Dean's Report 2021

Dean’s Report

I 2021

HARVARD MEDICAL SCHOOL

The crisis strengthened our resolve to serve humanity by advancing science, medicine, and education

On the cover: Second-year MD student Tyler LeComer with a COVID-19 test kit.

This page: Ashlee Conway, HMS research fellow in pediatrics at Boston Children’s Hospital, works on a formula that could be used to make artificial blood for transfusions. Here, Conway mixes the hormone erythro­poietin to add to the blood-generating formula.

rom the Dean

During the second year of the COVID-19 pandemic, Harvard Medical School remained steadfast in its mission to protect and improve human health. HMS scientists were instrumental in advancing our understanding of the novel coronavirus, in spurring development of lifesaving vaccines, and in creating a rapid-response system to address future health crises.

As SARS-CoV-2 transformed how we teach, learn, and work, silver linings emerged: We witnessed an extraordinary spirit of collaboration across global medical and scientific communities; we celebrated the countless lives saved by vaccines and the multitudes who were spared serious illness; we pursued groundbreaking research efforts to help understand and eradicate a broad range of human diseases; we benefited from the courage and dedication of health care workers; and we were inspired by the fortitude of our faculty, postdocs, students, and staff. In the same way that heat hardens steel, the crisis strengthened our resolve to serve humanity by advancing science, medicine, and education.

As always, the people of HMS make our goals achievable. The ongoing worldwide health crisis has challenged us all, but I am continually inspired by the resilience and dedication that have for centuries been hallmarks of the HMS community. I am proud to share with you here some of this year’s remarkable achievements. n

Teaching and Learning

First-year MD student Sara Castro receives her white coat from Natasha Johnson, associate director of the William Bosworth Castle Society

The pandemic challenged faculty to pioneer new avenues for engagement, instruction, and collaboration In Harvard Medical School classrooms

and labs, the pandemic challenged faculty to pioneer new avenues for engagement, instruction, and collaboration. Meanwhile, at the Francis A. Countway Library of Medicine, an $18 million renovation transformed two floors into interactive learning spaces to promote greater collaborative study and community-building.

Within the Program in Medical Education, the challenges of remote learning and pauses in clinical rotations drove pedagogical innovation. Faculty, for instance, rapidly created a five-module, multimodal, asynchronous telemedicine curriculum to teach students clinical skills, regulatory issues, professionalism, and innovations related to telemedicine.

Three affiliated hospitals collaborated on a virtual radiology core clerkship, which included flipped-classroom modules, largegroup didactic lectures, and small group activities, all emphasizing a patient-centered approach to clinical scenarios, proper imaging utilization, and patient safety.

A newly launched advanced integrated science course combines women’s health with LGBTQ health and covers sexual and gender fluidity. It looks at how sexual orientation affects health, health care, and health policy and explores how to conduct and critique biomedical research related to sex and gender.

HMS students continued to excel. Seven received Paul and Daisy Soros Fellowships for New Americans, representing nearly a quarter of all Soros awards given at schools nationwide. The students’ research explores topics such as neuropsychiatric disease, health care delivery for underserved populations, and medical device innovation.

The Harvard-MIT Program in Health Sciences and Technology introduced a pilot for first-year students that unites clinical reasoning with scientific innovation. Students were guided by preclinical curriculum faculty through a clinical case that reinforced how foundational sciences intersect in the context of clinical care. Employing creativity and problem-solving, students identified points in a patient’s experience of illness to determine where innovation could improve treatments for future patients.

HMS remained the No. 1 ranked medical school for research and rose to No. 8 for primary care education by U.S. News & World Report, up from No. 10 last year.

Graduate Education programs grew significantly, with the shift to remote instruction making courses more accessible to a greater number of learners, including clinicians and midcareer professionals. Master’s program enrollments increased more than 62 percent in the past two years.

Next year, HMS will launch its ninth master’s degree concentration with a newly approved one-year master of science degree in media, medicine, and health.

To further promote diversity in these programs, the Dean’s Scholarships for HMS Master’s Students was established, with funds allocated for students with financial need or those from populations underrepresented in science and medicine. Funding this year provided 20 students with tuition discounts.

Significant progress was made in centralizing graduate student support services and developing new course evaluation technology. Advising for graduate student scientists was enhanced by mentorship training for faculty across PhD programs.

The Harvard Integrated Life Sciences

program, a network of all 14 Harvard life sciences PhD programs, now has its administrative home at HMS, allowing best practices to be efficiently shared.

