The John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) convened the seventy-second meeting of its Advisory Board on Tuesday, May 19, 2009, at 10:40 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 8:00 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 10:40 a.m. to 3:00 p.m. Dr. Michael P. Johnson, Deputy Director, FIC, presided. The Board roster is appended as Attachment 1.
Dr. Johnson welcomed everyone to the open session. On behalf of FIC, he later welcomed Dr. Barbara Alving, Director, National Center for Research Resources (NCRR), NIH, who was attending her first Board meeting as a new ex officio member of the Board.
VI. Director’s Update and Discussion of Current and Planned FIC Activities
Dr. Roger I. Glass, Director, FIC
Dr. Glass participated in the Board meeting via video conferencing from Geneva, where he was attending the World Health Assembly. He thanked Dr. Jimmy Whitworth, Head of International Activities, The Wellcome Trust, for coming to meet with FIC and to participate in the Board’s discussions. He introduced two new staff members of FIC’s Division of International Relations (DIR): Dr. Letitia Robinson, and Dr. Rob Lyerla (who will be joining FIC in September 2009).
Dr. Glass noted that the terms of two Board members are expiring: Drs. Arthur Kleinman and William A. Vega. He thanked each of them for their contributions to the Board and said that FIC may be calling on them in the future. He noted that Dr. Jim Yong Kim, who was unable to attend the Board meeting, has been elected President of Dartmouth College (effective July 1, 2009) and will step aside from service on the Board.
Dr. Glass commented that, as part of the U.S. delegation to the World Health Assembly, he had an opportunity with other agency representatives to introduce the new Health and Human Services Secretary, Kathleen Sebelius, to global health. He noted that, while in Geneva, she met with Director-General Margaret Chan of the World Health Organization (WHO) and with officials of the ministries of health of several countries, including Canada, China, Mexico, and United Kingdom, from whom she received various invitations to visit. Dr. Glass mentioned that although the scheduled topic for the assembly was chronic diseases, the H1N1 flu outbreak took precedence and the participants addressed policy issues and country responses regarding the pandemic.
Update on FIC Activities
Dr. Glass reported on his visits to universities and with NIH institutes and centers (ICs) to discuss global health programs and FIC opportunities. He recently visited the global health programs at Boston University, Mt. Sinai School of Medicine, and Yale University. Dr. Glass noted that, in June 2009, FIC will convene a small group of university leaders in global health and that this meeting will be followed by a larger conference on global health, at NIH in September 2009.
At NIH, Dr. Glass recently met with staff of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Cancer Institute (NCI). He noted that, on May 21, FIC will host an NIH Retreat on International Activities at which IC leaders will share their experiences in global health. A summary of the discussions and recommendations from this meeting will be presented in June at the NIH Directors’ Forum.
Dr. Glass thanked several Board members—Drs. Antman, Claudio, Reingold, Hotez, and Cassell—for their active engagement in recent FIC activities. He mentioned, in particular, FIC’s anniversary event at which Dr. Jeffrey Sachs spoke on “Planet in Crisis: The Case for Investing in Global Health during a Financial Meltdown.” Dr. Glass noted that, during his visit with FIC, Dr. Sachs met with various IC groups and with a dozen IC directors. Dr. Glass encouraged the Board members to participate in upcoming FIC activities.
VII. Review of Funding Plans under the Stimulus Legislation
Dr. Michael P. Johnson, Deputy Director, FIC
Dr. Johnson presented an overview of the American Recovery and Reinvestment Act of 2009 (ARRA) and its impact on NIH and FIC. President Obama signed the governing legislation, Public Law 111-5, on February 17, 2009, at the Denver Museum of Nature and Science. The aim is to create and preserve jobs, stimulate long-term economic health, and advance investment in science and technology. Government-wide information on ARRA is available at www.recovery.gov, and information specific to NIH and FIC is available at www.fic.nih.gov, the FIC website. This information is being updated continually and rapidly.
NIH Allocation and Use of ARRA Funds. Dr. Johnson reported that NIH has received approximately $10 billion, or 1.3 percent, of the total stimulus package of approximately $800 billion. The NIH funds are being allocated as follows: $8.2 billion for extramural scientific research; $1.0 billion for repair, improvement, and construction of extramural facilities; $0.3 billion for extramural scientific equipment; and $0.5 billion for repair, improvement, and construction of intramural facilities. Another $0.4 billion is for comparative effectiveness research in collaboration with the Agency for Healthcare Research and Quality (AHRQ).
