PMC:7454258 / 147590-178292 JSONTXT

{"project":"LitCovid-PD-FMA-UBERON","denotations":[{"id":"T30","span":{"begin":20384,"end":20389},"obj":"Body_part"},{"id":"T31","span":{"begin":28718,"end":28723},"obj":"Body_part"},{"id":"T32","span":{"begin":29546,"end":29549},"obj":"Body_part"}],"attributes":[{"id":"A30","pred":"fma_id","subj":"T30","obj":"http://purl.org/sig/ont/fma/fma7490"},{"id":"A31","pred":"fma_id","subj":"T31","obj":"http://purl.org/sig/ont/fma/fma7490"},{"id":"A32","pred":"fma_id","subj":"T32","obj":"http://purl.org/sig/ont/fma/fma278683"}],"text":"Identified cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

{"project":"LitCovid-PD-UBERON","denotations":[{"id":"T46","span":{"begin":5807,"end":5812},"obj":"Body_part"},{"id":"T47","span":{"begin":6922,"end":6927},"obj":"Body_part"}],"attributes":[{"id":"A46","pred":"uberon_id","subj":"T46","obj":"http://purl.obolibrary.org/obo/UBERON_0002542"},{"id":"A47","pred":"uberon_id","subj":"T47","obj":"http://purl.obolibrary.org/obo/UBERON_0002542"}],"text":"Identified cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

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cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

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cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

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cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

{"project":"LitCovid-PD-GO-BP","denotations":[{"id":"T65376","span":{"begin":320,"end":333},"obj":"http://purl.obolibrary.org/obo/GO_0006412"},{"id":"T19732","span":{"begin":9826,"end":9839},"obj":"http://purl.obolibrary.org/obo/GO_0009566"},{"id":"T57593","span":{"begin":10180,"end":10188},"obj":"http://purl.obolibrary.org/obo/GO_0007610"},{"id":"T64267","span":{"begin":10790,"end":10796},"obj":"http://purl.obolibrary.org/obo/GO_0040007"},{"id":"T73470","span":{"begin":15239,"end":15245},"obj":"http://purl.obolibrary.org/obo/GO_0007601"},{"id":"T80651","span":{"begin":15775,"end":15786},"obj":"http://purl.obolibrary.org/obo/GO_0006412"}],"text":"Identified cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

{"project":"LitCovid-PubTator","denotations":[{"id":"739","span":{"begin":1506,"end":1514},"obj":"Disease"},{"id":"740","span":{"begin":4597,"end":4619},"obj":"Disease"},{"id":"741","span":{"begin":5300,"end":5329},"obj":"Disease"},{"id":"745","span":{"begin":5519,"end":5524},"obj":"Species"},{"id":"746","span":{"begin":5567,"end":5572},"obj":"Species"},{"id":"747","span":{"begin":5435,"end":5459},"obj":"Disease"},{"id":"750","span":{"begin":10192,"end":10197},"obj":"Species"},{"id":"751","span":{"begin":11488,"end":11496},"obj":"Disease"},{"id":"753","span":{"begin":13457,"end":13462},"obj":"Species"},{"id":"755","span":{"begin":17761,"end":17769},"obj":"Disease"},{"id":"757","span":{"begin":22837,"end":22841},"obj":"Chemical"},{"id":"761","span":{"begin":24322,"end":24336},"obj":"Disease"},{"id":"762","span":{"begin":24489,"end":24498},"obj":"Disease"},{"id":"763","span":{"begin":24905,"end":24908},"obj":"Disease"},{"id":"768","span":{"begin":29495,"end":29500},"obj":"Species"},{"id":"769","span":{"begin":29523,"end":29541},"obj":"Disease"},{"id":"770","span":{"begin":29546,"end":29549},"obj":"Disease"},{"id":"771","span":{"begin":29550,"end":29554},"obj":"Disease"},{"id":"773","span":{"begin":30603,"end":30622},"obj":"Disease"}],"attributes":[{"id":"A739","pred":"tao:has_database_id","subj":"739","obj":"MESH:C000657245"},{"id":"A745","pred":"tao:has_database_id","subj":"745","obj":"Tax:9606"},{"id":"A746","pred":"tao:has_database_id","subj":"746","obj":"Tax:9606"},{"id":"A747","pred":"tao:has_database_id","subj":"747","obj":"MESH:C000657245"},{"id":"A750","pred":"tao:has_database_id","subj":"750","obj":"Tax:9606"},{"id":"A751","pred":"tao:has_database_id","subj":"751","obj":"MESH:C000657245"},{"id":"A753","pred":"tao:has_database_id","subj":"753","obj":"Tax:9606"},{"id":"A755","pred":"tao:has_database_id","subj":"755","obj":"MESH:C000657245"},{"id":"A761","pred":"tao:has_database_id","subj":"761","obj":"MESH:D019966"},{"id":"A762","pred":"tao:has_database_id","subj":"762","obj":"MESH:D007239"},{"id":"A763","pred":"tao:has_database_id","subj":"763","obj":"MESH:C566369"},{"id":"A768","pred":"tao:has_database_id","subj":"768","obj":"Tax:9606"},{"id":"A769","pred":"tao:has_database_id","subj":"769","obj":"MESH:D003141"},{"id":"A770","pred":"tao:has_database_id","subj":"770","obj":"MESH:D015658"},{"id":"A771","pred":"tao:has_database_id","subj":"771","obj":"MESH:D000163"},{"id":"A773","pred":"tao:has_database_id","subj":"773","obj":"MESH:D003141"}],"namespaces":[{"prefix":"Tax","uri":"https://www.ncbi.nlm.nih.gov/taxonomy/"},{"prefix":"MESH","uri":"https://id.nlm.nih.gov/mesh/"},{"prefix":"Gene","uri":"https://www.ncbi.nlm.nih.gov/gene/"},{"prefix":"CVCL","uri":"https://web.expasy.org/cellosaurus/CVCL_"}],"text":"Identified cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

