The John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) convened the seventy-first meeting of its Advisory Board on Tuesday, February 10, 2009, at 10:30 a.m., in the Conference Room of the Lawton Chiles International House, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held from 8:30 a.m. to 10:15 a.m., as provided in Sections 552b(c) (4) and 552b(c) (6), Title 5, U.S. Code, and Section 10 (d) of Public Law 92-463, for the review, discussion, and evaluation of grant applications and related information.1 The meeting was open to the public from 10:30 a.m. to 2:36 p.m. Dr. Roger I. Glass, Chair, FIC Advisory Board, and Director, FIC, presided. The Board roster is appended as Attachment 1.
VI. Overview of FIC Activities and Developments
Dr. Roger I. Glass, Director, FIC
Dr. Glass welcomed everyone to the open session. He noted that the Board would be addressing four overall questions: regional priorities for FIC, global health as an instrument of diplomacy, the possibility of a trans-NIH center for global health, and FIC action with regard to the Institute of Medicine (IOM) report on America’s vital interest in global health. Dr. Glass presented an update on FIC activities since the previous Board meeting. He highlighted directions that FIC has taken as it concluded its 40th anniversary year and began its 41st year.
- Anniversary Celebration. Dr. Glass noted that the Fogarty 40th anniversary dinner, held October 15, 2008, was arranged by the Foundation for the National Institutes of Health (FNIH), sponsored by several private-sector entities, and hosted by the Italian Embassy. The celebration included presentation of awards to Congressman Donald M. Payne (D-NJ) and Senator Richard G. Lugar (R-IN) for their support of global health activities.
- Private–Public Partnerships. Also on October 15, the FNIH sponsored the second of two partnership meetings. Dr. Glass reported that the meeting brought together 12 companies from various sectors to present and discuss research needs in implementation science. He noted that a number of initiatives have emerged from the partnership meetings (see, for example, “Dissemination and Implementation” below). Mrs. Nalini Anand is the FIC contact for this activity.
- Summit on African Research. On November 5–6, 2008, FIC hosted an NIH summit on African research. Dr. Glass noted that, other than research on HIV/AIDS, the NIH invests very little in research in sub-Saharan Africa. The aim of the meeting was to stimulate NIH research support in the region, specifically to enhance research infrastructure, train researchers and sustain research, and build partnerships. Those attending included 6 African investigators, 29 NIH-supported African researchers residing in the United States, and 21 institute and center (IC) directors or senior staff. FIC hopes that the effort will generate African interest in FIC programs such as the Fogarty International Research Collaboration Award (FIRCA). (See also section VII below under Topic 1: Identifying Regional Priorities.)
- Georgetown–FIC Symposium on Global Health Diplomacy. On November 12, 2008, the O’Neill Institute for National and Global Health Law, at Georgetown University, joined with FIC to co-host the FIC’s 40th anniversary symposium, “The Role of Science in Advancing Global Health Diplomacy.” Held at the Georgetown Law Center in Washington, D.C., the symposium attracted more than 200 individuals who came to discuss the role and importance of global health diplomacy and its relationship to science—an area of interest to the new Administration. Key speakers included former NIH Director Dr. Elias Zerhouni; former Ambassador to Uganda Jimmy Kolker, now at the United Nations Children’s Fund (UNICEF); and FIC Board member Dr. Jim Yong Kim. A summary of the meeting will be published.
- David E. Barmes Lecture. On December 16, 2008, former NIH Director Dr. Harold E. Varmus presented the annual Barmes lecture that FIC co-sponsors with the National Institute of Dental and Craniofacial Research (NIDCR). Dr. Varmus addressed the soon-to-be-released IOM report, The U.S. Commitment to Global Health: Recommendations for the New Administration. Dr. Varmus co-chairs the IOM committee, with Ambassador Thomas R. Pickering, that developed the report, and he co-chairs the President’s Council of Advisors on Science and Technology. Dr. Glass noted that the FIC engaged 17 ICs to contribute to the report, which updates the IOM’s 1997 report on America’s Vital Interest in Global Health: Protecting Our People, Enhancing Our Economy, and Advancing Our International Interests. The new report reflects the changes in investment and interest in global health since 1997; a second part of the update will address the role of nongovernmental institutions in global health. (See section VIII below for additional information.)
- Malnutrition–Enteric Diseases Research Network. In January 2009, the Bill & Melinda Gates Foundation awarded a $30 million grant to FNIH to launch a network of eight field sites in Latin America, Asia, and Africa to assess the interaction of malnutrition and enteric infections, for example in basic studies of the gut microbiome and host genomic studies. This effort will begin with a meeting on Enteric Infections and Malnutrition, held at NIH February 15–18, 2009. Dr. Mark Miller is the FIC contact.
