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FY 2010 Statement of the Director

Introduction | Non-communicable Disease | Implementation Science | Global Health Research | About Dr. Glass

Budget Request for Fiscal Year 2010

Testimony Submitted to the Senate Subcommittee on Labor-HHS-Education Appropriations

Roger I. Glass, M.D., Ph.D., Director, Fogarty International Center

May 21, 2009

Mr. Chairman and Members of the Committee:

I am pleased to present the President’s Budget for the Fogarty International Center (FIC) of the National Institutes of Health (NIH). The Fiscal Year (FY) 2010 budget of $69,227,000 includes an increase of $536,000 over the FY 2009 appropriated level of $68,691,000.

Over the past year, Congress has renewed its commitment to confronting global health issues, recognizing that these investments will not only improve the health and well-being of all, but also enhance U.S. stature abroad, economic development, and U.S. competitiveness. As the recent H1N1 virus outbreak illustrates, solving health problems in an interconnected world requires greater international collaboration than ever before. To effectively confront complex health issues that transcend national boundaries, scientific collaborations must be continually developed and nurtured. Research advances are more likely to occur when investigators study diseases on-site, and U.S. scientists partner with international scientists to develop health interventions that are responsive to local and international needs and priorities. This model requires a critical mass of trained, in-country scientists and capable institutions that are uniquely positioned to address local study populations and to support sustainable collaborations with U.S. and other investigators.

Since its inception, the Fogarty International Center (FIC) has been the focal point for global health at the National Institutes of Health (NIH). FIC supports and facilitates global health research conducted by U.S. and foreign investigators, builds collaborations between U.S. and health research institutions worldwide, and trains the next generation of scientists to address global health needs. FIC-supported research and research training programs address a wide range of diseases and needs, including HIV/AIDS, malaria, TB and other infectious diseases; non-communicable diseases, such as brain disorders and cancer; and cross-cutting areas that foster sustainable research environments, including research ethics and informatics for health research. In 2008, FIC launched a Strategic Plan that addresses emerging areas of science and shifting disease burdens, and strengthens the global health research workforce in the U.S. and around the world.

Addressing the Rising Burden of Non-communicable Disease

Rapidly developing countries like India, Brazil, Mexico, China and Bangladesh have seen life expectancies grow for the past 40 years. Population forecasts now predict that by 2030, one out of eight people will be 65 or over — 1 billion adults. In addition, poorly balanced nutrition, less physical activity, and tobacco use are all on the rise in developing countries as a result of poverty, industrialization, urbanization and global marketing of goods and products. With increasing longevity, convergence of risk factors and diseases blurs the distinction between disease burdens in developing and developed countries, and calls for a common health research agenda. International research collaborations to study these diseases in highly endemic areas accelerate scientific advances on how to prevent and treat them. In response to this trend, FIC established the new Millennium Promise Awards in Non-Communicable Disease Program in partnership with several other NIH Institutes, designed to support research training in low- and middle-income countries in fields related to cancer, stroke, lung diseases, obesity and environmental factors.

According to the World Health Organization, tobacco use kills 5.4 million people every year – an average of one person every six seconds. Almost half the world's children breathe air polluted by tobacco smoke, and it is a risk factor for six of the eight leading causes of death in the world. If current smoking patterns continue, this number will rise to eight million in 2030, with approximately 80% of the deaths occurring in developing countries. FIC, in partnership with the National Cancer Institute and the National Institute on Drug Abuse, is helping to address this rising epidemic through its International Tobacco and Health Research and Capacity Building Program. This program enhances the ability of scientists in low- and middle-income nations to understand risk factors for smoking uptake, particularly in youth, to develop effective prevention and mitigation programs, and to identify the most effective implementation and communications strategies to reduce the negative impacts of smoking on populations. The knowledge gained and effective interventions developed abroad through the Tobacco Program will also benefit U.S. populations who share common risk factors with low-resource communities in developing countries.

The continuing burden of infectious disease in low income populations, as well as the rapid rate at which microbial agents can evolve, adapt and develop resistance to antibiotics, demand that FIC continue to invest in infectious disease research and training. In particular, FIC will continue to support interdisciplinary research that develops predictive models and principles governing the transmission dynamics of infectious disease agents. This will result in increased capacity to forecast outbreaks and improved understanding of how diseases like the H1N1 flu emerge and re-emerge, and strategies to control them.

Advancing Implementation Science

Unprecedented resources are being invested in interventions that have been proven safe and effective, although many have not been implemented on a wide scale due to logistical, cultural, financial, and other barriers. Bridging the gap between effective interventions and improved health outcomes will in large part depend on a cadre of local scientists who can ask and answer questions regarding what works, what does not, and why, in particular settings. To advance this area of science FIC supports research training for scientists who can generate knowledge to improve scale-up of interventions and help identify the most effective ways to translate research findings into clinical and public health practice.

For example, FIC's International Clinical, Operational, and Health Services AIDS/TB Research Training Program is developing a network of researchers who are studying how to best apply research knowledge and new technologies related to HIV/AIDS and TB in clinical and community settings. With support from this program, scientists in Haiti have developed a new masters degree in public health program at a Haitian university and are training the personnel needed to monitor and evaluate the implementation of a new country-wide program to provide a standardized package of HIV care and prevention to 300,000 people per year.