With these monies, NIH aims to accelerate biomedical research using existing mechanisms (e.g., administrative supplements) and focusing on research project grants (e.g., R01s, R21s, and R03s). NIH also seeks to expand science by supporting new programs, such as competitive supplements for existing programs, new NIH-wide ARRA programs, and a limited number of new IC-specific ARRA programs. Discretionary directions regarding the use of ARRA funds will be guided by ICs’ strategic plans. The focus is decidedly domestic, as foreign expenditures are limited to the lower figure of $25,000 or 10 percent of an award.
Dr. Johnson noted two limitations in FIC accessing ARRA funds: (i) FIC’s support of research (vs. research training) accounts for only about 30 percent of its portfolio, compared with 70–90 percent at other ICs, and (ii) the emphasis on domestic use of funds. Of five NIH-wide ARRA programs, FIC is participating or involved in two—Challenge Grants, and summer jobs for high school and college students and teachers to work in science labs. The remaining three NIH-wide programs are Grand Opportunities (GO) grants, recruitment of new domestic faculty to conduct research, and Academic Research Enhancement Awards (AREA) (R15s).
FIC Priorities and a Proposed ARRA Portfolio. FIC has identified two sets of priorities for accessing NIH-wide ARRA funds. For the Challenge Grants, which provide up to $500,000 total costs per year for up to 2 years, the FIC priority areas are stigma-related conditions, information communication technologies (ICT) to improve health and to enhance global health research and training, non-communicable diseases (e.g., diabetes mellitus, cardiovascular disease) in low- and middle-income countries, and models to predict health effects of climate change. For high-priority “signature initiatives” (i.e., exceptionally creative projects to address major challenges in biomedical research) to which the NIH Office of the Director could add supplemental funding, three priorities are expansion of the Framework Programs for Global Health, creation of the trans-NIH Center for Global Health Research and Policy (to be housed in building 16A), and development of a research agenda on the health effects of climate change in collaboration with the National Institute of Environmental Health Sciences (NIEHS).
Dr. Johnson noted that FIC will directly receive approximately $17 million of the NIH stimulus monies. To utilize these funds, FIC is proposing an ARRA portfolio of research project grants (comprising approximately 30 percent of the $17 million), research support grants (comprising 13 percent), and administrative supplements and other awards (comprising 52 percent). Dr. Johnson emphasized that the overall portfolio and projects will receive extensive review and oversight at multiple levels, from the NIH to the White House.
With respect to research project grants, Dr. Johnson said that FIC proposes to fund four additional projects in its Brain Disorders in Developing World program and to increase support for two programs (ICBG, EID) and post-doctoral supplements. Under research support grants, FIC has been able to fund one International Research Scientist Development Award and four additional Framework programs (at Dartmouth Medical School, University of California at Irvine School of Medicine, University of New Mexico School of Medicine, and Yale University School of Medicine). Administrative supplements and other awards would be used for Framework programs, clinical fellows, post-doctoral investigators, ICT efforts, and the trans-NIH Center for Global Health Research and Policy (building 16A).
Dr. Reingold asked about FIC’s plans for organizing and funding the trans-NIH center. Dr. Johnson said that the planning for this center is still at the very early stages. FIC is considering how best to blend intramural and extramural inputs and possibly using a competitively awarded cooperative agreement mechanism to provide support for personnel and participating scholars or fellows. Dr. Vermund mentioned several precedents (e.g., the clinical trials networks) for integrating staff from private organizations into the activities of public agencies such as the NIH and the Centers for Disease Control and Prevention (CDC).
Dr. Glass commented that FIC staff have exerted incredible effort over the past several months to handle the review of extra applications stimulated by ARRA. Dr. Johnson assured the Board that extensive reporting will accompany use of ARRA funds and that expenditures will be reviewed closely to ensure that they fulfill the economic aims of the stimulus. Dr. Ken Bridbord, Director, Division of International Training and Research (DITR), FIC, emphasized that the aims of ARRA—to create and preserve jobs, as well as to advance science—are “driving” the NIH ARRA awards.
Dr. Black asked about FIC’s role in the review of Challenge Grants. Dr. Bridbord noted that the NIH Center for Scientific Review (CSR) has primary responsibility for peer review of these grants. To date, NIH has received approximately 21,000 applications for Challenge Grants, of which more than 230, and possibly twice that number, could be assigned to FIC for second-level review, either as primary or secondary IC.
