are addressing workforce issues laid bare by the COVID-19 pandemic and how they are taking advantage of local opportunities to expand their science, technology, engineering, mathematics, and medicine (STEMM) workforces to position them for success going forward, the Board of Higher Education and Workforce of the National Academies of Sciences, Engineering, and Medicine convened a series of workshops to identify immediate and near-term regional STEMM workforce needs in the wake of the COVID-19 pandemic. The workshop planning committee identified five U.S. cities and their associated metropolitan areas - Birmingham, Alabama; Boston, Massachusetts; Richmond, Virginia; Riverside, California; and Wichita, Kansas - to host workshops highlighting promising practices that communities can use to respond urgently and appropriately to their STEMM workforce needs. A sixth workshop discussed how the lessons learned during the five region-focused workshops could be applied in other communities to meet STEMM workforce needs. This proceedings of a virtual workshop series summarizes the presentations and discussions from the six public workshops that made up the virtual workshop series and highlights the key points raised during the presentations, moderated panel discussions and deliberations, and open discussions among the workshop participants." --

Radioactive Sources: Applications and Alternative Technologies assesses the status of medical, research, sterilization, and other commercial applications of radioactive sources and alternative (nonradioisotopic) technologies in the United States and internationally. Focusing on Category 1, 2, and 3 sources, this report reviews the current state of these sources by application and reviews the current state of existing technologies on the market or under development that are or could be used to replace radioisotopic technologies in those applications. Radioactive Sources will support existing and future activities under the National Nuclear Security Administration Office of Radiological Security program to reduce the use of high-risk radiological materials in commercial applications.--

The effective use of data science - the science and technology of extracting value from data - improves, enhances, and strengthens acquisition decision-making and outcomes. Using data science to support decision making is not new to the defense acquisition community; its use by the acquisition workforce has enabled acquisition and thus defense successes for decades. Still, more consistent and expanded application of data science will continue improving acquisition outcomes, and doing so requires coordinated efforts across the defense acquisition system and its related communities and stakeholders. Central to that effort is the development, growth, and sustainment of data science capabilities across the acquisition workforce. At the request of the Under Secretary of Defense for Acquisition and Sustainment, Empowering the Defense Acquisition Workforce to Improve Mission Outcomes Using Data Science assesses how data science can improve acquisition processes and develops a framework for training and educating the defense acquisition workforce to better exploit the application of data science. This report identifies opportunities where data science can improve acquisition processes, the relevant data science skills and capabilities necessary for the acquisition workforce, and relevant models of data science training and education.

The past century has witnessed remarkable advances in life expectancy in the United States and throughout the world. In 2010, however, progress in life expectancy in the United States began to stall, despite continuing to increase in other high-income countries. Alarmingly, U.S. life expectancy fell between 2014 and 2015 and continued to decline through 2017, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918-1919). The recent decline in U.S. life expectancy appears to have been the product of two trends: (1) an increase in mortality among middle-aged and younger adults, defined as those aged 25-64 years (i.e., "working age"), which began in the 1990s for several specific causes of death (e.g., drug- and alcohol-related causes and suicide); and (2) a slowing of declines in working-age mortality due to other causes of death (mainly cardiovascular diseases) after 2010. High and Rising Mortality Rates among Working Age Adults highlights the crisis of rising premature mortality that threatens the future of the nation's families, communities, and national wellbeing. This report identifies the key drivers of increasing death rates and disparities in working-age mortality over the period 1990 to 2017; elucidates modifiable risk factors that could alleviate poor health in the working-age population, as well as widening health inequalities; identifies key knowledge gaps and make recommendations for future research and data collection to fill those gaps; and explores potential policy implications. After a comprehensive analysis of the trends in working-age mortality by age, sex, race/ethnicity, and geography using the most up-to-date data, this report then looks upstream to the macrostructural factors (e.g., public policies, macroeconomic trends, social and economic inequality, technology) and social determinants (e.g., socioeconomic status, environment, social networks) that may affect the health of working-age Americans in multiple ways and through multiple pathways.

At the request of the U.S. Army, the Board on Army Research and Development of the National Academies of Sciences, Engineering, and Medicine conducted a 3-day workshop to explore how the Army can improve its strategic medical infrastructure planning with a view to 2035. The workshop, held July 14-16, 2020, brought together experts and key stakeholders from academia, industry, and government. The Army requires fidelity, consistency, and predictability in planning and managing research, development, test, and evaluation resources for medical infrastructure across all appropriation sources to effectively develop, deliver, and respond to military medical capability needs. In response to the Army's requirement, the workshop was designed to address the components of a sustainable, reinforcing enterprise framework (organizational and fiscal). Presentations and discussions examined roles, responsibilities, and coordinating mechanisms among major stakeholders of battlefield medicine; case studies of comparably complex non-government enterprise solutions; and opportunities to link ends, ways, and means for improvements. This publication summarizes the presentations and discussion of the workshop.

