May 12, 2015 Advisory Board Meeting Summary Minutes

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

Eighty-second Meeting of the Advisory Board
Minutes of Meeting
May 12, 2015, 2015
John Edward Porter Neuroscience Center, Building 35, Conference Room
National Institute of Health, Bethesda, MD

The John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) convened the eighty-second meeting of its Advisory Board on Tuesday, May 12, 2015 at 9:00 a.m., in Building 35, Conference Room, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held on May 11, 2015 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 May 12, 2015 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.

Attendee Information

Board Members Present

Roger I. Glass, M.D., Ph.D. (Chair)
Michelle Barry, M.D.
Janine Clayton, M.D. (ex-officio)
Wafaa El-Sadr, M.D., M.P.H.
Greg Germino, M.D. (ex-officio)
King Holmes, M.D., Ph.D.
George C. Hill, Ph.D.
Vikas Kapil, M.D. (ex-officio)
Joseph Kolars, M.D.
Walter Koroshetz, M.D. (ex-officio)
Stephen Morrison Ph.D.
Rebecca Richards-Kortum, Ph.D..
Bill Tierney, M.D.

Members of the Public Present

Wally Carlo, University of Alabama
Ghada El-Haj Fuleihan, American University of Beirut-Medical Center
John Monahan, Georgetown University
Oladosu Ojengbede, University of Ibadan
Purevdorj B. Olkhanud (Puje), Mongolian National University of Medical Sciences
David Warburton, University of Southern California
O’ Dale Williams, Florida International University

Federal Agency Representatives Present

Nalini Anand, FIC
Farah Bader, FIC
Craig Barger, FIC
Rachel Bishop, NEI
Katrina Blair, FIC
Kenneth Bridbord, FIC
Lois Cohen, NIDCR
Dexter Collins, FIC
Rob Eiss, FIC
Lyn Hardy, NINR
Maggie Brewinski Issacs, NICHD
Flora Katz, FIC
Vesna Kutlesic, NICHD
Kathleen Michels, FIC
Mark Miller, FIC
Joseph Millum, CC/FIC
Laura Povlich, FIC
Ann Puderbaugh, FIC
Myat Htoo Razak, FIC
Lana Shekim, NIDCD
Hillary Sigmon, CSR
Barbara Sina, FIC
Rachel Sturke, FIC
Stacy Wallick, FIC
Kristen Weymouth, FIC
Celia Wolfman, FIC

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Closed Session

Open Session

Director's Update: Current and Planned FIC Activities

Dr. Glass welcomed those present and introduced new Board member Dr. Walldenara Carlo, and noted that two others, Dr. Haile Debas and Dr. Vanessa Bradford Kerry would be joining the Board as well. Concerning recent activities, Dr. Glass mentioned that Dr. Don Lindberg recently retired as head of the National Library of Medicine, which under his aegis has had a significant impact on spreading health information throughout the world. The NLM has materials in over fifty languages, which is accessed every day by millions around the globe, a free service of NIH. Dr. Glass noted that Dr. Jack Whitescarver will join the meeting during the day, adding that 40% of the Fogarty budget is related to AIDS research. Dr. Whitescarver is involved in most of the AIDS research activities at NIH. Finally, he stated that Kevin Bialy is in Liberia working on the Ebola situation.

Dr. Glass mentioned that he was in India to attend the launch by Prime Minister Modi of Rotavac, a rotavirus initiative with the goal of bringing the vaccine to children for less than $3.00 for the three-dose regimen. It is the first new vaccine made in India in the last hundred years. Following the India visit, Dr. Glass was awarded with the Albert B. Sabin Gold Medal for his rotavirus vaccine research.

