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-sixth Meeting of the Advisory Board
Minutes of Meeting
May 11, 2016
John E. Fogarty International Center for Advanced Study in the Health Sciences (FIC) convened the eighty-sixth meeting of its Advisory Board on Tuesday, September 13, 2016 at 9:00 a.m., in Stone House, Building 16, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held on Monday, September 12, 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 September 13, 2016 at 9:00 a.m., until adjournment at 3:00 p.m. Dr. Roger I. Glass, Director, FIC, presided.
Board Members Present
ROGER I. GLASS, M.D., Ph.D., Chair
WALDEMAR A. CARLO, M.D., Member
JANINE AUSTIN CLAYTON, M.D., Ex Officio Member
WAFAA M. EL-SADR, M.D., M.P.H., Member
GREGORY GERMINO, M.D., Ex Officio Member
KING HOLMES, Ph.D., M.D., A.B., Member
VIKAS KAPIL, D.O., M.P.H., Ex Officio Member
JOSEPH C. KOLARS, M.D., Member
MICHAEL MERSON, M.D., Member
J. STEPHEN MORRISON, Ph.D., Member
Kristen Weymouth, Executive Secretary
Nalini Anand, FIC
Gretchen Birbeck, University of Rochester
Michele Bloch, NCI
Ken Bridbord, FIC
Pamela Collins, NIMH
Wilson Compton, NIDA
Michael P. Johnson, FIC
Flora Katz, FIC
Patrick Kelley, IOM/NAM
Peter Kilmarx, FIC
Marya Levintova, FIC
Kathy Michels, FIC
John Monahan, Georgetown University
Patricia Powell, NIAAA
Josh Rosenthal, FIC
Francine Sellers, FIC
Cecile Viboud, FIC
Ken Warren, NIAAA
Judith Wasserheit, University of Washington
Mitch Wolfe, OGA
Director's Update and Discussion of Current and Planned FIC Activities
Dr. Glass opened the meeting by introducing new NIH leadership. Patricia Flateley Brennan is the Director of National Library of Medicine (NLM), Maureen Goodenow is the Director of Office of AIDS Research (OAR), Joshua Gordon is the Director of National Institute of Mental Health (NIMH), and Diana Bianchi is the Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
Dr. Glass presented at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Advisory Council meeting on May 18, 2016. Dr. Glass highlighted the Institute’s vital role in global health over the past decade and the importance of their guidance and leadership in the future.
Fogarty’s alumni and grantees’ have had fabulous success. Patty Garcia just became the Minister of Health in Peru. Fogarty has been pushing a generic protocol internationally for countries that want to partner with FIC to recognize the value of NIH grants by giving internationally competitive grantees money for postdocs so they can amplify their training and mentoring experiences. The NIH including Fogarty only gives 8% overhead to foreign grants. All of the U.S. institutions get around 50%.
The first visit by the Minister of Health of Cuba, Roberto Tomas Morales Ojeda to NIH, followed the first delegation to the tropical medicine meeting last year. Kevin Bialy has been instrumental in building the relationships with foreign delegations. Peter Kilmarx has also been fabulous. After the last board meeting, Dr. Glass went to the World Health Assembly and met with Dr. Tedros from Ethiopia. Dr. Tedros was instrumental in getting the Medical Educational Partnership Initiative (MEPI) program into Ethiopia. He also put broadband into all of the medical schools.
In June, Drs. Glass and Francis Collins went to Japan for the Heads of International Research Organizations (HIROs) meeting. These meetings have been a way to bring leadership in research around the world together to discuss common issues. Drs. Glass and Collins also met with the Global Alliance for Chronic Diseases. For the Global Mental Health Program, Pamela Collins has guided the Global Health Initiative and has helped to host a World Bank meeting where it was decided that all World Bank world health programs will include a mental health component. NHLBI has been instrumental in leading the initiative for environmental lung disease, household air pollution, and outdoor air pollution. These types of pollution kill an estimated 4 million people per year, according to the IHME.
Dr. Francis Collins and Dr. Glass went to the RIKEN Institute in Yokohama. The director is a former NIH grantee. Thailand is involved in the most NIH grants in Asia. Drs. Collins and Glass visited with the 1,000 Genome Project. They have been doing wonderful work on how patients with HIV/AIDS should disclose their conditions. After visiting Thailand, Dr. Glass went to Cali, Colombia. Rodrigo Guerrero, a physician, now mayor of Cali, Colombia, has instituted programs to prevent violence and trauma. He spearheaded an alcohol awareness program and passed a law restricting sale of alcohol after 2:00 a.m. As a result of the law, homicides have declined precipitously.
