Department of Health and Human Services
Public Health Service | National Institutes of Health
John E. Fogarty International Center for Advanced Study in the Health Sciences
Seventy-eighth Meeting of the Advisory Board
Minutes of Meeting
September 11, 2012
The John E. Fogarty International center for Advanced Study in the Health Sciences (FIC) convened the seventy-eighth meeting of its Advisory Board on Tuesday, September 11, 2012 at 9:00 a.m., in the Conference Room of the Lawton Chiles International House, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held on September 10 , 2012, as provided in Sections 552(b)(4) and 552(b)(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. The meeting was open to the public on September 11, 2012 at 9:00 a.m., until adjournment at 3:00 p.m. Dr. Roger I. Glass, Director, FIC, presided. The Board roster is appended as Attachment 1.
Board Members Present
Dr. Roger Glass, Chair
Dr. Gail H. Cassell
Dr. Peter Hotez (via telephone)
Dr. Bonita Stanton
Board Members Absent
Dr. Robert A. Black
Dr. Barry Bloom
Dr. Maria Friere
Dr. Roscoe Moore
Dr. Derek Yach
Dr. Kevin DeCock (ex officio)
Dr. Alan Guttmacher, NICHD/NIH (ex officio)
Dr. Donald Lindberg (ex officio)
Dr. Susan Shurin (ex officio)
Members of the Public Present
Dr. Peter Agre, Johns Hopkins University
Dr. Robert Bollinger, Johns Hopkins University
Dr. George Hill, Vanderbilt University
Dr. King Holmes, University of Washington
Dr. Farin Kamange, Morgan State University
Dr. Peter Ndumbe, WHO
Dr. Norm Neureiter, AAAS
Dr. Funmi Olopade , University of Chicago
Dr. William Tierney, Indiana University
Federal Employees Present
Ms. Nalini Anand, FIC
Mr. Rick Berzon, NIMH
Dr. Kenneth Bridbord, FIC
Kasima Brown, FIC
Dr. Lois Cohen, NIDCR
Mr. Dexter Collins, FIC
Mr. Robert Eiss, FIC
Dr. Flora Katz, FIC
Ladan Fakory, State
Laura Faux-Gable, State
Dr. Dan Gernnedsay, CSR
Jeffrey Gray, FIC
Judy Levin, FIC
Maya Levine, FIC
Dr. Enid Light, NIMH
Dr. Jeanne McDermott, FIC
Dr. Kathleen Michaels, FIC
Elise Morocco, FIC
Dr. Vivian Pinn, FIC
Sybil Philip, NICHD
Dr. Myat Htoo Razak, FIC
Dr. Joshua Rosenthal, FIC
Julia Royall, FIC
Dr. Hillary Sigmon, FIC
Kristen Weymouth, FIC
Director's Update and Discussion of Current and Planned FIC Activities
Dr. Roger Glass
Dr. Glass opened the meeting and welcomed all present. The recording of the scheduled presentation by Dr. Nelson Sewankambo from Gulu, Uganda was garbled because of teleconference problems and could not be transcribed. Dr. Sewankambo spoke about the recent second annual Medical Education Partnership (MEPI) Consortium. He announced several transition involving distinguished Fogarty partners:
- Maria Freire, Board member, has joined the Foundation for NIH
- Gary Gibbons has become the director of the National Heart, Lung and Blood Institute
- Janine Clayton has become director of the Office of Research on Women’s Health
- Vivian Pinn has joined Fogarty as a senior scientist emeritus, joining Alan Guttmacher and Joel Bremen as senior scholars emeritus
- Salim Abdool Karim, a long-time AIDS worker, has become head of the MRC, South Africa
- Kevin Bialy, who is a program officer in Fogarty’s Latin American program, has transitioned to a married partnership with his new wife
- Maya Levine has joined Fogarty as a Presidential Management Intern
Dr. Glass also mentioned a number of interesting and important events:
- A Celebration of Science held at the National Portrait Gallery on September 7-9, co-hosted by NIH and the Milken Foundation
- The Medical Education Partnership Initiative annual meeting in Addis Ababa, August 6-8, with 250 participants, 40 medical schools, 12 partnering organizations and 5 NIH ICs
- The establishment of the Partnerships for Enhanced Engagement in Research (PEER) Health, under which USAID can provide grant funding for international projects and NSF can supplement funding for the U.S. investigators associated with those projects
- An AIDS conference in July to celebrate AITRP’s 25 years as a continuing grant, and the anniversary of the AIDS/TB program
With regard to the strategic plan, Fogarty is working with the NIH Director, Francis Collins, and a number of ICs to increase the extramural and international grants at a time when budgets have been flat lined. There have been co-funding agreements reached with the Indian government and the Chinese NSF, and there are efforts under way to expand that o-funding opportunity the other BRIC countries. Dr. Glass mentioned the beginnings of possible cooperation with Cuba, which has been under a no-contact policy for years. Recently Kevin Bialy arranged a first cooperative agreement allowing an exchange of information, narrowly focused on a unique murine monoclonal antibody sequence developed by the Cuban. It is essential for a program now under way in the Pediatric Oncology Branch.
