May 11, 2016 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-fifth Meeting of the Advisory Board
Minutes of Meeting
May 11, 2016

The John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) convened the eighty-fifth meeting of its Advisory Board on Wednesday, May 11, 2016 at 9:00 a.m., in Stone House, Building 16, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held on May 10, 2016, prior to the open session meeting, 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 11, 2016 at 9:00 a.m., until adjournment at 3:00 p.m. Dr. Roger I. Glass, Director, FIC, presided.

Attendee Information

Board Members Present

Roger I. Glass, M.D., Ph.D. (Chair)
Michele Barry, M.D.
Waldemar A. Carlo, M.D.
Wafaa M. El-Sadr, M.D., M.P.H.
George C. Hill, Ph.D.
Joseph C. Kolars, M.D.
Janine Austin Clayton, M.D., ORWH (ex-officio)
Gregory G. Germino, M.D., NIDDK (ex-officio)
Vikas Kapil, M.D., CDC (ex-officio)

Board Members Absent

King Holmes, Ph.D., M.D.
Michael Merson, M.D.
J. Stephen Morrison, Ph.D.
Rebecca Richards-Kortum, Ph.D., M.S.

Also Present

Kristen Weymouth, Advisory Board Executive Secretary, FIC
Nalini Anand, FIC
John Balbus, NIEHS
Kiros Berhane, University of Southern California
Robert C. Bollinger, JHU
Ken Bridbord, FIC
Sahrish Durrani, FIC
Robert Eiss, FIC
Gary L. Ellison
Sarah Felknor
Gray Handley, NIAID
Christine Jessup, FIC
Peter Kilmarx, FIC
Abera Kumie, Addis Ababa University School of Public Health
Linda Kupfer, FIC
Maureen Lichtveld, Tulane University School of Public Health and Tropical Medicine
Ellis McKenzie, FIC
Aubrey Miller
John T. Monahan, Georgetown University
Zeba Rasmussen (by teleconference), FIC
Joshua Rosenthal, FIC
Andres Sanchez, International Development Research Centre, Canada
Rachel Sturke, FIC
Cecile Viboud, Staff Scientist, DIEPS, FIC
Judith N. Wasserheit, University of Washington
Mitchell I. Wolfe, OGA, DHHS
Wilco Zijlmans, Research Center Academic Hospital Suriname

Director's Update and Discussion of Current and Planned FIC Activities

Dr. Roger Glass

Dr. Glass called the meeting to order and welcomed Dr. Judith N. Wasserheit, Dr. Robert C. Bollinger, Jr., and Mr. John T. Monahan, who are currently in the vetting process to become FIC Advisory Board members. He noted that the new Vivian W. Pinn Seminar at the Office of Research on Women’s Health (ORWH) was named for FIC’s Senior Scientist Emeritus.

NIH and FIC have recently received visits from the health ministers of Albania and Canada, a “Zika squad” from Brazil, Dr. Faldo Khuri from the American University of Beirut, and a delegation from Cuba.

Dr. Glass addressed the 2nd Annual Conference of T-32 Trainees at Harvard on March 16. He recently met with global health groups at the University of Alabama at Birmingham. A review of DIEPS was conducted on April 4. The Center for Strategic and International Studies (CSIS) launched the Global Health Programs and Partnerships on April 1.

The seventh annual conference of the Consortium of Universities for Global Health (CUGH) took place in San Francisco from April 9-11. FIC conducted a session at the conference.

On April 13 the World Bank, World Health Organization (WHO), and George Washington University cohosted Out of the Shadows, a conference focused on making mental health a global development priority.

In 2017-18 FIC will celebrate its 50th anniversary with advocacy events, videos and testimonials from Fogarty grantees, special symposia, supplements to journals and much more.

Dr. Glass showed the Board the 10-year survival of patients with AIDS receiving antiretroviral therapy in Haiti. Over 50 percent of the study participants were alive and receiving care.

NIH and the Bill & Melinda Gates Foundation (BMGF) held their annual meeting on April 18. Topics included HIV/AIDS; malaria; tuberculosis; maternal and newborn health; child health and development; pneumonia, enteric diseases, and indoor air pollution; and contraceptive research.

In April Dr. Glass addressed a conference in Bangladesh where about 20 percent of the attendees said they had benefitted from FIC programs.