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cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}

{"project":"LitCovid-PD-HP","denotations":[{"id":"T110","span":{"begin":29024,"end":29031},"obj":"Phenotype"}],"attributes":[{"id":"A110","pred":"hp_id","subj":"T110","obj":"http://purl.obolibrary.org/obo/HP_0001513"}],"text":"Identified cross-governmental coordination strategies for strengthening national nutrition research\nImproved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries. Key identified strategies are summarized in Table 3 and reviewed below. These options were not found to be mutually exclusive and could be even more effective in combination.\nTABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress\nModeled after the Office of the Director of National Intelligence\nCoordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community\nEnsure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model\nDedicated leadership, staff, and funding\nBuilds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform\nCan be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation\nMay be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation\nPresidential appointment of the Director, with Senate confirmation\nNew US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation\nModeled after the US Global Change Research Program\nOverseen by the Executive Office of the President and facilitated by a National Coordination Office\nFunded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model\nDedicated structure, staff, and budget\nBuilds on the ICHNR\nRenewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area\nStaffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)\nCongressional authorization, ideally associated with Congressional appropriations\nNew Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed\nServes as the President's advisor on issues related to nutrition research\nModeled after other Associate Director positions and initiatives\nProvides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts\nIdentify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning\nElevates work and impact of individual federal departments and agencies and the ICHNR\nCan hire advisors, special assistants, and fellows to deepen expertise and impact\nCreates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success\nOSTP initiatives may not align with focus or levels of research funding\nStaffing often small, transient, and reliant on temporary staff\nSuccess highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation\nNew US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research\nModeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria\nCo-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies\nComplementary Presidential Advisory Council\nWould develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model\nExecutive Order would elevate federal prioritization of nutrition research\nCabinet-level leadership\nConcrete National Action Plan with required annual reports\nAdvisory Council to leverage external expertise\nStrengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding\nMore transient in nature, with defined scope and time period Presidential Executive Order\nPresidential directive to revise the ICHNR structure\nCongressional inquiry on the above actions\nLegislation to revise the ICHNR charge, structure, and funding\n1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.\n\nNew Office of the National Director of Food and Nutrition\nModeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3). ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies. Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible. ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size. Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies. Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.\nONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress. Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.\n\nAdvantages\nThis tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies. ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies. ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives. A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation. There could also be additional Congressional oversight as needed and interests arise. ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation. These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics. A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.\nLike ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations. ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health. ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more. This would help meet the almost explosive growth in public demand for better information on the science of diet-related health. ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292). Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview. A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).\n\nDisadvantages\nThis new position and office would require Congressional (legislative) authorization and appropriations. As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation. ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.\n\nPath forward\nCongress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs. The mandate should include a clear emphasis on strengthening national nutrition research. Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN. Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate. The President would then appoint the National Director of Food and Nutrition.\n\nNew US Global Nutrition Research Program\nA new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4). The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294). This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change. Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295). USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff. USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296). Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics. Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).\nSimilar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President. Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency. In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system). Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.\n\nAdvantages\nThis is a tested, successful model on a similarly crucial area of science. USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies. Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations. Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation. Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries. Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.\nICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions. As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC. Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298). USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.\n\nDisadvantages\nIf based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest. Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far. Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.\n\nPath forward\nUSGNRP could be established by a Presidential Initiative, without legislative action. For longer-term success, Congress could later codify USGNRP into law (296). Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR). In any of these cases, separate Congressional appropriations are not needed but would be ideal.\n\nNew Associate Director for Nutrition Science within the OSTP\nA new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5). OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282). OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299). In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation. The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility. Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director. The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs. President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300). President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301). President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).\nPrior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015. However, OSTP has never had an Associate Director of Nutrition Science. Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.\n\nAdvantages\nOSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions. OSTP advises the OMB on research and development programs for annual White House budgetary requests. For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303). OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304). An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science. The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR. The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries. Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.\n\nDisadvantages\nOSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness. OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies. Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment. OSTP initiatives may not align with focus or levels of research funding.\n\nPath forward\nA President can appoint an Associate Director for Nutrition Science, with Senate confirmation. Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).\n\nNew US Task Force on Federal Nutrition Research\nA new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307). As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309). In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310). This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF. Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress. In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311). The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).\nModeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6). Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies. A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President. This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.\n\nAdvantages\nThis is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313). The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress. The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies. The high-level Advisory Council provides a formal mechanism to leverage external expertise and input. These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda. Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies. This approach does not require legislation.\n\nDisadvantages\nDespite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria. That task force also has not developed any coordinated budget initiatives to date. A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place). A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.\n\nPath forward\nThe President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research. The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model. Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination. Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.\n\nOther new cross-governmental options\nAt the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).\nCongress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.\nHHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.\nAn ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.\nCongress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).\nCongress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest. The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics. Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research."}