This July there was nearly 100 participants in the FIC Fellows and Scholars program orientation, including 11 Fogarty-Fulbright fellows as well as fellows from the FIC-Doris Duke program.
Dr. Glass said that many IC directors had come in and met with the students. Dr. Janine Clayton, Director of ORWH spoke to the students about the sex distribution of mice and rats in research. Dr. Greg Germino, Deputy Director of NIDDK spoke about diabetes prevention. Many IC Directors spent time with the students including NIH Director Dr. Francis Collins.
Drs. Collins and Glass went to Tanzania for the annual MEPI meeting. The Government of Tanzania said that it would provide postdocs to anyone who had an NIH grant and perhaps some administrative funding. Dr. Glass explained that this type of country partnership is the future of global health. Muhimbili University is involved in grants from a half-dozen different institutes at NIH. NIH has already announced the next round of grants from NIH. The African leaders organized AFRE (African Forum for Resource in Education and Health) which took the idea of the MEPI PI Council and expanded it to include people from allied health professionals, nursing, and others. The NCD agenda is being built through Fogarty fellows and scholars working in Nairobi. Drs. Glass and Collins visited the Kenyan Ministry of Health with Dr. Kevin DeCock from CDC.
Drs. Glass and Collins visited Eldoret and the AMPATH program where there is a Duke University mentor. Eldoret has linked with Purdue on a pharmacy program. They have also established an electronic medical records program. The last place Drs. Glass and Collins visited was Makerere. The Minister of Science, Technology, and Budget in Uganda was a Fogarty Fellow. Drs. Glass and Collins spoke to people who were HIV positive and discussed the value of clinical trials to treat HIV, like PMTCT, microbicides, and vaginal inserts. Makerere is one of the repositories of H3 Africa. Dr. Peter Mugyenyi of the Joint Clinical Research Center was one of the first researchers to use antiretrovirals and has been a luminary in the AIDS field for ages.
Fogarty will commemorate its 50th year of operating beginning on April 7-9, 2017 at Consortium of Universities of Global Health (CUGH) conference in Washington, DC. There will be a panel discussion and reception at ASTMH in Baltimore on November 5-9, 2017 and on May 1, 2018 there will be FIC’s scientific symposium highlighting the impact of the Center’s work, past, present and future, at the Natcher building on the NIH campus. Upcoming board meetings in 2017 will be: February 6-7, May 8-9, September 11-12.
Dr. Barbara Sina indicated that Fogarty is joining H3 Africa for their second five years of building capacity in human genetics and genomics in Africa. Fogarty will be helping with training and running the RFA for bioinformatics training. There are seven RFAs out at this point.
Dr. Cecile Viboud noted that there has been a lot of excitement about big data around surveillance and disease control. DIEPS put together a special issue of the Journal of Infectious Disease on Big Data for Infectious Diseases and Surveillance and Control. The journal has a big epi and clinical audience. Big data can be used to monitor disease patterns and human behavior. Digital data streams are not specifically created for public health so there is an issue with persistence of the system. The way forward is to develop hybrid systems and expand coverage in low-income settings. There have been and will be future DIEPS workshops on capacity building in computational methods and biosafety as well as research workshops on infectious diseases modeling and vaccines.
Dr. Josh Rosenthal indicated that the cookstove initiative is trying to discover how clean cooking technology needs to be in order to generate benefits for respiratory health. Fogarty has recently funded four projects to isolate particular interventions. Fogarty has also launched a call for case studies to look at some of the larger clean cooking programs that have been rolled out over the world. The health impacts are enormous and varied, from low birth weight to stroke and heart disease.