Dr. Glass noted that the Ebola outbreak continued, and that FIC was particularly concerned with preventing similar outbreaks in the future. Unfortunately, future preparedness programs are not always given top priority.

The 10th INTEREST Workshop was held in Yaounde from May 3-6. The Global Action on Transforming Health Workforce Education & Training towards Universal Health Coverage & Well-being of Humanity in the Developing World 2016-2030 recently took place in Thailand.

The World Health Assembly (WHA) is scheduled for May 23-28. The Heads of International Research Organizations (HIRO) meeting will take place in June in Tokyo, along with the Board Meeting of the Global Alliance for Chronic Diseases (GACD). The next Medical Education Partnership Initiative (MEPI) Annual meeting will be held from August 1-4 in Nairobi. Other upcoming meetings include the GEOHealth Network Meeting from May 12-13, the mHealth Institute from June 6-9, and Fellows & Scholars Orientation from July 5-9.

Dr. Hill asked about the challenges in continuing the MEPI program. Dr. Glass said the meeting would be a chance for the grantees and other entities involved to showcase their activities and build new collaborative efforts. Dr. Wasserheit said MEPI was one of FIC’s most important activities. Dr. Barry said it was important that potential philanthropic donors attend the MEPI meeting. Dr. Glass said that FIC had sent invitations to interested parties.

Dr. Glass invited Nalini Anand and her team to provide an update on the Center for Global Health Studies (CGHS). Ms. Anand said CGHS has been thinking about ways in which it can measure its success. Rachel Sturke spoke about an Implementation Science Workshop at the FIC Global Brain Disorders Meeting on April 7. Linda Kupfer reported on a President’s Emergency Plan for AIDS Relief (PEPFAR) workshop on non-communicable diseases (NCDs) from April 11-13. Joshua Rosenthal said the Clean Cooking Implementation Science Network held its third workshop on May 5-6. Ms. Anand said staff was making final arrangements for the mHealth Research Training Institute. She also mentioned that FIC did an evaluation of the Trauma Program, which can be found on the FIC website, and found it to be instrumental in enhancing empirical evidence, leveraging funding beyond NIH, building capacity, and impacting policy and programs.

Program Concept: NIH-NSF Ecology & Evolution of Infectious Diseases Program: A Joint Program for Multidisciplinary Research

Dr. Christine Jessup, Program Officer, Division of International Training and Research (DITR), FIC

The Ecology and Evolution of Infectious Diseases (EEID) Program is a unique, multiagency, competitive research grant program administered by FIC and the National Science Foundation (NSF) since 2000. The central theme of a submitted project needs to be quantitative or computational modeling of pathogen transmission dynamics. The program directly addresses one of the goals of FIC’s strategic plan, to enhance and strengthen partnerships to advance global health research. FIC has several partners on this program in addition to NSF, including the U.S. Department of Agriculture, the UK Research Council, the U.S.-Israel Binational Science Foundation, the National Institute of Allergy and Infectious Diseases, and the National Institute of General Medical Sciences. The program has supported 127 research grants to date, and has been instrumental in launching investigators in the U.S. and in low and middle income countries (LMICs).

Dr. Jessup presented the Board with a series of proposed changes in direction for the program: (1) Include explicit language in the NSF solicitation about FIC’s interest; (2) Explicitly state that FIC is interested in meritorious R01 applications as well as smaller grants.

Dr. Kapil asked how programs at NIH and FIC linked to programs with overlapping focus areas. Dr. Jessup said FIC performed extensive outreach with various communities. Dr. Hill asked about funding for the EEID Program. Dr. Jessup said FIC contributed about 10 percent.

Division of International Epidemiology and Population Studies (DIEPS)

Dr. Peter Kilmarx, Deputy Director, FIC, and Acting Director, DIEPS, FIC

Dr. Kilmarx said DIEPS conducts research in epidemiology and mathematical modeling of infectious diseases. The objectives of its May 4 consultation were to assess how its current strengths can be harnessed to have greatest scientific impact; identify the most promising scientific areas of focus; and recommend approaches for future strategic partnerships within and outside NIH.

