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Summary of the NIH International Representatives MeetingMay 12, 2009Dr. James Herrington, Director, Division of International Relations (DIR), NIH Fogarty International Center (FIC), served as Acting Chair of the Session and welcomed the NIH IC representatives to the NIH Stone House. He introduced CDR Leticia Robinson, Ph.D., who now serves as the FIC/DIR Program Officer for Sub-Saharan Africa. Prior to joining DIR, Dr. Robinson worked with the Health Resources and Services Administration, HIV/AIDS Bureau, Global HIV/AIDS Program, as a Senior Public Health Analyst. Dr. Robinson also worked with the HIV/AIDS Bureau's Division of Science and Policy where she was responsible for reviewing legislation, clinical research and regulations; developing strategies and approaches for program implementation and preparing national and international public health issue and policy papers related to HIV/AIDS. A registered nurse by profession, Dr. Robinson has experience working in a variety of clinical areas to include biomedical research, psychiatry, specialty surgery, infectious diseases and other chronic conditions, and with obstetric and neonate populations. Dr. Herrington informed the participants about the upcoming 62nd World Health Assembly (WHA) that will be held in Geneva, Switzerland next week. Secretary Sibelius will be leading that U.S. delegation at the meeting and she will be accompanied by representatives from CDC, FDA, the HHS Office of Global Health Affairs, the State Department and the U.S. Agency for International Development. Dr. Roger Glass, FIC Director and NIH Associate Director for International Research will also serve on the U.S. delegation. This year's WHA agenda has been truncated and the overall meeting time shortened so as to focus discussions on international cooperation to deal with the H1NI influenza virus outbreak. A FIC Perspective on U.S.-Mexico Cooperation on Pandemic Influenza:Dr. Herrington introduced Dr. Mark Miller, FIC Director of the Division of International Epidemiology and Population Studies (DIEPS), who gave a presentation on U.S.-Mexico research cooperation related to pandemic influenza. Dr. Miller provided an overview of the different pandemic emergence and global circulation of influenza viruses in recent history. He cited and provided brief overviews of the 1918 Spanish Influenza, the 1957 Avian Influenza and 1968 Hong Kong Influenza outbreaks. He also highlighted influenza virus seasonal patterns and latitude throughout North and South America. He explained that U.S.-Mexico research cooperation on pandemic influenza has been ongoing even before the current H1N1 Swine Influenza outbreak. Such cooperation has been with the Instituto Nacional de Salud Pública (INSP) in Cuernavaca as well as with Mexico's Department of Epidemiology in the Ministry of Health. He indicated that indeed a cooperative manuscript on investigating potential policies of pandemic control utilizing 1918 demographic data from Mexico was recently completed. To better understand concerns about the recent H1N1 flu outbreak in Mexico, Dr. Miller provided data indicating that higher mortalities have been witnessed in the 20 to 50 age group than what is usually witnessed. He noted that NIH has been analyzing phylodynamics of the eight gene segments of the influenza virus and is also analyzing epidemiological data and providing clinical support via NIAID activities and staff. In conclusion, questions remain: Why is this virus more lethal in Mexico than elsewhere? Should the current response be containment given that the virus may not prove to be as virulent as initially feared? What should be the clinical response to current therapeutics? What additional efforts are needed related to vaccines, antivirals and diagnostic development? Dr. Miller's PowerPoint presentation is attached. Sub-Saharan Africa eHealth and Open Source TechnologiesDr. Herrington introduced Mr. Pape Gaye, President and CEO of IntraHealth International and members of his team, Mr. Dykki Settle, Director of IntraHealth's Health Informatics Division, as well as Ms. Heather LeGarde, Director of IntraHealth's Communications Division. IntraHealth International is dedicated to providing health care workers in developing countries with the training, support and infrastructure they need to address their own communities' public health issues. For 30 years, IntraHealth International has mobilized and developed health care services in some of the world's most vulnerable communities in sub-Saharan Africa and southern Asia. Mr. Gaye noted that 800 million people lack access to health services and 57 countries have far fewer health care workers than the minimum standard (5 for every 10,000 people) needed to provide even the most basic health care. Only three percent of the global health workforce is in Africa, despite that continent bearing 24 percent of the world's burden of disease. He noted that IntraHealth's Open Source Health Care Initiative (OPEN initiative) is designed to assist health care workers with their burgeoning workloads as well as to address the need to obtain more health care workers in communities in need. Mr. Settle made a presentation on IntraHealth's OPEN initiative. Open source technology is well suited for application in low-resource settings. It is collaborative, transparent and free of licensing and upgrade fees. It encourages independent, affordable and creative solutions to the biggest health and infrastructure problems in the developing world, including shortages of medical personnel, access to maternal and child health care, and distribution of needed medicines. Using web-based interfaces, mobile phones and PDAs, open source systems can provide innovative tools to support increased efficiency, productivity and performance of health services across Africa. Through its OPEN initiative, IntraHealth is collaborating with African governments and private institutions to design and apply open-source solutions to strengthen local abilities to use health information for strategic health policy and planning. Mr. Settle's PowerPoint presentation is attached. Ms. LeGarde also provided information on an outreach effort using musical artists and celebrities to draw attention and encourage support of the OPEN initiative. Other Issues:Copies of President Obama's May 5 “Global Health Initiative” were made available at the meeting. It calls for an FY2010 budget of $8.6 billion for a variety of global health programs, including enhanced funding for PEPFAR and the President's Initiative on Malaria, among others. Next Meeting:July 14, 2009, at a location to be determined. Attendance:Dr. James Herrington, Acting Chair
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