Ms. Nalini Anand gave the mHealth update. In June mHealth had its training institute. There were 33 trainees from multiple disciplines represented. The training model was a mix of didactic training and team work. The PMTCT (prevention of mother-to-child transmission) Implementation Science (IS) Alliance is a collaboration between Office of the Global AIDS Coordinator (OGAC) and NIH centered on catalyzing interaction between end users of research and NIH-funded researchers. A recent 15-paper supplement in JAIDS wrapped up the project that really frames the unmet need and unfinished agenda related to implementation science for PMTCT. Key findings include recognizing that the alliance model provides a unique platform stakeholders and that there are differential timelines between researchers and policy makers. There is also tension between context and generalizability, and IS capacity is limited in LMICs. The current activities in implementation science include the following: 1) Portfolio analysis of IS investment over 10 years 2) IS networks in brain learning, adolescent implementation science, and clean cooking 3) Co-Chairing the Global Track at the 9th Annual Conference on the Science of Dissemination and Implementation on Health 4) Articulation of IS research agendas. Future activities will include a workshop on training models for IS and a short-term training institute in SSA.
BRAIN Disorders (R01, R21)
Dr. Kathy Michels presented the proposal to continue the highly successful program for global brain and nervous disorders research across the life cycle. The program has been configured as a two-year planning grant. The program has over 150 two-year planning grants involving developing countries which has resulted in 50 R01s. Recently there was a Nature supplement in which many of the program grantee participated in. The program has received many strong and diverse applications involving Sub-Saharan Africa. The proposal is to continue the program much as is, but to build in more of a focus on implementation science.
Partnership Initiative for Health Professional Education and Research in Selected PEPFAR Countries
Dr. Flora Katz indicated that DITR collaborated in an initiative with PEPFAR through MEPI and NEPI. DITR gave 13 grants, those grants reached out to less established medical schools in Africa, ending up with a network of 33 medical schools and 23 US partners. The follow-up proposal with PEPFAR is to support another round of grants in the most HIV-affected, low-resource countries in Africa. There are two initiatives. One is to enhance the PI Council. The second initiative are programmatic awards directly to institutions. There was a consultative meeting in Africa last February. The Africans want to do more research on education.
Building Global Health Research Careers – FIC's International Research Scientist Development Award (IRSDA)
Dr. Christine Jessup, Program Officer, DITR, FIC
Dr. Jessup indicated that the IRSDA program has been active since 1999. The purpose of the IRSDA session was to provide an update and some background on the program. The big question that IRSDA is trying to tackle is how to build a robust global health workforce. This will require 1) Well-trained individuals 2) Protected time to conduct research in LMICs 3) Strong mentorship from US investigators with experience working in LMIC settings and from LMIC investigators. The goals of the IRSDA K01 program are to prepare individuals for research careers that will have a significant impact on LMIC health-related research needs, develop strong global health investigators who are competitive for independent funding, and build long-lasting collaborations with LMIC investigators. It features an individual award, 3-5 years of mentored research/career development, requires US and LMIC mentors, an in-country time requirement, and an identified global health research topic. Since 1999, there have been 71 IRSDA recipients who conducted research in 26 LMICs. In order to apply for the IRSDA K01, one must be a post-doctoral student (US citizen, non-citizen national, or permanent resident). It is a full-time appointment at the applicant institution and a full-time effort (9 person months, 75% effort). The annual salary is up to $75,000 plus fringe benefits. Research support is up to $30,000 each year. Fifty percent of the effort must be in an LMIC over the project period.
Dr. Jeffrey M. Bethony, Professor, Vice-Chair for Translational Research Microbiology, Immunology, and Tropical Medicine and AIDS and Cancer Specimen Resource, George Washington University
Dr. Bethony received his IRSDA in 2000 and in 2014 he became a tenured professor at George Washington University. Dr. Bethony spent his time in Brazil in Minas Gerais state in a very resource-limited setting. He focused on the genetic determinants of helminthic co-infection in Brazil. Dr. Bethony said that he had to be very resourceful in terms of obtaining the blood samples and doing the statistics (quantitative genetics). He learned a lot about human subjects research and consent. Now Dr. Bethony does a lot of Phase 1 trials in endemic countries, such as first in-human vaccine trials. People think that Brazil is very genetically diverse, but there are small villages where people settle then never leave. The first study that Dr. Bethony published from his IRSDA was a multi-household extended pedigree susceptibility to S. mansoni – which was basically one big extended family. He used math to determine whether there was heritability to any of the traits that he was looking at. Because of his relationship with the community, Dr. Bethony was able to build a Phase 1 clinic sponsored by the Gates Foundation. Dr. Bethony still works very closely with his mentors.