Dr. Glass commented that Fogarty often partners with other Institutes on global health activities such as the NICHD Global Health Consultation Meeting on research gaps at the intersection of child neurodevelopment, neural inflammation and nutrition in the low resource setting. Dr. Glass recognized Stacy Wallick for her support of several ICs in negotiating an agreement whereby the NIH and the South African Medical Research Council would jointly fund a $40 million, multi-year effort on HIV prevention among South African women, including research on HIV related to breast cancer outcomes and on pediatric tuberculosis treatment. A very small part of the Fogarty portfolio is related to disease prevention and the promotion of research in MENA (Middle East and North African) countries. Dr. Glass commented that he and Stacy Wallick had participated in a conference in Oman in early March that involved 400 participants from 33 countries, plus NIH, CDC, WHO and others. There have been other site visits, including a visit in mid-February to Lima, Peru involving over 60 Fogarty alumni. Among other Fogarty programs, there is an effort at the University of California, San Diego School of Medicine that includes a number of MEPI grantees.

In March Dr. Glass stated that he, several Fogarty staff and three Board members participated in the meeting of the Consortium of Universities for Global Health (CUGH), which included a session on Fogarty fellows that drew over 150. He recalled that the Consortium was started at an initial meeting at NIH. On April 13, at a meeting of the Center for Strategic and International Studies (CSIS), Dr. Pamela Collins presented a report entitled Circumpolar Health: Arctic Human Development. She explained that it has become clear that mental health is the key factor that explains the exceptionally high rate of suicide among the populations in the arctic regions, particularly among Eskimo communities. She commented that the high rate is among the younger men and comorbid factors might include alcohol use, unemployment, and a weakening of traditional cultural values. Board member Dr. Steve Morrison, of CSIS, briefly commented on the effort, which has not had additional funding in the past few years. He expressed appreciation to Dr. Collins for her contribution, and noted that there was some interest by Senator Mikulski that might lead to additional funding.

Dr. Glass stated that Fogarty has had a commitment to clean cookstoves. He highlighted the inaugural meeting of the Clean Cooking Implementation Science Network in April. The Network is sponsored by several ICs, the Common Fund, the Bill and Melinda Gates Foundation, and the Global Alliance for Clean Cookstoves (GACC). Josh Rosenthal commented that the big issue is whether evidence can be identified that respiratory disease can be reduced through household interventions that can be scaled up to the community level. Dr. Glass mentioned an OAR meeting at which an agreement with the Russian Foundation for Basic Research was extended. That effort is looking at HIV and tuberculosis.

At the end of April Fogarty and other partners sponsored a meeting with the Wellcome Trust to define the research environment and geographic distribution of research, and part of that effort was to update the World RePORT web site (www.worldreport.nih.gov), at which one may find both NIH grants and foreign components of domestic awards, which provides a much more complete picture of the global research grant landscape.

Concerning future events, Dr. Kathy Michels will lead the NCD network meeting on May 13-15, a program which involves 432 trainees, who have produced 342 published papers. On May 18-22, the World Health Assembly will meet, which will include representation of a number of MEPI countries, other partnership countries, including the BRICs countries. In late May, Dr. Rachel Sturke will host the final meeting of the PEPFAR Consultation on PMCTC, which will be held at Fogarty’s Center for Global Health Studies (CGHS). On June 1, in Ottawa, the Global Alliance for Chronic Diseases (GACD) will meet. GACD’s first call four years ago was on hypertension, followed by the recently released call on diabetes, and it is anticipated that in a year or so the third call will be on environmental lung disease, followed by mental health and a scale-up of the hypertension call. On June 18th, Dr. Chris Murray will visit to share his thoughts about the global burden of disease, specifically in three areas: 1) high resolution mapping of GBD; 2) new insights into NCD risk factors; and 3) surprises in the GBD in the U.S., including minority health, health disparities, and alcohol abuse. In early July the orientation for Fogarty Fellows, Scholars and Fulbright-Fogarty Fellows will take place.