The Office for External Education pivoted to deliver innovative educational opportunities, developing resources that address the current crisis and the future of health care. Global audiences, including clinicians and health care professionals, business leaders, pre-health career learners, patients, and families are increasingly turning to HMS for insights or professional growth opportunities.

One executive education program provided more than 460 health care leaders with the knowledge, tools, and strategies to design and implement technology-enabled change initiatives in health care. Another customized program was developed for 1,200 clinical development leaders at Boehringer Ingelheim.

To keep professionals current on medical science developments, three new HMX Pro courses were launched on topics such as genetic testing and sequencing; chronic inflammation, autoimmunity, and allergy; and drug delivery. Through a philanthropic gift, four medical schools in Tunisia now offer HMX Fundamentals courses.

New health publishing agreements were made with companies such as Google and Apple. Additionally, a new grant is funding a portal for people with autism who are transitioning into adulthood and will provide a full curriculum for physicians.

Continuing medical education credits were awarded to more than 300,000 clinicians worldwide. In its first year, a partnership with Egypt’s Ministry of Health and Population included 1,600 postgraduate certificate program learners and 15 master’s students in four HMS programs.

A COVID-19 clinical education video series, ongoing webinars focused on health disparities, and an accredited event for HMS alumni on mitigating implicit bias provided important insights for frontline clinicians while advancing HMS’ focus on diversity and inclusion. n

From uncovering the mechanism cells use to selforganize in early embryonic development, to increasing our understanding of how certain melanoma cells evade targeted therapy, to deciphering how the brain forms longterm memories, Harvard Medical School scientists continue to push the boundaries of scientific knowledge.

This year, 15 HMS researchers were selected to participate in the Human Cell Atlas, a global effort to map each cell in the human body. Nine faculty were elected members of the National Academy of Medicine, six were elected fellows of the American Association for the Advancement of Science, three were elected to the American Academy of Arts and Sciences, and three were elected to the National Academy of Sciences. Two researchers received Gruber prizes for work in neuroscience and genetics, and one received the Canada Gairdner International Award for major advances in the treatment of type 2 diabetes, obesity, and intestinal disorders.

To further advance fundamental discovery efforts on the Quad, basic life-science departments embarked on a novel faculty search approach—first identifying outstanding candidates across all of the fields represented in the Blavatnik Institute at HMS and then working with the candidates to determine appropriate departmental affiliations. In evaluating candidates, the search committee prioritized scientific excellence and achievement along with a demonstrated commitment to the School’s institutional values of diversity and inclusion.

Four candidates accepted offers to join HMS Quad-based departments. The initiative also engendered support from one of our affiliated institutions, Boston Chil-

dren’s Hospital, which made offers to two additional candidates who will have primary academic appointments in the Blavatnik Institute. These new faculty join seven junior faculty who established labs at HMS during the pandemic. All new faculty will benefit from the mentorship of senior faculty and will have the freedom to map their own paths at HMS, taking full advantage of infrastructures designed to nurture their experience and stimulate their science.

HMS is also advancing therapeutics research, accelerating the translation of basic science discoveries toward new medicines, and training the inventors of those future medicines.

In a collaborative research alliance with AbbVie, HMS is working to develop therapies against emergent viral infections, particularly respiratory pathogens such as coronaviruses.

Two programs are developing small-molecule and antibody therapeutics; others are investi­gating immunology and host-pathogen interactions.

The Dean’s Innovation Awards continue to catalyze collaborations in fundamental, curiosity-driven research. Nearly half of all Quad faculty have applied for funding from the Quadrangle Fund for Advancing and Seeding Translational Research, which has awarded nearly $8 million to 44 projects, spawning several new companies, generating 29 patents, and securing more than $63 million in follow-on funding.

Projects range from the design and development of therapeutic strategies to improve tactile abnormalities in autism spectrum disorders, to a new diagnostic to detect SARSCoV-2, to novel biologics for cancer therapies, to new therapies for hereditary blindness.

Meanwhile, the Blavatnik Therapeutics Challenge Awards, open to all HMS faculty, is investing $20 million over four years on innovative Quad- and affiliate-based projects, such as an initiative to develop treatments for frontotemporal dementia that would restore normal functioning to defective genes. Nine projects have received $9.3 million to date.

The new Fairbairn Family Lyme Research Initiative is probing numerous aspects of pathogen biology, including the immunology and neuroimmunology of a disease that affects more than 475,000 people in the U.S. each year, according to the Centers for Disease Control and Prevention. Comprehensive public education about prevention is part of the program.

The Bertarelli Rare Cancers Fund awarded more than $9 million to nine teams throughout HMS and its affiliates focused on preventing, treating, and curing rare cancers.