Dr. Mina Hosseinipour, Research Professor of Medicine, School of Medicine, Scientific Director, UNC Project-Malawi
Dr. Hosseinipour did her IRSDA in Malawi. The reason that Dr. Hosseinipour did the Fogarty was that she wanted to spend the majority of her time in Malawi looking at the effect of parasitic infection on HIV. The country priority when she arrived become the introduction of ART, not HIV/parasite coinfection. The IRSDA program gave Dr. Hosseinipour the opportunity to learn certain things from scratch: how to create databases, how to conduct analyses, how to obtain human subject consent, etc. Being a long-term investigator on the ground allows IRSDA scholars to make important relationships with key decision makers. Dr. Hosseinipour has been involved in many of the Fogarty training programs. Being in Malawi allowed Dr. Hosseinipour to build an enormous number of trainees, and as new trainees arrive, they already have access to a gifted collaborator. She has also focused a great deal on medical doctor trainees in the Malawi programs. A large number of Malawian investigators have received their specialist training through the program. The expectations for the trainees are 1) Integration into a well-developed research program 2) Close working relationship with an international trainee at the same level 3) Development of one or more well-defined research projects that can be completed in one year. Dr. Hosseinipour said that the IRSDA allowed her to be in the right place at the right time. The complementary Fogarty programs have built both Malawian and US capacity to conduct research. The new K43 will address one of the continued challenges for Malawian investigators.
Dr. Rajesh Vedanthan, Assistant Professor, Zena and Michael A. Wiener Cardiovascular Institute, Department of Medicine, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
Dr. Vedanthan worked in rural western Kenya evaluating nurse management of hypertension. The research had four aims: 1) Community-based participatory research/qualitative methods 2) Human performance engineering/management sciences 3) Biostatistics/outcomes and impact evaluation 4) Modeling techniques/operations research. Aim 1 evaluated barriers to nurse-based management of hypertensive patients – this meant conducting key informant interviews, focus group discussions, and field observations. Aim 2 looked at developing a smartphone-based decision support and integrated record-keeping (DESIRE) tool. Evaluate usability and feasibility using qualitative methods (think-aloud, mock patient encounters, semi-structured interviews, and focus groups). Aim 3 included the impact evaluation of a pilot program for nurse-based management of hypertension to be implemented by AMPATH (secondary analysis of routine clinical data and the primary outcome measure of change in systolic blood pressure). Aim 4 estimated the nurse workforce requirements for stable, long-term treatment of hypertension. This included four aspects: 1) Needs-based workforce estimation model 2) Qualitative methods 3) Time-motion study 4) Delphi exercise. Publications have included K01-specific manuscripts, Kenya-specific manuscripts, global CVD manuscripts, and CV health promotion manuscripts. Dr. Vedanthan has been able to obtain the following grants and awards 1) U01: Optimizing linkage and retention to hypertension care in Kenya (NHLBI) 2) R01: Bridging income generation with group integrated care (NHLBI) 3) SFRN: Family-based approach to the prevention of cardiovascular disease in a minority community integrating systems-biology (AHA).
Celia Wolfman, Global Health Research and Policy Analyst, DISPPE, FIC
Ms. Wolfman presented preliminary findings from the IRSDA award evaluations. The evaluation was framed around four major themes: 1) Ascertaining the characteristics of the IRSDA applicants 2) Understanding the outcomes of the IRSDA awardees in terms of scientific productivity and retention in global health research 3) Understanding whether IRSDA fills a niche within the NIH K-awards. The average success rate for IRSDA over 16 fiscal years has been 41% which is comparable to the NIH K01 which has been 37%. The applicant pool of who is being funded from 1999 to 2015 – of those who were awarded 57% were female and 43% male. The average age was 36 years and the highest degree earned by awardees was evenly split between M.D.s and Ph.D.s. Post-IRSDA, 43% of the awardees went on to obtain an R01. Forty-nine percent of NIH GH K01s went on to obtain an R01. Most of the IRSDA (98%) and NIH GH K01 (96%) grantees went on to publish at least one article. IRSDA has 86% of its former awardees in a global health research profession as of 2016. IRSDA is comparable to NIH K01 in demographics, application success rate, scientific productivity, and probability of independent career in global health research.