The MEPI annual meeting in Zimbabwe will be held on July 14-16. It will be the fifth and final meeting under the current program, and Fogarty is working with OGAC to support an extension of the program. Drs. Wafaa El-Sadr and Bill Tierney will co-chair the July 28-29 PEPFAR-NCD meeting, and on July 28 NIH will host Dr. Agnes Binagwaho, Minister of Health for Rwanda, as this year’s David E. Barmes Lecturer. Finally, Dr. Glass noted that the Global Forum on Bioethics in Research, which had become dormant for a few years, was being reactivated and a meeting in scheduled for later in the year, with Drs. Joe Millum and Barbara Sina representing Fogarty.

Dr. Glass offered a special thanks to Rob Eiss for his very effective role as Associate Director in the Office of the Director, NIH, and for his diplomatic aplomb in successfully managing two important annual meetings, one with the Heads of International Research Organizations (HIRO) and the other with the Bill and Melinda Gates Foundation. He also thanked Dr. Ken Bridbord for serving as Acting Deputy Director of FIC.

In closing. Dr. Glass reminded the Board of the next meeting on September 14-15.

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Program Concepts: Bioethics, Trauma, IRSDA, Dr. Christine Jessup and Dr. Myat Htoo

Fogarty International Research Scientist Development Award (IRSDA)

Dr. Jessup announced that she would present a program renewal concept for the Fogarty International Research Scientist Development Award (IRSDA), and an update on a parallel program for LMIC scientists that was cleared by the Board in 2013. The program has supported 65 individuals in 26 LMICs, in a wide variety of fields. It is a key element in providing opportunities for launching research careers, using the NIH K award. The Fogarty program requires the fellow to have both U.S.-based and LMIC-based mentors, and that the recipient spend at least half his or her time in the LMIC. The recipient must devote 75% of his/her time (9 months a year) to the award responsibilities, which works out to about 4.5 months a year in the LMIC. Dr. Jessup showed a graph of the NIH ICs that support similar programs. Significant support comes from NIAID, NICHD, NIDA, NIEHS, and NIMH.

A parallel program, the new program cleared by the Board in February 2013, is modeled on the IRSDA program, except that the program is open only to LMIC scientists who hold a junior faculty position at an LMIC institution. They cannot receive outside research funding, and will work under the mentorship of both U.S. and LMIC scientists, and the research effort must take place mainly in an LMIC.

Dr. Glass asked if this type of program could be done for engineers, and Dr. Rebecca Richards-Kortum stated that junior faculty might face difficulties with the restrictions of the programs. A problem of allowing grantees to participate in a cooperative program in the U.S. is the cost of living challenge. Dr. Holmes commented that the program seems to be laudable, but the salaries paid are too low considering the requirement to travel internationally to participate. It was noted that the salary set by the award is $75,000 for most institutions. Dr. Glass agreed that the salary issue has been raised by a number of individuals and it is an issue that needs to be addressed. Asked about the flexibility of the time in country requirement, Dr. Jessup noted that there was good flexibility, and that the individual could allocate the required time in country to any part of the five-year grant period, as long as they spend at least three months a year in country every year. Dr. El-Sadr commented that the salary would probably have to be supplemented by the grantee’s institution. There was a comment that current graduating medical school debt is as much as $300,000. That would preclude consideration of the program by most newly minted physicians. There was also an observation that medical school typically have significant debt, which restricts how much supplemental support can be allocated to these programs.

Trauma

Dr. Myatt Htoo Razak stated that, according to the WHO, injuries kill more than 5 million a year. There are more than 1.2 million traffic injuries a year. Injuries affect all ages, men, women and children. There is a need for evidence-based interventions to reduce this toll, especially in LMICs where there is very little research support available. The Fogarty International Collaborative Trauma and Injury Research Training Program (TRAUMA) was begun in 2004 with a dozen grants in the first seven years, and six more between 2007 and 2016. Those grants, covering a huge geographic area, were for about $160,000 each per year over five years. The present grants expire in February 2016.

The concept proposal is to continue and to strengthen the program in academic institutions in LMICs with training programs ranging from non-degree to advanced degrees (Ph.D.). It has been shown that progress can be achieved in injury reduction when there are qualified doctorate level researchers involved, especially in the LMICs. The program will support, at the institutional level, research faculty involved in injury research. The specific content of the programs is determined by the local institutions.