Maintaining U.S. Leadership In Global Health Research

If we are to continue to lead in biomedical research, then U.S. researchers must be supported to effectively participate in international science. Biomedical research has always been an inherently international enterprise. Many significant scientific advances have resulted from research conducted by teams of scientists working across international borders. For example, U.S. and local scientists together pioneered the development of oral rehydration therapy (ORT) for treatment of cholera. ORT is now the first line treatment for childhood dehydration worldwide and recommended for treatment of every American child with diarrhea. In this era of globalization, this trend will not only continue, but will likely become stronger. It will also require a well-trained cadre of U.S. health scientists who are able to work seamlessly in diverse settings.

To this end, FIC support strengthens the ability of U.S. academic institutions to engage in the global scientific marketplace. The vast majority of FIC awards support scientists in U.S. institutions, who in turn collaborate with colleagues in foreign institutions. Additionally, FIC is capitalizing on the burgeoning interest in global health on U.S. university campuses through two innovative programs. First, we are providing a launching pad for American health sciences students and junior researchers to build relationships abroad and to address critical global health research questions through the Fogarty International Clinical Research Scholars Program (FICRS). This program responds to the acute need for future clinical investigators who can help translate basic research advances into clinical practice on a global scale. This next generation of clinical researchers will require hands-on experience in conducting clinical trials and clinical research in countries where the disease burdens are highest. The FICRS provides highly motivated U.S. graduate students in the health sciences and medical residents or fellows one year of mentored clinical research training at distinguished low- and middle-income country research institutions. Each U.S. student is paired with a foreign student, who also receives training as an equal partner, thus strengthening scientific capacity in the U.S. and abroad simultaneously. Several NIH Institutes partner with FIC in the effort, and therefore, the program includes a wide breadth of research areas, including cancer, maternal and child health, and extensively drug-resistant TB.

An increasing number of U.S. and foreign academic research institutions are welcoming the opportunity to use their substantial creative resources to make a significant and lasting difference in global health. As scientific problems become more complex, there is a need for team and systems approaches to tackle important health challenges. To help catalyze this approach in academic research institutions, Fogarty's Framework Programs for Global Health support the development of multidisciplinary global health programs on campuses in the United States and in low- and middle-income countries. This innovative program develops new curricula and degree programs that cut across departments and schools to create a pipeline for a new generation of researchers schooled in multiple fields to address global health challenges. Schools representing over 17 different disciplines participate in the program including, Engineering, Environmental Sciences, Journalism, Business, Law, Medicine and Public Health.

Congressman Fogarty was prescient in arguing that the needs and rewards of global health research will benefit the U.S. as well as the global community. FIC is extending his vision, given that international trade, travel and communications have created a truly interdependent world. As we look to the next two decades, we envision a world in which a global scientific workforce is equipped with the knowledge and the skills to better prevent and treat disease as a result of rigorous global research. This workforce will form the backbone of research institutions in the U.S. and abroad, which will be effectively linked with each other through years of sustained productive research and training collaborations. Working towards this vision moves us closer to the ideal of global health - one that reflects the aspiration of all people to live long and healthy lives.

About Dr. Roger I. Glass

Dr. Roger Glass M.D., Ph.D., was appointed to the position of Associate Director for International Research at NIH as well as the Director of the Fogarty International Center. Prior to coming to NIH, Dr. Glass spent 20 years (1986-2006) at the Centers for Disease Control & Prevention (CDC) as Chief, in the Viral Gastroenteritis Section, Respiratory and Enterovirus Branch Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases. He has also served as Clinical Associate Professor, Division of Infectious Diseases, Department of Pediatrics, at Emory University School of Medicine from 1986 to 1996, and became Clinical Professor in 1996. From 1991 to the present he continues to be Adjunct Professor, Division of International Health School of Public Health, at Emory University.

Highlights in education include degrees from Harvard, a Fulbright Fellowship in Argentina, residency in internal medicine at Mount Sinai Hospital in N.Y., and a year at University of Göteborg, Sweden.

Dr. Glass' research areas include: epidemiology of infections, enteric diseases, cholera, rotavirus, and viral agents of gastroenteritis; vaccinology and new vaccine development and testing; assessment of the disease burden of enteric infections; virology and viral diagnostics; food- and water-borne diseases and their control. He is board certified with the American Board of Internal Medicine, the American Board of Preventive Medicine, and the American Board of Epidemiology. He also holds medical licenses in Georgia, New York, New Jersey, and Maryland.

Special projects span almost 40 years, some of which include: from 1972-78 work with the U.S.-U.S.S.R. Joint Committee on Environmental Health Research; in 1979 Health surveillance for Cambodian refugees arriving in Thailand, International Committee of the Red Cross; in 1982 control of cholera in Aceh Province, Indonesia; in 1991 epidemiological evaluation of the effects of the cyclone in Bangladesh, UNICEF; and in 2001 the Bioterrorism Engagement Program – Studies in Russia with former bioweaponeers.

In 1994 Dr. Glass received an Outstanding Service Medal, U.S. Public Health Service, and in 2000 the Secretary's Award for Distinguished Service (DHHS). In 2003 he became a member of the Institute of Medicine, U.S. National Academy of Science. In 2007 he received the Charles C. Shepard Lifetime Scientific Achievement Award from CDC and in 2008, the Dr. Charles Merieux Award from the National Foundation for Infectious Diseases. Patents include: Astrovirus sequence and its application for use in diagnostics and vaccines (1993-CDC), and Neonatal rotavirus strain 116E for use as a rotavirus vaccine (1994-CDC).