Dr. Ellis McKenzie, Senior Scientist, DIEPS, FIC; Ms. Sahrish Durrani, Research Associate, DIEPS, FIC; Dr. Cecile Viboud, Staff Scientist, DIEPS, FIC

Ms. Durrani reported on behalf of Dr. Zeba Rasmussen, the lead PI of DIEPS’ projects in Pakistan. The first project she reported on was the Water, Sanitation, Health, and Hygiene Interventions Project (WSHHI), a child health study in Oshikhandass, a village in northern Pakistan. The study aimed to determine the change in incidence of diarrhea and pneumonia in children under the age of five after 15-20 years, and the long term health impact of those diseases on growth and educational development. For diarrhea, it found that morbidity had not changed, but mortality had decreased 13-fold from 1990, and episode duration had decreased. Pneumonia’s incidence had also decreased over time, and it was found to be more common in colder, drier weather. Polymerase chain reaction analysis of nasopharyngeal swabs revealed that entero- and rhinoviruses were the most common pathogens found, followed by respiratory syncytial virus. Eighty-five percent of the original cohort of 1,857 was interviewed for the follow-up. The mean reported age was 20.1 years; 55.8 percent were full-time students; the median educational level was grade 12; 72 percent had a normal body mass index; 97 percent had normal blood pressure; and 82 percent reported good or excellent health status.

The 2011-2014 Child Health Project identified the need for biosafety education. DIEPS has held four bioawareness workshops throughout Pakistan from 2014-16. It has developed, translated, and disseminated training materials for promotion of biorisk management and responsible conduct in the life sciences. DIEPS has two new projects in 2016. The first provides training and capacity building to improve management aspects of biosecurity and biosafety culture; the second provides training to participating institutions for implementing CWA Standard 15793. DIEPS has engaged 84 institutions across Pakistan and trained 250 participants in bioawareness workshops.

Dr. Hill asked about the logistics of security for these projects. Ms. Durrani said most of the people engaged in these projects were aware of the security risks, and thus far there had not been any issues. Dr. Barry asked about microbiomes. Ms. Durrani said the team had microbiome samples collected from 2012-14, but the laboratories did not have the capacity at the time to analyze them. Dr. Clayton asked about the sex breakdown of WSHHI. Ms. Durrani said it was close to an even split between males and females. Dr. Wasserheit asked what the most important implications of the project were. Ms. Durrani said she thought it illustrated how interventions have had a positive impact on the region.

Dr. McKenzie reported on the Research and Policy for Infectious Disease Dynamics (RAPIDD) program. The goal of RAPIDD was to improve the state of the art of infectious disease modeling. The program revolved around four core working groups: Emerging Infectious Diseases, Small Mammal Reservoirs, Mosquito-borne Infections, and Model Hierarchies. In its lifespan, RAPIDD led to the publication of 906 papers, which have been cited over 22,000 times.

One study focused on key processes in zoonotic dynamics. It found major gaps with respect to cross-species spillover, stuttering chains, and pathogen evolution. Another study found that bats harbored twice as many zoonotic virus species per species as rodents. A third research thread looked at cell phone data and satellite night-lights imagery in an effort to improve surveillance and response. Cluster investigations in Peru found that human movement was the primary driver of dengue virus transmission. A study was able to anticipate the spread of Zika from Brazil. Work in Mexico and Swaziland has helped create operational strategies and map regional transmission for eliminating malaria.

Dr. Viboud briefed the Board on the Multinational Influenza Seasonal Mortality Study (MISMS), an international collaborative program focused on the epidemiology and evolutionary dynamics of influenza viruses. Its main focus is to document and quantify pandemic risk and transmission dynamics. Guiding influenza vaccination strategies is another key objective. The animal-human interface has been instrumental in the surveillance of swine influenza. MISMS scientists have been interested in influenza’s interactions with HIV, pneumococcus, and various chronic diseases. Also of concern is the emergence of mutations conferring resistance to antivirals. The program has served as a catalyst for influenza full-genome sequencing and data sharing.

The DIEPS international and multidisciplinary network fosters links between academia, government, and non-governmental organizations (NGOs), and promotes informed use of models and tools to guide public health policy and practice. A bibliometric analysis of DIEPS publications from 2009-2015 found that there had been 927 peer-reviewed articles, with an average of 23 citations per paper. Seventy-two percent of those articles involved foreign co-authors, and 51 percent had co-authors from LMICs. Dr. Viboud argued that DIEPS had a strong track record for generating high-impact results, but that it needed additional resources to continue its success.