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Impact and Direction of the Fogarty Center for Global Health Studies (CGHS)

Nalini Anand, Director, Division of International Science Policy, Planning & Evaluation, and Director, Center for Global Health Studies, FIC

Ms. Anand, noting that the CGHS was three years old, outlined the evolving mission statement – to help identify emerging priorities and stimulate scientific advances in global health; to advance the implementation science agenda; and to encourage multi-disciplinary collaborations across sectors and regions, that speaks to expanding cooperation beyond the science arena, and engaging the community, private sector, foundations, and more. CGHS will coordinate trans-NIH projects that have importance to various ICs and that can benefit from implementation science. Areas of interest include HIV and NCD research and training, clean cookstoves and household air pollution, and mHealth. To give the projects legs, criteria for each is established – to insure the project is consonant with the overall Fogarty mission; serves multiple IC missions; will result in concrete deliverables; and insures a contribution to implementation science, research and training

A primary deliverable has been and will be scientific publications, but future deliverables will include research collaborations, development of networks, creation of training materials and tools, the creation of a web-based tool kit for research dissemination, and presentations that can be used at various major conferences. Ms. Anand noted that one important aspect of Center projects is the effort to engage LMICs whenever possible, not only as recipients of the project’s output, but as participants in the planning and execution of the project. Ms. Anand also described the extent of the projects being actively pursued and planned through 2015. Currently seven projects have been completed and there are nine in the pipeline. Within NIH there are 15 ICs in partnerships or collaborations; the five most involved, each with five or more collaborative projects: NIMH, NICHD, NHLBI, OAR and NCI. There are a number of Federal partners (CDC, USAID, State Dept.), and the Center is encouraging participation by NGOs, professional societies, private sector companies, foundations, research groups and journals.

Ms. Anand was pleased to announce the formation of a subcommittee of the Advisory Board to support the Center, comprised of Drs. Haile Debas, Joe Kolars and King Holmes. In reviewing the discussion, Ms. Anand suggested that dissemination of CGHS’s products should go beyond publication of a paper, that there should be a proactive connection between those products and NIH funding opportunities, and that implementation science should continue to be a focus, as should development of new partnerships.

Dr. Holmes commended CGHS for defining its niche as a leader in sponsoring crosscutting projects across disciplines, ICs, other agencies, sectors and regions. That role appears to encompass the important area of implementation science in terms of research and training. Dr. Kolars also commended Nalini and her team, and felt one important goal was to extend the impact of the CGHS’s work beyond the ordinary publication of papers as a project output.

Dr. Glass invited other comments. Dr. El-Sadr suggested that targeted training grants in implementation science be considered, and perhaps developing more proposals specifically focused on implementation science. For that effort collaboration with ICs would be required. She added that implementation science research proposals are different from the traditional grant applications and the reviewers of traditional grants may not be the most appropriate for assessing implementation science grants. She also suggested that developing a standing study group with an implementation science orientation would be a positive step.

Dr. Povlich commented that NIH has a specially-appointed implementation science study section to look at implementation science proposals from all ICs. The study section is made up of experts in implementation science. Dr. Pamela Collins mentioned a new RFA recently released that combines a proposal for specific research with an added layer of sustainable implementation activities. Dr. Richards-Kortum suggested linking short-term training Institutes to RFAs both at the applicant level and the reviewer level. An appropriate short-term training Institute to consider would be one on injury prevention because it would have broad appeal for the community. Dr. Glass asked if there were lessons to be learned from the CSIS, albeit that the focus is on policy at CSIS and on research and implementation at the Center. Dr. Morrison responded that it is difficult to quantify impact when the focus is on identifying serious policy problems in global health, and then trying to engage the Executive Branch and Congress in a dialog to address the problems. He added that there are also unique opportunities that arise in the transition period between an administration that has had an eight-year run and the arrival of a new administration. He suggested that these opportunities might also exist for Fogarty, particularly for reaching new outside partners.