Dr. Glass commented that he and co-chair Susan Shurin are meeting regularly to develop a presentation in the fall for the IC directors, which will focus on data, clinical trials and communications. Part of the effort is aimed at defining how many programs and how much funding is being directed into the global health arena.
In December the third meeting of the mHealth Summit will focus on linking cell phone technology to health in low-income countries, especially in rural areas. Finally, Sir Mark Walport, director of the Wellcome Trust and newly appointed Chief Scientific Officer in the UK, will deliver the annual Barmes Lecture, discussing his views on the last ten years of African heath care.
Dr. Glass mentioned the importance of the Fellows and Scholars Program, managed by Myat Htoo Razak, which trains U.S. postdocs in low-income countries to do research that could lead to K awards. Several ICs have research platform abroad, including NCI, NHLBI, NICHD and NIMH. Also supporting such research is the new Fogarty Fulbright program that includes undergraduates, medical students and postdocs. It will be established in eight countries. Finally, there is also the Global Health Program for Fellows and Scholars, which has a total of 72 researchers receiving funding support through five educational institutions in the U.S. (UC Berkeley, UC Global Health Institute, University of North Carolina, Vanderbilt, and the University of Washington.
Minority capacity building in global health research
Dr. Glass commented that there is an issue concerning minorities in some of these programs, and diversity is an issue that must addressed. The Minority International Research Program is one group Fogarty has been working with to encourage greater diversity. Dr. Glass invited Board member George Hill, whose career has been focused on diversity, to comment. Dr. Hill observed that Dr. Pinn, also a long-time advocate of diversity, is an important new asset to Fogarty. She was involved in the National Center for Women’s Health and Research and was active in the National Medical Association, the leading association of minority physicians. It is clear that minority scientists are interested in global health, and Dr. Hill suggested three points that would support advancement in that area.
First, there must continue to be development of valid statistical data to track progress; second, if there is a commitment to addressing diversity, Fogarty must step onto the playing field and consistently and persistently promote activities and programs that will expose the scientific community to Fogarty; and third, Fogarty mush begin a strategic planning process. Dr. Pinn added that there is a legal requirement to identify race/ethnicity and sex of all participants in clinical trials. She felt that should be extended to those participating in career development programs and grants. That would provide additional statistical information to inform the programs that promote diversity.
Report of the Center for Global Health Studies
Ms. Anand began her discussion of the Center for Global Health Studies with its mission, to provide a platform for project-based scholarship in global health with a focus on three areas – the intersection of science and policy to achieve the translation of science into better programs and policies; short-term training that does not duplicate that offered by traditional educational institutions; and creating a research roadmap to identify priorities and concrete deliverables.
With support from Dr. Bollinger and the Center for Global Education at Johns Hopkins, there will be a summit in February dealing with ICT for education in the global health workforce. With significant support from Fogarty in the area of recruiting partners and bringing in stakeholders, the summit will be held in New York City, hosted by the UN Office of Global Partnerships. The Center will provide policy briefs on current issues relate to the topic.
The Center hosted a three-day writing workshop on bioethics in late May, and the product of the workshop will be papers related to Fogarty’s bioethics programs over the past ten years, with recommendations for the future. In October the Center will host a three-day institute related to household pollution at which 20 trainees will look at how cookstoves work. Dr. Glass added that, on October 9, there will be a cookstove cookout, all invited, to see how they work. The attendance of Dr. Collins will emphasize the importance of the issues of indoor air pollution and how the cookstoves are part of the problem.