- World Health Organization (WHO) Ministerial Meeting. In November 2008, Dr. Glass was the senior person of the American delegation at this meeting in Bamako, Mali, that was attended by representatives from 59 countries. The Bamako Declaration resulting from the meeting states that developing countries should have more say in research taking place in their territories, health research in developing countries should be broadened to cover social and other determinants of health, and governments and donors should invest in local research and training. The declaration is available on the World Wide Web and will be presented to the World Health Assembly in May 2009. Dr. Glass noted that a session on implementation research revealed that trainees and grantees need to be made aware that untapped funds for implementation science and evaluation are available from the World Bank, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the U.S. Agency for International Development (USAID).
- European Commission–NIH Agreement. Dr. Glass reported that FIC staff contributed to efforts to reach agreement with the European Commission (EC) in September 2008 to broaden access to European research funds for U.S. investigators. Specifically, funding from EC Framework Program 7 is now open to U.S. applicants. This broader access promises to lead to greater trans-Atlantic cooperation in science, including triangular partnerships.
- Trans-NIH Working Group on Climate Change. Dr. Glass noted that FIC has engaged 15 ICs to participate in this trans-NIH working group. The working group, led by FIC’s Dr. Josh Rosenthal, is completing an analysis of the NIH portfolio pertaining to health and climate change and will develop priorities for health research in this area. Climate change is a priority of the new Administration.
- Scientific Advances and Publications. Dr. Glass encouraged Board members to access FIC's website to stay abreast of the many scientific advances and publications by FIC staff, trainees, and grantees. He highlighted an article provided to the Board, "Fogarty at 40: NIH Center Updates Its Strategies for Supporting Global Health" (published in the Journal of the American Medical Association, December 24, 2008).
- Dissemination and Implementation. On January 28–29, 2009, FIC particpated in the 2nd Annual NIH Conference on the Science of Dissemination and Implementation: Building Research Capacity to Bridge the Gap from Science to Service. Dr. Glass noted that this effort arose out of FIC’s recognition that a number of ICs are seeking ways to implement promising programs. Approximately 400 individuals representing six ICs attended the conference, and Board member Dr. Jim Yong Kim gave the keynote talk on implementation and global health. The focus was on identifying and addressing obstacles to getting science into public practice.
- Chronic Diseases in the Developing Regions of Africa and Asia. Just returning from this meeting in Uganda in February, Dr. Glass commented that 95 percent of the population in sub-Saharan Africa does not have HIV/AIDS, but is at risk for a “silent epidemic” of chronic diseases. The meeting was sponsored by WHO and the Aga Khan Development Network to build and promote an agenda of research on chronic diseases. Dr. Glass noted that a key participant was a senior project officer from the National Heart, Lung, and Blood Institute (NHLBI), with which FIC is partnering on global health issues. The discussions at the meeting focused on major health issues identified in the Disease Control Priority Project, such as smoking, salt intake, diet, and exercise. Recommendations will be presented at the World Health Assembly in May.
While in Uganda, Dr. Glass was hosted by Dr. Nelson Sewannkambo, Dean of the Makerere College of Health Sciences, and an early grantee under FIC’s AIDS International Training and Research Program (AITRP). Dr. Glass noted that over the past 20 years Dr. Sewankambo and his colleagues have attracted major grants from other ICs and donors, bringing tens of millions of dol–programs and small seed grants for stimulating sustainable economic activity in developing countries. The FIC training led to additional training outside of Uganda for the first generation of researchers, as well as new training programs, health science schools, and research laboratories in Uganda. With the development of quality research opportunities in Uganda, African investigators now complete their doctoral education and pursue research that addresses local priorities in country—and the availability of in-country opportunities diminishes a “brain drain” of African scientists to industrialized countries. Dr. Glass highlighted the number of Ugandan researchers trained in FIC programs and the state-of-the-art facilities (e.g., video conferencing, Web-based long-distance learning) now available to them. He noted that Uganda now has a network of approximately 150 FIC alumni who meet for different activities.
- Latin America Cancer Program. Dr. Glass reported that FIC is partnering with the National Cancer Institute (NCI) to increase understanding of cancer and cancer research and care in Latin America and to help develop in-country resources and expertise for cancer research, including clinical studies and trials. An inaugural meeting of partners from Argentina, Brazil, Chile, Mexico, and Uruguay will be held at the NIH March 18–20, 2009. He introduced and thanked Dr. Jorge Gomez, the NCI project officer, for integrating FIC into this effort.