Asked about the recent developments in Latin America, particularly Mexico, to reduce obesity, Dr. Germino commented that his Institute was considering the commitment to that kind of specific challenge, and implementation science in general. There was a proposal that, when policies and programs are considered, it would be appropriate to include representatives from the LMICs at the outset, particularly since they have a perspective that might be difficult for more developed countries to articulate.

Dr. Glass mentioned the role of women in global health, in areas like extending life expectancy, childbirth, and HIV mother-to-child transmission. Dr. Clayton commended the Fogarty emphasis on implementation science, noting that involvement of multiple sectors in dealing with some of the very complex health issues that are part of women’s health is critical, especially because so many aspects of women’s health require a multidisciplinary approach.

Dr. Kolars commented that there should be a repository of exemplars of the global health successes that Fogarty has experienced. Dr. Glass responded that many of those successes have been chronicled in Fogarty’s Global Health Matters, but the audience may be somewhat limited. Ms. Puderbaugh commented that Fogarty does have success stories, but actually fewer than desired. She suggested challenging the grantee community to identify new successes and bring them to Fogarty’s attention so that they can be moved into the mainstream media.

Dr. Glass described a project in Malawi using low-cost computer-based technology to employ sonograms to diagnose pregnancy, and to identify pediatric cardiology problems such a valvular disease and congenital heart problems. He suggested a trans-NIH consultation on low cost technology developed for global health. Dr. Glass asked about the HIV/AIDS program in Eldoret, and Dr. Tierney responded that early on it was clear that the issues far exceeded HIV/AIDS diagnosis and treatment. There were issues of intimate partner violence, orphans, malnutrition, housing and employment that had to be considered. The program expanded to be truly population based and data was gathered from over a million people to identify needs, both immediate and longer term. Dr. Tierney commented that since there was no resource for learning how to develop the program that development was evolutionary, trying things, making mistakes, responding to the mistakes and developing a more effective program over time. He said there is a need for a forum that can develop and share best practices. Ms. Anand added that the PEPFAR-NCD project, under the guidance of Drs. El-Sadr and Tierney, will address the complex issues mentioned. One outcome will be regional meetings to exchange experiences and best practices about what has worked in various program venues. Dr. Warburton, who has a grant for a project in Mongolia, commented that one of the greatest challenges is getting information out about the project. He suggested the information needs to be graphically attractive and developed in a digital format. Dr. Glass reiterated the importance of sending such information to Ms. Puderbaugh.

In closing the discussion, Dr. Glass commented that the planned tribute to Dr. Jack Whitescarver, who at the last minute was not able to attend the meeting, would be prepared in writing. Dr. Glass added that he would send a letter of appreciation for his support of Fogarty’s HIV/AIDS programs, along with a slide set demonstrating much of his NIH career that was to be presented at the meeting.

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A Worldwide Sampler of Fogarty Research Training in Non-Communicable Diseases and Disorders

Dr. Glass introduced the afternoon session devoted to an overview by Kathy Michels’ non-communicable disease program, which will have four presenters, followed by Board discussion.

Dr. Kathy Michels, Program Officer, Division of International Training & Research, FIC

Dr. Michels demonstrated that NCDs have been increasing in proportion to communicable diseases over the past 15 years. Although NCDs cause deaths, they also cause a significant burden of morbidity. Over that time 12 NIH ICs have collaborated to support programs in NCDs to sustainably strengthen the capabilities of LMICs to train in-country experts and to contribute to the research data base. Beginning in 2001, the International Clinical, Operational and Health Services Research and Training Award (ICOHRTA) had as an integral part an implementation component, although it was not then called implementation science. A few years later, the ICs drove the Implementation Science agenda, which was mainly mental health, substance abuse, nutrition, maternal and child health, and diabetes. In 2008, realizing there were gaps, the Millennium Promise Non-communicable Disease Program was implemented, to cover cardiovascular, respiratory disease, cancer and psychiatric genetics. In 2010, the umbrella program covered non-communicable chronic diseases and disorders across the lifespan. By that time the original five IC partners had increased to ten. There are now 43 countries involved, 12 NIH partners, and 432 trainees. There are also new multinational collaborations being formed, mainly in Asia, some of which are self-supporting. Dr. Michels invited the grantees to present their programs.