Seven HMS Foundry Awards this year, totaling more than $2 million, are supporting improvements to research infrastructure and core facilities and advancing technological innovation on the Quad.

The new Center for Computational Biomedicine is bringing machine learning into labs and creating additional digital spaces for the storage of biomedical data.

HMS is making significant investments in new and renewed infrastructure and optimizing space across the Quad for the creation of new laboratories, technology, and educational facilities.

The School’s information technology systems are enabling our science and empowering our community. In one example, new infrastructure to facilitate an efficient internal awards distribution system processed 275 awards totaling $68 million last year. n

This year, 15 HMS researchers were selected to participate in the Human Cell Atlas, a global effort to map each cell in the human body

MORE RESEARCH NEWS hms.harvard.edu/news/discovery

iscovery and Scholarshi

In a search for climate change solutions, Max Schubert, HMS research fellow in genetics, is studying whether it’s possible to boost the ability of ocean cyanobacteria to cleanse the atmosphere of excess carbon dioxide.

ervice and Leadershi

Clockwise from upper left: First-year DMD student Kaila Daniels at the Class of 2025’s White Coat Ceremony; a masked bicyclist on the HMS Quad; Tony Johnson, associate dean of student social equity and inclusion at the Rhode Island School of Design, sings at the HMS Stand Against Racism rally; Willy Lensch (left), now associate provost for research at Harvard, helps install the “Women Before Me” exhibit while artist and alumna Pamela Chen, HMS clinical fellow in pediatrics at Boston Children’s Hospital, looks on.

Our long history of basic science research, and the convening power of Harvard Medical School, continue to provide a vital reservoir of data, information, and talent for the Massachusetts Consortium on Pathogen Readiness (MassCPR).

This collaboration of 17 institutions, including all four Massachusetts-based medical schools, HMS academic teaching hospitals and research institutions, MIT, local biopharma companies, and China’s Guangzhou Institute of Respiratory Health, provided $17.6 million to support 63 research projects and platforms at 38 institutions.

That commitment led to one of the most significant discoveries of the year, a direct correlation between viral load and disease course, and supplied early support for a diagnostic testing platform that now handles approximately 10 percent of all COVID testing nationwide. It also supported rapid pointof-care diagnostics and a central biobank network where investigators can obtain clinical specimens critical to research.

MassCPR members helped create national clinical care guidelines for COVID-19 treatment, played a pivotal role in the development of Johnson & Johnson’s adenovirus-based vaccine, and led a clinical trial that studied the efficacy and safety of Moderna’s mRNA-based vaccine.

Members also pioneered an antibody profiling system and identified data-driven prognostic factors to help quickly detect patients at highest risk for becoming severely ill.

MassCPR is now focusing on two additional areas: the impact of long COVID and the growing complexities of viral variants.

Harvard Catalyst created COVID Authors, an open-source, international database of 475,000-plus authors who have published more than 126,000 articles related to coronaviruses. Investigators at HMS-affiliated hospitals requested an unprecedented 900 biostatistics consultations supported by Harvard Catalyst, with approximately 100 focusing on COVID-19 studies.

Through SMART IRB, Harvard Catalyst facilitated the institutional review board (IRB) process for just under 300 COVID-19-related

multisite studies throughout the U.S. since 2020. Its Connector program supported clinical research studies at HMS-affiliated hospitals, including 103 related to COVID-19.

Faculty at affiliate hospitals made major contributions, from studying how long SARSCoV-2 antibodies confer protective immunity, to investigating multisystem inflammatory syndrome in children (MIS-C), to establishing the safety and benefits of COVID vaccination during pregnancy and lactation.

The pandemic underscored how social and health care inequities are contributing to the spread and lethality of the virus.

HMS is committed to addressing those broader, systemic health care inequities and to fostering a more representative community at home. To do this, we advanced our Better Together commitment to diversity and inclusion to ensure that every individual at HMS feels empowered to contribute, succeed, and thrive. We are developing people and infrastructure, building community and belonging, addressing culture and communication, and holding ourselves accountable for our progress.

This year, a Program in Medical Education Task Force to Address Racism, made up of 150 faculty, students, and staff, reviewed the MD curriculum, faculty and staff development, admissions processes, assessment practices, and student affairs, with an eye to dismantling structural racism in medicine.

Task force recommendations included instituting anti-racism training, increasing the number of faculty underrepresented in medicine (URiM), and improving the coordination of diversity efforts between HMS and its affiliated hospitals.