Finally, the Center will be part of a collaboration with the State Department’s Office of the Global AIS+DS Coordinator, along with the NICHD, with funding support from OGAC, to publish an RFA on implementation science related to prevention of mother-to-child transmission. The RFA would bring together researchers and in-country implementers to form a network that hopefully will survive the two-year grant period. The network would maintain a dialogue and exchange of information to keep researchers and health care providers up to date. Ms. Anand mentioned several projects that would be ongoing during the coming year or so – projects in brain disorders, the mapping of tobacco use, workshops on HIV and NCDs, a Global Mental Health writer’s workshop, and a workshop on urbanization gender and health.
Finally, the Center is looking forward to developing a scholars-in-residence program that would invite scholars to devote a few months, two to six, working on various topics related to Fogarty’s mission. There is thought of creating an advisory group from the Board membership to advise the director on strategy and directions the Center might take to contribute to that mission.
Dr. Mahmoud commented that the advisory body is an excellent idea that will require funding, and should consider advisors outside the Board, and even outside NIH. Dr. Cassell agreed, adding that the outside organizations, both educational and commercial, might even provide sabbatical support for six months or a year.
Research Opportunities in the Middle East/North Africa Region (MENA): Science in Iran
Dr. Glass introduced Judy Levin, who heads the MENA program at Fogarty, an area of the world that receives less than 5% NIH funding. Even that small amount, Dr. Levin observed, is considerably larger than just a few years ago, thanks to the support of the Division of International Training and Research, and to the establishment of new programs, especially research training programs. Dr. Levin noted that a dozen ICs provide 46 grants to 16 MENA countries. In addition, some of the wealthy Gulf countries provide supplemental funding, usually in collaboration with specific NIH-funded researchers.
Dr. Levin commented that a recurring question is why Iran? Since in Iran is sophisticated, but there is an ignorance about what is actually happening there and what the science capacity is. But there is increasing collaboration and it would be helpful to focus on those experiences.
Dr. Levin stated that there would be four presentations about research opportunities in the region.
Dr. Agre explained that, on invitation of the Iranian Foreign Minister Alehi, he and colleagues were invited to Iran, hosted upon arrival by the Minister of Science and Technology, and sponsored by the director of the Elites Foundation, the equivalent of the U.S. National Academies. Individual expressed concerns not about whether the U.S. was a suitable and friendly partner, but about the sanctions being imposed by the U.S. State Department. For example, they were having serious difficulties obtaining chemical reagents needed for research. Nonetheless there is great interest in developing collaborations if some of these restrictions could be alleviated.
Dr. Neureiter commented on the effect of the extremely difficult political environment that exists between the U.S. and Iran, even though there is simultaneously a very strong interest in the scientific communities of both countries to develop partnerships. In spite of the restrictions there are still efforts to overcome the roadblocks. There have been a number of joint workshops in the last several years, and there are over 2,500 Iranian nationals attending universities in the U.S. There have been workshops on food-borne illnesses, higher education, ecology and the Caspian Sea, and more workshops are being planned. Despite the discouraging politics, the State Department has begun issuing multiple-entry visas to Iranian students, and there is promise of an arrangement to allow U.S. students to visit newly established science parks in Iran, which demonstrate how young entrepreneurs can start their own businesses.
Dr. Navid Madani introduced herself as an Iranian-American scientist, who first visited Iran in 2003. She explained that Iran has been a major factor in science and technology in the region since 1300, and most governments in recent times have maintained S&T as a high priority. During her presentation she discussed stem cell research, cardiovascular research (40% of all deaths are related to heart disease), oncology and HIV/AIDS.
The Royan Institute, originally a fertility clinic, was approved as a cell-based research center in 1998, and in 2002 there was approval to begin research with embryonic stem cells as long as the cells were “pre-ensoulment” (before the nervous system develops and before the embryo has the soul of a human being). In 2008 a sheep and a goat were cloned. Stem cell research has also been focused on spinal cord war injuries and a few rare genetic diseases (glycogenic storage disease).