Dr. Ghada El-Haj Fuleihan, Professor of Medicine, Director Calcium Metabolism and Osteoporosis Program. American University of Beirut-Medical Center

Dr. Fuleihan stated that the American University of Beirut (AUB) was established in 1866, now has 700 faculty and 8,000 students, and 120 programs offering degrees to the Ph.D. level. Her program, the Calcium Metabolism and Osteoporosis Program, was established in 1997. The program is mainly involved with translational research, and works with basic research scientists and other University programs. The program partners with other departments in the AUB, with institutions in Lebanon, and with international societies and organizations.

The Scholars in Health Program (SHARP) was awarded in 2012 and launched in 2013. Its mission is to provide superior didactic education complemented with state-of-the-art interactive and practical training in health research, with a focus on non-communicable diseases research. It is intended for physicians and other health care professionals, to improve and advance the health care agenda for non-communicable diseases in Lebanon and the region. It is a hybrid between curriculum building and training, addresses population and patient-oriented research needs, and brings together research and academia, clinical practice, management and health policy.

There is an intensive summer program, with options to pursue a master’s level degree. The summer certificate program has grown over the past several years, with applications coming from most of the MENA countries. There are challenges to any successful NCD agenda, and there are challenges that are specific to an agenda related to a limited national infrastructure and limited human and financial resources. Dr. Fuleihan stated that her program is addressing the challenges and capitalizing on unique opportunities that may arise. In conclusion, Dr. Fuleihan stated that two programs have contributed to capacity building in bone metabolism, the Calcium Metabolism and Osteoporosis Program, and the SHARP program.

Dr. Oladosu Ojengbede, Professor of Obstetrics and Gynecology, Director, Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, University College Hospital, Ibadan

Dr. Ojengbede noted his affiliation with the University of Ibadan and the University of Chicago, adding that the D43 Partnership plans to build multidisciplinary teams of collaborators across the two institutions. The output of the collaborations should improve clinical practices, and contribute to the development of health policy in Nigeria. Dr. Ojengbede mentioned that he was on the National Reproductive Health Working Group, the highest policy advisory body in Nigeria.

There is strong support for research, promoting the development of teams at all levels of training, building networks (including peer support groups and mentorship programs), and making infrastructure available for the conduct of clinical trials by D43 scientists. The structure of the training plan includes long-term training programs leading to college level degrees, medium term training that provides shorter courses of 3-6 months in areas such as food management; and finally short term training that includes week-long training courses, seminars and workshops.

There are focus areas, one of which is cancer treatment. Examples of improving infrastructure include a D43 nurse Ph.D. who established a genetic counseling and cancer risk clinic at the University of Ibadan, and a pharmacist who used his D43 training to replicate best practices to create an oncology pharmacy safe room. Dr. Ojengbede mentioned the sponsorship of the African Cancer Leaders Institute as part of the 2013 and 2015 AORTIC Conference. The focus on cancer is in part because of the high prevalence of breast cancer in Africa and the consequent mortality and morbidity. D43 trainees are working with Novartis to develop at least 100 tumor/normal pairs sequenced from 250 tumor biopsies.

In general there is strong PI leadership and mentorship support, solid institutional infrastructure, and good training potential.