Dr. King Holmes led the discussion. Dr. Merson said that going abroad for a long period of time is hard for young people who want to start a family. There needs to be help to support young investigators who go abroad. The majority of the grant awardees are single. Dr. Vedanthan said that his wife is a working professional and that going abroad was a very difficult challenge. The program was very flexible and allowed Dr. Vedanthan to go back and forth between Kenya and New York. One thing to think about is, what does it mean to commit to a global health career? Dr. Birbeck said that academic departments need to be sensitive to the perception that colleagues who go abroad are getting special treatment. Dr. Clayton said that the program is going to need some more creative solutions. Stanford University actually financially supports a variety of caregiving activities. Dr. Vedanthan asked if the reason behind the foreign time commitment is to demonstrate a commitment to global health. Dr. Bethony said that resourceful people are attracted to this type of commitment. Dr. Holmes said that the program is very successful and that the purpose of the discussion was to improve the program. Dr. Wasserheit said that the time in-country provides the platform for on-going collaborations both individually and at the institutional level. One thing to think about is whether an annual salary of $75,000 is reasonable? How does the program go forward in a more vibrant way? Perhaps a family supplement could be in the mix that treats everybody the same. The program does work with grantees after they get an award if they need some flexibility.
The IRSDA program has matched the K awards from all the other institutes. The IRSDA awards along with the fellowships probably has the greatest return on investment of anything Fogarty does. Only NCI is the only contributing partner to this. This is an opportunity to grow the IRSDA program. It would be good if the Institutes and Centers would promote research on the basis of the quality of the science that is out there. IRSDA is the next growth industry for Fogarty.
Dr. Bethony said that there has been a fall off of scientists working on tropical diseases. Dr. Vedanthan said that at the time he was applying for IRSDA that the playing field for global cardiovascular was quite challenging. The NHLBI COE had just been in place for a few years. The ability to find a funding body to do global cardiovascular research was quite limited. Even though there are challenges to going abroad, getting an IRSDA grant can act as a kind of bargaining chip with one’s academic department. Fogarty is one of the few places that is willing to support global cardiovascular disease research. Dr. Hosseinipour selected the IRSDA because she wanted to spend time abroad.
Dr. Birbeck said that one of the things that has facilitated the success of people getting K23s and K08s through NINDS has been the brain disorders program. Dr. Wasserheit said that the Gates and Rockefeller foundations have increasingly talked about talent development – have these foundations shown any interest in partnering in expanding support for this program? Dr. Glass said that Fogarty has an annual meeting with the Gates Foundation and that Fogarty has not been successful in getting capacity building on the agenda. One building space for Fogarty is the ICs. The other is that Fogarty is going to be having different meetings with various societies (e.g. kidney, heart, lung) which now have a global track program. This is a great opportunity to reach out to the community more broadly.
Global Mental Health Research Update
Dr. Pamela Collins, Director, Office for Research on Disparities & Global Mental Health, Director, Office of Rural Mental Health Research, NIMH
Dr. Collins said that the burden of mental disorders is large and growing. Globally, few people receive the treatment that they need. The good news is that there are effective interventions and care. Almost one in five people report having a common mental disorder in the previous 12 months. Lifetime prevalence for mental illness approaches 30% globally. Global health research efforts will help to uncover the mechanisms underlying mental disorders and a better understanding of their etiology. These are long-term goals. The short-term goals revolve around research related to delivering care.
Adding depression to a chronic disease worsens the health status of the patient. There are limited resources to address this kind of problem. There is an average of nine mental health workers per 100,000 people. The Cook County jail is America’s largest mental health facility. NIMH is focusing on research related to several recommendations from the World Health Organization’s World Health Report: 1) Providing treatment through primary care 2) Giving care in the community 3) Developing human resources 4) Supporting more research. In 2007 the Lancet issued a call to action to scale up mental health services in low and middle income countries and to strengthen the protection of human rights. In 2009, NIMH established the Office for Research on Disparities & Global Mental Health.