Cardiovascular diseases are being studied in a number of hospitals and universities, and a major study was mounted based on the Framingham design. It has 60,000 adults who are followed annually. Over 300 publications have come from that study. Finally, in oncology, there are studies looking at natural products (like saffron, which comes from Korasan Province) as possible treatments for cancers.
Dr. Madani commented that there is a silent AIDS epidemic in Iran, mainly among IV drug users. Iran is the major route of opium traffic moving into Europe. There is significant research, especially in genotyping HIV, as well as government involvement by key leaders to support efforts to reduce use and ameliorate stigma.
Dr. Madani concluded that there is a strong science base in Iran, and great opportunities for collaboration. Dr. Hotez interjected a comment that there is a need for “vaccine diplomacy” in Iran, which has expertise but not the resources to pursue vaccine development that would benefit the entire region. He recalled that Albert Sabin developed his polio vaccine in collaboration with Russian scientists and he accomplished that during the Cold War.
Dr. Dawsey, an intramural researcher from the Division of Cancer Epidemiology and Genetics, discussed gastric and esophageal malignancies in China and Northern Iran. Esophageal cancer is the sixth most common cause of cancer death in the world, and 80% of all esophageal cancers are squamous cell carcinoma (ESCC). The highest incidence in the world is located in the Caspian Sea area into Northern China (there is also high incidence in southeastern Africa). The rates in these areas are ten times higher than in other areas of the world. After a country-wide survey of cause of death in China in 1973. Before that, in 1959, the Chinese began to study ESCC by setting up a permanent field station, establishing a cancer registry, and initiating natural history research programs. NIH entered the picture in the early eighties with two projects. The first was a large study in Linxian, which randomized 30,000 to a number of cohorts, each receiving a different combination of supplements. Results of that study suggested that factor D (selenium, beta carotene and vitamin E) significantly reduced total cancer mortality. Secondly, although polycyclic aromatic hydrocarbon (PAH) exposure was high, the negative effects in terms of cancer incidence were less from smoking than from wood-burning cookstoves. The study also revealed that endoscopic exams were more effective at diagnosis than balloon cytology. That study expanded to a national screening program that screens 150,000 annually.
Shifting to Iran, Dr. Dawsey described the Golestan Case-Control Study beginning in 2003 that recruited 300 diagnosed ESCC subjects, 571 neighborhood controls, and 300 controls from the Atrak Clinic. The data was collected through the use of lifestyle surveys and some tissue samples. Following the Golestan study, the Gemini Project (2004-2008) was begun with a larger study population (over 50,000 adults), using the same data collection process. Follow-up was 99% reliant on cell phone contact, with only a 1% lost to follow-up rate. One result was confirmation that PAH exposure was extremely high, but the specific cause of the exposure has not been defined. Dr. Dawsey commented that the Gemini model has been used in other countries, including Kashmir, Kenya and Brazil.
Lessons learned, aside from the scientific conclusions from the studies? There must be a benefit to the people involved in the studies, the choice of principal investigators is very important, developing good relationship with collaborators significantly enhances results, and insofar as possible politics must be excluded from the study design.
During discussion there were a number of observations:
- NIH has funded grants to Iranian institutions. It requires an extra step to obtain a license from The State Depart Office of Foreign Assets Control. It is not an onerous process. NIDA obtained the first of these licenses in 2008.
- The Middle East is three regions – very poor countries (Djibouti and Yemen), middle income countries (Iraq, Iran, Pakistan) that do have resources but are politically complicated, and the Gulf oil states that have money but lack human resources and are looking for collaborators. The Qatar Foundation put $8 billion into an endowment that created Education City, and seven U.S. universities are already establishing a presence there.
- The countries that lack financial resources often have significant human resources in terms of trained scientists and researchers. The richer Gulf States need training programs but, being rich, don’t qualify for U.S. grants.
- There is a culture barrier. In one Iran, 56% of medical school graduates are women who have difficulty finding residency program appointments that traditionally go to male graduates. The religious establishment is also very influential and must be considered in making policy decisions.
- Two avenues of contact in the region are engaging the Diaspora, and supporting fellows and scholars.
- CDC is substantially engaged in the region through a global version of the CDC Epidemiology and Intelligence Service. The region benefits in three ways – receiving support for outbreak investigations; training programs for managers and health officials; and mentoring in research that is resulting in increased publications from the region.