Dr. McKenzie said DIEPS had identified possible future directions: interactions between and among diseases, antimicrobial resistance, implementation science, economics and social sciences, and the microbiome. It later combined implementation science with economics and social sciences. The aim was to have a disproportionate, catalytic effect on areas of focus.

Dr. Wasserheit asked the presenters to comment on microbiomes. Dr. Kilmarx said a group of consultants had said that microbiomes may not yet be the best area for investment without further scoping. Dr. Bollinger added that there was a sense that area of focus needed additional people with experience before it could grow. Dr. Barry disagreed with the consultants’ assessment, arguing that DIEPS should be on the cutting edge. Dr. Bollinger said one of the questions the consultants raised was whether more basic science research and better methods for measurement were necessary.

The Board recessed for lunch.

Global Environmental and Occupational Health (GEOHealth) Hubs Program

Dr. Christine Jessup, Program Officer, DITR, FIC

Dr. Jessup outlined the objective of this program: to support the development of institutions in LMICs that will serve as regional Hubs for collaborative research, data management, training, curricula, and policy support around high priority local, national, and regional environmental and occupational health threats. Each Hub has at its core a developing country research institution, in partnership with other national or regional research institutions, U.S. research institutions, government ministries, and/or NGOs. Seven GEOHealth Hubs were awarded in September 2015, based in Peru, Suriname, Ghana, Ethiopia, India, Bangladesh, and Thailand.

Dr. John Balbus, Senior Advisor for Public Health, NIEHS

NIEHS’ mission is to discover how the environment affects people in order to promote healthier lives. From fiscal year (FY) 2012 through FY2014, it funded 157 global environmental health studies worldwide. The GEOHealth program builds on a collaboration of FIC, NIEHS, and the National Institute of Occupational Safety and Health (NIOSH) that supported research and training from 1995-2011 through the International Training and Research in Environmental and Occupational Health program. After 16 years, it was felt that a new model of training was necessary. NIEHS views the H3Africa program, which is entering Phase II, as an ideal venue for building capacity for looking at heredity and gene environment interactions.

Caribbean GEOHealth Hub – Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH): Dr. Maureen Lichtveld, Professor and Department Chair, Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine; Dr. Wilco Zijlmans, Director, Research Center Academic Hospital Suriname

Dr. Lichtveld outlined CCREOH’s focus areas: gold mining-related mercury contamination of indigenous food sources, access and use of pesticides in agriculture, and environmental contamination of nutraceuticals and indigenous medicinal plants. CCREOH’s strengths include diverse, longstanding partnerships; a GEOHealth planning grant; academic and public health infrastructure; an experienced in-country research coordinator; and a strong and supportive FIC staff team. CCREOH research centered around exposure assessment, exposure source characterization, birth outcomes, neurodevelopmental outcomes, and dissemination and community outreach.

Dr. Zijlmans said the overall goal of CCREOH was to assess the impact of exposures to neurotoxicants on maternal and child health in Suriname. Study subjects included 600 pregnant women in the capital city, Paramaribo; 200 in Nickerie in the western coastal region; and 200 in the country’s interior. Twelve months after birth, the study will examine the 200 children with the highest levels of exposure and the 200 with the lowest. Follow-ups will be conducted after 36 and 48 months.

Dr. Lichtveld reported that the CCREOH team had published 25 abstracts and manuscripts. CUGH selected three CCREOH abstracts for publication in the Annals of Global Health. The Caribbean Public Health Agency Research Conference will feature six presentations from CCREOH-affiliated researchers. Dr. Zijlmans has proposed a new name for the project: MeKi Tamara, or “making tomorrow.”

Eastern Africa GEOHealth Hub – Research and Training in Eastern Africa: Dr. Kiros Berhane, Professor, Department of Preventive Medicine, University of Southern California (USC); Dr. Abera Kumie, Head, Environmental and Occupational Health, Addis Ababa University School of Public Health

Dr. Kumie said the Hub evolved through existing partnerships between USC and universities in Ethiopia and Uganda, existing activities in East Africa with a focus on emerging environmental issues, and USC’s strong track record of environmental health research. Objectives at the planning phase included establishing a GEOHealth Hub in East Africa, conducting a Situational Analysis and Needs Assessment (SANA), assessing key stakeholder activities and training/research capacity, and fostering partnerships within and between East African and U.S. partners.