- Upcoming Activities. Dr. Glass highlighted additional activities for 2009. On March 8–10, FIC will hold its annual scientific session for FIC alumni scholars and fellows, as well as interviews for new scholars. On March 13, Dr. Jeffrey Sachs will givethe Fogarty Visiting Scholar lecture. And, on March 25–27, the Brazilian FIC alumni association will meet for the first time. During the year, FIC will co-host and/or participate in a number of international meetings. These include a meeting of the Multinational Influenza Seasonal Mortality Study (MISMS), in Dakar, Senegal, in April; a symposium on Cancer and Environmental Health, in China, May 18–22; the Global Health Council’s International Conference, in Washington, D.C., May 26–28; the Behavioral and Mental Health in the Circumpolar Arctic Meeting, in Anchorage, Alaska, June 1–3; a meeting on New Directions in Prostate Cancer Chemotherapy, at NIH, August 20–21; and the U.S.–Russia HIV Prevention Workshop, in Moscow, October 26–30. Dr. Glass highlighted, in particular, a workshop to celebrate and build on 30 years of NCI research in China, which will be held in China, in November, in association with the Chinese Academy of Medical Sciences. This April and July, representatives of other ICs, including NHLBI, will be visiting China to increase NIH collaborations there.
In closing, Dr. Glass encouraged all Board members to continue and increase their engagement in FIC activities.
Dr. Luz Claudio asked about the new FIC system for tracking the success of former FIC trainees. Dr. Glass noted that anecdotal evidence shows that FIC training has reached an enormous number of individuals and that a systematic FIC effort to evaluate this and other investments is necessarily complex and long-term. Dr. Linda Kupfer, Acting Director, Division of International Science Policy, Planning, and Evaluation (DISPPE), said that FIC’s first-of-its-kind “Career Track” system is now available for trainees to input career data. FIC’s intent is to attain quantitative and qualitative data on trainees’ careers, publications, and policy implications of their work. Dr. Arthur Reingold asked about FIC’s long-term vision and potential support for alumni associations. Noting that several alumni associations are nascent, Dr. Glass tabled discussion of this topic until the next Board meeting.
VII. Emerging FIC Program and Policy Considerations
Dr. Roger Glass, Director, FIC
Dr. Glass introduced a series of three topics, asking for brief presentations and robust discussions.
Topic 1: identifying regional priorities
Dr. Linda Kupfer, Acting Director, DISPPE, FIC
Discussant: Dr. Charles Rotimi, Director, Center for Research on Genomics and
Global Health, National Human Genome Research Institute (NHGRI), NIH
NIH Investments by World Region. Dr. Kupfer presented data on NIH and FIC research investments by world region and posed two questions for discussion. She highlighted, in particular, the comparatively small investments made in two regions: sub-Saharan Africa, and the Middle East and North Africa. Of the $580 million (0.25 percent of the overall NIH budget) that NIH allocated to foreign research grants in Fiscal Year (FY) 2004–2005, 12 percent went to researchers in sub-Saharan Africa and 0.2 percent went to researchers in the Middle East and North Africa. In sub-Saharan Africa, the great majority of NIH funds was for HIV/AIDS research in South Africa. The two regions are similarly underrepresented in the intramural NIH Visiting Program. During FY 2004–2005, only 92 scientists came from sub-Saharan Africa and only 78 came from the Middle East and North Africa. And, as shown by September 2007 data, most scientists from sub-Saharan Africa came from South Africa.
FIC’s investment in these regions is relatively slight as well. Of the $19 million that FIC allocated internationally in FY 2004–2005, 19 percent went to researchers in sub-Saharan Africa, and mostly (15 percent) to researchers in South Africa. In addition, 10-year (1992–2003) data show that only 4 percent of FIRCAs went to African investigators. Yet, 1988–2007 data from FIC’s new tracking system show that sub-Saharan Africa has the second highest number of FIC trainees (after Latin America and the Caribbean), at more than 650, while the Middle East and North Africa has the lowest number, only a few.
Dr. Kupfer noted that these data focused NIH attention on Africa and led FIC to organize and host the summit on African research, held at NIH November 5–6, 2008. Referring the Board to Goal V in the FIC Strategic Plan for 2008–2012 (to build strategic alliances and partnerships for global health research and training), she posed two questions: Should FIC explore or implement new partnership agreements with ascendant economies (e.g., China, India), and do more to direct available resources to regions with limited capacity (e.g., sub-Saharan Africa)? And, if so, what criteria should be considered to choose the areas and countries of focus?