Dr. David Warburton, Director, Developmental Biology, Regenerative Medicine and Global Child Health Program, Saban Research Institute, Children’s Hospital Los Angeles
Dr. Purevdorj B. Olkhanud (Puje), Chair, Department of Environmental Health Sciences, School of Public Health, Mongolian National University of Medical Sciences

Dr. Warburton explained that Mongolia, the only democracy in the region, is landlocked between Russia to the north and China to the south. He invited Dr. Purevdorj Olkhanud to describe the D43 program there. Dr. Olkhanud confirmed that economic growth in Mongolia during the past several; years has been 18%, heavily dependent on mining, which contributes about 80% to GDP. That growth has occurred in the midst of the traditional nomadic/agrarian economy, which has resulted in some cultural tensions and some negative impact on environmental health. To address the issues the Mongolian government enacted laws that, among other requirements, mandate a formal Health Impact Assessment. However, Mongolia did not have sufficient human resources and technical capability to address the assessment. Programs were established to develop masters and doctoral level scientists, supported by seminars to bolster scientific and medical training. Including education in children’s and women’s health, public health, and pollution monitoring and abatement.

Dr. Olkhanud described achievements to date, which include establishing a Department of Environmental and Occupational Health at the School of Public Health, MNUMS; building a sustainable multidisciplinary local and international Public-Private Partnership; and starting graduate level degree programs focusing on Environmental and Occupational Health with 24 master’s and three doctoral candidates. The D43 program has been important to supporting research in Mongolia, including organizing national and international research conferences to promote collaboration and knowledge sharing.

Dr. O’ Dale Williams, Chair, Department of Biostatistics, Florida International University

Dr. Williams discussed the Madras Diabetes Research Foundation (MDRF) in Chennai, India, noting that funding has come from Fogarty through ICHORTA and other sources that support MDRF. The program includes a national seminar, in-house workshops, intensive seminars and a genomics workshop. There are also several medical institutions in India that support workshops. There is a focus on building faculty in India, which is mainly Indian nationals. A video was shown of Dr. Mohan, who described the Foundation program, including the development of the INDIAB national survey, which reached 124,000 individuals and accommodated 23 languages. With all the successes, NCDs continue to be an increasing challenge.

Discussion

During discussion a number of individual thoughts were offered.

  • NIDDK’s first RFA with India had a robust response. The RFA required a U.S. investigator and an Indian collaborator, and the grants were reviewed in both countries. There were some applicants who were graduates of D43 training.
  • There is significant infrastructure in India that could serve the NCD issue, but the challenge is identifying gaps and filling them.
  • Concerning the increase in NCDs in India, Dr. Williams explained that the obesity rate has increased and with it the incidence of diabetes. There was also a complacency about the threat of NCDs, partly because of lack of data. That is changing.
  • Concerning the bridge between training and implementation science, there is a clear emerging focus on training early career researchers about implementation and scale-up. Policy makers understand the threat, but they must be educated in what can be done.
  • Concerning sickle cell disease, Nigeria has about 25% of the world population with sickle cell disease. Before the current efforts there was little screening, but that has changed, allowing earlier diagnosis, treatment, and counseling.
  • Concerning stability of career pathways post D43 and the potential for a brain drain, D43 trainees experience short visits to the U.S., which reduces the brain drain effect. There are also funding programs that make it more attractive for researchers to return to institutions in their own countries. One kind of brain drain that is not negative is the movement of researchers between institutions in the same country.
  • It can be discouraging to provide health care to an individual who lives in a home that has serious indoor air pollution. One approach was to provide the health care along with a highly efficient cookstove that would reduce the level of air pollution in the home.
  • There is an advantage to having strong local PIs who have access to the community and to policy makers, and who can provide recommendations for research that is germane to the community.
  • One issue that affects ultimate outcomes is the tendency to diffuse funding such that there is a broad menu of causes to champion, but little focus – the idea of being a mile wide in interests and an inch deep in funding.
  • At NIH there is a tendency to think of issues in terms of specific diseases or organ system, silo style. That approach may not be appropriate in global health.

Adjournment

Dr. Glass expressed appreciation to all who attended the Board meeting. The meeting was adjourned at 3:00 p.m.

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