In closing, Dr. Glass mentioned two opportunities for FIC arising from the NIH ARRA stimulus: it may double the NCI budget over the next 5–6 years, and it allocates $5 million to address the ethics of medical research. Dr. Glass noted that FIC could have an impact in both areas, for FIC already participates in a trans-NIH working group on cancer and currently accounts for 40 percent of the NIH expenditures in bioethics.
VIII. Reforms in the NIH Peer Review System
Mr. Bruce Butrum, Chief Grants Management Officer, FIC
Mr. Butrum summarized key changes that NIH is making in its peer review system Phased implementation of selected actions began in September 2008, following a year-long deliberative effort to gather input (from June 2007 to February 2008) and the design of an implementation plan (in March–June 2008).
- Changes Effective as of January–February 2009. Mr. Butrum described two changes: (i) a new policy on resubmission of applications, and (ii) identification of applications from early-stage investigators (ESIs). Beginning with applications that have due dates of January 25, 2009, and beyond, NIH is accepting only a single amendment to an applicant’s initial application. Applicants who had applications in the system before January 25 are able to submit an amendment (A2) application up to the January 2011 receipt date.
Beginning with R01 grant applications received as of February 5, 2009, NIH is identifying applications from new investigators (NIs) and ESIs. ESIs are NIs who have received their terminal research degree or completed clinical residency within the past 10 years. NIs who wish to be considered for ESI eligibility must update their eRA Commons profiles, which will then display their ESI eligibility. When feasible, NIH is clustering NI and ESI applications during reviews beginning in May 2009. The aim is to support R01 applications from NIs at success rates comparable to those of new applications from established investigators.
- Changes Effective as of May 2009. Mr. Butrum noted four changes: (i) a new 1–9 scoring system, (ii) scoring of individual core criteria, (iii) templates for structured critiques, and (iv) enhancements to review criteria. The NIH has adopted a new scoring system for applications that ranges from 1 (for exceptional) to 9 (for poor). This scale is being used for both overall impact/ priority and individual criteria. Each score is multiplied by 10, to yield scores of 10 to 90. Scores that each reviewer assigns to individual criteria are reported in summary statements and for all applications. Reviewers consider these scores when determining an overall impact/priority score, as appropriate for each application, and preliminary impact/priority scores are used to help determine which applications to discuss. For structuring their critiques, NIH provides reviewers with a template (text box) in which to write their comments (in bullet form or short narrative), and templates are then uploaded to the summary statements. Mr. Butrum did not elaborate on enhancements to the review criteria.
- Changes Effective as of FY 2011. Applications due in January 2010 and beyond will be restructured to be shorter in length and to realign sections with the review criteria. Mr. Butrum noted that NIH is working on the details of restructuring applications and will publish these in the NIH Guide.
In closing, Mr. Butrum encouraged the Board members to access the NIH website on enhancing peer review and/or contact him directly on any questions.
IX. H1N1 Flu Update
Dr. Mark Miller, Director, Division of International Epidemiology and Population Studies, FIC
Dr. Miller described the emergence and global circulation of influenza A virus pandemics, the signature features of the current influenza A(H1N1) virus pandemic and prior pandemics of influenza A virus, and NIH involvement in identifying and studying the A(H1N1) outbreak in Mexico. He noted that FIC is one of several ICs helping to elucidate the recent outbreak. Approximately 10 years ago, FIC initiated the Multinational Influenza Seasonal Mortality Study (MISMS) and can now draw on relationships established with health officials and epidemiologists in Mexico and leverage FIC’s training of individuals globally to collect secondary source data on the seasonal mortality effects of influenza.
Dr. Miller charted the global circulation of influenza A viruses in recent history, beginning with A(H1N1) in the 1918 pandemic, to A(H2N2) in 1957, and A(H3N2) in 1968. In 1976, A(H1N1) appeared as the cause of swine flu and, in 2009, it is circulating globally among humans. Since 1997, health officials have perceived a threat of A(H5N1) from Avian species. Dr. Miller pointed to several signature features of the current A(H1N1) pandemic: its timing (occurring atypically in late March–early April), age distribution (being most severe among individuals 20 to 40 years of age), and transmission dynamics (potentially a doubling of cases every 6.5 days). Comparison with signature features of prior pandemics, which MISMS researchers have studied, suggests that the appearance of A(H1N1) in Mexico could be a prelude, or first wave, of a pandemic of multiple waves and that individuals who had the milder flu in this wave may be protected subsequently in a main wave to come.