In fiscal year 2015, NIMH supported 233 awards with foreign components in 52 countries. In addition to foreign components, NIMH directly funds foreign institutions. The 2015 distribution of direct awards saw a shift, where there were 13 awards to LMICs. Suicide is the leading cause of death among older adolescent girls. In South Asia suicide is the leading killer of women, surpassing maternal mortality. In the last two years, social and epidemic emergencies have further increased the demand for mental health intervention. NIMH has decided to stimulate research to reduce the treatment gap. In 2010 NIMH hosted its first global health workshop that brought together policymakers, researchers, international NGOs, and representatives of advocacy organizations. NIMH asked those convened at the workshop how research could help them best achieve their goals. This workshop has grown into an annual mental health meeting that attracts over 300 people. Some of the focuses that came out of these workshops include: 1) Scientific opportunity 2) Equity – addressing the treatment gap 3) Responding to global public health trends 4) Integrating mental health into global health platforms 5) Supporting a diverse scientific workforce. Another exercise was to come to a global consensus on the research priorities for mental health. This exercise engaged more 400 people from 60 countries, they identify 40 challenges and six grand challenge goals. Dr. Collins focused on one of those goals: building human research resource capacity.
From 2011 to 2013, NIMH funded five collaborative hubs for international research and mental health research, training, education, and practice that incorporate the views and needs of local people. Each of the hubs consists of four to six countries. One of the goals was to look at task-shifting. NIMH wanted to improve the likelihood of uptake of research findings at the end. Across the hubs, there is a variety of non-specialist providers that are being used. Peru and Brazil are looking at how to use technology and nurse-supported care for depression, diabetes, and hypertension. They are linking people with severe mental illnesses with care in Brazil and Chile. The hub in South Africa is training health workers to map maternal depression. In Ethiopia they are using primary care workers to manage psychosis in rural communities. Another hub is looking at using peers to delivery depression care and perinatal services in India and Pakistan. Another hub is teaching complementary and alternative healers to manage psychosis and linking them with primary care in Nigeria and Ghana. With this work NIMH wants to learn about community health workers, primary care teams, traditional providers, nurses, and peers. Peers have been shown to be able to deliver care and be trained to supervise care delivery by other peers.
Another goal is conducting research on integrating mental health into chronic disease care. A third goal is identifying root causes and protective factors, which NIMH has been able to do through Fogarty’s Global Brain Disorders initiative and the H3 Africa program. The collaborative hubs have made tremendous progress in research capacity building. They are training pre- and post-doctoral fellows and master’s students.
NIMH has been able to develop a pathway for global mental health researchers in the U.S. The point of entry might be through the Fogarty Global Health Fellows and Scholars program or through T32s or global mental health K awards. NIMH has also engaged other funders. Grand Challenges Canada announced its first $20 million in global mental health funding when NIMH published the grand challenges in global mental health. The Mental Health Innovation Network supported by Grand Challenges Canada is a wonderful database of innovations of new and approaching readiness to scale. Last year NIMH launched an FOA focused on building research partnerships for scaling up mental health interventions. Many of the new programs are focusing on children and youth.
In 2012 the U.S. co-sponsored a resolution on mental health that called for a comprehensive, coordinated response to global burden of mental disorders. NIMH works closely with the HHS office of global affairs and provides technical support. In 2013 the first WHO mental health action plan was released. NIMH also co-chaired activities for the National Academy of Medicine’s neuroscience forum which has a working group on mental and neurological disorders in Sub-Saharan Africa. NIMH’s most recent initiative involves vulnerable populations in high-income countries. The U.S. is currently the chair of the Arctic Council. The Arctic Council has been charged with investigating the high rates of suicides in Arctic indigenous communities.
2015 was a big year for mental health. The millennium development goals gave way to sustainable development goals. There has been a lot of work in the mental health advocacy community to ensure that mental health was a part of these goals. The question is how to communicate the evidence. NIMH and others want to push the boundaries of global health. The ideas of reverse innovation and reverse translation need to be taken seriously. Successes and failures need to be disseminated. All global health activities need to include the range of sciences and bring in researchers from poor countries.
Dr. Merson asked what can be learned from the experience of NIMH in global health. NIMH does not have a lot of money. Having NIH say something important and bring people together is a wonderful way to be effective catalysts. The mental health field is in an uptick and everybody is ready to make things happen. The Grand Challenges helped bring a lot of visibility to the field as well. Dr. Birbeck asked why it was that of the 13 grants in low and middle income countries, 12 of the grants were in middle income countries and one was in a low income country? Dr. Collins responded that a lot of the reason has to do with infrastructure and capacity.