"This report, by a committee of experts, conducts an evaluation of the expected medium- and long-term evolution of the grid. This evaluation focuses on developments that include the emergence of new technologies, planning and operating techniques, grid architecture, and business models."

"The Roundtable on Obesity Solutions of The National Academies of Sciences, Engineering, and Medicine held a virtual workshop on September 16, 2020 titled Using Systems Applications to Inform Obesity Solutions. It explored various systems science approaches (i.e., methodologies and tools) and support structures that could guide future obesity research and action, and featured examples of how these approaches can inform decision making within policy and program areas. Workshop speakers discussed the support structures (e.g., data sources, modeling expertise, training, and partnerships and collaborations) that encourage and engage researchers and decision makers to use systems science approaches to better understand the causes of and solutions to the obesity epidemic. This publication summarizes the presentations and discussions from the workshop." --

The Food Forum of the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop on July 22-23, 2020 that explored integration of the health, societal, economic, and environmental effects and future needs of the food system. The main objective of the workshop was to understand how to achieve a more sustainable, resilient, equitable, and nourishing food system. The workshop covered a number of topics, including new expectations for the food system within three dimensions of the food system (vulnerabilities, resiliency, and transformation). Discussions also covered global change, access to nutritious food, resiliency in complex dynamic systems and resiliency for the future, and consumption- and production-oriented strategies for transforming the food system. This publication summarizes the presentations and discussions from the workshop.

"At the request of the Deputy Assistant Secretary of the Army for Research and Technology, Powering the U.S. Army of the Future examines the U.S. Army's future power requirements for sustaining a multi-domain operational conflict and considers to what extent emerging power generation and transmission technologies can achieve the Army's operational power requirements in 2035. The study was based on one operational usage case identified by the Army as part of its ongoing efforts in multi-domain operations. The recommendations contained in this report are meant to help inform the Army's investment priorities in technologies to help ensure that the power requirements of the Army's future capability needs are achieved." --

The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on September 19, 2019 titled Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream. The term upstream refers to the higher levels of action to improve health. Medical services act downstream (i.e., at the patient level) in improving population health, while such activities as screening and referring to social and human services (e.g., for housing, food assistance) are situated midstream, and the work of changing laws, policies, and regulations (e.g., toward affordable housing, expanding healthy food access) to improve the community conditions for health represents upstream action. The workshop explored the growing attention on population health, from health care delivery and health insurance organizations to the social determinants of health and their individual-level manifestation as health-related social needs, such as patients' needs. The workshop showcased collaborative population health improvement efforts, each of which included one or more health systems. This publication summarizes the presentations and discussions from the workshop.

In 2002, the U.S. Food and Drug Administration (FDA) launched the Pharmaceutical Quality for the 21st Century Initiative to encourage adoption of innovative technologies that would lead to an agile, flexible pharmaceutical manufacturing sector. The goal was to encourage a transition to manufacturing processes and approaches that could produce high-quality drugs reliably without extensive regulatory oversight. Much progress has been made toward that goal as the industry has developed and advanced new technologies, but more progress is required as recent natural disasters and the coronavirus pandemic have revealed vulnerabilities in supply chains and highlighted the need to modernize pharmaceutical manufacturing further. At the request of the FDA Center for Drug Evaluation and Research (CDER), Innovations in Pharmaceutical Manufacturing on the Horizon identifies emerging technologies - such as product technologies, manufacturing processes, control and testing strategies, and platform technologies - that have the potential to advance pharmaceutical quality and modernize pharmaceutical manufacturing for products regulated by CDER. This report describes many innovations to modernize the manufacture of drug substances and drug products, to advance new control approaches, and to develop integrated, flexible, and distributed manufacturing networks within 5-10 years.

"High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels. Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs." --

Immunization against disease is among the most successful global health efforts of the modern era, and substantial gains in vaccination coverage rates have been achieved worldwide. However, that progress has stagnated in recent years, leaving an estimated 20 million children worldwide either undervaccinated or completely unvaccinated. The determinants of vaccination uptake are complex, mutable, and context specific. A primary driver is vaccine hesitancy - defined as a "delay in acceptance or refusal of vaccines despite availability of vaccination services". The majority of vaccine-hesitant people fall somewhere on a spectrum from vaccine acceptance to vaccine denial. Vaccine uptake is also hampered by socioeconomic or structural barriers to access. On August 17-20, 2020, the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 4-day virtual workshop titled The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy. The workshop focused on two main areas (vaccine access and vaccine confidence) and gave particular consideration to health systems, research opportunities, communication strategies, and policies that could be considered to address access, perception, attitudes, and behaviors toward vaccination. This publication summarizes the presentations and discussion of the workshop.