In the Mexican outbreak, FIC and other ICs have participated in analysis of the phylodynamics of the eight gene segments of A(H1N1) and of epidemiological data (e.g., studies of transmission, stratification of risks) and in development of novel vaccines and transfer of viral sequences and viruses for viral seeds. NIH also has supported clinical studies of treatment. The questions that continue are: Was this virus more lethal in Mexico? Does the current response represent containment or a potential immunizing effect of a first wave? Ongoing studies are focused on the clinical response to current therapeutics and development of diagnostics, antivirals, and vaccines.
Board members asked whether analyses of the Mexican outbreak are yielding any clues about transmission of A(H1N1) next fall and whether manufacturing of flu vaccines is being diverted to focus on the A(H1N1) virus. Dr. Miller said that comparative studies of mild and severe cases in Mexico could elucidate risk factors. He noted that the usual seasonal flu vaccines are being made and that seed lots from the A(H1N1) virus are being prepared for vaccines.
X. Inaugural Conference of the Brazilian Alumni Association: The Brazilian Example
Mr. Kevin Bialy, Acting International Program Officer for the Western Hemisphere, DIR, FIC
Dr. Lee W. Riley, Professor, Epidemiology and Infectious Diseases, School of Public Health, University of California, Berkeley, and former member, FIC Advisory Board (via telephone)
Mr. Bialy reported on the first meeting of an NIH alumni association, the inaugural conference of the Brazilian Alumni Association. In July 2003, FIC helped establish the NIH Visiting Fellows Committee (NIHVFC). From this group, the notion of alumni associations arose, and FIC added supplements to its AIDS International Training and Research Program (AITRP) grants to support creation of five alumni associations, in Brazil, China, India, Mexico, and South Africa. Championed by a doctor and former co-chair of NIHVFC, the Brazilian Alumni Association is the only one that took shape. As an informal communication network, the association established an external advisory board and a website linked to NIH (www.nihaabr.org).
The inaugural conference, or 1st International Workshop of the NIH Alumni Association in Brazil (NIHAABR), was held in Rio de Janeiro on March 25–27, 2009. The goals were to convene NIH-trained researchers for networking, consider approaches to increasing intramural and extramural cooperative programs, and formalize the Brazilian association. The supporting organizations are FIC, NIEHS, NIHVFC, Academia Brasileira de Ciências, Universidade Federal do Rio de Janeiro, Banco do Brasil, and CAPES (a graduate-degree funding part of the Brazilian Ministry of Education). Representatives from three other NIH components—the National Institute of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver Institute of Child Health and Human Development (NICHD), and CSR—attended as well.
The 3-day meeting consisted of scientific presentations, consideration of policy issues (e.g., exchange of scientists, actions of institutional review boards), and discussion of the organization, goals, and sustainability of the NIHAABR. The outcomes include encouraging the establishment of cooperative programs between NIH and Brazilian organizations and working with the Academia Brasileira de Ciências and Government of Brazil to accelerate the grant approval process for NIH grants in Brazil. In addition, the association will contact funding partners to support future activities, to help ensure sustainability, and provide peer support for writing and submitting research grants. The association is seeking to expand its membership and will organize a 2nd NIHAABR workshop to include more U.S. researchers. The intent is to hold workshops every 2 years.
Dr. Riley thanked Dr. Glass for inviting him to represent FIC at the conference. He noted that he was the only American recipient attending that had an FIC grant supporting work in Brazil. Dr. Riley addressed two points: the role and sustainability of alumni associations. He commented that the association has a very important and useful role to play in that it could serve as a conduit for American investigators wishing to conduct collaborative research or research training in Brazil. It also could be useful for identifying potential research trainees and helping U.S. investigators negotiate grant application processes in Brazil. He strongly encouraged FIC to continue to support NIHAABR as a model for alumni associations in other countries where NIH has a significant involvement.
Dr. Johnson expressed FIC’s appreciation to Dr. Riley for participating in the conference. He raised the question of whether FIC could provide grants smaller than $25,000 to new alumni associations to support networking and development of websites. Dr. Stanton suggested that the competitive NIH R13 (conference grant) mechanism could be made available to those who wish to organize an alumni association.