- AAAS has an agreement with Saudi Arabia to review grant proposals, which are strong for some industries (like petroleum) and weak for others (health care). Fogarty might find a place to contribute to resolving that problem.
Present and Future Directions of MEPI
Dr. Glass led a wide-ranging discussion in the afternoon session concerning the past and future of the MEPI program. MEPI is a five-year program co-sponsored by PEPFAR, in partnership with HRSA, focused on Sub-Saharan Africa to increase research capacity in medical schools and train new physicians. There are a number of partners, including CDC and several NIH ICs. He noted that MEPI is in its third year, with a few years left to build a sustainable partnership among the universities, to develop a cadre of teachers for the future, and to develop a research agenda that will support those teachers. He invited the program coordinator, Myat Htoo Razak to comment on the program.
Dr. Razak commented that all of the MEPI programs have focused on medical education and training in the first three years, working closely with partner U.S. universities, and working on decentralized, community-based training sites. In Uganda, for example, there are 95 such sites spread fairly evenly across the country. He stated that ICT is an important part of the training infrastructure and in one area of South Africa there is a platform that is compatible with teaching through PDAs, Blackberry phones, intranet connections to laptops, and the Internet cloud.
Dr. Razak noted that the goals include improved research capabilities that lead to evidence-based health services, improved faculty recruitment and retention, and support for a broad range of students in medicine, nursing, pharmacy, technology, dentistry and other specialties. Without support from the country governments, MEPI cannot reach its goals. And three are examples of countries that are coming to the plate – Zimbabwe providing $200,000 to improve medical education, Ethiopia increasing the number of medical schools and medical students during the last few years, and support from the African Medical Schools Association in developing collaborations from many countries including Brazil, the U.S., and India.
During discussion there was a comment that some of the challenges include the fact that U.S. models cannot be easily transposed to the Sub-Saharan environment; medical education needs to be contextual; there is a lack of experienced trainers; structural development is needed, as well as physical laboratories; and there is a need to provide training in pedagogy.
Dr. Morales briefly described the Nursing Education Program Initiative (NEPI) that has basically the same principles, goals and objectives as MEPI. Funding is slightly different, beginning with a PEPFAR-supported needs assessment and an arrangement with the ministries of health to identify the nursing schools that should take advantage of the NEPI support. NEPI is currently functioning in six countries.
Dr. Mullan described his coordinating center’s efforts to provide advice on evaluation, technical assistance and education, and conducting site visits to all 13 schools in his area of responsibility. All were visited in year one, and eleven in year two. The visits involve the participation of two faculty members from George Washington University, two from Professor Omwasa’s team, the African Center for Global Health and Social Transformation, and a principal investigator from one of the schools visited. Professor Omwasa observed that, although there has been some economic stress in the past, there is new hope in the regions that the present improvement in the economies will continue, as will the MEPI support for the medical schools. The governments are also becoming more engaged, partly because of the requirement that they must in order to be eligible for the MEPI grants. Finally, there is the need to address the financing of medical education for students through revisions in the tuition policies. For a government to mandate free medical school education may result in no one receiving sufficient funding for tuition.
There were a number of observations that included a comment that shared curricula should be a priority, even with the challenges of working with various regulatory bodies in the various countries. There is also the need to continue developing ICT infrastructure, and learning how to use it efficiently once it is built. There was a comment that partnering with the private sector is particularly challenging and complicated, but that making a few small steps in that direction might create a foundation for future growth in such cooperation.
Dr. Glass invited Executive Director Rob Eiss to make closing comments. Mr. Eiss announced that the strategic plan revision was in mid-course and that the Board would be provided with a draft for review prior to sending the draft to the ICs.
There would be an invitation for two volunteers to serve as co-chairs of a steering committee for the Center for Clinical Studies.
Discussions will be initiated to look at a partnership between Fogarty and the Qatar Foundation.
A calendar of events will be sent to Board members, with an invitation to consider participating in any of the Fogarty functions scheduled for the near future.
Finally, in the current tight budget environment, reliance would be placed on Board members to elevate the visibility of the Fogarty International Center and its activities.
Dr. Glass expressed appreciation for all of the contributions to a very successful meeting. He adjourned the meeting at 2:35 p.m.