This year, nearly a quarter of the entering MD class are from populations underrepresented in medicine, the majority are female, and 20 percent self-identify as LGBTQ. New promotions criteria now take faculty members’ diversity and inclusion efforts into account, and new technology improves our ability to support and monitor faculty searches to help ensure diversity in both the formation of search committees and candidate pools.

The Department of Global Health and Social Medicine, celebrating its 150th anniversary, has integrated prevention, clinical care, and social support systems in its response to the pandemic, especially within hard-hit communities; the Department of Health Care Policy continues to report on the impact of health care disparities on disadvantaged populations.

We renamed a student academic society in honor of William Augustus Hinton, an internationally recognized infectious disease researcher and the first Black full professor at Harvard, and we introduced more inclusive campus artwork. One new installation features portraits of four alumnae who made significant contributions to medicine.

The number of women and URiM individuals increased among faculty chairs both on campus and in our hospitals, and new affinity groups, formed by community members, include the HMS Black Postdoctoral Association and the Black Staff Caucus.

In the wake of the Derek Chauvin trial the community rallied to Stand Against Racism. HMS also joined with King Boston for a memorable Juneteenth celebration and partnered with the Massachusetts Medical Society, the state of Massachusetts, and its three other medical schools to adopt principles that promote a more equitable medical culture in the Commonwealth.

Of course, there is more work to do. For the first time, we launched a PulseWave 2 Survey on Inclusion and Belonging, polling our affiliate faculty and trainees. While many are satisfied with experiences and opportunities at HMS, it is clear we can do more to support URiM and female faculty.

Above all, we remain committed to greater inclusion and advancement for all so that HMS can achieve the excellence to which it aspires, better reflect the populations it serves, and continue to develop leaders who are well prepared to respond vigorously to the health challenges of the 21st century. n

HMS by the Numbers

702 12,202 10

Financial Report

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Total students: MD PhD 888 (886 HMS, 2 HSDM) MD-PhD 192: basic sciences 164, social sciences 28 (total included in MD and PhD counts) DMD 142 master’s 457 (410 HMS, 47 HSDM) DMSc 36 Trainees (residents and postdoctoral fellows) 8,839

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Total faculty Tenured and tenure-track faculty on campus in 11 preclinical departments 193 Voting faculty on campus and at affiliates 6,487 Full-time faculty on campus and at affiliates 10,175

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8,002 I

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Nobel Prizes (cumulative) Physiology or Medicine, Peace 16 recipients National Academy of Sciences members (current) 85 National Academy of Medicine members (current) 165 Howard Hughes Medical Institute (current) 40 (3 Faculty Scholars, 36 Investigators, 1 Professor)

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MD applicants Admitted 222 (2.8%) MD entering 2021 164 (includes 16 MD-PhD) I Men 79 (48%) Women 83 (51%) Different identity 2 (>1%) Underrepresented in medicine (African American, Hispanic, Mex­ican American, Native American) 38 (23%) Asian 58 (35%)

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Entering 2021: PhD 133 DMD 35 master’s 284 (270 HMS, 14 HSDM) DMSc 11 Additional combined degree programs: MD-MAD, MD-MMSc, MD-MBA, MD-MPH, MD-MPP

10,822

Medical school living alumni

(MD and master’s)

AS OF SEPTEMBER 2021

Affiliates Beth Israel Deaconess Medical Center Boston Children’s Hospital Brigham and Women’s Hospital Cambridge Health Alliance Dana-Farber Cancer Institute Harvard Pilgrim Health Care Institute Hebrew SeniorLife Joslin Diabetes Center Judge Baker Children’s Center Massachusetts Eye and Ear Massachusetts General Hospital McLean Hospital Mount Auburn Hospital Spaulding Rehabilitation Network VA Boston Healthcare System

Despite the challenges of the COVID-19 pandemic, Harvard Medical School is poised to emerge a more financially resilient institution, better positioned to achieve its goals and fulfill its mission. In 2017, HMS had begun steadily reducing cash-flow shortfalls after many years of recurring budget deficits. The School was on track to break even at the end of FY20 when the pandemic began. Just a few weeks into the COVID-19 shutdown, our financial projections changed significantly, and we anticipated potential losses of up to $60 million.

Acting with a shared sense of responsibility, the HMS community responded quickly and decisively. Our campus planning and facilities team made prudent cost-saving decisions regarding renovation and building projects.

Our research, education, and administrative departments and units revised budgets, cut expenses, and deferred backfilling of positions, allowing us to significantly blunt pandemic financial losses.