Dr. Riley mentioned that NIHAABR is an NIH, not just FIC, alumni association. He noted that resources are needed to sustain the organization and could come from Brazil, other ICs, and the extramural research community. He suggested that FIC could raise the usefulness of alumni associations in discussions with other ICs. Dr. Vermund posed the possibility of regional associations (e.g., South Asia) which could have an added benefit of stimulating research collaborations among countries within a region. Dr. Jimmy Whitworth of The Wellcome Trust suggested the possibility of tagging a regional alumni association onto the South Asia Forum for Health Research. Dr. Kleinman mentioned that Harvard Foundation alumni groups in Asia have been sustainable and have yielded unanticipated benefits over time.
XI. FIC Planning Priorities for FY 2010
Dr. Roger Glass, Director, FIC (via video conferencing)
Dr. Glass opened the session by asking the Board to address two specific issues: building research capacities in Sub-Saharan Africa, and strengthening the global health research network in the United States. With respect to the first issue, he noted that over the past 20 years FIC has largely supported single-focus programs, in many cases modeled after the highly successful AITRP. He raised the question of whether FIC should continue to emphasize single-focus programs targeted to specific diseases and topics (e.g., HIV/AIDS), or change course and extend its activities to address broader concerns such as building infrastructure and strengthening capacity for global health research.
Issue One: Innovative Approaches to Building Research Capacities in Sub-Saharan Africa
Comments by Dr. Jimmy Whitworth, The Wellcome Trust
Co-moderators: Drs. Arthur Reingold and Sten Vermund
Dr. Whitworth commented that building, or strengthening, capacity has three components: (i) supporting bright individuals in well-equipped, well-functioning institutions; (ii) providing ethical oversight; and (iii) assuring that the overall system and environment allow researchers and research institutions to flourish. All three components would need to be addressed in many parts of Sub-Saharan Africa. For efforts to be successful, local voices and communities must be able to express their own needs and visions, and research teams must be broadened to include economists, epidemiologists, statisticians, anthropologists, and data managers and analysts.
Dr. Whitworth suggested that FIC encourage a “mixed economy” of research institutions that would include centers of excellence as well as other local research facilities. This approach gives recognition to the facts that change is ever present, that some environments are inherently unstable, and that some institutions may not be sustainable over time. Similarly, he encouraged FIC to adopt a mix of disease topics on which to focus, which would vary by institution and shared interests.
Dr. Reingold emphasized that there is no single answer for building research capacity in Sub-Saharan Africa and that any effort must be long term. He noted varying success with the AITRP in Ivory Coast, Uganda, and Zimbabwe.
Dr. Vermund agreed with Dr. Reingold and said that the success of AITRP training in Zambia varied across trainees and institutions. Over time, he and his colleagues became more strategic in concentrating on research-focused institutions and sought more substantial partnerships with other entities, such as the President’s Emergency Program for AIDS Research (PEPFAR). He noted that building capacity at a research-focused entity [e.g., Center for Infectious Disease Research (CIDR) in Zambia, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDRB)] is qualitatively different from building capacity at a government-funded university or college.
Dr. Vermund suggested that FIC could experiment with high-risk, potentially high-gain support of capacity-building in universities, as a complement to foundations’ long-standing investments in research-focused entities. He noted that international funders have not pursued this approach in the poorest countries, with the exception of Uganda and Makerere University.
The Board noted the importance of issue one and focused on building capacity in universities. The topics addressed are summarized below.
Models of Institution Building. Dr. Kleinman suggested that FIC study other models of capacity-building, inside and outside the health field. He noted the success of the Carnegie Foundation for Advancement of Teaching in building capacity at African universities (e.g., University of Nairobi, University of Dar es Salaam) and the success of the Harvard Kennedy School in training policymakers in China and Vietnam. Dr. Black highlighted additional examples of successful capacity-building around the world. He urged FIC to reflect on the lessons learned and to think creatively and differently about how to build capacity in Sub-Saharan Africa (i.e., what will make a difference?) and how to support and sustain these efforts.
Dr. Black favored long-term, multi-organizational commitments to building capacity, particularly in national academic institutions, for research, research leadership, and translation of research into policy. Drs. Antman and Whitworth agreed with Dr. Black on the value of strengthening educational institutions broadly across all disciplines related to health. Dr. Kleinman encouraged FIC to bring together U.S. and African university leaders in the health sciences to discuss links with the social sciences and humanities in solving local and global health and environmental problems.