The SANA focused on air pollution, occupational safety, and climate change and their effects on health. The main findings were a strong regional interest in environmental and occupational health issues and common concerns around air pollution, occupational health, and climate change. Shared challenges included lack of basic environmental monitoring data, insufficient strategic research addressing critical gaps, lack of evidence-based policy processes, inadequate capacity in relevant sectors, and unclear translation paths from evidence to policy.

Dr. Berhane said the aims of the training component (U2R) are to immerse lead scientists in research, curriculum development, and policy; develop curricula for training in exposure assessment, research methods, and health assessment; provide targeted training for research teams; expand the program through dissemination at national and regional levels; and develop approaches for translating research opportunities into policies, regulations, and other actions.

Dr. Kolars asked if the East African Hub had had any dialogue with the Hub in Ghana. Dr. Berhane said there had been some discussion during the planning, but nothing formal. He expected further interaction in the near future. Dr. El-Sadr commented that most of the grants were small in size, and proposed harmonizing some of the measures across cohorts. Dr. Berhane said that was already happening to a large extent.

Dr. Andres Sanchez, Senior Program Specialist, International Development Research Centre, Canada (IDRC)

Dr. Sanchez enumerated IDRC’s strategic objectives: invest in knowledge and innovation for large-scale positive change, build the leaders for today and tomorrow, and be the partner of choice for greater impact. IDRC supports ideas and innovations in developing countries through programming in agriculture and environment, inclusive economies, and technology and innovation. Dr. Sanchez observed that a wide diversity of pathways can influence policy, and there were multiple feedback loops in research that shaped policy and practice. He cited two studies: one on health research, training, and outreach in the Arab world, where the primary research driver was the health science faculty of the American University of Beirut; and one on intermittent rice irrigation for malaria control on the north coast of Peru, which was mostly driven by the Ministry of Health Peru. IDRC is thinking beyond project boundaries, and using adaptive strategies to build multi-stakeholder relations and incremental influence.

Discussion Moderated by Vikas Kapil, DO, MPH, Associate Director for Science/Chief Medical Officer, Center for Global Health Leadership, CDC

Dr. Balbus said one of the components of the NIEHS WHO Collaborating Centre was a risk assessment network, which now has dozens of regulatory agencies sharing best practices. He added that NIEHS’ National Toxicology Program was working on evidence-based decision making in environmental health. Dr. Glass pointed out that NIEHS and other ICs had been involved in a Superfund activity monitoring pregnant women, and proposed that something similar be done with Zika.

Dr. Kapil asked if Board members had any thoughts on how they might engage with the work described in the presentations. Dr. Wasserheit said that her institution, the University of Washington, had partnered with Cayetano University in Peru, which was heavily involved in the Peru GEOHealth Hub, and had worked with major institutions in Kenya. She proposed inviting the in-country leads to talk about their partnerships at a future FIC meeting. Dr. Glass pointed out that each Hub provided an opportunity to build a network of investigators. Dr. Barry suggested that the Hubs be places for mentorship. Dr. Carlo proposed that the Hubs work together and develop common efforts and protocols, which could lead to a monitoring network.

Dr. Kapil reminded the Board that the Hubs were intended to be a dynamic rollout over several years, during which time additional partners and sources of funding could be identified. Dr. Lichtveld asserted that the Hubs were a great opportunity for lasting partnerships, and predicted they would have an impact on environmental policy.

Dr. Sarah Felknor said NIOSH was pleased that of the seven Hubs, there were at least four with significant occupational components. Dr. Gary Ellison noted that cancer incidence was increasing in LMICs, so it was important for the National Cancer Institute (NCI) to invest in the GEOHealth Hubs program.

Dr. Wasserheit said she perceived a large focus on the environmental component of GEOHealth, and that if the framework were expanded to encompass adaptive responses to climate and global environmental change, it would enable the program to approach other funders. Dr. Barry pointed out that GEOHealth might fall under the rubric of planetary health.

Closing Comments

Dr. Glass said that listening to the presentations gave him high hopes for the GEOHealth Network meeting later in the week. He observed that Dr. Lichtveld, Dr. Berhane, and Dr. Rasmussen had immigrated to the U.S. and praised them for their efforts to build up the research capacity in their native countries. He stressed the importance of partnerships, which enable FIC to work on a global scale.

Adjournment

Dr. Glass thanked everyone for their attendance and contributions, and adjourned the meeting.

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