Effective Advocacy Through Public Comments to Agencies

The Global Health Advocacy Incubator (GHAI) helps advocates around the world launch effective campaigns that change health policies for the better. One opportunity to elevate the voices of advocates and experts on an issue is through public comment. When government agencies propose a new rule or regulation, they solicit comments to collect feedback from the public. This provides advocates with an important opportunity to voice their stance on a particular issue.

Public comments are critical in developing sound rules and regulations, as they give a voice to a variety of stakeholders who will be affected by a potential rule change. Constituents can use public comments to check the power of agencies behind those actions, as it is often required that agencies read and acknowledge all public comments. Advocates should consider these guidelines when preparing a public comment.

How to Write an Effective Public Comment

Not all public comments are created equal. To write an effective public comment, GHAI advocates suggest that you:

1. Coordinate with your partners and stakeholders: Before writing your comment, meet with stakeholders and partners that have similar goals in your issue area. Discussing and aligning comments can be powerful, as hearing the same suggestion from multiple groups will amplify your argument.
2. Give clear suggestions: To ensure suggestions are heard, it is important to keep comments clear and concise. Provide succinct and feasible actions that an agency can take to revise their proposed rule.
3. Own your expertise: Emphasize the unique perspective your organization brings at the outset of your comment to establish yourself as a reliable source. Elaborate on why your feedback and expertise is valuable.
4. Incorporate relevant research: All government rules and regulations should be informed by evidence. Your public comment should incorporate recent and relevant studies, citing key findings to strengthen your arguments.
5. Garner support and attention on the issue: Advocacy does not end once your comment is submitted and made public. Engaging with the media and posting on social media to ensure there is publicity and attention on proposed changes is an important way to gain widespread recognition of a potential policy change.

In 2023, GHAI followed these guidelines to advocate for broader access to addiction treatment.

Case Study: Advocating for Addiction Treatment Through Public Comment

In response to the COVID-19 Public Health Emergency (PHE) declaration, the United States Drug Enforcement Agency (DEA) issued regulatory flexibilities that enabled individuals to continue receiving medications for opioid use disorder (MOUD) via telehealth. This included the telehealth prescribing of buprenorphine, an FDA-approved form of MOUD that can prevent overdoses and prevent future drug use. The flexibility allowed for the prescribing of buprenorphine without the requirement of an in-person visit to a provider, which significantly increased receipt of buprenorphine during the PHE.

Upon the expiration of the PHE, in February 2023, the DEA released a notice of proposed rulemaking rolling back these flexibilities, causing significant pushback among patients and advocates alike. The proposed change would require patients to see a provider in person after initiating buprenorphine treatment via telehealth.

GHAI’s Overdose Prevention Initiative met with partners and stakeholders that held similar views on this regulatory change to discuss concerns, align positions on the rule change, and share resources to strengthen the collective arguments. This amplified our shared stances and concerns on this rule.

GHAI submitted our comment with clear and concise recommendations on how the DEA should follow the evidence and allow for continued flexibility on the telehealth prescribing of buprenorphine. Illustrating our expertise on advocating for evidence-based policies that increase access to treatment, we included research from the CDC that showed an increase in buprenorphine initiation and reduced odds of overdose for individuals prescribed buprenorphine via telehealth.

The DEA received a record breaking 38,000 comments on this proposed rule change, most of which urged the DEA to not reverse policies that have proven to be effective in facilitating access to treatment.

In May, shortly after the public comment period ended, the DEA reversed its rule change. Acknowledging the high volume of responses on this issue, the agency extended the PHE flexibilities for six-months while considering comments from the public. This reversal demonstrates the power that public comments can have when a number of groups come together with shared frustrations on an issue and present their points clearly with evidence.