Building on Existing Investments In-Country. Dr. Alving suggested that FIC conduct a “portfolio analysis” of existing investments in a country (including those of the U.S. military, corporations, universities, and institutions and of multinational and development agencies) to determine whether and how FIC could leverage its resources to build on these investments through partnerships. Dr. Reingold added CDC to the list and suggested that FIC pursue the possibility of adding research training to ongoing CDC and U.S. military efforts. Other potential partners include the Department of State and U.S. Agency for International Development (USAID). Dr. Johnson agreed that there are tremendous opportunities for partnerships with institutions outside the health field, including, for example, business schools.
A Team Approach in Capacity-building. Dr. Alving agreed with Dr. Whitworth on the need to engage other specialists (e.g., in economics, business, public health) in a team approach to capacity-building. Dr. Johnson highlighted the need for individuals trained in bioethics, ICT, and research administration, and he noted that FIC supports training in these areas. Dr. Alving commented that NCRR-supported Clinical and Translational Science Award (CTSA) programs include research administrators with master’s degrees in business administration, and Dr. Vermund credited the FIC’s Framework Programs for Global Health for mandating cross-discipline interaction.
Short- vs. Long-term Engagement. Dr. Kleinman emphasized the importance of becoming deeply engaged in building research infrastructures at universities. Dr. Hotez suggested comparing the benefits of different approaches adopted by three countries. That is, France (e.g., Institut Pasteur) tends to support “brick and mortar” construction in countries that have long-standing infrastructures, whereas the United Kingdom (e.g., The Wellcome Trust) supports the building of long-term infrastructures, and the United States (e.g., NIH) mostly provides relatively short-term funding tied to grant cycles.
Commenting on the U.K. experience, Dr. Whitworth noted that, in an institution in a developing country, having several independent research leaders and a director for oversight is a more effective model than having a director who runs everything. Dr. Black noted that trainees’ success often depends on their ability to generate continued funding for research and that institutions often do not have sufficient resources to absorb a trainee into other research endeavors. Also, researchers may be partnering with different U.S. universities, a situation that may foster separate research fiefdoms within an institution.
Dr. Stanton mentioned that NIH has had a long-standing commitment to ICDDRB, one of the more successful research entities globally. Other long-term partnerships for NIH include the Centers for AIDS Research, Comprehensive Cancer Centers, and National Heart, Lung, and Blood Institute’s new Collaborative Centers of Excellence. Members noted that FIC could possibly link with these entities to support long-term capacity building.
An institution’s ability to cover the costs of research is another factor in building long-term, sustainable research capacity. Drs. Vermund and Antman noted that, as in the United States, universities in developing countries would have to bear part of the costs of research in order to sustain the research endeavor over time. These funds could come, for example, from the university and/or entrepreneurial or development partners.
Issue Two: Strengthening the Global Health Research Network in the United States – New Directions for Framework
Staff Overview: Dr. Flora Katz, Program Officer, DITR, FIC
Co-moderators: Drs. Karen Antman and Arthur Kleinman
Dr. Katz presented an overview of FIC’s Framework Programs for Global Health. The goal of the program is to develop multidisciplinary educational programs in global health at universities in the United States and in low- and middle-income countries. The FIC initiated the program in 2005 and has made 35 awards, of which 32 are to U.S. universities and 3 are to foreign universities. Applicants are required to include at least three different schools with different disciplines and to have a certain number of global health grants to form the basis for their program. Approximately 17 disciplines are represented across the awardees, ranging from public health and medicine to professional schools, economics, law, engineering, business, communication, social sciences, and the humanities.
Dr. Katz highlighted several features that have been essential to the success of the Framework Programs. These include a requirement for multidisciplinary participation, which has opened up career paths for students and stimulated deans to contribute resources to the program. The FIC also requires that programs create administrative entities (e.g., an institute for global health) at the university, which have been able to leverage additional resources. Two additional requirements are provision of concrete deliverables (i.e., curricula), and research experiences for students, and the latter have stimulated faculty interest in international collaborations.
Dr. Katz noted that the Framework Programs constitute three different paradigms. In the trans-university paradigm (e.g., at Vanderbilt University), awardees are creating new courses and degree programs, as well as virtual communities of global health with directories, websites, and seminar series. In the co-curriculum development paradigm (e.g., at Tufts University, University of Pennsylvania), awardees are partnering fully with foreign institutions to construct curricula, usually involving an electronic, global classroom. In the study–practice paradigm (e.g., at the University of Southern California), awardees are developing curricula globally on a specific issue (e.g., tobacco cessation).