Summit on African Research. Dr. Rotimi introduced himself to the Board and reported on the summit on African research. Born and educated in Nigeria, Dr. Rotimi is director of the NIH Center for Research on Genomics and Global Health, within NHGRI. Among his aims at the center are to engage NIH, and specifically the intramural program, in Africa and to involve African scientists in NIH research and research training. Dr. Rotimi also is president of the African Society of Human Genetics, which, he noted, holds annual meetings in different African countries.
Dr. Rotimi noted that the NIH summit on African research was well attended and tremendously successful as the participants adopted a collaborative mindset to discuss ways of working together to begin to impact research and health in developing countries and, specifically, sub-Saharan Africa. He highlighted three issues addressed at the summit: (i) how to expand and apply scientific knowledge to benefit society; (ii) how to relate limited resources to local needs and conditions; and (iii) how to turn the “brain drain” to a “brain gain” for Africa.
Dr. Rotimi suggested that targeting funds to individuals who provide training and run programs, thereby enabling them to expand their programs, is more effective than spending funds to simply train more and more individuals. He noted the increasing disparities in global health and burden of disease in countries, such as those in sub-Saharan Africa, that are experiencing an “incomplete transition” epidemiologically—that is, are confronting communicable (i.e., infectious) and noncommunicable (i.e., chronic) diseases at the same time. He emphasized the need to identify ways not only to train individuals, but also to provide the resources needed (e.g., laboratories) for them to do research. In addition, Dr. Rotimi suggested that programs such as FIRCA could be restructured to give more African scientists an opportunity to compete for and succeed in research training. Potential obstacles, such as lack of awareness about available training programs or inexperience in grantwriting, need to be addressed.
Dr. Glass opened the discussion with two perspectives. To help expand FIC activities in Africa, he suggested the possibilities of enlisting former African NIH grantees (“diaspora scientists” in the United States) to identify Africans who would be eligible for the FIRCA or research fellowship program; identifying FIC clinical scholars and fellows of different specialties who would spend a year in sub-Saharan Africa to develop a research agenda leading to partnerships with other ICs; and building on HIV/AIDS research models to address other chronic diseases such as cancer and cardiovascular disease. With respect to China and India, countries that already have research budgets and programs, he mentioned that FIC is interested in building collaborative partnerships based on a sharing of resources and ideas.
Acknowledging Diversity within Countries. Dr. Kleinman urged FIC to not view China and India as monoliths, for their efforts tend to be focused on coastal areas, with little medical research or public health expenditure occurring in the vast interior. Emphasizing the diversity within countries, including African countries, he encouraged FIC to systematically rethink its approach to countries in relation to their internal diversity.
A Case For and Against Regional Priorities. Dr. Hotez made a special appeal for greater NIH attention to Latin America and the Caribbean. He listed several points of rationale: only 8 percent of NIH international dollars are invested in Latin America and the Caribbean, the United States has a special obligation to this neighboring region, approximately 100 million people in Latin America live on less that $1 a day, European research institutions already have a substantial commitment in Africa and are not likely to attend to this region, and the largest pool of former FIC trainees (approximately 750)—who could be mobilized for an expanded effort—are in Latin America and the Caribbean. He encouraged NIH to focus, in particular, on Mesoamerica (e.g., the countries of Central America, Hispaniola, Haiti, Dominican Republic), where health disparities are enormous.
Dr. Rotimi argued that all developing countries need as much research support as they can get, whether they are in South America, Africa, or Asia. Dr. Glass noted that NIH is a research, not a humanitarian or donor, agency and that the issues addressed (e.g., pertaining to inequity) are research-driven. He returned to the FIRCA data, which indicate that, in 1992–2003, only 4 percent of FIRCAs went to African researchers, compared with 29 percent to Latin America and Caribbean researchers.
A Possibility for Triangular Research Partnerships in Africa. Dr. Pablos-Méndez suggested that Brazil would be a good “entry point” for triangulation of partnerships with China and India to work in African countries. Brazil has strong colonial ties to Africa and Europe, shares the Portuguese language with African countries that are among the poorest on the continent, is emerging economically and politically, and is a strong regional partner in Latin America. Dr. Reingold said that new models are needed to entice comparatively resource-rich countries, such as Brazil, to engage substantively in partnerships, so as to not take away funding for resource-limited countries.
Adopting a Strategic vs. Regional Focus. Dr. Black noted reluctance for FIC to adopt regional priorities because of its limited resources. He suggested that a strategic focus on chronic disease areas, for example, would enable FIC to better link with other ICs and tap into the larger budgets. Dr. Hotez agreed, saying that a regional focus could be a political liability.