HMS then entered FY21 with a financial plan anchored on three principles articulated

by Harvard University leadership: to prioritize community health and safety, to promote teaching and research excellence, and to support our most precious resource—our people. As the year unfolded, it became clear that the School’s investments in technology, its commitment to providing exceptional virtual education experiences, and its community of resilient and passionate faculty, postdocs, students, and staff would lead to financial results much more favorable than estimated at the start of the year.

As documented by generally accepted accounting principles (GAAP), FY21 revenues grew by $23 million to nearly $833 million due to resumption of annual affiliate-hospital contributions, which were forgiven by HMS in FY20. Sponsored revenues decreased by 5 percent in FY21, and spending of grants and contracts at $296 million was effectively flat from the prior year.

Overall, FY21 expenses were level at $765 million, reflecting constrained spending and hiring, as budgeted. GAAP results, which

Fundraising reflect a surplus, include the benefit of donor funds received throughout the year that will be invested in subsequent years.

Taking a more critical reflection on our financial performance, and focusing instead on unrestricted cash flows, HMS ended the year with a $2 million deficit, a strong result considering initial fears regarding the lingering effects of the pandemic. Reinstated support from our affiliated hospitals and growth in master’s and external education programs served to bolster HMS’ revenues. Additionally, support from the University, along with careful budget management, helped to offset the costs of COVID testing, personal protective equipment, and other safety measures.

In keeping with our principles, we continue to invest in our mission, our priorities,

and our people. In FY21, we recruited several new faculty members, broke ground on new research facilities, avoided broad layoffs and furloughs, diversified our portfolio of funding sources, and rapidly adopted online teaching and learning strategies that catered to a broader remote universe of students.

To have accomplished all of this in the midst of the COVID-19 pandemic serves as a potent demonstration of the resilience of our community and our return to financial stability. We are now at a point of greater optimism and renewed enthusiasm for making strategic investments in our community that will enable us to further realize our mission of alleviating suffering and improving health and well-being for all.

—Dean George Q. Daley

FY21 OPERATING REVENUE 6%

4%

13%

n Research grants and contracts 35%

18% 4% 6% 24% 13%

35%

18%

n Endowment distribution

for operations n Other revenues* n Gifts for current use n Rental income n Tuition (net) Total

$293,094,060 35% $200,542,822 24% $151,288,732 18% $110,908,205 13% $44,822,427 6% $32,321,563 4% $832,977,809

* Includes continuing medical education, publications, service income, and royalties

6% 24% 10% 42%

13%

FY21 OPERATING EXPENSES 29% 6% 10%

n Personnel costs 42%

13%

29%

n Supplies and other expenses n Research subcontracts

and affiliates n Plant operations and interest n Depreciation Total

$318,170,247 $218,806,662 $99,986,324

42% 29% 13%

$80,362,696 $47,924,239 $765,250,168

10% 6%

As the COVID-19 pandemic lingers, we are reminded of the urgency and significance of the Harvard Medical School mission.

Thanks to our circle of loyal supporters, 4,164 of whom gave a total of more than $167 million in FY21, our faculty, staff, and students have been able to pursue this mission relentlessly, working every day to alleviate suffering and improve health and well-being for all.

Gifts and grants from devoted alumni, friends, volunteers, faculty, staff, foundations, and corporations have been expansive and transformative.

Buoyed by Bertarelli Foundation funding to investigators across HMS and our affiliated hospitals, we are accelerating life-changing research into rare cancers, which account for just over a quarter of all cancers and cancer deaths. Together with the Clalit Research Institute, we launched The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration to propel the science and practice of precision medicine, illuminating individualized treatments based on a person’s genetic makeup, immune profile, health history, and lifestyle.

We increased the number of scholarships, financial aid packages, and fellowship funds for our students and boosted funding for postdoctoral researchers. We advanced cutting-edge approaches to address Parkinson’s disease, strengthened our efforts to recruit a diverse student body, probed the mysteries of aging, made strides to improve our understanding of bipolar disorder, and further promoted global health equity by establishing two new professorships.

Faithful philanthropic support makes these advances in science, education, medicine, and health possible. n

HMS GIVING hms.harvard.edu/giving

Credits: Writing and editing by M.R.F. Buckley, Allison

Eck, and Brandy Newlon; design and art direction by Paul DiMattia; copyediting by Bobbie Collins, Susan Karcz, and Ann Marie Menting. Photography by Stephanie Dutchen/ HMS, Gretchen Ertl, Steve Gilbert, Michael Goderre/Boston Children’s, Rose Lincoln/Harvard, and Steve Lipofsky.

Printed by Lane Press.

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