In closing, Dr. Katz said that the 35 awardees have accomplished a great deal over the past 3 years and all want to expand their programs. She noted that the FIC is preparing for a re-competition of the program, and she asked to Board to advise on the attributes for the next generation of the program.
Drs. Antman and Kleinman described the Framework programs at their respective institutions. Dr. Antman noted that the program at Boston University is a centralized, integrated international health program with activities in Lesotho, India, and Pakistan. A three-tiered program, it includes primary care, research on trauma (accidents), and medical education. Medical students can participate in care and/or research. The program is correlated with the university’s international studies program within the arts and sciences. Boston University has offices in 44 countries and campuses in 22 countries.
Dr. Kleinman described the Framework program at Harvard University as a non-integrated, multischool program. He said the university does not have a centralized focus for global health even though there are at least eight major research programs in AIDS. Yet, global health is taken seriously at the undergraduate level, as approximately 50 percent of Harvard undergraduates express interest in global health. A high percentage of medical students also are interested in global health, and first-year medical students are required to take a course in global health. In addition, the school of pharmacy has a huge investment worldwide.
Dr. Kleinman noted that he and his colleagues are creating a ladder of curricula for undergraduates interested in global health, whereby students could progress from entry-level courses to more advanced and specialized courses, supervised fieldwork, and then a senior honors thesis research project. A similar effort is under way to create curricula for medical students. Dr. Kleinman noted that the opportunity for engaging students is so large that the president of Harvard University has identified global health as one of her two major interests. He suggested that the world is entering a “golden age of global health” and that never before has global health played such a large role in education.
For the next generation of Framework Programs, Dr. Kleinman suggested that FIC filter out approaches that are less successful and emphasize those that are more successful, to have a national and possibly global impact on all aspects of education vis-à-vis global health, including curricula, textbooks, and supervised research experiences in the field. He encouraged FIC to think beyond the re-competition to consider having a central role in coordinating and integrating global health programs across U.S. universities, perhaps through a clearinghouse function.
Dr. Glass opened the discussion by noting three points: the Framework Programs represent FIC’s constituencies in global health (e.g., cancer centers, heart centers); many awardees have leveraged FIC resources to bring other funding to global health; and the Framework award is a niche grant with tremendous value and impact. The questions now are how to continue and what to do next. The Board’s comments are summarized below.
- A Portal or Clearinghouse for Global Health Education. Dr. Hotez suggested that FIC capitalize on students’ enthusiasm for global health by creating a portal for global health education on its website, with tools for educators and students. The tools would not include standardized curricula, which would squash innovation. Dr. Antman suggested that FIC could help nourish students’ research experiences overseas by offering a clearinghouse of good programs and settings on its website.
- Synergies and Partnerships. Dr. Whitworth suggested that The Wellcome Trust, which is overwhelmed with applications for its intern programs overseas, could explore potential synergies with FIC programs in Africa. He offered that the Bill and Melinda Gates Foundation is interested in supporting revitalization of medical education in Africa and could be a potential partner as well.
- Defining Global Health through Collaboration. Drs. Alving and Antman suggested a reframing of the Frameworks Program to emphasize collaboration across university silos in African universities, much as CTSAs pool infrastructure resources across research centers. Dr. Whitworth described another possibility for defining global health, through the exchange of students between Western and African universities that have a partnership in global health.
- University Commitment and Funding. Dr. Black suggested that universities participating in the Frameworks Program be required to commit funds to the program, in order to achieve a commitment for the long term. Drs. Kleinman and Antman noted that university leaders are highly interested in global health and are committing resources for students, faculty, and curricula development.
- Networking North–South and South–South. Dr. Glass suggested that the Framework Program could promote linkages and networking across these venues to improve the quality of global health education (e.g., curricula development) and broaden participation in it. Dr. Vega mentioned that, with a Gates Foundation planning grant, the University of California is conceptualizing an initiative to link education across all of its campuses and across the U.S.-Mexico border. Dr. Whitworth noted that The Wellcome Trust is providing targeted funding to develop a consortium consisting of U.K. public health schools and an Indian public health foundation to train faculty for India.
The meeting was adjourned at 3:00 p.m. on May 19, 2009.