Strengthening Research Infrastructures. Dr. Black said that the difficult long-term issue of research infrastructures in developing countries is not being addressed adequately. He suggested that NIH has a role in rethinking how to build infrastructure. An initial step could be, for example, to pay legitimate overhead rates on grants. Dr. Rotimi mentioned two considerations raised at the summit on African research; that is, assuring that overhead resources are used to develop infrastructure, and enabling NIH to pay more overhead expenses without reducing the number of research grants funded.
Achieving Depth of Focus in Research. Drs. Rotimi and Kleinman emphasized the need for sustained resources to enable investigators to achieve a desired depth of focus in their research. Dr. Kleinman further suggested that FIC consider an investigator’s depth of focus as an evaluation criterion in the support and tracking of trainees.
Fostering Research Designs for Chronic Diseases. Dr. Stanton suggested that FIC include an incentive in its training and research initiatives to stimulate partnerships across clinical, behavioral, and intervention research. Such an incentive would help focus attention on type of research (i.e., research on chronic diseases), rather than specific disease entities.
Establishing Centers of Excellence. Dr. Glass raised the idea of building up research centers of excellence, for example in East Africa or West Africa, to focus on chronic diseases. Centers could be developed, with support from other ICs, at institutions (e.g., Makerere) that already have research laboratories and a clinical trials capability. Dr. Fedoroff expressed support for the idea, noted that South America has several centers of excellence on which to focus to build equal relationships, and encouraged FIC to organize an international coalition of partners that could foster collaborations in Africa. Referring to Dr. Kleinman’s earlier comment, Dr. Glass mentioned that centers of excellence could conduct research on health inequities within countries. Dr. Pablos-Méndez noted that the dynamic of change in broadband connectivity occurring across Africa offers intriguing possibilities for focused investments in Africa.
Topic 2: global health research as an instrument of diplomacy
Ms. Judy Levin, Program Officer, Middle East, North Africa, and Sub-Saharan Africa, Division of International Relations (DIR), FIC
Discussants: Dr. Nina Fedoroff, Science & Technology Advisor to the Secretary of State and to the Administrator of the U.S. Agency for International Development (USAID); Mr. John Monahan, Visiting Professor of Law, Georgetown Public Policy Institute, Georgetown University
Israeli–Palestinian Science Organization (IPSO). Ms. Levin described a small, novel public–private partnership to support a 5-year project of Israeli–Palestinian cooperation in training, research, and services to prevent genetic disorders in the Palestinian population. She highlighted this project as an example of using global health research as an instrument of diplomacy and DIR’s role and activities in this regard. She noted that the aim is to pursue good science to improve the health of the population. First conceived during an April 2006 brainstorming session involving IPSO and FIC, the idea was adopted by former NIH Director Zerhouni and expanded and developed by FIC. It builds on existing IPSO-funded research teams and Israeli clinicians’ awareness of a major health issue—hereditary deafness affecting up to 45 percent of the Palestinian population. IPSO researchers developed the proposal, Dr. Zerhouni involved Dr. Fedoroff at the Department of State, and she engaged Dr. Fodor of Affymetrix, a manufacturer of microarray instrumentation that is donating several microarray systems to strengthen the research infrastructure on both sides. With monies contributed by Dr. Zerhouni from the NIH Director’s discretionary fund, the effort is attracting additional funding for research and services.
Using Science to Improve Countries’ Relationships. Dr. Fedoroff noted a tremendous opportunity in the new Administration to use the entire range of science—from agriculture to health, medicine, and engineering—to build better relationships between countries and to address global issues such as health, food, and local capacity building. She mentioned, in particular, USAID’s interest in building local enterprises in country in partnership with the private sector and the Department of State’s receptivity in championing science and technology internationally. In a recent article, Dr. Fedoroff highlighted the role of entrepreneurship and science in a world without borders (see “Science Diplomacy for the 21st Century,” Seed Magazine, February 3, 2009).
Dr. Glass noted that FIC is working with Dr. Fedoroff to develop a Fogarty Fulbright-type program for the health sciences. Dr. Aaron Primack is the FIC contact.