Global Health Research at NIH
Dr. Francis Collins, Director, NIH
Dr. Collins began his talk by speaking about his own interest in global health. Dr. Collins volunteered to serve as a missionary doctor in a small hospital in Nigeria. He took his daughter along, who was at the time a college student who later became a physician. Dr. Collins realized that there were a lot of research opportunities in Africa and in global health in general. During the Genome Project, Dr. Collins realized that if he wanted to understand genetic variation, he would have to study Africans in Africa. The success of the HapMap can be attributed to the need to think globally. After being asked to serve as NIH Director, Dr. Collins made global health research one of NIH's priorities.
Dr. Collins said that his recent trip to Africa with Dr. Glass was a memorable visit and ripe with potential. In Tanzania, Dr. Collins said that there is a serious possibility of a matching program. If NIH is giving a grant to or involving a Tanzanian investigator, then it is possible that Tanzania would match the grant. In Kenya, Dr. Collins had a chance to speak at the annual MEPI meeting. MEPI is one of the biggest drivers in terms of building research network capabilities in Africa. Linking up educational institutes across Africa through MEPI has been invaluable. When Africa Institutions and African PIs receive funds directly they are more capable of linking to other established African PIs. Makerere also has a lot of impressive research going on, particularly with HIV prevention. Dr. Collins was also able to tour the H3 Africa biobank.
It has been a time of growing and bringing institutes together. The relationship with the Gates Foundation is tighter than it has ever been. Dr. Collins has served as the chair of the Heads of International Research Organizations (HIRO) which represents the major funding agencies for biomedical research around the world. One of the major initiatives that came out of Dr. Collins’ time as chair of HIROs, was World RePORT which is a database NIH set-up with other granting agencies around the world to try to make it easier to find out who is doing what. Dr. Collins wants to support global health research. The Alliance for Accelerating Excellence in Africa (AESA) started by the Wellcome Trust and the African Union, provides an institutional framework for further encouraging research. This is a great moment to build on what has been learned about networking. There should be a center of gravity shift to the developing countries for research. Fogarty punches far above its weight in global health.
Dr. Collins said that knocking down silos at NIH will get more institutes more interested in global health. The health needs of the other countries in the world aren’t defined by the same org chart that defines NIH’s myriad of institutes. A lot of people are more interested in a more holistic approach to health. NIH should support research that aims to encourage a broader view. More South-South collaboration needs to be fostered, sometimes U.S. sponsors act in ways that discourage South-South collaboration.
Dr. Collins said that the case for global health research is easy to make to member of Congress. Disease knows no boundaries. Zika and Ebola are good examples of this. If anyone is concerned about the health of the U.S., they must also be concerned about the health of the world. We are all in this together. The U.S. also needs to learn about how diseases happen and how life works and being engaged in global health present these opportunities for research. Last year NIH put forward a strategic plan last December that outlines how NIH sets priorities and there is a discussion of global health in that document. The strategic plan has been well-received by members of Congress.
Dr. Collins said that in the case of Ebola all of the government was working together. The US won a lot of gratitude from parts of the world that were desperate for help. Dr. Merson thought that NIH should start an effort at Davos, which can have a far-reaching impact. Dr. Collins agreed that Davos is an opportunity to make something happen and have follow-up.
Dr. Glass asked if NIH could boost Fogarty’s effort on capacity building. Dr. Collins said that the most important resource in global health is “the people.” More and more students are saying that they are interested in global health. Dr. Kolars said that there is an opportunity to broaden the possibilities for trainees. There is an appetite for system transformation and system enabling.
Dr. Rotimi said that NIH often falls short when it comes to turning discovery into health, especially in the global arena. Dr. Collins said that this is a high priority. The Gates Foundation is very interested in this issue. What is needed in low income countries is not just focusing on one disease but focusing on the entire health system. NIH needs to figure out how to support research projects where every NIH institute feels like it’s worth its time to contribute to a trans-NIH effort that is going to reap many rewards for low income countries and also benefit the U.S. This will probably require getting over some NIH traditions and the desire of staff to "own" their own portfolios. There are things that can only be done together rather than separately.
Dr. Glass said Fogarty needs to think about how to capture the imagination, excitement, and commitment of the entire NIH community. The role of Fogarty has been and will continue to be an investment in people. Dr. Glass encouraged the board members to provide their ideas to Fogarty and to think about how to grow the global health research agenda. The next meeting of the board will be February 6-7.