Georgetown–FIC Symposium on Global Health Diplomacy. Mr. Monahan offered a perspective on the November 12, 2008, anniversary symposium, “The Role of Science in Advancing Global Health Diplomacy,” held at Georgetown Law Center. He said that Georgetown University was pleased to partner with an organization of distinction such as FIC and he complimented FIC staff for their excellence in organizing a strong symposium that was both important and timely. He noted that global health is of critical importance and is a priority of the president of the university. Mr. Monahan offered two “take aways” from the speakers at the symposium: (i) the framing of research and health as part of diplomacy and national security is “smart power “or, as some term it, “soft power,” and FIC is on target in focusing on these issues; and (ii) international instruments of diplomacy, such as international agreements, could serve as powerful tools for addressing the complexity and challenges of vertical assistance programs and the breadth of horizontal needs faced by particular countries.
Dr. Glass opened the discussion by saying that the term diplomacy is not well received on the NIH campus, but that the use of science to pursue research questions and advance health, as in the IPSO project, enables NIH to serve two ends—research and international relations.
Collaborations among Developing Countries. Dr. Rotimi noted that the governments of Brazil, China, and India, for example, are appreciating the tremendous opportunities for their own development of collaborations with countries in sub-Saharan Africa and that the interaction among these countries is increasing. He suggested that FIC and other ICs could take advantage of these relationships to foster collaborations between and among developing countries.
Beyond Politics: Science to Advance Health. Drs. Hotez and Fedoroff commented on the history of superpowers working together during the Cold War (e.g., to develop the polio vaccine) and the possibilities for pursuing similar relationships to advance health in countries such as Korea or Iran. Dr. Kleinman mentioned that Harvard University scientists are collaborating with North Korean scientists on that country’s epidemic of multidrug-resistant tuberculosis. He and Dr. Fedoroff agreed that insertion of pro-social values, such as good health, social justice, or food safety, into diplomacy is enormously important and that science can serve as a vehicle for this insertion. Dr. Fedoroff mentioned, in particular, that physicians in Pakistan are collaborating with North American physicians of Pakistani descent to distribute cell phones to health care workers in all Pakistani villages so that they can readily communicate with doctors throughout Pakistan. Dr. Kleinman noted that fundamental international ties are being forged by the extensive diaspora of engineering and medical science students coming from East Asia and Southeast Asia to study in the United States—and that such diasporas will have significant implications for the future of science and medicine.
Global Health as a Moral Movement. Dr. Kleinman noted the on-campus emergence of global health as a moral movement, relating this to the emergence of medical missionaries and other social movements at the end of the 19th century. He anticipated that the motivation for global health, which links diplomacy with values, will surpass that for the Peace Corps and could have spin-offs beyond science and health care. Dr. Fedoroff suggested that the movement is larger than health alone and includes, for example, food supply. She also noted that, in contrast to the 19th century, partners around the world are demanding to be equal partners—a demand that will necessitate a paradigm shift in foreign policy and diplomatic efforts. Dr. Michael P. Johnson, Deputy Director, FIC, mentioned that the Congress is interested in pursuing a Global Health Service Corps, which was first outlined in the President’s Emergency Program for AIDS Relief (PEPFAR); he suggested that Board members may wish to provide input to this effort.
In closing the discussion, Dr. Glass said that the United States is known for its science and the ability to share science and that the NIH can best help to facilitate relations by partnering with other countries to advance science.
Topic 3: proposed center for global health studies at the stone house annex
Mr. Robert Eiss, Senior Public Health Advisor, Office of the Director, FIC
Discussants: Dr. Robert A. Black, Dr. Arthur Reingold
Dr. Glass informed the Board that FIC is embarking on a 1-year renovation of the small house (building 16A) that is adjacent to the Lawton Chiles International House. The intent is to rebuild the facility as a trans-NIH “think tank” that could have a high impact on global health issues at a low cost. The “incubator space” could house up to 20 professional and support staff and would include offices and conference facilities. Dr. Glass noted that funds for the renovation were provided in the FY 2007 NIH budget and that Mr. Timothy J. Tosten, FIC’s Executive Officer, is handling the renovation. He invited one or two Board members to participate in the planning of the space.
Outline of the Proposed Center. Mr. Eiss presented an outline of the center as conceived initially by a small FIC working group. He noted that there has been a rapid ramp-up of cross-IC collaborations and trans-NIH intramural initiatives in recent years. The proposed center could enable FIC to expand its in-house research program to be a focus for bringing together NIH scientists from diverse disciplines. A precedent is the former FIC Scholars-in-Residence program. Mr. Eiss said that FIC hopes to begin activities in a year. For a conceptual framework, the working group suggests that the center should have a pragmatic focus, actively seek public–private partnerships through engagement of academia and philanthropies, support interdisciplinary research that builds on qualitative and quantitative research methodologies, and focus on problems of low- and middle-income countries. In addition, the center should build on FIC’s existing scientific expertise (e.g., mathematical modeling, dynamics of complex systems, global transmission of disease) and have a complementary training mission for pre- and postdoctoral scientists.
The working group envisages that the center would be funded by set-aside and/or pooled monies, in collaboration with other ICs, academia, and philanthropies. Scientists would serve joint or dedicated appointments, participation would be embedded in the competitive peer review process, and a scientific management board would oversee activities. Mr. Eiss said that FIC will actively engage the Advisory Board in the planning process and the management of research directions. He noted that, over the next year, Dr. Glass will establish a proof of concept by exploring the notion of an NIH center for advanced studies with the NIH leadership; FIC will organize a trans-NIH planning group and consult with academia, philanthropies, and other groups in the private sector to determine how the center would complement their activities; and FIC will develop a scientific blueprint, or business plan, that will indicate how the research that is generated would be applied to public health policy or clinical medicine.
Activities and Attributes. Dr. Black agreed with the outline presented by Mr. Eiss and said that the incubator space is a great opportunity for FIC and NIH to create new research and research training initiatives. He noted that a process is needed for deciding on the nature of the center’s activities. This process could be competitive or strategic and involve only FIC staff and the Advisory Board. As an incubator space, the center could be used, for example, to develop ideas set forth in the FIC’s Strategic Plan (e.g., implementation research, research on non-communicable diseases or injury) or to address rapidly emerging issues (e.g., a disease or opportunity). In addition, the center could function as a think tank and have a policy role, with its scientists analyzing and synthesizing science information, similar to the role FIC had in the Disease Control Priorities Project. The center also could adopt a research agenda-setting function whereby staff would convene groups to frame and prioritize research questions.
From the perspective of academia, Dr. Black suggested several attributes that would be attractive. These include funding of sabbaticals for faculty to be research leaders in residence at the center, support for one or more resident scholars from low- to middle-income countries, activities that are product-driven and have concrete outcomes (e.g., signature FIC reports), emphasis on postdoctoral trainees, amenities such as a good meeting space and videoconferencing, and funding to catalyze initiatives.
Focus and Mix of Activities. Dr. Reingold envisioned a model for the center in which scientists collaborate on two or three different research focuses, and he argued for significant emphasis on non-infectious diseases. He encouraged FIC to consider partnerships with other Federal agencies, including the Department of State and Department of Defense. Activities could include short-term sabbaticals to draw in experts who would transfer skills and knowledge within weeks’ time; a seminar series and invited speakers, to impart an academically rich environment; and a mix of foreign and U.S. scientists, young and senior investigators, and intramural and extramural researchers to achieve a vibrant sharing of ideas. In closing, Dr. Black noted that the selection of a director and full-time staff is potentially very important.
Models to Emulate. Dr. Kleinman suggested that the FIC working group visit several existing institutes of advanced study to gain insight on the potential role and activities of the proposed center. He noted that, as there is no Institute of Advanced Study in the Health Sciences, the FIC center could fulfill this role. He further suggested that FIC draw on the expertise of those who designed the intellectual and physical architecture of established, well-configured venues for research scholars.
Activities. Dr. Hotez supported Dr. Reingold’s concept of the center as a think tank, and Dr. Pablos-Méndez noted that the William and Flora Hewlett Foundation recently committed funds to foster think tanks. Dr. Fedoroff suggested that the center could bring in individuals to organize videoconference lecture series or courses for students in less developed countries. Dr. Glass added that videoconferences could be linked to international sites to expand the network of participants. Dr. Pablos-Méndez supported the notion of leveraging the location of the NIH center to reach a larger audience.
Dr. Claudio pursued the concept of scientists from varied disciplines working together to find solutions, and Dr. Glass noted that this might include epidemiologists, economists, policymakers, and modelers, who are generally not well represented at NIH and could focus, for example, on predictions of chronic disease burden or values of investments in health. Dr. Fedoroff named the Santa Fe Institute as an example of a community of radical thinkers comprised of a small resident faculty and a large, diverse external faculty. Dr. James Herrington, Director, DIR, noted that FIC has and could facilitate within the center an interchange among NIH intramural investigators. Dr. Stefano Bertuzzi, National Institute of Neurological Disorders and Stroke, emphasized the potential importance of the center as a space in which FIC could bring extramural scientists to interdigitate with intramural investigators.
VIII. The IOM Report on The U.S. Commitment to Global Health: Recommendations for the New Administration
Dr. Ruth Levine, Vice President for Programs and Operations and Senior Fellow, Center for Global Development
Dr. Levine described the charge and context, relevant findings, and draft recommendations for this IOM report, which will be released and disseminated broadly in spring 2009. Dr. Levine is a member of the IOM Committee on the U.S. Commitment to Global Health and the author of Millions Saved: Proven Successes in Global Health (Center for Global Development, 2004). A copy of the draft IOM report, as well as the committee’s December 2008 letter report to the new Administration, was provided to Board members.
Charge and Context. Dr. Levine reported that the IOM committee has a three-part charge: to examine the current U.S. Government (USG) commitment to global health, identify areas that need more attention, and envision future USG investments and activities. Co-chaired by Ambassador Thomas R. Pickering and former NIH Director Harold E. Varmus, the committee has many government and non-government sponsors. Dr. Levine noted that the committee held extensive discussions on the definition of global health and adopted one that includes Americans, but focuses on how the USG can best improve health in low- and middle-income countries. Although recognizing the inevitable link among health, development, and the environment, the report focuses on the health sector per se and does not address other aspects (e.g., food security, water and sanitation, gender equity).
Relevant Findings. Dr. Levine observed that USG (Department of State and USAID) spending on global health rose significantly in 2001–2008 and that virtually all of these monies were spent on HIV/AIDS. Among countries in the Organization for Economic Development and Cooperation (OECD), the United States allocates a higher-than-average share of OECD aid to health (23 percent compared with 16 percent), but remains last in overall development assistance as a percentage of gross national income (0.16 percent compared with an average of 0.45 percent). Only 6 of 22 OECD countries met or exceeded the assistance level (0.54 percent) targeted in the Millennium Development Goals (MDGs). Dr. Levine noted that the IOM committee comments on the effort still needed to achieve the MDGs (e.g., reducing childhood mortality by two-thirds) by 2015. She also noted that USG expenditures in development assistance do not correlate well with the growing burden (disability-adjusted life years, mortality) of chronic non-communicable, non-infectious diseases in low- and middle-income countries
Draft Recommendations. The committee leads off its recommendations by highlighting global health as a pillar of U.S. foreign policy and by proposing creation of a White House Interagency Committee on Global Health chaired by a senior White House official. Dr. Levine noted that the committee will recommend a specific level of increased funds—for example, to balance the portfolio of global health aid, provide more for health systems and underfunded or neglected areas, and increase funding for chronic diseases and injuries. It will make a strong case for maximizing the effect of monies allocated by, for example, evaluating the impact of U.S. investments and better aligning U.S. activities with needs identified by national governments and countries. She noted that the committee recognizes American’s traditional strengths in global health research and will recommend ways to bolster the generation of knowledge, for example, through increased funding, partnerships, and harnessing of information technology. Finally, the committee will encourage constructive U.S. engagement with WHO to fulfill its own mandates.
Dr. Glass invited the Board’s discussion of the issues and draft recommendations in the IOM report. He noted that FIC will solicit a last round of comments from IC directors to submit to the IOM committee for its final deliberation.
The Board members offered its congratulations to the IOM committee for its efforts and report. Dr. Black strongly encouraged the committee to ramp up the recommendations for research and to specify the proportion of monies to be allocated to research of various kinds, as well as the roles of different USG agencies. Drs. Kleinman and Pablos-Méndez agreed and urged the committee not to “waffle” on the investments needed, insofar as a relatively small investment of a few billion dollars in today’s economic climate could yield large returns in global health. Dr. Kleinman noted that the report should specify the increase in funding needed for FIC. Dr. Daniel A. Singer, National Institute of Child Health and Human Development, NIH, encouraged the committee to add national security as a rationale for increased support of global health, to better engage members of Congress and the non-health community. He referred the committee and Board to the December 2008 release of the National Intelligence Estimate on the Strategic Implications of Global Health.
Dr. Hotez asked whether the committee had received any feedback yet on the report and how it plans to “give the report teeth.” Dr. Levine noted that the IOM has a comprehensive outreach strategy to disseminate the report that includes private briefings and possibly a public event in coordination with other groups or organizations.
IX. Concluding Discussions and Next Steps
Dr. Roger Glass, Director, FIC
Dr. Glass thanked the Board and speakers for their input and participation, quality of the discussions, and outcomes of the meeting. He said that Mr. Eiss would be sending FIC’s calendar of events, including network meetings, to the Board, and he invited and encouraged the members to participate in these gatherings. Dr. Glass thanked the entire staff for making FIC an incredibly productive organization.
The meeting was adjourned at 2:36 p.m. on February 10, 2009.